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Charge Type Setting Price  
Service Code NDC 0904671760
Hospital Charge Code 0904671760
Hospital Revenue Code 250
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.03
Rate for Payer: Aetna Government $0.03
Rate for Payer: Brighton Health Commercial $0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.04
Rate for Payer: Cigna LocalPlus Benefit Plan $0.04
Rate for Payer: EmblemHealth Commercial $0.03
Rate for Payer: Group Health Inc Commercial $0.03
Rate for Payer: Group Health Inc Medicare $0.02
Rate for Payer: Hamaspik Choice Inc Medicaid $0.03
Rate for Payer: Hamaspik Choice Inc Medicare $0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.03
Service Code NDC 4359881115
Hospital Charge Code 4359881115
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.01
Rate for Payer: Aetna Government $0.01
Rate for Payer: Brighton Health Commercial $0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.02
Rate for Payer: Cigna LocalPlus Benefit Plan $0.02
Rate for Payer: EmblemHealth Commercial $0.01
Rate for Payer: Group Health Inc Commercial $0.01
Rate for Payer: Group Health Inc Medicare $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.02
Service Code NDC 5107959720
Hospital Charge Code 5107959720
Hospital Revenue Code 250
Min. Negotiated Rate $0.87
Max. Negotiated Rate $2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.25
Rate for Payer: Aetna Government $1.25
Rate for Payer: Brighton Health Commercial $1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1.70
Rate for Payer: EmblemHealth Commercial $1.25
Rate for Payer: Group Health Inc Commercial $1.25
Rate for Payer: Group Health Inc Medicare $0.87
Rate for Payer: Hamaspik Choice Inc Medicaid $1.25
Rate for Payer: Hamaspik Choice Inc Medicare $1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.62
Service Code NDC 0904671761
Hospital Charge Code 0904671761
Hospital Revenue Code 250
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Brighton Health Commercial $0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.12
Rate for Payer: Cigna LocalPlus Benefit Plan $0.10
Rate for Payer: EmblemHealth Commercial $0.08
Rate for Payer: Group Health Inc Commercial $0.08
Rate for Payer: Group Health Inc Medicare $0.05
Rate for Payer: Hamaspik Choice Inc Medicaid $0.08
Rate for Payer: Hamaspik Choice Inc Medicare $0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.10
Service Code NDC 0904671746
Hospital Charge Code 0904671746
Hospital Revenue Code 250
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.05
Rate for Payer: Aetna Government $0.05
Rate for Payer: Brighton Health Commercial $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.09
Rate for Payer: Cigna LocalPlus Benefit Plan $0.07
Rate for Payer: EmblemHealth Commercial $0.05
Rate for Payer: Group Health Inc Commercial $0.05
Rate for Payer: Group Health Inc Medicare $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.05
Rate for Payer: Hamaspik Choice Inc Medicare $0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.07
Service Code NDC 0904671760
Hospital Charge Code 0904671760
Hospital Revenue Code 250
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.03
Rate for Payer: Hamaspik Choice Inc Medicaid $0.03
Service Code NDC 1657140250
Hospital Charge Code 1657140250
Hospital Revenue Code 250
Min. Negotiated Rate $1.25
Max. Negotiated Rate $1.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1.25
Service Code NDC 5107959720
Hospital Charge Code 5107959720
Hospital Revenue Code 250
Min. Negotiated Rate $1.25
Max. Negotiated Rate $1.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1.25
Service Code NDC 0904671761
Hospital Charge Code 0904671761
Hospital Revenue Code 250
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.08
Rate for Payer: Hamaspik Choice Inc Medicaid $0.08
Service Code NDC 4359881115
Hospital Charge Code 4359881115
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Service Code NDC 0904671746
Hospital Charge Code 0904671746
Hospital Revenue Code 250
Min. Negotiated Rate $0.05
Max. Negotiated Rate $0.05
Rate for Payer: Hamaspik Choice Inc Medicaid $0.05
Service Code NDC 4359881112
Hospital Charge Code 4359881112
Hospital Revenue Code 250
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Service Code NDC 1657140250
Hospital Charge Code 1657140250
Hospital Revenue Code 250
Min. Negotiated Rate $0.87
Max. Negotiated Rate $2.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.25
Rate for Payer: Aetna Government $1.25
Rate for Payer: Brighton Health Commercial $1.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1.70
Rate for Payer: EmblemHealth Commercial $1.25
Rate for Payer: Group Health Inc Commercial $1.25
Rate for Payer: Group Health Inc Medicare $0.87
Rate for Payer: Hamaspik Choice Inc Medicaid $1.25
Rate for Payer: Hamaspik Choice Inc Medicare $1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.62
Service Code NDC 6809400459
Hospital Charge Code 6809400459
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 NDC 0904676520
Hospital Charge Code 0904676520
Hospital Revenue Code 250
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.02
Rate for Payer: Hamaspik Choice Inc Medicaid $0.02
Service Code NDC 6809400459
Hospital Charge Code 6809400459
Hospital Revenue Code 250
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.29
Rate for Payer: Aetna Government $0.29
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.37
Service Code NDC 5167240708
Hospital Charge Code 5167240708
Hospital Revenue Code 250
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.15
Rate for Payer: Aetna Government $0.15
Rate for Payer: Brighton Health Commercial $0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.24
Rate for Payer: Cigna LocalPlus Benefit Plan $0.21
Rate for Payer: EmblemHealth Commercial $0.15
Rate for Payer: Group Health Inc Commercial $0.15
Rate for Payer: Group Health Inc Medicare $0.11
Rate for Payer: Hamaspik Choice Inc Medicaid $0.15
Rate for Payer: Hamaspik Choice Inc Medicare $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.20
Service Code NDC 4580297426
Hospital Charge Code 4580297426
Hospital Revenue Code 250
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Service Code NDC 5167240708
Hospital Charge Code 5167240708
Hospital Revenue Code 250
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.15
Rate for Payer: Hamaspik Choice Inc Medicaid $0.15
Service Code NDC 5167221028
Hospital Charge Code 5167221028
Hospital Revenue Code 250
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Service Code NDC 6809400462
Hospital Charge Code 6809400462
Hospital Revenue Code 250
Min. Negotiated Rate $0.20
Max. Negotiated Rate $0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.29
Rate for Payer: Aetna Government $0.29
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.37
Service Code NDC 5167221028
Hospital Charge Code 5167221028
Hospital Revenue Code 250
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.04
Rate for Payer: Aetna Government $0.04
Rate for Payer: Brighton Health Commercial $0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.07
Rate for Payer: Cigna LocalPlus Benefit Plan $0.06
Rate for Payer: EmblemHealth Commercial $0.04
Rate for Payer: Group Health Inc Commercial $0.04
Rate for Payer: Group Health Inc Medicare $0.03
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Rate for Payer: Hamaspik Choice Inc Medicare $0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.05
Service Code NDC 6809400462
Hospital Charge Code 6809400462
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 NDC 4580297426
Hospital Charge Code 4580297426
Hospital Revenue Code 250
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.04
Rate for Payer: Aetna Government $0.04
Rate for Payer: Brighton Health Commercial $0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.07
Rate for Payer: Cigna LocalPlus Benefit Plan $0.06
Rate for Payer: EmblemHealth Commercial $0.04
Rate for Payer: Group Health Inc Commercial $0.04
Rate for Payer: Group Health Inc Medicare $0.03
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Rate for Payer: Hamaspik Choice Inc Medicare $0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.06
Service Code NDC 0904676520
Hospital Charge Code 0904676520
Hospital Revenue Code 250
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.02
Rate for Payer: Aetna Government $0.02
Rate for Payer: Brighton Health Commercial $0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.04
Rate for Payer: Cigna LocalPlus Benefit Plan $0.03
Rate for Payer: EmblemHealth Commercial $0.02
Rate for Payer: Group Health Inc Commercial $0.02
Rate for Payer: Group Health Inc Medicare $0.02
Rate for Payer: Hamaspik Choice Inc Medicaid $0.02
Rate for Payer: Hamaspik Choice Inc Medicare $0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.03