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Charge Type Price  
Hospital Charge Code 40504020
Hospital Revenue Code 260
Min. Negotiated Rate $3.47
Max. Negotiated Rate $7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.96
Rate for Payer: Aetna Government $4.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $7.94
Rate for Payer: Cigna LocalPlus Benefit Plan $6.75
Rate for Payer: Group Health Inc Commercial $4.96
Rate for Payer: Group Health Inc Medicare $3.47
Rate for Payer: Hamaspik Choice Inc Medicaid $4.96
Rate for Payer: Hamaspik Choice Inc Medicare $4.96
Hospital Charge Code 40504021
Hospital Revenue Code 260
Min. Negotiated Rate $2.85
Max. Negotiated Rate $6.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.52
Rate for Payer: Cigna LocalPlus Benefit Plan $5.54
Rate for Payer: Group Health Inc Commercial $4.08
Rate for Payer: Group Health Inc Medicare $2.85
Rate for Payer: Hamaspik Choice Inc Medicaid $4.08
Rate for Payer: Hamaspik Choice Inc Medicare $4.08
Hospital Charge Code 40509780
Hospital Revenue Code 260
Min. Negotiated Rate $7.07
Max. Negotiated Rate $16.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.10
Rate for Payer: Aetna Government $10.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.16
Rate for Payer: Cigna LocalPlus Benefit Plan $13.74
Rate for Payer: Group Health Inc Commercial $10.10
Rate for Payer: Group Health Inc Medicare $7.07
Rate for Payer: Hamaspik Choice Inc Medicaid $10.10
Rate for Payer: Hamaspik Choice Inc Medicare $10.10
Hospital Charge Code 40509786
Hospital Revenue Code 260
Min. Negotiated Rate $3.72
Max. Negotiated Rate $8.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $5.32
Rate for Payer: Aetna Government $5.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $8.51
Rate for Payer: Cigna LocalPlus Benefit Plan $7.24
Rate for Payer: Group Health Inc Commercial $5.32
Rate for Payer: Group Health Inc Medicare $3.72
Rate for Payer: Hamaspik Choice Inc Medicaid $5.32
Rate for Payer: Hamaspik Choice Inc Medicare $5.32
Hospital Charge Code 40509785
Hospital Revenue Code 260
Min. Negotiated Rate $3.10
Max. Negotiated Rate $7.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.43
Rate for Payer: Aetna Government $4.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $7.09
Rate for Payer: Cigna LocalPlus Benefit Plan $6.02
Rate for Payer: Group Health Inc Commercial $4.43
Rate for Payer: Group Health Inc Medicare $3.10
Rate for Payer: Hamaspik Choice Inc Medicaid $4.43
Rate for Payer: Hamaspik Choice Inc Medicare $4.43
Hospital Charge Code 40501200
Hospital Revenue Code 260
Min. Negotiated Rate $1.74
Max. Negotiated Rate $3.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.48
Rate for Payer: Aetna Government $2.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.98
Rate for Payer: Cigna LocalPlus Benefit Plan $3.38
Rate for Payer: Group Health Inc Commercial $2.48
Rate for Payer: Group Health Inc Medicare $1.74
Rate for Payer: Hamaspik Choice Inc Medicaid $2.48
Rate for Payer: Hamaspik Choice Inc Medicare $2.48
Service Code HCPCS C1713
Hospital Charge Code 40209800
Hospital Revenue Code 278
Min. Negotiated Rate $183.00
Max. Negotiated Rate $183.00
Rate for Payer: Hamaspik Choice Inc Medicaid $183.00
Rate for Payer: Hamaspik Choice Inc Medicare $183.00
Service Code HCPCS C1713
Hospital Charge Code 40209800
Hospital Revenue Code 278
Min. Negotiated Rate $128.10
Max. Negotiated Rate $384.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $201.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $183.00
Rate for Payer: Cigna LocalPlus Benefit Plan $210.45
Rate for Payer: Fidelis Medicare Advantage $384.30
Rate for Payer: Group Health Inc Commercial $183.00
Rate for Payer: Group Health Inc Medicare $128.10
Rate for Payer: Hamaspik Choice Inc Medicaid $183.00
Rate for Payer: Hamaspik Choice Inc Medicare $183.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $237.90
Service Code HCPCS C1781
Hospital Charge Code 40209802
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $2,137.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,119.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,018.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,170.70
Rate for Payer: Fidelis Medicare Advantage $2,137.80
Rate for Payer: Group Health Inc Commercial $1,018.00
Rate for Payer: Group Health Inc Medicare $712.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,018.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,018.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,323.40
Service Code HCPCS C1781
Hospital Charge Code 40209802
Hospital Revenue Code 278
Min. Negotiated Rate $1,018.00
Max. Negotiated Rate $1,018.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,018.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,018.00
Hospital Charge Code 40501500
Hospital Revenue Code 260
Min. Negotiated Rate $5.09
Max. Negotiated Rate $11.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.26
Rate for Payer: Aetna Government $7.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.62
Rate for Payer: Cigna LocalPlus Benefit Plan $9.88
Rate for Payer: Group Health Inc Commercial $7.26
Rate for Payer: Group Health Inc Medicare $5.09
Rate for Payer: Hamaspik Choice Inc Medicaid $7.26
Rate for Payer: Hamaspik Choice Inc Medicare $7.26
Service Code HCPCS C1713
Hospital Charge Code 40200577
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,236.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,171.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,065.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,224.75
Rate for Payer: Fidelis Medicare Advantage $2,236.50
Rate for Payer: Group Health Inc Commercial $1,065.00
Rate for Payer: Group Health Inc Medicare $745.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,065.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,065.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,384.50
Service Code HCPCS C1713
Hospital Charge Code 40200577
Hospital Revenue Code 278
Min. Negotiated Rate $1,065.00
Max. Negotiated Rate $1,065.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,065.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,065.00
Service Code HCPCS C1781
Hospital Charge Code 40209803
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $225.00
Rate for Payer: Cigna LocalPlus Benefit Plan $258.75
Rate for Payer: Fidelis Medicare Advantage $472.50
Rate for Payer: Group Health Inc Commercial $225.00
Rate for Payer: Group Health Inc Medicare $157.50
Rate for Payer: Hamaspik Choice Inc Medicaid $225.00
Rate for Payer: Hamaspik Choice Inc Medicare $225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $292.50
Service Code HCPCS C1781
Hospital Charge Code 40209803
Hospital Revenue Code 278
Min. Negotiated Rate $225.00
Max. Negotiated Rate $225.00
Rate for Payer: Hamaspik Choice Inc Medicaid $225.00
Rate for Payer: Hamaspik Choice Inc Medicare $225.00
Service Code HCPCS C1713
Hospital Charge Code 40209807
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,238.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,172.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,066.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,225.90
Rate for Payer: Fidelis Medicare Advantage $2,238.60
Rate for Payer: Group Health Inc Commercial $1,066.00
Rate for Payer: Group Health Inc Medicare $746.20
Rate for Payer: Hamaspik Choice Inc Medicaid $1,066.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,066.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,385.80
Service Code HCPCS C1713
Hospital Charge Code 40209807
Hospital Revenue Code 278
Min. Negotiated Rate $1,066.00
Max. Negotiated Rate $1,066.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,066.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,066.00
Hospital Charge Code 40203563
Hospital Revenue Code 272
Min. Negotiated Rate $579.60
Max. Negotiated Rate $1,324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $910.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $828.00
Rate for Payer: Aetna Government $828.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,324.80
Rate for Payer: Cigna LocalPlus Benefit Plan $1,126.08
Rate for Payer: Group Health Inc Commercial $828.00
Rate for Payer: Group Health Inc Medicare $579.60
Rate for Payer: Hamaspik Choice Inc Medicaid $828.00
Rate for Payer: Hamaspik Choice Inc Medicare $828.00
Service Code HCPCS C1713
Hospital Charge Code 40209808
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,782.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,457.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,325.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,523.75
Rate for Payer: Fidelis Medicare Advantage $2,782.50
Rate for Payer: Group Health Inc Commercial $1,325.00
Rate for Payer: Group Health Inc Medicare $927.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,722.50
Service Code HCPCS C1713
Hospital Charge Code 40209808
Hospital Revenue Code 278
Min. Negotiated Rate $1,325.00
Max. Negotiated Rate $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,325.00
Hospital Charge Code 30011001
Hospital Revenue Code 239
Min. Negotiated Rate $163.72
Max. Negotiated Rate $374.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $257.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $233.89
Rate for Payer: Aetna Government $233.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $374.22
Rate for Payer: Cigna LocalPlus Benefit Plan $318.09
Rate for Payer: Group Health Inc Commercial $233.89
Rate for Payer: Group Health Inc Medicare $163.72
Rate for Payer: Hamaspik Choice Inc Medicaid $233.89
Rate for Payer: Hamaspik Choice Inc Medicare $233.89
Hospital Charge Code 30011002
Hospital Revenue Code 239
Min. Negotiated Rate $163.72
Max. Negotiated Rate $374.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $257.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $233.89
Rate for Payer: Aetna Government $233.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $374.22
Rate for Payer: Cigna LocalPlus Benefit Plan $318.09
Rate for Payer: Group Health Inc Commercial $233.89
Rate for Payer: Group Health Inc Medicare $163.72
Rate for Payer: Hamaspik Choice Inc Medicaid $233.89
Rate for Payer: Hamaspik Choice Inc Medicare $233.89
Service Code HCPCS C1713
Hospital Charge Code 40200573
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $750.00
Rate for Payer: Cigna LocalPlus Benefit Plan $862.50
Rate for Payer: Fidelis Medicare Advantage $1,575.00
Rate for Payer: Group Health Inc Commercial $750.00
Rate for Payer: Group Health Inc Medicare $525.00
Rate for Payer: Hamaspik Choice Inc Medicaid $750.00
Rate for Payer: Hamaspik Choice Inc Medicare $750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $975.00
Service Code HCPCS C1713
Hospital Charge Code 40200573
Hospital Revenue Code 278
Min. Negotiated Rate $750.00
Max. Negotiated Rate $750.00
Rate for Payer: Hamaspik Choice Inc Medicaid $750.00
Rate for Payer: Hamaspik Choice Inc Medicare $750.00
Service Code HCPCS C1713
Hospital Charge Code 40200575
Hospital Revenue Code 278
Min. Negotiated Rate $1,325.00
Max. Negotiated Rate $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,325.00