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Charge Type Price  
Service Code HCPCS C1781
Hospital Charge Code 40205900
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,027.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $538.04
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 $489.12
Rate for Payer: Cigna LocalPlus Benefit Plan $562.49
Rate for Payer: Fidelis Medicare Advantage $1,027.16
Rate for Payer: Group Health Inc Commercial $489.12
Rate for Payer: Group Health Inc Medicare $342.39
Rate for Payer: Hamaspik Choice Inc Medicaid $489.12
Rate for Payer: Hamaspik Choice Inc Medicare $489.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $635.86
Service Code HCPCS C1781
Hospital Charge Code 40205225
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,526.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $799.42
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 $726.75
Rate for Payer: Cigna LocalPlus Benefit Plan $835.76
Rate for Payer: Fidelis Medicare Advantage $1,526.18
Rate for Payer: Group Health Inc Commercial $726.75
Rate for Payer: Group Health Inc Medicare $508.72
Rate for Payer: Hamaspik Choice Inc Medicaid $726.75
Rate for Payer: Hamaspik Choice Inc Medicare $726.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $944.78
Service Code HCPCS C1781
Hospital Charge Code 40205225
Hospital Revenue Code 278
Min. Negotiated Rate $726.75
Max. Negotiated Rate $726.75
Rate for Payer: Hamaspik Choice Inc Medicaid $726.75
Rate for Payer: Hamaspik Choice Inc Medicare $726.75
Service Code HCPCS C1781
Hospital Charge Code 40205677
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $332.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $174.32
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 $158.47
Rate for Payer: Cigna LocalPlus Benefit Plan $182.24
Rate for Payer: Fidelis Medicare Advantage $332.79
Rate for Payer: Group Health Inc Commercial $158.47
Rate for Payer: Group Health Inc Medicare $110.93
Rate for Payer: Hamaspik Choice Inc Medicaid $158.47
Rate for Payer: Hamaspik Choice Inc Medicare $158.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $206.01
Service Code HCPCS C1781
Hospital Charge Code 40205677
Hospital Revenue Code 278
Min. Negotiated Rate $158.47
Max. Negotiated Rate $158.47
Rate for Payer: Hamaspik Choice Inc Medicaid $158.47
Rate for Payer: Hamaspik Choice Inc Medicare $158.47
Service Code HCPCS C1781
Hospital Charge Code 40205765
Hospital Revenue Code 278
Min. Negotiated Rate $180.50
Max. Negotiated Rate $180.50
Rate for Payer: Hamaspik Choice Inc Medicaid $180.50
Rate for Payer: Hamaspik Choice Inc Medicare $180.50
Service Code HCPCS C1781
Hospital Charge Code 40205765
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $379.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $198.55
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 $180.50
Rate for Payer: Cigna LocalPlus Benefit Plan $207.58
Rate for Payer: Fidelis Medicare Advantage $379.05
Rate for Payer: Group Health Inc Commercial $180.50
Rate for Payer: Group Health Inc Medicare $126.35
Rate for Payer: Hamaspik Choice Inc Medicaid $180.50
Rate for Payer: Hamaspik Choice Inc Medicare $180.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $234.65
Service Code HCPCS C1781
Hospital Charge Code 40206253
Hospital Revenue Code 278
Min. Negotiated Rate $44.80
Max. Negotiated Rate $134.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $70.40
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 $64.00
Rate for Payer: Cigna LocalPlus Benefit Plan $73.60
Rate for Payer: Fidelis Medicare Advantage $134.40
Rate for Payer: Group Health Inc Commercial $64.00
Rate for Payer: Group Health Inc Medicare $44.80
Rate for Payer: Hamaspik Choice Inc Medicaid $64.00
Rate for Payer: Hamaspik Choice Inc Medicare $64.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $83.20
Service Code HCPCS C1781
Hospital Charge Code 40206253
Hospital Revenue Code 278
Min. Negotiated Rate $64.00
Max. Negotiated Rate $64.00
Rate for Payer: Hamaspik Choice Inc Medicaid $64.00
Rate for Payer: Hamaspik Choice Inc Medicare $64.00
Service Code HCPCS C1781
Hospital Charge Code 40200003
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,203.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $630.63
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 $573.30
Rate for Payer: Cigna LocalPlus Benefit Plan $659.30
Rate for Payer: Fidelis Medicare Advantage $1,203.93
Rate for Payer: Group Health Inc Commercial $573.30
Rate for Payer: Group Health Inc Medicare $401.31
Rate for Payer: Hamaspik Choice Inc Medicaid $573.30
Rate for Payer: Hamaspik Choice Inc Medicare $573.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $745.29
Service Code HCPCS C1781
Hospital Charge Code 40200003
Hospital Revenue Code 278
Min. Negotiated Rate $573.30
Max. Negotiated Rate $573.30
Rate for Payer: Hamaspik Choice Inc Medicaid $573.30
Rate for Payer: Hamaspik Choice Inc Medicare $573.30
Service Code HCPCS J0461
Hospital Charge Code 41645521
Hospital Revenue Code 636
Min. Negotiated Rate $0.07
Max. Negotiated Rate $13.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.70
Rate for Payer: Cigna LocalPlus Benefit Plan $12.30
Rate for Payer: Fidelis CHP/HARP/Medicaid $0.08
Rate for Payer: Group Health Inc Commercial $10.70
Rate for Payer: Group Health Inc Medicare $7.49
Rate for Payer: Hamaspik Choice Inc Medicaid $10.70
Rate for Payer: Hamaspik Choice Inc Medicare $10.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid $0.07
Rate for Payer: SOMOS Essential $0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $13.91
Service Code HCPCS J0461
Hospital Charge Code 41655521
Hospital Revenue Code 636
Min. Negotiated Rate $10.70
Max. Negotiated Rate $10.70
Rate for Payer: Hamaspik Choice Inc Medicaid $10.70
Rate for Payer: Hamaspik Choice Inc Medicare $10.70
Service Code HCPCS J0461
Hospital Charge Code 41655521
Hospital Revenue Code 636
Min. Negotiated Rate $0.07
Max. Negotiated Rate $13.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.70
Rate for Payer: Cigna LocalPlus Benefit Plan $12.30
Rate for Payer: Fidelis CHP/HARP/Medicaid $0.08
Rate for Payer: Group Health Inc Commercial $10.70
Rate for Payer: Group Health Inc Medicare $7.49
Rate for Payer: Hamaspik Choice Inc Medicaid $10.70
Rate for Payer: Hamaspik Choice Inc Medicare $10.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid $0.07
Rate for Payer: SOMOS Essential $0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $13.91
Service Code HCPCS J0461
Hospital Charge Code 41645521
Hospital Revenue Code 636
Min. Negotiated Rate $10.70
Max. Negotiated Rate $10.70
Rate for Payer: Hamaspik Choice Inc Medicaid $10.70
Rate for Payer: Hamaspik Choice Inc Medicare $10.70
Service Code HCPCS J0461
Hospital Charge Code 41651489
Hospital Revenue Code 636
Min. Negotiated Rate $0.07
Max. Negotiated Rate $1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.49
Rate for Payer: Cigna LocalPlus Benefit Plan $1.71
Rate for Payer: Fidelis CHP/HARP/Medicaid $0.08
Rate for Payer: Group Health Inc Commercial $1.49
Rate for Payer: Group Health Inc Medicare $1.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1.49
Rate for Payer: Hamaspik Choice Inc Medicare $1.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid $0.07
Rate for Payer: SOMOS Essential $0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.94
Service Code HCPCS J0461
Hospital Charge Code 41641489
Hospital Revenue Code 636
Min. Negotiated Rate $0.07
Max. Negotiated Rate $1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.49
Rate for Payer: Cigna LocalPlus Benefit Plan $1.71
Rate for Payer: Fidelis CHP/HARP/Medicaid $0.08
Rate for Payer: Group Health Inc Commercial $1.49
Rate for Payer: Group Health Inc Medicare $1.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1.49
Rate for Payer: Hamaspik Choice Inc Medicare $1.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid $0.07
Rate for Payer: SOMOS Essential $0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.94
Service Code HCPCS J0461
Hospital Charge Code 41651489
Hospital Revenue Code 636
Min. Negotiated Rate $1.49
Max. Negotiated Rate $1.49
Rate for Payer: Hamaspik Choice Inc Medicaid $1.49
Rate for Payer: Hamaspik Choice Inc Medicare $1.49
Service Code HCPCS J0461
Hospital Charge Code 41641489
Hospital Revenue Code 636
Min. Negotiated Rate $1.49
Max. Negotiated Rate $1.49
Rate for Payer: Hamaspik Choice Inc Medicaid $1.49
Rate for Payer: Hamaspik Choice Inc Medicare $1.49
Service Code HCPCS J0461
Hospital Charge Code 41653819
Hospital Revenue Code 636
Min. Negotiated Rate $0.07
Max. Negotiated Rate $1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1.72
Rate for Payer: Fidelis CHP/HARP/Medicaid $0.08
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid $0.07
Rate for Payer: SOMOS Essential $0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95
Service Code HCPCS J0461
Hospital Charge Code 41653819
Hospital Revenue Code 636
Min. Negotiated Rate $1.50
Max. Negotiated Rate $1.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Service Code HCPCS J0461
Hospital Charge Code 41643819
Hospital Revenue Code 636
Min. Negotiated Rate $1.50
Max. Negotiated Rate $1.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Service Code HCPCS J0461
Hospital Charge Code 41643819
Hospital Revenue Code 636
Min. Negotiated Rate $0.07
Max. Negotiated Rate $1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1.72
Rate for Payer: Fidelis CHP/HARP/Medicaid $0.08
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.09
Rate for Payer: SOMOS CHP/HARP/Medicaid $0.07
Rate for Payer: SOMOS Essential $0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95
Hospital Charge Code 41652198
Hospital Revenue Code 250
Min. Negotiated Rate $1.05
Max. Negotiated Rate $2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.50
Rate for Payer: Aetna Government $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2.04
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95
Hospital Charge Code 41642198
Hospital Revenue Code 250
Min. Negotiated Rate $1.05
Max. Negotiated Rate $2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.50
Rate for Payer: Aetna Government $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2.04
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95