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Charge Type Price  
Service Code HCPCS C1776
Hospital Charge Code 40205238
Hospital Revenue Code 278
Min. Negotiated Rate $201.80
Max. Negotiated Rate $605.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial $317.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $288.28
Rate for Payer: Cigna LocalPlus Benefit Plan $331.52
Rate for Payer: Fidelis Medicare Advantage $605.39
Rate for Payer: Group Health Inc Commercial $288.28
Rate for Payer: Group Health Inc Medicare $201.80
Rate for Payer: Hamaspik Choice Inc Medicaid $288.28
Rate for Payer: Hamaspik Choice Inc Medicare $288.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $374.76
Service Code HCPCS C1776
Hospital Charge Code 40205238
Hospital Revenue Code 278
Min. Negotiated Rate $288.28
Max. Negotiated Rate $288.28
Rate for Payer: Hamaspik Choice Inc Medicaid $288.28
Rate for Payer: Hamaspik Choice Inc Medicare $288.28
Hospital Charge Code 40005300
Hospital Revenue Code 272
Min. Negotiated Rate $57.40
Max. Negotiated Rate $131.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $82.00
Rate for Payer: Aetna Government $82.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $131.20
Rate for Payer: Cigna LocalPlus Benefit Plan $111.52
Rate for Payer: Group Health Inc Commercial $82.00
Rate for Payer: Group Health Inc Medicare $57.40
Rate for Payer: Hamaspik Choice Inc Medicaid $82.00
Rate for Payer: Hamaspik Choice Inc Medicare $82.00
Service Code HCPCS C1713
Hospital Charge Code 40008261
Hospital Revenue Code 278
Min. Negotiated Rate $45.00
Max. Negotiated Rate $45.00
Rate for Payer: Hamaspik Choice Inc Medicaid $45.00
Rate for Payer: Hamaspik Choice Inc Medicare $45.00
Service Code HCPCS C1713
Hospital Charge Code 40008261
Hospital Revenue Code 278
Min. Negotiated Rate $31.50
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $49.50
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 $45.00
Rate for Payer: Cigna LocalPlus Benefit Plan $51.75
Rate for Payer: Fidelis Medicare Advantage $94.50
Rate for Payer: Group Health Inc Commercial $45.00
Rate for Payer: Group Health Inc Medicare $31.50
Rate for Payer: Hamaspik Choice Inc Medicaid $45.00
Rate for Payer: Hamaspik Choice Inc Medicare $45.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $58.50
Service Code HCPCS C1713
Hospital Charge Code 40204671
Hospital Revenue Code 278
Min. Negotiated Rate $29.99
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $47.12
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 $42.84
Rate for Payer: Cigna LocalPlus Benefit Plan $49.27
Rate for Payer: Fidelis Medicare Advantage $89.96
Rate for Payer: Group Health Inc Commercial $42.84
Rate for Payer: Group Health Inc Medicare $29.99
Rate for Payer: Hamaspik Choice Inc Medicaid $42.84
Rate for Payer: Hamaspik Choice Inc Medicare $42.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $55.69
Service Code HCPCS C1713
Hospital Charge Code 40204671
Hospital Revenue Code 278
Min. Negotiated Rate $42.84
Max. Negotiated Rate $42.84
Rate for Payer: Hamaspik Choice Inc Medicaid $42.84
Rate for Payer: Hamaspik Choice Inc Medicare $42.84
Service Code HCPCS C1713
Hospital Charge Code 40204672
Hospital Revenue Code 278
Min. Negotiated Rate $42.84
Max. Negotiated Rate $42.84
Rate for Payer: Hamaspik Choice Inc Medicaid $42.84
Rate for Payer: Hamaspik Choice Inc Medicare $42.84
Service Code HCPCS C1713
Hospital Charge Code 40204672
Hospital Revenue Code 278
Min. Negotiated Rate $29.99
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $47.12
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 $42.84
Rate for Payer: Cigna LocalPlus Benefit Plan $49.27
Rate for Payer: Fidelis Medicare Advantage $89.96
Rate for Payer: Group Health Inc Commercial $42.84
Rate for Payer: Group Health Inc Medicare $29.99
Rate for Payer: Hamaspik Choice Inc Medicaid $42.84
Rate for Payer: Hamaspik Choice Inc Medicare $42.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $55.69
Service Code HCPCS C1713
Hospital Charge Code 40203411
Hospital Revenue Code 278
Min. Negotiated Rate $36.73
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $57.72
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 $52.47
Rate for Payer: Cigna LocalPlus Benefit Plan $60.34
Rate for Payer: Fidelis Medicare Advantage $110.19
Rate for Payer: Group Health Inc Commercial $52.47
Rate for Payer: Group Health Inc Medicare $36.73
Rate for Payer: Hamaspik Choice Inc Medicaid $52.47
Rate for Payer: Hamaspik Choice Inc Medicare $52.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $68.21
Service Code HCPCS C1713
Hospital Charge Code 40203411
Hospital Revenue Code 278
Min. Negotiated Rate $52.47
Max. Negotiated Rate $52.47
Rate for Payer: Hamaspik Choice Inc Medicaid $52.47
Rate for Payer: Hamaspik Choice Inc Medicare $52.47
Hospital Charge Code 40005301
Hospital Revenue Code 272
Min. Negotiated Rate $285.60
Max. Negotiated Rate $652.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $448.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $408.00
Rate for Payer: Aetna Government $408.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $652.80
Rate for Payer: Cigna LocalPlus Benefit Plan $554.88
Rate for Payer: Group Health Inc Commercial $408.00
Rate for Payer: Group Health Inc Medicare $285.60
Rate for Payer: Hamaspik Choice Inc Medicaid $408.00
Rate for Payer: Hamaspik Choice Inc Medicare $408.00
Service Code HCPCS C1776
Hospital Charge Code 40029616
Hospital Revenue Code 278
Min. Negotiated Rate $900.80
Max. Negotiated Rate $900.80
Rate for Payer: Hamaspik Choice Inc Medicaid $900.80
Rate for Payer: Hamaspik Choice Inc Medicare $900.80
Service Code HCPCS C1776
Hospital Charge Code 40029616
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,891.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $990.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $900.80
Rate for Payer: Cigna LocalPlus Benefit Plan $1,035.92
Rate for Payer: Fidelis Medicare Advantage $1,891.68
Rate for Payer: Group Health Inc Commercial $900.80
Rate for Payer: Group Health Inc Medicare $630.56
Rate for Payer: Hamaspik Choice Inc Medicaid $900.80
Rate for Payer: Hamaspik Choice Inc Medicare $900.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,171.04
Service Code HCPCS C1713
Hospital Charge Code 40205605
Hospital Revenue Code 278
Min. Negotiated Rate $76.65
Max. Negotiated Rate $229.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $120.45
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 $109.50
Rate for Payer: Cigna LocalPlus Benefit Plan $125.92
Rate for Payer: Fidelis Medicare Advantage $229.95
Rate for Payer: Group Health Inc Commercial $109.50
Rate for Payer: Group Health Inc Medicare $76.65
Rate for Payer: Hamaspik Choice Inc Medicaid $109.50
Rate for Payer: Hamaspik Choice Inc Medicare $109.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $142.35
Service Code HCPCS C1713
Hospital Charge Code 40205605
Hospital Revenue Code 278
Min. Negotiated Rate $109.50
Max. Negotiated Rate $109.50
Rate for Payer: Hamaspik Choice Inc Medicaid $109.50
Rate for Payer: Hamaspik Choice Inc Medicare $109.50
Service Code HCPCS C1713
Hospital Charge Code 40205646
Hospital Revenue Code 278
Min. Negotiated Rate $82.50
Max. Negotiated Rate $82.50
Rate for Payer: Hamaspik Choice Inc Medicaid $82.50
Rate for Payer: Hamaspik Choice Inc Medicare $82.50
Service Code HCPCS C1713
Hospital Charge Code 40205646
Hospital Revenue Code 278
Min. Negotiated Rate $57.75
Max. Negotiated Rate $173.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $90.75
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 $82.50
Rate for Payer: Cigna LocalPlus Benefit Plan $94.88
Rate for Payer: Fidelis Medicare Advantage $173.25
Rate for Payer: Group Health Inc Commercial $82.50
Rate for Payer: Group Health Inc Medicare $57.75
Rate for Payer: Hamaspik Choice Inc Medicaid $82.50
Rate for Payer: Hamaspik Choice Inc Medicare $82.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $107.25
Service Code HCPCS C1713
Hospital Charge Code 40205542
Hospital Revenue Code 278
Min. Negotiated Rate $200.50
Max. Negotiated Rate $200.50
Rate for Payer: Hamaspik Choice Inc Medicaid $200.50
Rate for Payer: Hamaspik Choice Inc Medicare $200.50
Service Code HCPCS C1713
Hospital Charge Code 40205542
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $421.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.55
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 $200.50
Rate for Payer: Cigna LocalPlus Benefit Plan $230.58
Rate for Payer: Fidelis Medicare Advantage $421.05
Rate for Payer: Group Health Inc Commercial $200.50
Rate for Payer: Group Health Inc Medicare $140.35
Rate for Payer: Hamaspik Choice Inc Medicaid $200.50
Rate for Payer: Hamaspik Choice Inc Medicare $200.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.65
Service Code HCPCS C1713
Hospital Charge Code 40205952
Hospital Revenue Code 278
Min. Negotiated Rate $87.50
Max. Negotiated Rate $87.50
Rate for Payer: Hamaspik Choice Inc Medicaid $87.50
Rate for Payer: Hamaspik Choice Inc Medicare $87.50
Service Code HCPCS C1713
Hospital Charge Code 40205952
Hospital Revenue Code 278
Min. Negotiated Rate $61.25
Max. Negotiated Rate $183.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $96.25
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 $87.50
Rate for Payer: Cigna LocalPlus Benefit Plan $100.62
Rate for Payer: Fidelis Medicare Advantage $183.75
Rate for Payer: Group Health Inc Commercial $87.50
Rate for Payer: Group Health Inc Medicare $61.25
Rate for Payer: Hamaspik Choice Inc Medicaid $87.50
Rate for Payer: Hamaspik Choice Inc Medicare $87.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $113.75
Service Code HCPCS C1713
Hospital Charge Code 40205563
Hospital Revenue Code 278
Min. Negotiated Rate $1,344.00
Max. Negotiated Rate $1,344.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,344.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,344.00
Service Code HCPCS C1713
Hospital Charge Code 40205563
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,822.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,478.40
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 $1,344.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,545.60
Rate for Payer: Fidelis Medicare Advantage $2,822.40
Rate for Payer: Group Health Inc Commercial $1,344.00
Rate for Payer: Group Health Inc Medicare $940.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,344.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,344.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,747.20
Service Code HCPCS C1713
Hospital Charge Code 40205215
Hospital Revenue Code 278
Min. Negotiated Rate $71.05
Max. Negotiated Rate $213.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $111.65
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 $101.50
Rate for Payer: Cigna LocalPlus Benefit Plan $116.72
Rate for Payer: Fidelis Medicare Advantage $213.15
Rate for Payer: Group Health Inc Commercial $101.50
Rate for Payer: Group Health Inc Medicare $71.05
Rate for Payer: Hamaspik Choice Inc Medicaid $101.50
Rate for Payer: Hamaspik Choice Inc Medicare $101.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $131.95