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Charge Type Price  
Service Code HCPCS C1776
Hospital Charge Code 40024009
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $5,120.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,681.91
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 $2,438.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,803.82
Rate for Payer: Fidelis Medicare Advantage $5,120.01
Rate for Payer: Group Health Inc Commercial $2,438.10
Rate for Payer: Group Health Inc Medicare $1,706.67
Rate for Payer: Hamaspik Choice Inc Medicaid $2,438.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,438.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,169.53
Service Code HCPCS C1776
Hospital Charge Code 40024009
Hospital Revenue Code 278
Min. Negotiated Rate $2,438.10
Max. Negotiated Rate $2,438.10
Rate for Payer: Hamaspik Choice Inc Medicaid $2,438.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,438.10
Service Code HCPCS C1776
Hospital Charge Code 40024010
Hospital Revenue Code 278
Min. Negotiated Rate $1,339.54
Max. Negotiated Rate $1,339.54
Rate for Payer: Hamaspik Choice Inc Medicaid $1,339.54
Rate for Payer: Hamaspik Choice Inc Medicare $1,339.54
Service Code HCPCS C1776
Hospital Charge Code 40024010
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,813.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,473.49
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 $1,339.54
Rate for Payer: Cigna LocalPlus Benefit Plan $1,540.47
Rate for Payer: Fidelis Medicare Advantage $2,813.03
Rate for Payer: Group Health Inc Commercial $1,339.54
Rate for Payer: Group Health Inc Medicare $937.68
Rate for Payer: Hamaspik Choice Inc Medicaid $1,339.54
Rate for Payer: Hamaspik Choice Inc Medicare $1,339.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,741.40
Service Code HCPCS C1713
Hospital Charge Code 40205756
Hospital Revenue Code 278
Min. Negotiated Rate $772.00
Max. Negotiated Rate $772.00
Rate for Payer: Hamaspik Choice Inc Medicaid $772.00
Rate for Payer: Hamaspik Choice Inc Medicare $772.00
Service Code HCPCS C1713
Hospital Charge Code 40205756
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,621.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $849.20
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 $772.00
Rate for Payer: Cigna LocalPlus Benefit Plan $887.80
Rate for Payer: Fidelis Medicare Advantage $1,621.20
Rate for Payer: Group Health Inc Commercial $772.00
Rate for Payer: Group Health Inc Medicare $540.40
Rate for Payer: Hamaspik Choice Inc Medicaid $772.00
Rate for Payer: Hamaspik Choice Inc Medicare $772.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,003.60
Service Code HCPCS C1776
Hospital Charge Code 40208109
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,066.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,606.00
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 $1,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,679.00
Rate for Payer: Fidelis Medicare Advantage $3,066.00
Rate for Payer: Group Health Inc Commercial $1,460.00
Rate for Payer: Group Health Inc Medicare $1,022.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,460.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,898.00
Service Code HCPCS C1776
Hospital Charge Code 40208109
Hospital Revenue Code 278
Min. Negotiated Rate $1,460.00
Max. Negotiated Rate $1,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,460.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,460.00
Service Code HCPCS C1776
Hospital Charge Code 40206255
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,160.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,655.50
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 $1,505.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,730.75
Rate for Payer: Fidelis Medicare Advantage $3,160.50
Rate for Payer: Group Health Inc Commercial $1,505.00
Rate for Payer: Group Health Inc Medicare $1,053.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,505.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,956.50
Service Code HCPCS C1776
Hospital Charge Code 40206255
Hospital Revenue Code 278
Min. Negotiated Rate $1,505.00
Max. Negotiated Rate $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,505.00
Service Code HCPCS C1776
Hospital Charge Code 40202217
Hospital Revenue Code 278
Min. Negotiated Rate $3,449.00
Max. Negotiated Rate $3,449.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,449.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,449.00
Service Code HCPCS C1776
Hospital Charge Code 40202217
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $7,242.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,793.90
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 $3,449.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,966.35
Rate for Payer: Fidelis Medicare Advantage $7,242.90
Rate for Payer: Group Health Inc Commercial $3,449.00
Rate for Payer: Group Health Inc Medicare $2,414.30
Rate for Payer: Hamaspik Choice Inc Medicaid $3,449.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,449.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,483.70
Service Code HCPCS C1776
Hospital Charge Code 40205576
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,447.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,377.00
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 $3,070.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,530.50
Rate for Payer: Fidelis Medicare Advantage $6,447.00
Rate for Payer: Group Health Inc Commercial $3,070.00
Rate for Payer: Group Health Inc Medicare $2,149.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,070.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,070.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,991.00
Service Code HCPCS C1776
Hospital Charge Code 40205576
Hospital Revenue Code 278
Min. Negotiated Rate $3,070.00
Max. Negotiated Rate $3,070.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,070.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,070.00
Service Code HCPCS C1776
Hospital Charge Code 40205450
Hospital Revenue Code 278
Min. Negotiated Rate $3,285.00
Max. Negotiated Rate $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.00
Service Code HCPCS C1776
Hospital Charge Code 40205450
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,613.50
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 $3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,777.75
Rate for Payer: Fidelis Medicare Advantage $6,898.50
Rate for Payer: Group Health Inc Commercial $3,285.00
Rate for Payer: Group Health Inc Medicare $2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,270.50
Service Code HCPCS C1776
Hospital Charge Code 40205358
Hospital Revenue Code 278
Min. Negotiated Rate $3,285.00
Max. Negotiated Rate $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.00
Service Code HCPCS C1776
Hospital Charge Code 40205358
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,613.50
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 $3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,777.75
Rate for Payer: Fidelis Medicare Advantage $6,898.50
Rate for Payer: Group Health Inc Commercial $3,285.00
Rate for Payer: Group Health Inc Medicare $2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,270.50
Hospital Charge Code 40205831
Hospital Revenue Code 270
Min. Negotiated Rate $595.00
Max. Negotiated Rate $1,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $850.00
Rate for Payer: Aetna Government $850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,156.00
Rate for Payer: Group Health Inc Commercial $850.00
Rate for Payer: Group Health Inc Medicare $595.00
Rate for Payer: Hamaspik Choice Inc Medicaid $850.00
Rate for Payer: Hamaspik Choice Inc Medicare $850.00
Service Code HCPCS C1713
Hospital Charge Code 40205836
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,572.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $823.90
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 $749.00
Rate for Payer: Cigna LocalPlus Benefit Plan $861.35
Rate for Payer: Fidelis Medicare Advantage $1,572.90
Rate for Payer: Group Health Inc Commercial $749.00
Rate for Payer: Group Health Inc Medicare $524.30
Rate for Payer: Hamaspik Choice Inc Medicaid $749.00
Rate for Payer: Hamaspik Choice Inc Medicare $749.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $973.70
Service Code HCPCS C1713
Hospital Charge Code 40205836
Hospital Revenue Code 278
Min. Negotiated Rate $749.00
Max. Negotiated Rate $749.00
Rate for Payer: Hamaspik Choice Inc Medicaid $749.00
Rate for Payer: Hamaspik Choice Inc Medicare $749.00
Service Code HCPCS C1713
Hospital Charge Code 40205837
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 40205837
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 C1776
Hospital Charge Code 40208081
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,613.50
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 $3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,777.75
Rate for Payer: Fidelis Medicare Advantage $6,898.50
Rate for Payer: Group Health Inc Commercial $3,285.00
Rate for Payer: Group Health Inc Medicare $2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,270.50
Service Code HCPCS C1776
Hospital Charge Code 40208081
Hospital Revenue Code 278
Min. Negotiated Rate $3,285.00
Max. Negotiated Rate $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.00