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Charge Type Price  
Hospital Charge Code 40029613
Hospital Revenue Code 272
Min. Negotiated Rate $136.50
Max. Negotiated Rate $312.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $214.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $195.00
Rate for Payer: Aetna Government $195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $312.00
Rate for Payer: Cigna LocalPlus Benefit Plan $265.20
Rate for Payer: Group Health Inc Commercial $195.00
Rate for Payer: Group Health Inc Medicare $136.50
Rate for Payer: Hamaspik Choice Inc Medicaid $195.00
Rate for Payer: Hamaspik Choice Inc Medicare $195.00
Hospital Charge Code 40206249
Hospital Revenue Code 270
Min. Negotiated Rate $787.50
Max. Negotiated Rate $1,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,237.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,125.00
Rate for Payer: Aetna Government $1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,530.00
Rate for Payer: Group Health Inc Commercial $1,125.00
Rate for Payer: Group Health Inc Medicare $787.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,125.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,125.00
Hospital Charge Code 40205482
Hospital Revenue Code 270
Min. Negotiated Rate $80.15
Max. Negotiated Rate $183.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $125.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $114.50
Rate for Payer: Aetna Government $114.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $183.20
Rate for Payer: Cigna LocalPlus Benefit Plan $155.72
Rate for Payer: Group Health Inc Commercial $114.50
Rate for Payer: Group Health Inc Medicare $80.15
Rate for Payer: Hamaspik Choice Inc Medicaid $114.50
Rate for Payer: Hamaspik Choice Inc Medicare $114.50
Service Code HCPCS C1776
Hospital Charge Code 40205670
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,298.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,870.80
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 $4,428.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,092.20
Rate for Payer: Fidelis Medicare Advantage $9,298.80
Rate for Payer: Group Health Inc Commercial $4,428.00
Rate for Payer: Group Health Inc Medicare $3,099.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,428.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,428.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,756.40
Service Code HCPCS C1776
Hospital Charge Code 40205670
Hospital Revenue Code 278
Min. Negotiated Rate $4,428.00
Max. Negotiated Rate $4,428.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,428.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,428.00
Service Code HCPCS C1713
Hospital Charge Code 40029599
Hospital Revenue Code 278
Min. Negotiated Rate $8.61
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $13.53
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 $12.30
Rate for Payer: Cigna LocalPlus Benefit Plan $14.14
Rate for Payer: Fidelis Medicare Advantage $25.83
Rate for Payer: Group Health Inc Commercial $12.30
Rate for Payer: Group Health Inc Medicare $8.61
Rate for Payer: Hamaspik Choice Inc Medicaid $12.30
Rate for Payer: Hamaspik Choice Inc Medicare $12.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $15.99
Service Code HCPCS C1713
Hospital Charge Code 40029599
Hospital Revenue Code 278
Min. Negotiated Rate $12.30
Max. Negotiated Rate $12.30
Rate for Payer: Hamaspik Choice Inc Medicaid $12.30
Rate for Payer: Hamaspik Choice Inc Medicare $12.30
Service Code HCPCS C1713
Hospital Charge Code 40205567
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,270.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,713.25
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 $1,557.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,791.12
Rate for Payer: Fidelis Medicare Advantage $3,270.75
Rate for Payer: Group Health Inc Commercial $1,557.50
Rate for Payer: Group Health Inc Medicare $1,090.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,557.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,024.75
Service Code HCPCS C1713
Hospital Charge Code 40205567
Hospital Revenue Code 278
Min. Negotiated Rate $1,557.50
Max. Negotiated Rate $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,557.50
Service Code HCPCS C1713
Hospital Charge Code 40205948
Hospital Revenue Code 278
Min. Negotiated Rate $1,324.00
Max. Negotiated Rate $1,324.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,324.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,324.00
Service Code HCPCS C1713
Hospital Charge Code 40205948
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,780.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,456.40
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 $1,324.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,522.60
Rate for Payer: Fidelis Medicare Advantage $2,780.40
Rate for Payer: Group Health Inc Commercial $1,324.00
Rate for Payer: Group Health Inc Medicare $926.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,324.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,324.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,721.20
Service Code HCPCS C1713
Hospital Charge Code 40205648
Hospital Revenue Code 278
Min. Negotiated Rate $1,557.50
Max. Negotiated Rate $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,557.50
Service Code HCPCS C1713
Hospital Charge Code 40205648
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,270.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,713.25
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 $1,557.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,791.12
Rate for Payer: Fidelis Medicare Advantage $3,270.75
Rate for Payer: Group Health Inc Commercial $1,557.50
Rate for Payer: Group Health Inc Medicare $1,090.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,557.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,024.75
Service Code HCPCS C1776
Hospital Charge Code 40208119
Hospital Revenue Code 278
Min. Negotiated Rate $1,483.30
Max. Negotiated Rate $1,483.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,483.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,483.30
Service Code HCPCS C1776
Hospital Charge Code 40208119
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,114.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,631.63
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 $1,483.30
Rate for Payer: Cigna LocalPlus Benefit Plan $1,705.80
Rate for Payer: Fidelis Medicare Advantage $3,114.93
Rate for Payer: Group Health Inc Commercial $1,483.30
Rate for Payer: Group Health Inc Medicare $1,038.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1,483.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,483.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,928.29
Service Code HCPCS C1713
Hospital Charge Code 40203428
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $598.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial $313.62
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 $285.11
Rate for Payer: Cigna LocalPlus Benefit Plan $327.88
Rate for Payer: Fidelis Medicare Advantage $598.73
Rate for Payer: Group Health Inc Commercial $285.11
Rate for Payer: Group Health Inc Medicare $199.58
Rate for Payer: Hamaspik Choice Inc Medicaid $285.11
Rate for Payer: Hamaspik Choice Inc Medicare $285.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $370.64
Service Code HCPCS C1713
Hospital Charge Code 40203428
Hospital Revenue Code 278
Min. Negotiated Rate $285.11
Max. Negotiated Rate $285.11
Rate for Payer: Hamaspik Choice Inc Medicaid $285.11
Rate for Payer: Hamaspik Choice Inc Medicare $285.11
Service Code HCPCS C1713
Hospital Charge Code 40205425
Hospital Revenue Code 278
Min. Negotiated Rate $2,116.10
Max. Negotiated Rate $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Service Code HCPCS C1713
Hospital Charge Code 40205425
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,443.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,327.71
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 $2,116.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,433.52
Rate for Payer: Fidelis Medicare Advantage $4,443.81
Rate for Payer: Group Health Inc Commercial $2,116.10
Rate for Payer: Group Health Inc Medicare $1,481.27
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,750.93
Service Code HCPCS C1713
Hospital Charge Code 40206232
Hospital Revenue Code 278
Min. Negotiated Rate $728.00
Max. Negotiated Rate $728.00
Rate for Payer: Hamaspik Choice Inc Medicaid $728.00
Rate for Payer: Hamaspik Choice Inc Medicare $728.00
Service Code HCPCS C1713
Hospital Charge Code 40206232
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,528.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $800.80
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 $728.00
Rate for Payer: Cigna LocalPlus Benefit Plan $837.20
Rate for Payer: Fidelis Medicare Advantage $1,528.80
Rate for Payer: Group Health Inc Commercial $728.00
Rate for Payer: Group Health Inc Medicare $509.60
Rate for Payer: Hamaspik Choice Inc Medicaid $728.00
Rate for Payer: Hamaspik Choice Inc Medicare $728.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $946.40
Service Code HCPCS C1776
Hospital Charge Code 40208157
Hospital Revenue Code 278
Min. Negotiated Rate $1,622.60
Max. Negotiated Rate $1,622.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,622.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,622.60
Service Code HCPCS C1776
Hospital Charge Code 40208157
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,407.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,784.86
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 $1,622.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,865.99
Rate for Payer: Fidelis Medicare Advantage $3,407.46
Rate for Payer: Group Health Inc Commercial $1,622.60
Rate for Payer: Group Health Inc Medicare $1,135.82
Rate for Payer: Hamaspik Choice Inc Medicaid $1,622.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,622.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,109.38
Service Code HCPCS C1713
Hospital Charge Code 40205586
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,892.66
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 $1,720.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,978.69
Rate for Payer: Fidelis Medicare Advantage $3,613.26
Rate for Payer: Group Health Inc Commercial $1,720.60
Rate for Payer: Group Health Inc Medicare $1,204.42
Rate for Payer: Hamaspik Choice Inc Medicaid $1,720.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,720.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,236.78
Service Code HCPCS C1713
Hospital Charge Code 40205586
Hospital Revenue Code 278
Min. Negotiated Rate $1,720.60
Max. Negotiated Rate $1,720.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,720.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,720.60