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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40206231
Hospital Revenue Code 278
Min. Negotiated Rate $2,264.50
Max. Negotiated Rate $2,264.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,264.50
Rate for Payer: Hamaspik Choice Inc Medicare $2,264.50
Service Code HCPCS C1713
Hospital Charge Code 40206231
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,755.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,490.95
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 $2,264.50
Rate for Payer: Cigna LocalPlus Benefit Plan $2,604.18
Rate for Payer: Fidelis Medicare Advantage $4,755.45
Rate for Payer: Group Health Inc Commercial $2,264.50
Rate for Payer: Group Health Inc Medicare $1,585.15
Rate for Payer: Hamaspik Choice Inc Medicaid $2,264.50
Rate for Payer: Hamaspik Choice Inc Medicare $2,264.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,943.85
Service Code HCPCS C1776
Hospital Charge Code 40205317
Hospital Revenue Code 278
Min. Negotiated Rate $135.10
Max. Negotiated Rate $405.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $212.30
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 $193.00
Rate for Payer: Cigna LocalPlus Benefit Plan $221.95
Rate for Payer: Fidelis Medicare Advantage $405.30
Rate for Payer: Group Health Inc Commercial $193.00
Rate for Payer: Group Health Inc Medicare $135.10
Rate for Payer: Hamaspik Choice Inc Medicaid $193.00
Rate for Payer: Hamaspik Choice Inc Medicare $193.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $250.90
Service Code HCPCS C1776
Hospital Charge Code 40205317
Hospital Revenue Code 278
Min. Negotiated Rate $193.00
Max. Negotiated Rate $193.00
Rate for Payer: Hamaspik Choice Inc Medicaid $193.00
Rate for Payer: Hamaspik Choice Inc Medicare $193.00
Service Code HCPCS C1776
Hospital Charge Code 40205324
Hospital Revenue Code 278
Min. Negotiated Rate $3,940.00
Max. Negotiated Rate $3,940.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,940.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,940.00
Service Code HCPCS C1776
Hospital Charge Code 40205324
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $8,274.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,334.00
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 $3,940.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,531.00
Rate for Payer: Fidelis Medicare Advantage $8,274.00
Rate for Payer: Group Health Inc Commercial $3,940.00
Rate for Payer: Group Health Inc Medicare $2,758.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,940.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,940.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,122.00
Service Code HCPCS C1776
Hospital Charge Code 40205914
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $13,906.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7,284.20
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 $6,622.00
Rate for Payer: Cigna LocalPlus Benefit Plan $7,615.30
Rate for Payer: Fidelis Medicare Advantage $13,906.20
Rate for Payer: Group Health Inc Commercial $6,622.00
Rate for Payer: Group Health Inc Medicare $4,635.40
Rate for Payer: Hamaspik Choice Inc Medicaid $6,622.00
Rate for Payer: Hamaspik Choice Inc Medicare $6,622.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8,608.60
Service Code HCPCS C1776
Hospital Charge Code 40205914
Hospital Revenue Code 278
Min. Negotiated Rate $6,622.00
Max. Negotiated Rate $6,622.00
Rate for Payer: Hamaspik Choice Inc Medicaid $6,622.00
Rate for Payer: Hamaspik Choice Inc Medicare $6,622.00
Service Code HCPCS C1769
Hospital Charge Code 40005361
Hospital Revenue Code 272
Min. Negotiated Rate $4.08
Max. Negotiated Rate $239.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $164.45
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 $239.20
Rate for Payer: Cigna LocalPlus Benefit Plan $203.32
Rate for Payer: Group Health Inc Commercial $149.50
Rate for Payer: Group Health Inc Medicare $104.65
Rate for Payer: Hamaspik Choice Inc Medicaid $149.50
Rate for Payer: Hamaspik Choice Inc Medicare $149.50
Service Code HCPCS C1713
Hospital Charge Code 40029606
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $846.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $443.30
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 $403.00
Rate for Payer: Cigna LocalPlus Benefit Plan $463.45
Rate for Payer: Fidelis Medicare Advantage $846.30
Rate for Payer: Group Health Inc Commercial $403.00
Rate for Payer: Group Health Inc Medicare $282.10
Rate for Payer: Hamaspik Choice Inc Medicaid $403.00
Rate for Payer: Hamaspik Choice Inc Medicare $403.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $523.90
Service Code HCPCS C1713
Hospital Charge Code 40029606
Hospital Revenue Code 278
Min. Negotiated Rate $403.00
Max. Negotiated Rate $403.00
Rate for Payer: Hamaspik Choice Inc Medicaid $403.00
Rate for Payer: Hamaspik Choice Inc Medicare $403.00
Hospital Charge Code 40205336
Hospital Revenue Code 270
Min. Negotiated Rate $718.76
Max. Negotiated Rate $1,642.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,129.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,026.80
Rate for Payer: Aetna Government $1,026.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,642.88
Rate for Payer: Cigna LocalPlus Benefit Plan $1,396.45
Rate for Payer: Group Health Inc Commercial $1,026.80
Rate for Payer: Group Health Inc Medicare $718.76
Rate for Payer: Hamaspik Choice Inc Medicaid $1,026.80
Rate for Payer: Hamaspik Choice Inc Medicare $1,026.80
Service Code HCPCS C1713
Hospital Charge Code 40204496
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,032.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,588.40
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 $1,444.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,660.60
Rate for Payer: Fidelis Medicare Advantage $3,032.40
Rate for Payer: Group Health Inc Commercial $1,444.00
Rate for Payer: Group Health Inc Medicare $1,010.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,877.20
Service Code HCPCS C1713
Hospital Charge Code 40204496
Hospital Revenue Code 278
Min. Negotiated Rate $1,444.00
Max. Negotiated Rate $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Service Code HCPCS C1713
Hospital Charge Code 40204719
Hospital Revenue Code 278
Min. Negotiated Rate $1,444.00
Max. Negotiated Rate $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Service Code HCPCS C1713
Hospital Charge Code 40204719
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,032.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,588.40
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 $1,444.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,660.60
Rate for Payer: Fidelis Medicare Advantage $3,032.40
Rate for Payer: Group Health Inc Commercial $1,444.00
Rate for Payer: Group Health Inc Medicare $1,010.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,877.20
Service Code HCPCS C1713
Hospital Charge Code 40203392
Hospital Revenue Code 278
Min. Negotiated Rate $1,444.00
Max. Negotiated Rate $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Service Code HCPCS C1713
Hospital Charge Code 40203392
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,032.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,588.40
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 $1,444.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,660.60
Rate for Payer: Fidelis Medicare Advantage $3,032.40
Rate for Payer: Group Health Inc Commercial $1,444.00
Rate for Payer: Group Health Inc Medicare $1,010.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,877.20
Hospital Charge Code 40205402
Hospital Revenue Code 270
Min. Negotiated Rate $1.96
Max. Negotiated Rate $4.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.80
Rate for Payer: Aetna Government $2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.48
Rate for Payer: Cigna LocalPlus Benefit Plan $3.81
Rate for Payer: Group Health Inc Commercial $2.80
Rate for Payer: Group Health Inc Medicare $1.96
Rate for Payer: Hamaspik Choice Inc Medicaid $2.80
Rate for Payer: Hamaspik Choice Inc Medicare $2.80
Hospital Charge Code 40029592
Hospital Revenue Code 272
Min. Negotiated Rate $42.00
Max. Negotiated Rate $96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $60.00
Rate for Payer: Aetna Government $60.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $96.00
Rate for Payer: Cigna LocalPlus Benefit Plan $81.60
Rate for Payer: Group Health Inc Commercial $60.00
Rate for Payer: Group Health Inc Medicare $42.00
Rate for Payer: Hamaspik Choice Inc Medicaid $60.00
Rate for Payer: Hamaspik Choice Inc Medicare $60.00
Hospital Charge Code 40205582
Hospital Revenue Code 270
Min. Negotiated Rate $20.09
Max. Negotiated Rate $45.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial $31.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $28.70
Rate for Payer: Aetna Government $28.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $45.92
Rate for Payer: Cigna LocalPlus Benefit Plan $39.03
Rate for Payer: Group Health Inc Commercial $28.70
Rate for Payer: Group Health Inc Medicare $20.09
Rate for Payer: Hamaspik Choice Inc Medicaid $28.70
Rate for Payer: Hamaspik Choice Inc Medicare $28.70
Hospital Charge Code 40205590
Hospital Revenue Code 270
Min. Negotiated Rate $27.44
Max. Negotiated Rate $62.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial $43.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $39.20
Rate for Payer: Aetna Government $39.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $62.72
Rate for Payer: Cigna LocalPlus Benefit Plan $53.31
Rate for Payer: Group Health Inc Commercial $39.20
Rate for Payer: Group Health Inc Medicare $27.44
Rate for Payer: Hamaspik Choice Inc Medicaid $39.20
Rate for Payer: Hamaspik Choice Inc Medicare $39.20
Service Code HCPCS C1769
Hospital Charge Code 40202400
Hospital Revenue Code 278
Min. Negotiated Rate $80.50
Max. Negotiated Rate $80.50
Rate for Payer: Hamaspik Choice Inc Medicaid $80.50
Rate for Payer: Hamaspik Choice Inc Medicare $80.50
Service Code HCPCS C1769
Hospital Charge Code 40202400
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $169.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $88.55
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 $80.50
Rate for Payer: Cigna LocalPlus Benefit Plan $92.58
Rate for Payer: Fidelis Medicare Advantage $169.05
Rate for Payer: Group Health Inc Commercial $80.50
Rate for Payer: Group Health Inc Medicare $56.35
Rate for Payer: Hamaspik Choice Inc Medicaid $80.50
Rate for Payer: Hamaspik Choice Inc Medicare $80.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $104.65
Service Code HCPCS C1769
Hospital Charge Code 40205277
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $14.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.70
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 $7.00
Rate for Payer: Cigna LocalPlus Benefit Plan $8.05
Rate for Payer: Fidelis Medicare Advantage $14.70
Rate for Payer: Group Health Inc Commercial $7.00
Rate for Payer: Group Health Inc Medicare $4.90
Rate for Payer: Hamaspik Choice Inc Medicaid $7.00
Rate for Payer: Hamaspik Choice Inc Medicare $7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $9.10