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Charge Type Price  
Service Code HCPCS C1776
Hospital Charge Code 40009749
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $13,693.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7,172.55
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 $6,520.50
Rate for Payer: Cigna LocalPlus Benefit Plan $7,498.58
Rate for Payer: Fidelis Medicare Advantage $13,693.05
Rate for Payer: Group Health Inc Commercial $6,520.50
Rate for Payer: Group Health Inc Medicare $4,564.35
Rate for Payer: Hamaspik Choice Inc Medicaid $6,520.50
Rate for Payer: Hamaspik Choice Inc Medicare $6,520.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8,476.65
Service Code HCPCS C1776
Hospital Charge Code 40009749
Hospital Revenue Code 278
Min. Negotiated Rate $6,520.50
Max. Negotiated Rate $6,520.50
Rate for Payer: Hamaspik Choice Inc Medicaid $6,520.50
Rate for Payer: Hamaspik Choice Inc Medicare $6,520.50
Service Code HCPCS C1713
Hospital Charge Code 40203402
Hospital Revenue Code 278
Min. Negotiated Rate $146.23
Max. Negotiated Rate $146.23
Rate for Payer: Hamaspik Choice Inc Medicaid $146.23
Rate for Payer: Hamaspik Choice Inc Medicare $146.23
Service Code HCPCS C1713
Hospital Charge Code 40203402
Hospital Revenue Code 278
Min. Negotiated Rate $102.36
Max. Negotiated Rate $307.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial $160.85
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 $146.23
Rate for Payer: Cigna LocalPlus Benefit Plan $168.16
Rate for Payer: Fidelis Medicare Advantage $307.08
Rate for Payer: Group Health Inc Commercial $146.23
Rate for Payer: Group Health Inc Medicare $102.36
Rate for Payer: Hamaspik Choice Inc Medicaid $146.23
Rate for Payer: Hamaspik Choice Inc Medicare $146.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $190.10
Service Code HCPCS C1713
Hospital Charge Code 40009733
Hospital Revenue Code 278
Min. Negotiated Rate $1,873.30
Max. Negotiated Rate $1,873.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,873.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,873.30
Service Code HCPCS C1713
Hospital Charge Code 40009733
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,933.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,060.63
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 $1,873.30
Rate for Payer: Cigna LocalPlus Benefit Plan $2,154.30
Rate for Payer: Fidelis Medicare Advantage $3,933.93
Rate for Payer: Group Health Inc Commercial $1,873.30
Rate for Payer: Group Health Inc Medicare $1,311.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1,873.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,873.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,435.29
Service Code HCPCS C1713
Hospital Charge Code 40003442
Hospital Revenue Code 278
Min. Negotiated Rate $360.08
Max. Negotiated Rate $360.08
Rate for Payer: Hamaspik Choice Inc Medicaid $360.08
Rate for Payer: Hamaspik Choice Inc Medicare $360.08
Service Code HCPCS C1713
Hospital Charge Code 40003442
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $756.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $396.09
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 $360.08
Rate for Payer: Cigna LocalPlus Benefit Plan $414.09
Rate for Payer: Fidelis Medicare Advantage $756.17
Rate for Payer: Group Health Inc Commercial $360.08
Rate for Payer: Group Health Inc Medicare $252.06
Rate for Payer: Hamaspik Choice Inc Medicaid $360.08
Rate for Payer: Hamaspik Choice Inc Medicare $360.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $468.10
Hospital Charge Code 40008258
Hospital Revenue Code 270
Min. Negotiated Rate $19.11
Max. Negotiated Rate $43.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $30.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $27.30
Rate for Payer: Aetna Government $27.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $43.68
Rate for Payer: Cigna LocalPlus Benefit Plan $37.13
Rate for Payer: Group Health Inc Commercial $27.30
Rate for Payer: Group Health Inc Medicare $19.11
Rate for Payer: Hamaspik Choice Inc Medicaid $27.30
Rate for Payer: Hamaspik Choice Inc Medicare $27.30
Service Code HCPCS C1713
Hospital Charge Code 40004616
Hospital Revenue Code 278
Min. Negotiated Rate $20.30
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $31.90
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 $29.00
Rate for Payer: Cigna LocalPlus Benefit Plan $33.35
Rate for Payer: Fidelis Medicare Advantage $60.90
Rate for Payer: Group Health Inc Commercial $29.00
Rate for Payer: Group Health Inc Medicare $20.30
Rate for Payer: Hamaspik Choice Inc Medicaid $29.00
Rate for Payer: Hamaspik Choice Inc Medicare $29.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $37.70
Service Code HCPCS C1713
Hospital Charge Code 40004616
Hospital Revenue Code 278
Min. Negotiated Rate $29.00
Max. Negotiated Rate $29.00
Rate for Payer: Hamaspik Choice Inc Medicaid $29.00
Rate for Payer: Hamaspik Choice Inc Medicare $29.00
Service Code HCPCS C1713
Hospital Charge Code 40203423
Hospital Revenue Code 278
Min. Negotiated Rate $109.41
Max. Negotiated Rate $109.41
Rate for Payer: Hamaspik Choice Inc Medicaid $109.41
Rate for Payer: Hamaspik Choice Inc Medicare $109.41
Service Code HCPCS C1713
Hospital Charge Code 40203423
Hospital Revenue Code 278
Min. Negotiated Rate $76.59
Max. Negotiated Rate $229.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial $120.35
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 $109.41
Rate for Payer: Cigna LocalPlus Benefit Plan $125.82
Rate for Payer: Fidelis Medicare Advantage $229.76
Rate for Payer: Group Health Inc Commercial $109.41
Rate for Payer: Group Health Inc Medicare $76.59
Rate for Payer: Hamaspik Choice Inc Medicaid $109.41
Rate for Payer: Hamaspik Choice Inc Medicare $109.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $142.23
Service Code HCPCS C1713
Hospital Charge Code 40204201
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $526.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial $276.00
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 $250.91
Rate for Payer: Cigna LocalPlus Benefit Plan $288.55
Rate for Payer: Fidelis Medicare Advantage $526.91
Rate for Payer: Group Health Inc Commercial $250.91
Rate for Payer: Group Health Inc Medicare $175.64
Rate for Payer: Hamaspik Choice Inc Medicaid $250.91
Rate for Payer: Hamaspik Choice Inc Medicare $250.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $326.18
Service Code HCPCS C1713
Hospital Charge Code 40204201
Hospital Revenue Code 278
Min. Negotiated Rate $250.91
Max. Negotiated Rate $250.91
Rate for Payer: Hamaspik Choice Inc Medicaid $250.91
Rate for Payer: Hamaspik Choice Inc Medicare $250.91
Service Code HCPCS C1713
Hospital Charge Code 40204206
Hospital Revenue Code 278
Min. Negotiated Rate $250.91
Max. Negotiated Rate $250.91
Rate for Payer: Hamaspik Choice Inc Medicaid $250.91
Rate for Payer: Hamaspik Choice Inc Medicare $250.91
Service Code HCPCS C1713
Hospital Charge Code 40204206
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $526.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial $276.00
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 $250.91
Rate for Payer: Cigna LocalPlus Benefit Plan $288.55
Rate for Payer: Fidelis Medicare Advantage $526.91
Rate for Payer: Group Health Inc Commercial $250.91
Rate for Payer: Group Health Inc Medicare $175.64
Rate for Payer: Hamaspik Choice Inc Medicaid $250.91
Rate for Payer: Hamaspik Choice Inc Medicare $250.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $326.18
Service Code HCPCS C1713
Hospital Charge Code 40001788
Hospital Revenue Code 278
Min. Negotiated Rate $224.33
Max. Negotiated Rate $224.33
Rate for Payer: Hamaspik Choice Inc Medicaid $224.33
Rate for Payer: Hamaspik Choice Inc Medicare $224.33
Service Code HCPCS C1713
Hospital Charge Code 40001788
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $471.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial $246.76
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 $224.33
Rate for Payer: Cigna LocalPlus Benefit Plan $257.98
Rate for Payer: Fidelis Medicare Advantage $471.09
Rate for Payer: Group Health Inc Commercial $224.33
Rate for Payer: Group Health Inc Medicare $157.03
Rate for Payer: Hamaspik Choice Inc Medicaid $224.33
Rate for Payer: Hamaspik Choice Inc Medicare $224.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $291.63
Service Code HCPCS C1713
Hospital Charge Code 40001789
Hospital Revenue Code 278
Min. Negotiated Rate $133.72
Max. Negotiated Rate $133.72
Rate for Payer: Hamaspik Choice Inc Medicaid $133.72
Rate for Payer: Hamaspik Choice Inc Medicare $133.72
Service Code HCPCS C1713
Hospital Charge Code 40001789
Hospital Revenue Code 278
Min. Negotiated Rate $93.60
Max. Negotiated Rate $280.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $147.09
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 $133.72
Rate for Payer: Cigna LocalPlus Benefit Plan $153.78
Rate for Payer: Fidelis Medicare Advantage $280.81
Rate for Payer: Group Health Inc Commercial $133.72
Rate for Payer: Group Health Inc Medicare $93.60
Rate for Payer: Hamaspik Choice Inc Medicaid $133.72
Rate for Payer: Hamaspik Choice Inc Medicare $133.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $173.84
Hospital Charge Code 40204213
Hospital Revenue Code 272
Min. Negotiated Rate $324.05
Max. Negotiated Rate $740.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial $509.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $462.93
Rate for Payer: Aetna Government $462.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $740.69
Rate for Payer: Cigna LocalPlus Benefit Plan $629.58
Rate for Payer: Group Health Inc Commercial $462.93
Rate for Payer: Group Health Inc Medicare $324.05
Rate for Payer: Hamaspik Choice Inc Medicaid $462.93
Rate for Payer: Hamaspik Choice Inc Medicare $462.93
Service Code HCPCS C1713
Hospital Charge Code 40204262
Hospital Revenue Code 278
Min. Negotiated Rate $98.00
Max. Negotiated Rate $98.00
Rate for Payer: Hamaspik Choice Inc Medicaid $98.00
Rate for Payer: Hamaspik Choice Inc Medicare $98.00
Service Code HCPCS C1713
Hospital Charge Code 40204262
Hospital Revenue Code 278
Min. Negotiated Rate $68.60
Max. Negotiated Rate $205.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $107.80
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 $98.00
Rate for Payer: Cigna LocalPlus Benefit Plan $112.70
Rate for Payer: Fidelis Medicare Advantage $205.80
Rate for Payer: Group Health Inc Commercial $98.00
Rate for Payer: Group Health Inc Medicare $68.60
Rate for Payer: Hamaspik Choice Inc Medicaid $98.00
Rate for Payer: Hamaspik Choice Inc Medicare $98.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $127.40
Service Code HCPCS C1713
Hospital Charge Code 40003444
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $7,846.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,109.96
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 $3,736.33
Rate for Payer: Cigna LocalPlus Benefit Plan $4,296.78
Rate for Payer: Fidelis Medicare Advantage $7,846.29
Rate for Payer: Group Health Inc Commercial $3,736.33
Rate for Payer: Group Health Inc Medicare $2,615.43
Rate for Payer: Hamaspik Choice Inc Medicaid $3,736.33
Rate for Payer: Hamaspik Choice Inc Medicare $3,736.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,857.23