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Service Code HCPCS C1776
Hospital Charge Code 40004601
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,029.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $539.00
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 $490.00
Rate for Payer: Cigna LocalPlus Benefit Plan $563.50
Rate for Payer: Fidelis Medicare Advantage $1,029.00
Rate for Payer: Group Health Inc Commercial $490.00
Rate for Payer: Group Health Inc Medicare $343.00
Rate for Payer: Hamaspik Choice Inc Medicaid $490.00
Rate for Payer: Hamaspik Choice Inc Medicare $490.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $637.00
Service Code HCPCS C1776
Hospital Charge Code 40004601
Hospital Revenue Code 278
Min. Negotiated Rate $490.00
Max. Negotiated Rate $490.00
Rate for Payer: Hamaspik Choice Inc Medicaid $490.00
Rate for Payer: Hamaspik Choice Inc Medicare $490.00
Service Code HCPCS C1776
Hospital Charge Code 40004602
Hospital Revenue Code 278
Min. Negotiated Rate $819.00
Max. Negotiated Rate $819.00
Rate for Payer: Hamaspik Choice Inc Medicaid $819.00
Rate for Payer: Hamaspik Choice Inc Medicare $819.00
Service Code HCPCS C1776
Hospital Charge Code 40004602
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,719.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $900.90
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 $819.00
Rate for Payer: Cigna LocalPlus Benefit Plan $941.85
Rate for Payer: Fidelis Medicare Advantage $1,719.90
Rate for Payer: Group Health Inc Commercial $819.00
Rate for Payer: Group Health Inc Medicare $573.30
Rate for Payer: Hamaspik Choice Inc Medicaid $819.00
Rate for Payer: Hamaspik Choice Inc Medicare $819.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,064.70
Service Code HCPCS C1713
Hospital Charge Code 40003452
Hospital Revenue Code 278
Min. Negotiated Rate $138.00
Max. Negotiated Rate $138.00
Rate for Payer: Hamaspik Choice Inc Medicaid $138.00
Rate for Payer: Hamaspik Choice Inc Medicare $138.00
Service Code HCPCS C1713
Hospital Charge Code 40003452
Hospital Revenue Code 278
Min. Negotiated Rate $96.60
Max. Negotiated Rate $289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $151.80
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 $138.00
Rate for Payer: Cigna LocalPlus Benefit Plan $158.70
Rate for Payer: Fidelis Medicare Advantage $289.80
Rate for Payer: Group Health Inc Commercial $138.00
Rate for Payer: Group Health Inc Medicare $96.60
Rate for Payer: Hamaspik Choice Inc Medicaid $138.00
Rate for Payer: Hamaspik Choice Inc Medicare $138.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $179.40
Service Code HCPCS C1713
Hospital Charge Code 40003450
Hospital Revenue Code 278
Min. Negotiated Rate $138.00
Max. Negotiated Rate $138.00
Rate for Payer: Hamaspik Choice Inc Medicaid $138.00
Rate for Payer: Hamaspik Choice Inc Medicare $138.00
Service Code HCPCS C1713
Hospital Charge Code 40003450
Hospital Revenue Code 278
Min. Negotiated Rate $96.60
Max. Negotiated Rate $289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $151.80
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 $138.00
Rate for Payer: Cigna LocalPlus Benefit Plan $158.70
Rate for Payer: Fidelis Medicare Advantage $289.80
Rate for Payer: Group Health Inc Commercial $138.00
Rate for Payer: Group Health Inc Medicare $96.60
Rate for Payer: Hamaspik Choice Inc Medicaid $138.00
Rate for Payer: Hamaspik Choice Inc Medicare $138.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $179.40
Service Code HCPCS C1713
Hospital Charge Code 40204223
Hospital Revenue Code 278
Min. Negotiated Rate $138.00
Max. Negotiated Rate $138.00
Rate for Payer: Hamaspik Choice Inc Medicaid $138.00
Rate for Payer: Hamaspik Choice Inc Medicare $138.00
Service Code HCPCS C1713
Hospital Charge Code 40204223
Hospital Revenue Code 278
Min. Negotiated Rate $96.60
Max. Negotiated Rate $289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $151.80
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 $138.00
Rate for Payer: Cigna LocalPlus Benefit Plan $158.70
Rate for Payer: Fidelis Medicare Advantage $289.80
Rate for Payer: Group Health Inc Commercial $138.00
Rate for Payer: Group Health Inc Medicare $96.60
Rate for Payer: Hamaspik Choice Inc Medicaid $138.00
Rate for Payer: Hamaspik Choice Inc Medicare $138.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $179.40
Service Code HCPCS C1713
Hospital Charge Code 40008324
Hospital Revenue Code 278
Min. Negotiated Rate $224.00
Max. Negotiated Rate $224.00
Rate for Payer: Hamaspik Choice Inc Medicaid $224.00
Rate for Payer: Hamaspik Choice Inc Medicare $224.00
Service Code HCPCS C1713
Hospital Charge Code 40008324
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $470.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $246.40
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 $224.00
Rate for Payer: Cigna LocalPlus Benefit Plan $257.60
Rate for Payer: Fidelis Medicare Advantage $470.40
Rate for Payer: Group Health Inc Commercial $224.00
Rate for Payer: Group Health Inc Medicare $156.80
Rate for Payer: Hamaspik Choice Inc Medicaid $224.00
Rate for Payer: Hamaspik Choice Inc Medicare $224.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $291.20
Service Code HCPCS C1776
Hospital Charge Code 40008298
Hospital Revenue Code 278
Min. Negotiated Rate $576.00
Max. Negotiated Rate $576.00
Rate for Payer: Hamaspik Choice Inc Medicaid $576.00
Rate for Payer: Hamaspik Choice Inc Medicare $576.00
Service Code HCPCS C1776
Hospital Charge Code 40008298
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,209.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $633.60
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 $576.00
Rate for Payer: Cigna LocalPlus Benefit Plan $662.40
Rate for Payer: Fidelis Medicare Advantage $1,209.60
Rate for Payer: Group Health Inc Commercial $576.00
Rate for Payer: Group Health Inc Medicare $403.20
Rate for Payer: Hamaspik Choice Inc Medicaid $576.00
Rate for Payer: Hamaspik Choice Inc Medicare $576.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $748.80
Service Code HCPCS C1776
Hospital Charge Code 40008300
Hospital Revenue Code 278
Min. Negotiated Rate $576.00
Max. Negotiated Rate $576.00
Rate for Payer: Hamaspik Choice Inc Medicaid $576.00
Rate for Payer: Hamaspik Choice Inc Medicare $576.00
Service Code HCPCS C1776
Hospital Charge Code 40008300
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,209.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $633.60
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 $576.00
Rate for Payer: Cigna LocalPlus Benefit Plan $662.40
Rate for Payer: Fidelis Medicare Advantage $1,209.60
Rate for Payer: Group Health Inc Commercial $576.00
Rate for Payer: Group Health Inc Medicare $403.20
Rate for Payer: Hamaspik Choice Inc Medicaid $576.00
Rate for Payer: Hamaspik Choice Inc Medicare $576.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $748.80
Service Code HCPCS C1776
Hospital Charge Code 40008342
Hospital Revenue Code 278
Min. Negotiated Rate $555.00
Max. Negotiated Rate $555.00
Rate for Payer: Hamaspik Choice Inc Medicaid $555.00
Rate for Payer: Hamaspik Choice Inc Medicare $555.00
Service Code HCPCS C1776
Hospital Charge Code 40008342
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,165.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $610.50
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 $555.00
Rate for Payer: Cigna LocalPlus Benefit Plan $638.25
Rate for Payer: Fidelis Medicare Advantage $1,165.50
Rate for Payer: Group Health Inc Commercial $555.00
Rate for Payer: Group Health Inc Medicare $388.50
Rate for Payer: Hamaspik Choice Inc Medicaid $555.00
Rate for Payer: Hamaspik Choice Inc Medicare $555.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $721.50
Service Code HCPCS C1776
Hospital Charge Code 40005200
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $8,156.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,272.40
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 $3,884.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,466.60
Rate for Payer: Fidelis Medicare Advantage $8,156.40
Rate for Payer: Group Health Inc Commercial $3,884.00
Rate for Payer: Group Health Inc Medicare $2,718.80
Rate for Payer: Hamaspik Choice Inc Medicaid $3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,884.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,049.20
Service Code HCPCS C1776
Hospital Charge Code 40005200
Hospital Revenue Code 278
Min. Negotiated Rate $3,884.00
Max. Negotiated Rate $3,884.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,884.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,884.00
Service Code HCPCS C1776
Hospital Charge Code 40008336
Hospital Revenue Code 278
Min. Negotiated Rate $11,017.50
Max. Negotiated Rate $11,017.50
Rate for Payer: Hamaspik Choice Inc Medicaid $11,017.50
Rate for Payer: Hamaspik Choice Inc Medicare $11,017.50
Service Code HCPCS C1776
Hospital Charge Code 40008336
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $23,136.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12,119.25
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 $11,017.50
Rate for Payer: Cigna LocalPlus Benefit Plan $12,670.12
Rate for Payer: Fidelis Medicare Advantage $23,136.75
Rate for Payer: Group Health Inc Commercial $11,017.50
Rate for Payer: Group Health Inc Medicare $7,712.25
Rate for Payer: Hamaspik Choice Inc Medicaid $11,017.50
Rate for Payer: Hamaspik Choice Inc Medicare $11,017.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $14,322.75
Service Code HCPCS C1776
Hospital Charge Code 40204553
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,510.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,410.00
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 $3,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,565.00
Rate for Payer: Fidelis Medicare Advantage $6,510.00
Rate for Payer: Group Health Inc Commercial $3,100.00
Rate for Payer: Group Health Inc Medicare $2,170.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,030.00
Service Code HCPCS C1776
Hospital Charge Code 40204553
Hospital Revenue Code 278
Min. Negotiated Rate $3,100.00
Max. Negotiated Rate $3,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,100.00
Service Code HCPCS C1776
Hospital Charge Code 40003453
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,003.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,049.40
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 $954.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,097.10
Rate for Payer: Fidelis Medicare Advantage $2,003.40
Rate for Payer: Group Health Inc Commercial $954.00
Rate for Payer: Group Health Inc Medicare $667.80
Rate for Payer: Hamaspik Choice Inc Medicaid $954.00
Rate for Payer: Hamaspik Choice Inc Medicare $954.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,240.20