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Charge Type Price  
Service Code HCPCS C1776
Hospital Charge Code 40003453
Hospital Revenue Code 278
Min. Negotiated Rate $954.00
Max. Negotiated Rate $954.00
Rate for Payer: Hamaspik Choice Inc Medicaid $954.00
Rate for Payer: Hamaspik Choice Inc Medicare $954.00
Service Code HCPCS C1776
Hospital Charge Code 40008299
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
Service Code HCPCS C1776
Hospital Charge Code 40008299
Hospital Revenue Code 278
Min. Negotiated Rate $954.00
Max. Negotiated Rate $954.00
Rate for Payer: Hamaspik Choice Inc Medicaid $954.00
Rate for Payer: Hamaspik Choice Inc Medicare $954.00
Service Code HCPCS C1776
Hospital Charge Code 40204222
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,671.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,399.20
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 $1,272.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,462.80
Rate for Payer: Fidelis Medicare Advantage $2,671.20
Rate for Payer: Group Health Inc Commercial $1,272.00
Rate for Payer: Group Health Inc Medicare $890.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,272.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,272.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,653.60
Service Code HCPCS C1776
Hospital Charge Code 40204222
Hospital Revenue Code 278
Min. Negotiated Rate $1,272.00
Max. Negotiated Rate $1,272.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,272.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,272.00
Service Code HCPCS C1776
Hospital Charge Code 40008297
Hospital Revenue Code 278
Min. Negotiated Rate $1,700.00
Max. Negotiated Rate $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Service Code HCPCS C1776
Hospital Charge Code 40008297
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
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 $1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,955.00
Rate for Payer: Fidelis Medicare Advantage $3,570.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,210.00
Service Code HCPCS C1776
Hospital Charge Code 40009283
Hospital Revenue Code 278
Min. Negotiated Rate $1,700.00
Max. Negotiated Rate $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Service Code HCPCS C1776
Hospital Charge Code 40009283
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
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 $1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,955.00
Rate for Payer: Fidelis Medicare Advantage $3,570.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,210.00
Service Code HCPCS C1776
Hospital Charge Code 40009282
Hospital Revenue Code 278
Min. Negotiated Rate $4,100.00
Max. Negotiated Rate $4,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,100.00
Service Code HCPCS C1776
Hospital Charge Code 40009282
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $8,610.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,510.00
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 $4,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,715.00
Rate for Payer: Fidelis Medicare Advantage $8,610.00
Rate for Payer: Group Health Inc Commercial $4,100.00
Rate for Payer: Group Health Inc Medicare $2,870.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,330.00
Service Code HCPCS C1776
Hospital Charge Code 40001784
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $8,610.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,510.00
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 $4,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,715.00
Rate for Payer: Fidelis Medicare Advantage $8,610.00
Rate for Payer: Group Health Inc Commercial $4,100.00
Rate for Payer: Group Health Inc Medicare $2,870.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,330.00
Service Code HCPCS C1776
Hospital Charge Code 40001784
Hospital Revenue Code 278
Min. Negotiated Rate $4,100.00
Max. Negotiated Rate $4,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,100.00
Service Code HCPCS C1776
Hospital Charge Code 40204552
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 40204552
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 40203381
Hospital Revenue Code 278
Min. Negotiated Rate $2,000.00
Max. Negotiated Rate $2,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,000.00
Service Code HCPCS C1776
Hospital Charge Code 40203381
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,200.00
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 $2,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,300.00
Rate for Payer: Fidelis Medicare Advantage $4,200.00
Rate for Payer: Group Health Inc Commercial $2,000.00
Rate for Payer: Group Health Inc Medicare $1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,600.00
Service Code HCPCS C1776
Hospital Charge Code 40001783
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,200.00
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 $2,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,300.00
Rate for Payer: Fidelis Medicare Advantage $4,200.00
Rate for Payer: Group Health Inc Commercial $2,000.00
Rate for Payer: Group Health Inc Medicare $1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,600.00
Service Code HCPCS C1776
Hospital Charge Code 40001783
Hospital Revenue Code 278
Min. Negotiated Rate $2,000.00
Max. Negotiated Rate $2,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,000.00
Service Code HCPCS C1713
Hospital Charge Code 40008341
Hospital Revenue Code 278
Min. Negotiated Rate $339.00
Max. Negotiated Rate $339.00
Rate for Payer: Hamaspik Choice Inc Medicaid $339.00
Rate for Payer: Hamaspik Choice Inc Medicare $339.00
Service Code HCPCS C1713
Hospital Charge Code 40008341
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $711.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $372.90
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 $339.00
Rate for Payer: Cigna LocalPlus Benefit Plan $389.85
Rate for Payer: Fidelis Medicare Advantage $711.90
Rate for Payer: Group Health Inc Commercial $339.00
Rate for Payer: Group Health Inc Medicare $237.30
Rate for Payer: Hamaspik Choice Inc Medicaid $339.00
Rate for Payer: Hamaspik Choice Inc Medicare $339.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $440.70
Service Code HCPCS C1776
Hospital Charge Code 40009281
Hospital Revenue Code 278
Min. Negotiated Rate $1,700.00
Max. Negotiated Rate $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Service Code HCPCS C1776
Hospital Charge Code 40009281
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
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 $1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,955.00
Rate for Payer: Fidelis Medicare Advantage $3,570.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,210.00
Service Code HCPCS C1776
Hospital Charge Code 40001794
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
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 $1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,955.00
Rate for Payer: Fidelis Medicare Advantage $3,570.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,210.00
Service Code HCPCS C1776
Hospital Charge Code 40001794
Hospital Revenue Code 278
Min. Negotiated Rate $1,700.00
Max. Negotiated Rate $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00