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Charge Type Price  
Service Code HCPCS C1776
Hospital Charge Code 40204255
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,134.80
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 $4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,368.20
Rate for Payer: Fidelis Medicare Advantage $9,802.80
Rate for Payer: Group Health Inc Commercial $4,668.00
Rate for Payer: Group Health Inc Medicare $3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,068.40
Service Code HCPCS C1776
Hospital Charge Code 40204255
Hospital Revenue Code 278
Min. Negotiated Rate $4,668.00
Max. Negotiated Rate $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Service Code HCPCS C1776
Hospital Charge Code 40009279
Hospital Revenue Code 278
Min. Negotiated Rate $4,668.00
Max. Negotiated Rate $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Service Code HCPCS C1776
Hospital Charge Code 40009279
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,134.80
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 $4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,368.20
Rate for Payer: Fidelis Medicare Advantage $9,802.80
Rate for Payer: Group Health Inc Commercial $4,668.00
Rate for Payer: Group Health Inc Medicare $3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,068.40
Service Code HCPCS C1776
Hospital Charge Code 40204433
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,134.80
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 $4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,368.20
Rate for Payer: Fidelis Medicare Advantage $9,802.80
Rate for Payer: Group Health Inc Commercial $4,668.00
Rate for Payer: Group Health Inc Medicare $3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,068.40
Service Code HCPCS C1776
Hospital Charge Code 40204433
Hospital Revenue Code 278
Min. Negotiated Rate $4,668.00
Max. Negotiated Rate $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Service Code HCPCS C1776
Hospital Charge Code 40204432
Hospital Revenue Code 278
Min. Negotiated Rate $4,668.00
Max. Negotiated Rate $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Service Code HCPCS C1776
Hospital Charge Code 40204432
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,134.80
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 $4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,368.20
Rate for Payer: Fidelis Medicare Advantage $9,802.80
Rate for Payer: Group Health Inc Commercial $4,668.00
Rate for Payer: Group Health Inc Medicare $3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,068.40
Service Code HCPCS C1776
Hospital Charge Code 40204431
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,134.80
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 $4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,368.20
Rate for Payer: Fidelis Medicare Advantage $9,802.80
Rate for Payer: Group Health Inc Commercial $4,668.00
Rate for Payer: Group Health Inc Medicare $3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,068.40
Service Code HCPCS C1776
Hospital Charge Code 40204431
Hospital Revenue Code 278
Min. Negotiated Rate $4,668.00
Max. Negotiated Rate $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,668.00
Service Code HCPCS C1713
Hospital Charge Code 40001793
Hospital Revenue Code 278
Min. Negotiated Rate $2,199.00
Max. Negotiated Rate $2,199.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,199.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,199.00
Service Code HCPCS C1713
Hospital Charge Code 40001793
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,617.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,418.90
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 $2,199.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,528.85
Rate for Payer: Fidelis Medicare Advantage $4,617.90
Rate for Payer: Group Health Inc Commercial $2,199.00
Rate for Payer: Group Health Inc Medicare $1,539.30
Rate for Payer: Hamaspik Choice Inc Medicaid $2,199.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,199.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,858.70
Service Code HCPCS C1776
Hospital Charge Code 40008338
Hospital Revenue Code 278
Min. Negotiated Rate $309.75
Max. Negotiated Rate $929.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $486.75
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 $442.50
Rate for Payer: Cigna LocalPlus Benefit Plan $508.88
Rate for Payer: Fidelis Medicare Advantage $929.25
Rate for Payer: Group Health Inc Commercial $442.50
Rate for Payer: Group Health Inc Medicare $309.75
Rate for Payer: Hamaspik Choice Inc Medicaid $442.50
Rate for Payer: Hamaspik Choice Inc Medicare $442.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $575.25
Service Code HCPCS C1776
Hospital Charge Code 40008338
Hospital Revenue Code 278
Min. Negotiated Rate $442.50
Max. Negotiated Rate $442.50
Rate for Payer: Hamaspik Choice Inc Medicaid $442.50
Rate for Payer: Hamaspik Choice Inc Medicare $442.50
Service Code HCPCS C1776
Hospital Charge Code 40003449
Hospital Revenue Code 278
Min. Negotiated Rate $1,900.00
Max. Negotiated Rate $1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,900.00
Service Code HCPCS C1776
Hospital Charge Code 40003449
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,090.00
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 $1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,185.00
Rate for Payer: Fidelis Medicare Advantage $3,990.00
Rate for Payer: Group Health Inc Commercial $1,900.00
Rate for Payer: Group Health Inc Medicare $1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,470.00
Service Code HCPCS C1776
Hospital Charge Code 40008305
Hospital Revenue Code 278
Min. Negotiated Rate $1,664.00
Max. Negotiated Rate $1,664.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,664.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,664.00
Service Code HCPCS C1776
Hospital Charge Code 40008305
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,494.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,830.40
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 $1,664.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,913.60
Rate for Payer: Fidelis Medicare Advantage $3,494.40
Rate for Payer: Group Health Inc Commercial $1,664.00
Rate for Payer: Group Health Inc Medicare $1,164.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,664.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,664.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,163.20
Service Code HCPCS C1776
Hospital Charge Code 40009277
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,090.00
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 $1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,185.00
Rate for Payer: Fidelis Medicare Advantage $3,990.00
Rate for Payer: Group Health Inc Commercial $1,900.00
Rate for Payer: Group Health Inc Medicare $1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,470.00
Service Code HCPCS C1776
Hospital Charge Code 40009277
Hospital Revenue Code 278
Min. Negotiated Rate $1,900.00
Max. Negotiated Rate $1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,900.00
Service Code HCPCS C1776
Hospital Charge Code 40009275
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 40009275
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 C1713
Hospital Charge Code 40008331
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,275.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $668.25
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 $607.50
Rate for Payer: Cigna LocalPlus Benefit Plan $698.62
Rate for Payer: Fidelis Medicare Advantage $1,275.75
Rate for Payer: Group Health Inc Commercial $607.50
Rate for Payer: Group Health Inc Medicare $425.25
Rate for Payer: Hamaspik Choice Inc Medicaid $607.50
Rate for Payer: Hamaspik Choice Inc Medicare $607.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $789.75
Service Code HCPCS C1713
Hospital Charge Code 40008331
Hospital Revenue Code 278
Min. Negotiated Rate $607.50
Max. Negotiated Rate $607.50
Rate for Payer: Hamaspik Choice Inc Medicaid $607.50
Rate for Payer: Hamaspik Choice Inc Medicare $607.50
Service Code HCPCS C1776
Hospital Charge Code 40202637
Hospital Revenue Code 278
Min. Negotiated Rate $850.00
Max. Negotiated Rate $850.00
Rate for Payer: Hamaspik Choice Inc Medicaid $850.00
Rate for Payer: Hamaspik Choice Inc Medicare $850.00