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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40200575
Hospital Revenue Code 278
Min. Negotiated Rate $1,325.00
Max. Negotiated Rate $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,325.00
Service Code HCPCS C1713
Hospital Charge Code 40200574
Hospital Revenue Code 278
Min. Negotiated Rate $1,182.30
Max. Negotiated Rate $1,182.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,182.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,182.30
Service Code HCPCS C1713
Hospital Charge Code 40200574
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,482.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,300.53
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 $1,182.30
Rate for Payer: Cigna LocalPlus Benefit Plan $1,359.64
Rate for Payer: Fidelis Medicare Advantage $2,482.83
Rate for Payer: Group Health Inc Commercial $1,182.30
Rate for Payer: Group Health Inc Medicare $827.61
Rate for Payer: Hamaspik Choice Inc Medicaid $1,182.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,182.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,536.99
Service Code HCPCS C1713
Hospital Charge Code 40200576
Hospital Revenue Code 278
Min. Negotiated Rate $1,132.00
Max. Negotiated Rate $1,132.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,132.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,132.00
Service Code HCPCS C1713
Hospital Charge Code 40200576
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,377.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,245.20
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 $1,132.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,301.80
Rate for Payer: Fidelis Medicare Advantage $2,377.20
Rate for Payer: Group Health Inc Commercial $1,132.00
Rate for Payer: Group Health Inc Medicare $792.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,132.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,132.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,471.60
Service Code HCPCS C1713
Hospital Charge Code 40203000
Hospital Revenue Code 278
Min. Negotiated Rate $1,325.00
Max. Negotiated Rate $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,325.00
Service Code HCPCS C1713
Hospital Charge Code 40203000
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,782.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,457.50
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 $1,325.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,523.75
Rate for Payer: Fidelis Medicare Advantage $2,782.50
Rate for Payer: Group Health Inc Commercial $1,325.00
Rate for Payer: Group Health Inc Medicare $927.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,325.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,325.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,722.50
Service Code HCPCS C1776
Hospital Charge Code 40200578
Hospital Revenue Code 278
Min. Negotiated Rate $1,132.00
Max. Negotiated Rate $1,132.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,132.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,132.00
Service Code HCPCS C1776
Hospital Charge Code 40200578
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,377.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,245.20
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 $1,132.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,301.80
Rate for Payer: Fidelis Medicare Advantage $2,377.20
Rate for Payer: Group Health Inc Commercial $1,132.00
Rate for Payer: Group Health Inc Medicare $792.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,132.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,132.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,471.60
Service Code HCPCS C1713
Hospital Charge Code 40200580
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,307.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,732.50
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 $1,575.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,811.25
Rate for Payer: Fidelis Medicare Advantage $3,307.50
Rate for Payer: Group Health Inc Commercial $1,575.00
Rate for Payer: Group Health Inc Medicare $1,102.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,047.50
Service Code HCPCS C1713
Hospital Charge Code 40200580
Hospital Revenue Code 278
Min. Negotiated Rate $1,575.00
Max. Negotiated Rate $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Service Code HCPCS C1713
Hospital Charge Code 40200579
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,307.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,732.50
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 $1,575.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,811.25
Rate for Payer: Fidelis Medicare Advantage $3,307.50
Rate for Payer: Group Health Inc Commercial $1,575.00
Rate for Payer: Group Health Inc Medicare $1,102.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,047.50
Service Code HCPCS C1713
Hospital Charge Code 40200579
Hospital Revenue Code 278
Min. Negotiated Rate $1,575.00
Max. Negotiated Rate $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Service Code HCPCS C1713
Hospital Charge Code 40209921
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,307.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,732.50
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 $1,575.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,811.25
Rate for Payer: Fidelis Medicare Advantage $3,307.50
Rate for Payer: Group Health Inc Commercial $1,575.00
Rate for Payer: Group Health Inc Medicare $1,102.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,047.50
Service Code HCPCS C1713
Hospital Charge Code 40209921
Hospital Revenue Code 278
Min. Negotiated Rate $1,575.00
Max. Negotiated Rate $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Service Code HCPCS C1776
Hospital Charge Code 40208097
Hospital Revenue Code 278
Min. Negotiated Rate $1,575.00
Max. Negotiated Rate $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Service Code HCPCS C1776
Hospital Charge Code 40208097
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,307.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,732.50
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 $1,575.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,811.25
Rate for Payer: Fidelis Medicare Advantage $3,307.50
Rate for Payer: Group Health Inc Commercial $1,575.00
Rate for Payer: Group Health Inc Medicare $1,102.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,575.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,575.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,047.50
Service Code HCPCS C1713
Hospital Charge Code 40200581
Hospital Revenue Code 278
Min. Negotiated Rate $1,470.00
Max. Negotiated Rate $1,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,470.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,470.00
Service Code HCPCS C1713
Hospital Charge Code 40200581
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,087.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,617.00
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 $1,470.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,690.50
Rate for Payer: Fidelis Medicare Advantage $3,087.00
Rate for Payer: Group Health Inc Commercial $1,470.00
Rate for Payer: Group Health Inc Medicare $1,029.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,470.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,470.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,911.00
Service Code HCPCS C1776
Hospital Charge Code 40204610
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 40007529
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 40007529
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 40204610
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 82652
Hospital Charge Code 40609065
Hospital Revenue Code 300
Min. Negotiated Rate $30.80
Max. Negotiated Rate $61.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $52.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $38.50
Rate for Payer: Aetna Government $38.50
Rate for Payer: Cash Price $38.50
Rate for Payer: Cash Price $38.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $38.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $61.20
Rate for Payer: Cigna LocalPlus Benefit Plan $51.79
Rate for Payer: Elderplan Medicare Advantage $38.50
Rate for Payer: EmblemHealth Commercial $38.50
Rate for Payer: Fidelis CHP/HARP/Medicaid $34.65
Rate for Payer: Fidelis Essential Plan Aliesa $32.72
Rate for Payer: Fidelis Essential Plan QHP $34.26
Rate for Payer: Fidelis Medicare Advantage $38.50
Rate for Payer: Fidelis Qualified Health Plan $34.26
Rate for Payer: Group Health Inc Commercial $38.50
Rate for Payer: Group Health Inc Medicare $38.50
Rate for Payer: Hamaspik Choice Inc Medicaid $48.12
Rate for Payer: Hamaspik Choice Inc Medicare $38.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid $38.50
Rate for Payer: Healthfirst Medicare Advantage $38.50
Rate for Payer: Healthfirst QHP $38.50
Rate for Payer: Senior Whole Health Medicare Advantage $38.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $38.50
Rate for Payer: Wellcare CHP/FHP/Medicaid $30.80
Rate for Payer: Wellcare Medicare $34.65
Service Code HCPCS C1781
Hospital Charge Code 40209752
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $363.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $190.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $173.00
Rate for Payer: Cigna LocalPlus Benefit Plan $198.95
Rate for Payer: Fidelis Medicare Advantage $363.30
Rate for Payer: Group Health Inc Commercial $173.00
Rate for Payer: Group Health Inc Medicare $121.10
Rate for Payer: Hamaspik Choice Inc Medicaid $173.00
Rate for Payer: Hamaspik Choice Inc Medicare $173.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $224.90