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Charge Type Price  
Service Code HCPCS C1876
Hospital Charge Code 41569232
Hospital Revenue Code 278
Min. Negotiated Rate $1,079.08
Max. Negotiated Rate $1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid $1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,079.08
Service Code HCPCS C1876
Hospital Charge Code 41569241
Hospital Revenue Code 278
Min. Negotiated Rate $1,079.08
Max. Negotiated Rate $1,079.08
Rate for Payer: Hamaspik Choice Inc Medicaid $1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,079.08
Service Code HCPCS C1876
Hospital Charge Code 41569241
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,266.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,186.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,079.08
Rate for Payer: Cigna LocalPlus Benefit Plan $1,240.94
Rate for Payer: Fidelis Medicare Advantage $2,266.06
Rate for Payer: Group Health Inc Commercial $1,079.08
Rate for Payer: Group Health Inc Medicare $755.35
Rate for Payer: Hamaspik Choice Inc Medicaid $1,079.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,079.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,402.80
Service Code HCPCS C1876
Hospital Charge Code 41569228
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $1,830.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial $958.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $871.76
Rate for Payer: Cigna LocalPlus Benefit Plan $1,002.53
Rate for Payer: Fidelis Medicare Advantage $1,830.71
Rate for Payer: Group Health Inc Commercial $871.76
Rate for Payer: Group Health Inc Medicare $610.24
Rate for Payer: Hamaspik Choice Inc Medicaid $871.76
Rate for Payer: Hamaspik Choice Inc Medicare $871.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,133.29
Service Code HCPCS C1876
Hospital Charge Code 41569228
Hospital Revenue Code 278
Min. Negotiated Rate $871.76
Max. Negotiated Rate $871.76
Rate for Payer: Hamaspik Choice Inc Medicaid $871.76
Rate for Payer: Hamaspik Choice Inc Medicare $871.76
Service Code HCPCS C1876
Hospital Charge Code 41569243
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569243
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569245
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569245
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569246
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569246
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569248
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569248
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569247
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569247
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569244
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569244
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569242
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,603.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,363.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,239.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,425.55
Rate for Payer: Fidelis Medicare Advantage $2,603.17
Rate for Payer: Group Health Inc Commercial $1,239.60
Rate for Payer: Group Health Inc Medicare $867.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,611.49
Service Code HCPCS C1876
Hospital Charge Code 41569242
Hospital Revenue Code 278
Min. Negotiated Rate $1,239.60
Max. Negotiated Rate $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,239.60
Rate for Payer: Hamaspik Choice Inc Medicare $1,239.60
Service Code HCPCS C1876
Hospital Charge Code 41569249
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,520.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,320.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,200.27
Rate for Payer: Cigna LocalPlus Benefit Plan $1,380.31
Rate for Payer: Fidelis Medicare Advantage $2,520.57
Rate for Payer: Group Health Inc Commercial $1,200.27
Rate for Payer: Group Health Inc Medicare $840.19
Rate for Payer: Hamaspik Choice Inc Medicaid $1,200.27
Rate for Payer: Hamaspik Choice Inc Medicare $1,200.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,560.35
Service Code HCPCS C1876
Hospital Charge Code 41569249
Hospital Revenue Code 278
Min. Negotiated Rate $1,200.27
Max. Negotiated Rate $1,200.27
Rate for Payer: Hamaspik Choice Inc Medicaid $1,200.27
Rate for Payer: Hamaspik Choice Inc Medicare $1,200.27
Service Code HCPCS C1876
Hospital Charge Code 41569250
Hospital Revenue Code 278
Min. Negotiated Rate $1,334.22
Max. Negotiated Rate $1,334.22
Rate for Payer: Hamaspik Choice Inc Medicaid $1,334.22
Rate for Payer: Hamaspik Choice Inc Medicare $1,334.22
Service Code HCPCS C1876
Hospital Charge Code 41569250
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,801.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,467.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,334.22
Rate for Payer: Cigna LocalPlus Benefit Plan $1,534.36
Rate for Payer: Fidelis Medicare Advantage $2,801.87
Rate for Payer: Group Health Inc Commercial $1,334.22
Rate for Payer: Group Health Inc Medicare $933.96
Rate for Payer: Hamaspik Choice Inc Medicaid $1,334.22
Rate for Payer: Hamaspik Choice Inc Medicare $1,334.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,734.49
Service Code HCPCS C1876
Hospital Charge Code 41569252
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,520.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,320.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,200.27
Rate for Payer: Cigna LocalPlus Benefit Plan $1,380.31
Rate for Payer: Fidelis Medicare Advantage $2,520.57
Rate for Payer: Group Health Inc Commercial $1,200.27
Rate for Payer: Group Health Inc Medicare $840.19
Rate for Payer: Hamaspik Choice Inc Medicaid $1,200.27
Rate for Payer: Hamaspik Choice Inc Medicare $1,200.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,560.35
Service Code HCPCS C1876
Hospital Charge Code 41569252
Hospital Revenue Code 278
Min. Negotiated Rate $1,200.27
Max. Negotiated Rate $1,200.27
Rate for Payer: Hamaspik Choice Inc Medicaid $1,200.27
Rate for Payer: Hamaspik Choice Inc Medicare $1,200.27