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Service Code HCPCS C1876
Hospital Charge Code 41569251
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 41569251
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 41569253
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 41569253
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 41569191
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 41569191
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 41569192
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 41569192
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 41569193
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 41569193
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
Hospital Charge Code 41569935
Hospital Revenue Code 279
Min. Negotiated Rate $182.00
Max. Negotiated Rate $416.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $286.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $260.00
Rate for Payer: Aetna Government $260.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $416.00
Rate for Payer: Cigna LocalPlus Benefit Plan $353.60
Rate for Payer: Group Health Inc Commercial $260.00
Rate for Payer: Group Health Inc Medicare $182.00
Rate for Payer: Hamaspik Choice Inc Medicaid $260.00
Rate for Payer: Hamaspik Choice Inc Medicare $260.00
Hospital Charge Code 41569936
Hospital Revenue Code 279
Min. Negotiated Rate $58.10
Max. Negotiated Rate $132.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $91.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $83.00
Rate for Payer: Aetna Government $83.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $132.80
Rate for Payer: Cigna LocalPlus Benefit Plan $112.88
Rate for Payer: Group Health Inc Commercial $83.00
Rate for Payer: Group Health Inc Medicare $58.10
Rate for Payer: Hamaspik Choice Inc Medicaid $83.00
Rate for Payer: Hamaspik Choice Inc Medicare $83.00
Hospital Charge Code 41567005
Hospital Revenue Code 270
Min. Negotiated Rate $4.47
Max. Negotiated Rate $10.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.38
Rate for Payer: Aetna Government $6.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.21
Rate for Payer: Cigna LocalPlus Benefit Plan $8.68
Rate for Payer: Group Health Inc Commercial $6.38
Rate for Payer: Group Health Inc Medicare $4.47
Rate for Payer: Hamaspik Choice Inc Medicaid $6.38
Rate for Payer: Hamaspik Choice Inc Medicare $6.38
Hospital Charge Code 41567006
Hospital Revenue Code 270
Min. Negotiated Rate $2.36
Max. Negotiated Rate $5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.36
Rate for Payer: Aetna Government $3.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.38
Rate for Payer: Cigna LocalPlus Benefit Plan $4.58
Rate for Payer: Group Health Inc Commercial $3.36
Rate for Payer: Group Health Inc Medicare $2.36
Rate for Payer: Hamaspik Choice Inc Medicaid $3.36
Rate for Payer: Hamaspik Choice Inc Medicare $3.36
Hospital Charge Code 41568715
Hospital Revenue Code 270
Min. Negotiated Rate $10.50
Max. Negotiated Rate $24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $15.00
Rate for Payer: Aetna Government $15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $24.00
Rate for Payer: Cigna LocalPlus Benefit Plan $20.40
Rate for Payer: Group Health Inc Commercial $15.00
Rate for Payer: Group Health Inc Medicare $10.50
Rate for Payer: Hamaspik Choice Inc Medicaid $15.00
Rate for Payer: Hamaspik Choice Inc Medicare $15.00
Hospital Charge Code 41568713
Hospital Revenue Code 270
Min. Negotiated Rate $170.80
Max. Negotiated Rate $390.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $268.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $244.00
Rate for Payer: Aetna Government $244.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $390.40
Rate for Payer: Cigna LocalPlus Benefit Plan $331.84
Rate for Payer: Group Health Inc Commercial $244.00
Rate for Payer: Group Health Inc Medicare $170.80
Rate for Payer: Hamaspik Choice Inc Medicaid $244.00
Rate for Payer: Hamaspik Choice Inc Medicare $244.00
Hospital Charge Code 41568712
Hospital Revenue Code 270
Min. Negotiated Rate $5.04
Max. Negotiated Rate $11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.20
Rate for Payer: Aetna Government $7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.52
Rate for Payer: Cigna LocalPlus Benefit Plan $9.79
Rate for Payer: Group Health Inc Commercial $7.20
Rate for Payer: Group Health Inc Medicare $5.04
Rate for Payer: Hamaspik Choice Inc Medicaid $7.20
Rate for Payer: Hamaspik Choice Inc Medicare $7.20
Hospital Charge Code 41568714
Hospital Revenue Code 270
Min. Negotiated Rate $60.90
Max. Negotiated Rate $139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $87.00
Rate for Payer: Aetna Government $87.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $139.20
Rate for Payer: Cigna LocalPlus Benefit Plan $118.32
Rate for Payer: Group Health Inc Commercial $87.00
Rate for Payer: Group Health Inc Medicare $60.90
Rate for Payer: Hamaspik Choice Inc Medicaid $87.00
Rate for Payer: Hamaspik Choice Inc Medicare $87.00
Hospital Charge Code 41568718
Hospital Revenue Code 270
Min. Negotiated Rate $4.29
Max. Negotiated Rate $9.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.12
Rate for Payer: Aetna Government $6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.80
Rate for Payer: Cigna LocalPlus Benefit Plan $8.33
Rate for Payer: Group Health Inc Commercial $6.12
Rate for Payer: Group Health Inc Medicare $4.29
Rate for Payer: Hamaspik Choice Inc Medicaid $6.12
Rate for Payer: Hamaspik Choice Inc Medicare $6.12
Hospital Charge Code 41568719
Hospital Revenue Code 270
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.05
Rate for Payer: Aetna Government $0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.08
Rate for Payer: Cigna LocalPlus Benefit Plan $0.07
Rate for Payer: Group Health Inc Commercial $0.05
Rate for Payer: Group Health Inc Medicare $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.05
Rate for Payer: Hamaspik Choice Inc Medicare $0.05
Hospital Charge Code 41568711
Hospital Revenue Code 270
Min. Negotiated Rate $10.50
Max. Negotiated Rate $24.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $15.00
Rate for Payer: Aetna Government $15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $24.00
Rate for Payer: Cigna LocalPlus Benefit Plan $20.40
Rate for Payer: Group Health Inc Commercial $15.00
Rate for Payer: Group Health Inc Medicare $10.50
Rate for Payer: Hamaspik Choice Inc Medicaid $15.00
Rate for Payer: Hamaspik Choice Inc Medicare $15.00
Hospital Charge Code 41568708
Hospital Revenue Code 270
Min. Negotiated Rate $5.04
Max. Negotiated Rate $11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.20
Rate for Payer: Aetna Government $7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.52
Rate for Payer: Cigna LocalPlus Benefit Plan $9.79
Rate for Payer: Group Health Inc Commercial $7.20
Rate for Payer: Group Health Inc Medicare $5.04
Rate for Payer: Hamaspik Choice Inc Medicaid $7.20
Rate for Payer: Hamaspik Choice Inc Medicare $7.20
Hospital Charge Code 41568710
Hospital Revenue Code 270
Min. Negotiated Rate $60.90
Max. Negotiated Rate $139.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $95.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $87.00
Rate for Payer: Aetna Government $87.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $139.20
Rate for Payer: Cigna LocalPlus Benefit Plan $118.32
Rate for Payer: Group Health Inc Commercial $87.00
Rate for Payer: Group Health Inc Medicare $60.90
Rate for Payer: Hamaspik Choice Inc Medicaid $87.00
Rate for Payer: Hamaspik Choice Inc Medicare $87.00
Hospital Charge Code 41568709
Hospital Revenue Code 270
Min. Negotiated Rate $185.50
Max. Negotiated Rate $424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.00
Rate for Payer: Aetna Government $265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $424.00
Rate for Payer: Cigna LocalPlus Benefit Plan $360.40
Rate for Payer: Group Health Inc Commercial $265.00
Rate for Payer: Group Health Inc Medicare $185.50
Rate for Payer: Hamaspik Choice Inc Medicaid $265.00
Rate for Payer: Hamaspik Choice Inc Medicare $265.00
Hospital Charge Code 41568720
Hospital Revenue Code 270
Min. Negotiated Rate $14.35
Max. Negotiated Rate $32.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $22.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $20.50
Rate for Payer: Aetna Government $20.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $32.80
Rate for Payer: Cigna LocalPlus Benefit Plan $27.88
Rate for Payer: Group Health Inc Commercial $20.50
Rate for Payer: Group Health Inc Medicare $14.35
Rate for Payer: Hamaspik Choice Inc Medicaid $20.50
Rate for Payer: Hamaspik Choice Inc Medicare $20.50