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Charge Type Price  
Service Code HCPCS C1781
Hospital Charge Code 40209752
Hospital Revenue Code 278
Min. Negotiated Rate $173.00
Max. Negotiated Rate $173.00
Rate for Payer: Hamaspik Choice Inc Medicaid $173.00
Rate for Payer: Hamaspik Choice Inc Medicare $173.00
Service Code HCPCS C1781
Hospital Charge Code 40209753
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
Service Code HCPCS C1781
Hospital Charge Code 40209753
Hospital Revenue Code 278
Min. Negotiated Rate $173.00
Max. Negotiated Rate $173.00
Rate for Payer: Hamaspik Choice Inc Medicaid $173.00
Rate for Payer: Hamaspik Choice Inc Medicare $173.00
Service Code HCPCS C1781
Hospital Charge Code 40209754
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
Service Code HCPCS C1781
Hospital Charge Code 40209754
Hospital Revenue Code 278
Min. Negotiated Rate $173.00
Max. Negotiated Rate $173.00
Rate for Payer: Hamaspik Choice Inc Medicaid $173.00
Rate for Payer: Hamaspik Choice Inc Medicare $173.00
Service Code HCPCS C1713
Hospital Charge Code 40209809
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $611.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $320.10
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 $291.00
Rate for Payer: Cigna LocalPlus Benefit Plan $334.65
Rate for Payer: Fidelis Medicare Advantage $611.10
Rate for Payer: Group Health Inc Commercial $291.00
Rate for Payer: Group Health Inc Medicare $203.70
Rate for Payer: Hamaspik Choice Inc Medicaid $291.00
Rate for Payer: Hamaspik Choice Inc Medicare $291.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $378.30
Service Code HCPCS C1713
Hospital Charge Code 40209809
Hospital Revenue Code 278
Min. Negotiated Rate $291.00
Max. Negotiated Rate $291.00
Rate for Payer: Hamaspik Choice Inc Medicaid $291.00
Rate for Payer: Hamaspik Choice Inc Medicare $291.00
Service Code HCPCS C1776
Hospital Charge Code 40205276
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,039.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,068.10
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 $971.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,116.65
Rate for Payer: Fidelis Medicare Advantage $2,039.10
Rate for Payer: Group Health Inc Commercial $971.00
Rate for Payer: Group Health Inc Medicare $679.70
Rate for Payer: Hamaspik Choice Inc Medicaid $971.00
Rate for Payer: Hamaspik Choice Inc Medicare $971.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,262.30
Service Code HCPCS C1776
Hospital Charge Code 40205276
Hospital Revenue Code 278
Min. Negotiated Rate $971.00
Max. Negotiated Rate $971.00
Rate for Payer: Hamaspik Choice Inc Medicaid $971.00
Rate for Payer: Hamaspik Choice Inc Medicare $971.00
Service Code HCPCS C1713
Hospital Charge Code 40209394
Hospital Revenue Code 278
Min. Negotiated Rate $119.00
Max. Negotiated Rate $357.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $187.00
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 $170.00
Rate for Payer: Cigna LocalPlus Benefit Plan $195.50
Rate for Payer: Fidelis Medicare Advantage $357.00
Rate for Payer: Group Health Inc Commercial $170.00
Rate for Payer: Group Health Inc Medicare $119.00
Rate for Payer: Hamaspik Choice Inc Medicaid $170.00
Rate for Payer: Hamaspik Choice Inc Medicare $170.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $221.00
Service Code HCPCS C1713
Hospital Charge Code 40209394
Hospital Revenue Code 278
Min. Negotiated Rate $170.00
Max. Negotiated Rate $170.00
Rate for Payer: Hamaspik Choice Inc Medicaid $170.00
Rate for Payer: Hamaspik Choice Inc Medicare $170.00
Service Code HCPCS C1781
Hospital Charge Code 40209756
Hospital Revenue Code 278
Min. Negotiated Rate $193.54
Max. Negotiated Rate $193.54
Rate for Payer: Hamaspik Choice Inc Medicaid $193.54
Rate for Payer: Hamaspik Choice Inc Medicare $193.54
Service Code HCPCS C1781
Hospital Charge Code 40209756
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $406.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial $212.89
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 $193.54
Rate for Payer: Cigna LocalPlus Benefit Plan $222.57
Rate for Payer: Fidelis Medicare Advantage $406.43
Rate for Payer: Group Health Inc Commercial $193.54
Rate for Payer: Group Health Inc Medicare $135.48
Rate for Payer: Hamaspik Choice Inc Medicaid $193.54
Rate for Payer: Hamaspik Choice Inc Medicare $193.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $251.60
Service Code HCPCS C1781
Hospital Charge Code 40209757
Hospital Revenue Code 278
Min. Negotiated Rate $193.54
Max. Negotiated Rate $193.54
Rate for Payer: Hamaspik Choice Inc Medicaid $193.54
Rate for Payer: Hamaspik Choice Inc Medicare $193.54
Service Code HCPCS C1781
Hospital Charge Code 40209757
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $406.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial $212.89
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 $193.54
Rate for Payer: Cigna LocalPlus Benefit Plan $222.57
Rate for Payer: Fidelis Medicare Advantage $406.43
Rate for Payer: Group Health Inc Commercial $193.54
Rate for Payer: Group Health Inc Medicare $135.48
Rate for Payer: Hamaspik Choice Inc Medicaid $193.54
Rate for Payer: Hamaspik Choice Inc Medicare $193.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $251.60
Service Code HCPCS C1781
Hospital Charge Code 40209758
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $406.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial $212.89
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 $193.54
Rate for Payer: Cigna LocalPlus Benefit Plan $222.57
Rate for Payer: Fidelis Medicare Advantage $406.43
Rate for Payer: Group Health Inc Commercial $193.54
Rate for Payer: Group Health Inc Medicare $135.48
Rate for Payer: Hamaspik Choice Inc Medicaid $193.54
Rate for Payer: Hamaspik Choice Inc Medicare $193.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $251.60
Service Code HCPCS C1781
Hospital Charge Code 40209758
Hospital Revenue Code 278
Min. Negotiated Rate $193.54
Max. Negotiated Rate $193.54
Rate for Payer: Hamaspik Choice Inc Medicaid $193.54
Rate for Payer: Hamaspik Choice Inc Medicare $193.54
Service Code HCPCS C1713
Hospital Charge Code 40201234
Hospital Revenue Code 278
Min. Negotiated Rate $216.00
Max. Negotiated Rate $216.00
Rate for Payer: Hamaspik Choice Inc Medicaid $216.00
Rate for Payer: Hamaspik Choice Inc Medicare $216.00
Service Code HCPCS C1713
Hospital Charge Code 40201234
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $453.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $237.60
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 $216.00
Rate for Payer: Cigna LocalPlus Benefit Plan $248.40
Rate for Payer: Fidelis Medicare Advantage $453.60
Rate for Payer: Group Health Inc Commercial $216.00
Rate for Payer: Group Health Inc Medicare $151.20
Rate for Payer: Hamaspik Choice Inc Medicaid $216.00
Rate for Payer: Hamaspik Choice Inc Medicare $216.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $280.80
Service Code HCPCS C1713
Hospital Charge Code 40202315
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $407.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $213.40
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 $194.00
Rate for Payer: Cigna LocalPlus Benefit Plan $223.10
Rate for Payer: Fidelis Medicare Advantage $407.40
Rate for Payer: Group Health Inc Commercial $194.00
Rate for Payer: Group Health Inc Medicare $135.80
Rate for Payer: Hamaspik Choice Inc Medicaid $194.00
Rate for Payer: Hamaspik Choice Inc Medicare $194.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $252.20
Service Code HCPCS C1713
Hospital Charge Code 40202315
Hospital Revenue Code 278
Min. Negotiated Rate $194.00
Max. Negotiated Rate $194.00
Rate for Payer: Hamaspik Choice Inc Medicaid $194.00
Rate for Payer: Hamaspik Choice Inc Medicare $194.00
Hospital Charge Code 40001656
Hospital Revenue Code 270
Min. Negotiated Rate $134.05
Max. Negotiated Rate $306.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $210.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $191.50
Rate for Payer: Aetna Government $191.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $306.40
Rate for Payer: Cigna LocalPlus Benefit Plan $260.44
Rate for Payer: Group Health Inc Commercial $191.50
Rate for Payer: Group Health Inc Medicare $134.05
Rate for Payer: Hamaspik Choice Inc Medicaid $191.50
Rate for Payer: Hamaspik Choice Inc Medicare $191.50
Service Code HCPCS C1781
Hospital Charge Code 40209759
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,495.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $783.20
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 $712.00
Rate for Payer: Cigna LocalPlus Benefit Plan $818.80
Rate for Payer: Fidelis Medicare Advantage $1,495.20
Rate for Payer: Group Health Inc Commercial $712.00
Rate for Payer: Group Health Inc Medicare $498.40
Rate for Payer: Hamaspik Choice Inc Medicaid $712.00
Rate for Payer: Hamaspik Choice Inc Medicare $712.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $925.60
Service Code HCPCS C1781
Hospital Charge Code 40209759
Hospital Revenue Code 278
Min. Negotiated Rate $712.00
Max. Negotiated Rate $712.00
Rate for Payer: Hamaspik Choice Inc Medicaid $712.00
Rate for Payer: Hamaspik Choice Inc Medicare $712.00
Service Code HCPCS C1781
Hospital Charge Code 40209760
Hospital Revenue Code 278
Min. Negotiated Rate $712.00
Max. Negotiated Rate $712.00
Rate for Payer: Hamaspik Choice Inc Medicaid $712.00
Rate for Payer: Hamaspik Choice Inc Medicare $712.00