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Charge Type Price  
Service Code HCPCS C1874
Hospital Charge Code 66523364
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523364
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523365
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523365
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523366
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523366
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523367
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523367
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523368
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523368
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523369
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523369
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523370
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523370
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523371
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523371
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523372
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523372
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523373
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523373
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523431
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $5,029.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,634.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,395.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,754.25
Rate for Payer: Fidelis Medicare Advantage $5,029.50
Rate for Payer: Group Health Inc Commercial $2,395.00
Rate for Payer: Group Health Inc Medicare $1,676.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,395.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,395.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,113.50
Service Code HCPCS C1874
Hospital Charge Code 66523431
Hospital Revenue Code 278
Min. Negotiated Rate $2,395.00
Max. Negotiated Rate $2,395.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,395.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,395.00
Service Code HCPCS C1874
Hospital Charge Code 66523432
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $5,029.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,634.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,395.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,754.25
Rate for Payer: Fidelis Medicare Advantage $5,029.50
Rate for Payer: Group Health Inc Commercial $2,395.00
Rate for Payer: Group Health Inc Medicare $1,676.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,395.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,395.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,113.50
Service Code HCPCS C1874
Hospital Charge Code 66523432
Hospital Revenue Code 278
Min. Negotiated Rate $2,395.00
Max. Negotiated Rate $2,395.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,395.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,395.00
Service Code HCPCS C1874
Hospital Charge Code 66523374
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00