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Charge Type Price  
Service Code HCPCS C1781
Hospital Charge Code 40209760
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 40209761
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,201.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $629.20
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 $572.00
Rate for Payer: Cigna LocalPlus Benefit Plan $657.80
Rate for Payer: Fidelis Medicare Advantage $1,201.20
Rate for Payer: Group Health Inc Commercial $572.00
Rate for Payer: Group Health Inc Medicare $400.40
Rate for Payer: Hamaspik Choice Inc Medicaid $572.00
Rate for Payer: Hamaspik Choice Inc Medicare $572.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $743.60
Service Code HCPCS C1781
Hospital Charge Code 40209761
Hospital Revenue Code 278
Min. Negotiated Rate $572.00
Max. Negotiated Rate $572.00
Rate for Payer: Hamaspik Choice Inc Medicaid $572.00
Rate for Payer: Hamaspik Choice Inc Medicare $572.00
Service Code HCPCS C1781
Hospital Charge Code 40209762
Hospital Revenue Code 278
Min. Negotiated Rate $572.00
Max. Negotiated Rate $572.00
Rate for Payer: Hamaspik Choice Inc Medicaid $572.00
Rate for Payer: Hamaspik Choice Inc Medicare $572.00
Service Code HCPCS C1781
Hospital Charge Code 40209762
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,201.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $629.20
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 $572.00
Rate for Payer: Cigna LocalPlus Benefit Plan $657.80
Rate for Payer: Fidelis Medicare Advantage $1,201.20
Rate for Payer: Group Health Inc Commercial $572.00
Rate for Payer: Group Health Inc Medicare $400.40
Rate for Payer: Hamaspik Choice Inc Medicaid $572.00
Rate for Payer: Hamaspik Choice Inc Medicare $572.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $743.60
Service Code HCPCS C1781
Hospital Charge Code 40209763
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $1,075.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $563.20
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 $512.00
Rate for Payer: Cigna LocalPlus Benefit Plan $588.80
Rate for Payer: Fidelis Medicare Advantage $1,075.20
Rate for Payer: Group Health Inc Commercial $512.00
Rate for Payer: Group Health Inc Medicare $358.40
Rate for Payer: Hamaspik Choice Inc Medicaid $512.00
Rate for Payer: Hamaspik Choice Inc Medicare $512.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $665.60
Service Code HCPCS C1781
Hospital Charge Code 40209763
Hospital Revenue Code 278
Min. Negotiated Rate $512.00
Max. Negotiated Rate $512.00
Rate for Payer: Hamaspik Choice Inc Medicaid $512.00
Rate for Payer: Hamaspik Choice Inc Medicare $512.00
Hospital Charge Code 40001657
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 C1713
Hospital Charge Code 40202313
Hospital Revenue Code 278
Min. Negotiated Rate $113.40
Max. Negotiated Rate $340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $178.20
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 $162.00
Rate for Payer: Cigna LocalPlus Benefit Plan $186.30
Rate for Payer: Fidelis Medicare Advantage $340.20
Rate for Payer: Group Health Inc Commercial $162.00
Rate for Payer: Group Health Inc Medicare $113.40
Rate for Payer: Hamaspik Choice Inc Medicaid $162.00
Rate for Payer: Hamaspik Choice Inc Medicare $162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $210.60
Service Code HCPCS C1713
Hospital Charge Code 40201237
Hospital Revenue Code 278
Min. Negotiated Rate $162.00
Max. Negotiated Rate $162.00
Rate for Payer: Hamaspik Choice Inc Medicaid $162.00
Rate for Payer: Hamaspik Choice Inc Medicare $162.00
Service Code HCPCS C1713
Hospital Charge Code 40202313
Hospital Revenue Code 278
Min. Negotiated Rate $162.00
Max. Negotiated Rate $162.00
Rate for Payer: Hamaspik Choice Inc Medicaid $162.00
Rate for Payer: Hamaspik Choice Inc Medicare $162.00
Service Code HCPCS C1713
Hospital Charge Code 40201237
Hospital Revenue Code 278
Min. Negotiated Rate $113.40
Max. Negotiated Rate $340.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $178.20
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 $162.00
Rate for Payer: Cigna LocalPlus Benefit Plan $186.30
Rate for Payer: Fidelis Medicare Advantage $340.20
Rate for Payer: Group Health Inc Commercial $162.00
Rate for Payer: Group Health Inc Medicare $113.40
Rate for Payer: Hamaspik Choice Inc Medicaid $162.00
Rate for Payer: Hamaspik Choice Inc Medicare $162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $210.60
Service Code HCPCS C1713
Hospital Charge Code 40200582
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,467.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,292.50
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 $1,175.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,351.25
Rate for Payer: Fidelis Medicare Advantage $2,467.50
Rate for Payer: Group Health Inc Commercial $1,175.00
Rate for Payer: Group Health Inc Medicare $822.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,175.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,527.50
Service Code HCPCS C1713
Hospital Charge Code 40200582
Hospital Revenue Code 278
Min. Negotiated Rate $1,175.00
Max. Negotiated Rate $1,175.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,175.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,175.00
Service Code HCPCS C1713
Hospital Charge Code 40200583
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
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 $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1713
Hospital Charge Code 40200583
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1713
Hospital Charge Code 40200584
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,482.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,300.20
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 $1,182.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,359.30
Rate for Payer: Fidelis Medicare Advantage $2,482.20
Rate for Payer: Group Health Inc Commercial $1,182.00
Rate for Payer: Group Health Inc Medicare $827.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,182.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,182.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,536.60
Service Code HCPCS C1713
Hospital Charge Code 40200584
Hospital Revenue Code 278
Min. Negotiated Rate $1,182.00
Max. Negotiated Rate $1,182.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,182.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,182.00
Service Code HCPCS C1713
Hospital Charge Code 40005304
Hospital Revenue Code 278
Min. Negotiated Rate $63.35
Max. Negotiated Rate $63.35
Rate for Payer: Hamaspik Choice Inc Medicaid $63.35
Rate for Payer: Hamaspik Choice Inc Medicare $63.35
Service Code HCPCS C1713
Hospital Charge Code 40005304
Hospital Revenue Code 278
Min. Negotiated Rate $44.34
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $69.68
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 $63.35
Rate for Payer: Cigna LocalPlus Benefit Plan $72.85
Rate for Payer: Fidelis Medicare Advantage $133.04
Rate for Payer: Group Health Inc Commercial $63.35
Rate for Payer: Group Health Inc Medicare $44.34
Rate for Payer: Hamaspik Choice Inc Medicaid $63.35
Rate for Payer: Hamaspik Choice Inc Medicare $63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $82.36
Hospital Charge Code 40005305
Hospital Revenue Code 272
Min. Negotiated Rate $77.57
Max. Negotiated Rate $177.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $121.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $110.81
Rate for Payer: Aetna Government $110.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $177.30
Rate for Payer: Cigna LocalPlus Benefit Plan $150.70
Rate for Payer: Group Health Inc Commercial $110.81
Rate for Payer: Group Health Inc Medicare $77.57
Rate for Payer: Hamaspik Choice Inc Medicaid $110.81
Rate for Payer: Hamaspik Choice Inc Medicare $110.81
Service Code HCPCS C1713
Hospital Charge Code 40203443
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $422.50
Rate for Payer: Hamaspik Choice Inc Medicaid $422.50
Rate for Payer: Hamaspik Choice Inc Medicare $422.50
Service Code HCPCS C1713
Hospital Charge Code 40203443
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $464.75
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 $422.50
Rate for Payer: Cigna LocalPlus Benefit Plan $485.88
Rate for Payer: Fidelis Medicare Advantage $887.25
Rate for Payer: Group Health Inc Commercial $422.50
Rate for Payer: Group Health Inc Medicare $295.75
Rate for Payer: Hamaspik Choice Inc Medicaid $422.50
Rate for Payer: Hamaspik Choice Inc Medicare $422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $549.25
Service Code HCPCS C1713
Hospital Charge Code 40204725
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $887.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $464.75
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 $422.50
Rate for Payer: Cigna LocalPlus Benefit Plan $485.88
Rate for Payer: Fidelis Medicare Advantage $887.25
Rate for Payer: Group Health Inc Commercial $422.50
Rate for Payer: Group Health Inc Medicare $295.75
Rate for Payer: Hamaspik Choice Inc Medicaid $422.50
Rate for Payer: Hamaspik Choice Inc Medicare $422.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $549.25
Service Code HCPCS C1713
Hospital Charge Code 40204725
Hospital Revenue Code 278
Min. Negotiated Rate $422.50
Max. Negotiated Rate $422.50
Rate for Payer: Hamaspik Choice Inc Medicaid $422.50
Rate for Payer: Hamaspik Choice Inc Medicare $422.50