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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40205414
Hospital Revenue Code 278
Min. Negotiated Rate $458.00
Max. Negotiated Rate $458.00
Rate for Payer: Hamaspik Choice Inc Medicaid $458.00
Rate for Payer: Hamaspik Choice Inc Medicare $458.00
Hospital Charge Code 40205655
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
Service Code HCPCS C1713
Hospital Charge Code 40205440
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $961.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $503.80
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 $458.00
Rate for Payer: Cigna LocalPlus Benefit Plan $526.70
Rate for Payer: Fidelis Medicare Advantage $961.80
Rate for Payer: Group Health Inc Commercial $458.00
Rate for Payer: Group Health Inc Medicare $320.60
Rate for Payer: Hamaspik Choice Inc Medicaid $458.00
Rate for Payer: Hamaspik Choice Inc Medicare $458.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $595.40
Service Code HCPCS C1713
Hospital Charge Code 40205440
Hospital Revenue Code 278
Min. Negotiated Rate $458.00
Max. Negotiated Rate $458.00
Rate for Payer: Hamaspik Choice Inc Medicaid $458.00
Rate for Payer: Hamaspik Choice Inc Medicare $458.00
Service Code HCPCS C1769
Hospital Charge Code 40200362
Hospital Revenue Code 278
Min. Negotiated Rate $9.00
Max. Negotiated Rate $9.00
Rate for Payer: Hamaspik Choice Inc Medicaid $9.00
Rate for Payer: Hamaspik Choice Inc Medicare $9.00
Service Code HCPCS C1769
Hospital Charge Code 40200362
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $18.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.00
Rate for Payer: Cigna LocalPlus Benefit Plan $10.35
Rate for Payer: Fidelis Medicare Advantage $18.90
Rate for Payer: Group Health Inc Commercial $9.00
Rate for Payer: Group Health Inc Medicare $6.30
Rate for Payer: Hamaspik Choice Inc Medicaid $9.00
Rate for Payer: Hamaspik Choice Inc Medicare $9.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $11.70
Service Code HCPCS C1713
Hospital Charge Code 40205656
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $999.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $523.60
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 $476.00
Rate for Payer: Cigna LocalPlus Benefit Plan $547.40
Rate for Payer: Fidelis Medicare Advantage $999.60
Rate for Payer: Group Health Inc Commercial $476.00
Rate for Payer: Group Health Inc Medicare $333.20
Rate for Payer: Hamaspik Choice Inc Medicaid $476.00
Rate for Payer: Hamaspik Choice Inc Medicare $476.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $618.80
Service Code HCPCS C1713
Hospital Charge Code 40205656
Hospital Revenue Code 278
Min. Negotiated Rate $476.00
Max. Negotiated Rate $476.00
Rate for Payer: Hamaspik Choice Inc Medicaid $476.00
Rate for Payer: Hamaspik Choice Inc Medicare $476.00
Service Code HCPCS C1713
Hospital Charge Code 40200363
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,331.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $697.40
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 $634.00
Rate for Payer: Cigna LocalPlus Benefit Plan $729.10
Rate for Payer: Fidelis Medicare Advantage $1,331.40
Rate for Payer: Group Health Inc Commercial $634.00
Rate for Payer: Group Health Inc Medicare $443.80
Rate for Payer: Hamaspik Choice Inc Medicaid $634.00
Rate for Payer: Hamaspik Choice Inc Medicare $634.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $824.20
Service Code HCPCS C1713
Hospital Charge Code 40200363
Hospital Revenue Code 278
Min. Negotiated Rate $634.00
Max. Negotiated Rate $634.00
Rate for Payer: Hamaspik Choice Inc Medicaid $634.00
Rate for Payer: Hamaspik Choice Inc Medicare $634.00
Service Code HCPCS C1713
Hospital Charge Code 40200364
Hospital Revenue Code 278
Min. Negotiated Rate $634.00
Max. Negotiated Rate $634.00
Rate for Payer: Hamaspik Choice Inc Medicaid $634.00
Rate for Payer: Hamaspik Choice Inc Medicare $634.00
Service Code HCPCS C1713
Hospital Charge Code 40200364
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,331.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $697.40
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 $634.00
Rate for Payer: Cigna LocalPlus Benefit Plan $729.10
Rate for Payer: Fidelis Medicare Advantage $1,331.40
Rate for Payer: Group Health Inc Commercial $634.00
Rate for Payer: Group Health Inc Medicare $443.80
Rate for Payer: Hamaspik Choice Inc Medicaid $634.00
Rate for Payer: Hamaspik Choice Inc Medicare $634.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $824.20
Service Code HCPCS C1713
Hospital Charge Code 40205658
Hospital Revenue Code 278
Min. Negotiated Rate $64.92
Max. Negotiated Rate $194.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $102.02
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 $92.75
Rate for Payer: Cigna LocalPlus Benefit Plan $106.66
Rate for Payer: Fidelis Medicare Advantage $194.78
Rate for Payer: Group Health Inc Commercial $92.75
Rate for Payer: Group Health Inc Medicare $64.92
Rate for Payer: Hamaspik Choice Inc Medicaid $92.75
Rate for Payer: Hamaspik Choice Inc Medicare $92.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $120.58
Service Code HCPCS C1713
Hospital Charge Code 40205658
Hospital Revenue Code 278
Min. Negotiated Rate $92.75
Max. Negotiated Rate $92.75
Rate for Payer: Hamaspik Choice Inc Medicaid $92.75
Rate for Payer: Hamaspik Choice Inc Medicare $92.75
Service Code HCPCS C1713
Hospital Charge Code 40205659
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $651.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $341.00
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 $310.00
Rate for Payer: Cigna LocalPlus Benefit Plan $356.50
Rate for Payer: Fidelis Medicare Advantage $651.00
Rate for Payer: Group Health Inc Commercial $310.00
Rate for Payer: Group Health Inc Medicare $217.00
Rate for Payer: Hamaspik Choice Inc Medicaid $310.00
Rate for Payer: Hamaspik Choice Inc Medicare $310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $403.00
Service Code HCPCS C1713
Hospital Charge Code 40205659
Hospital Revenue Code 278
Min. Negotiated Rate $310.00
Max. Negotiated Rate $310.00
Rate for Payer: Hamaspik Choice Inc Medicaid $310.00
Rate for Payer: Hamaspik Choice Inc Medicare $310.00
Service Code HCPCS C1713
Hospital Charge Code 40205657
Hospital Revenue Code 278
Min. Negotiated Rate $56.88
Max. Negotiated Rate $170.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $89.38
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 $81.25
Rate for Payer: Cigna LocalPlus Benefit Plan $93.44
Rate for Payer: Fidelis Medicare Advantage $170.62
Rate for Payer: Group Health Inc Commercial $81.25
Rate for Payer: Group Health Inc Medicare $56.88
Rate for Payer: Hamaspik Choice Inc Medicaid $81.25
Rate for Payer: Hamaspik Choice Inc Medicare $81.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $105.62
Service Code HCPCS C1713
Hospital Charge Code 40205657
Hospital Revenue Code 278
Min. Negotiated Rate $81.25
Max. Negotiated Rate $81.25
Rate for Payer: Hamaspik Choice Inc Medicaid $81.25
Rate for Payer: Hamaspik Choice Inc Medicare $81.25
Service Code HCPCS C1713
Hospital Charge Code 40205660
Hospital Revenue Code 278
Min. Negotiated Rate $131.25
Max. Negotiated Rate $131.25
Rate for Payer: Hamaspik Choice Inc Medicaid $131.25
Rate for Payer: Hamaspik Choice Inc Medicare $131.25
Service Code HCPCS C1713
Hospital Charge Code 40205660
Hospital Revenue Code 278
Min. Negotiated Rate $91.88
Max. Negotiated Rate $275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $144.38
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 $131.25
Rate for Payer: Cigna LocalPlus Benefit Plan $150.94
Rate for Payer: Fidelis Medicare Advantage $275.62
Rate for Payer: Group Health Inc Commercial $131.25
Rate for Payer: Group Health Inc Medicare $91.88
Rate for Payer: Hamaspik Choice Inc Medicaid $131.25
Rate for Payer: Hamaspik Choice Inc Medicare $131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $170.62
Service Code HCPCS C1776
Hospital Charge Code 40208165
Hospital Revenue Code 278
Min. Negotiated Rate $111.12
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $174.62
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 $158.75
Rate for Payer: Cigna LocalPlus Benefit Plan $182.56
Rate for Payer: Fidelis Medicare Advantage $333.38
Rate for Payer: Group Health Inc Commercial $158.75
Rate for Payer: Group Health Inc Medicare $111.12
Rate for Payer: Hamaspik Choice Inc Medicaid $158.75
Rate for Payer: Hamaspik Choice Inc Medicare $158.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $206.38
Service Code HCPCS C1776
Hospital Charge Code 40208165
Hospital Revenue Code 278
Min. Negotiated Rate $158.75
Max. Negotiated Rate $158.75
Rate for Payer: Hamaspik Choice Inc Medicaid $158.75
Rate for Payer: Hamaspik Choice Inc Medicare $158.75
Service Code MS-DRG 880
Min. Negotiated Rate $905.00
Max. Negotiated Rate $20,976.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,859.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $20,565.64
Rate for Payer: Aetna Government $20,565.64
Rate for Payer: Brighton Health Commercial $13,841.70
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $20,976.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16,484.99
Rate for Payer: Cigna LocalPlus Benefit Plan $13,604.12
Rate for Payer: Elderplan Medicare Advantage $19,537.36
Rate for Payer: EmblemHealth Commercial $905.00
Rate for Payer: Fidelis Medicare Advantage $20,565.64
Rate for Payer: Group Health Inc Commercial $20,565.64
Rate for Payer: Group Health Inc Medicare $20,565.64
Rate for Payer: Hamaspik Choice Inc Medicare $20,565.64
Rate for Payer: Healthfirst Medicare Advantage $9,563.02
Rate for Payer: Senior Whole Health Medicare Advantage $20,565.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $20,565.64
Rate for Payer: Wellcare Medicare $19,537.36
Service Code MS-DRG 289
Min. Negotiated Rate $12,671.30
Max. Negotiated Rate $28,376.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $21,788.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $27,819.68
Rate for Payer: Aetna Government $27,819.68
Rate for Payer: Brighton Health Commercial $21,426.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $28,376.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $25,518.40
Rate for Payer: Cigna LocalPlus Benefit Plan $21,058.88
Rate for Payer: Elderplan Medicare Advantage $26,428.70
Rate for Payer: EmblemHealth Commercial $12,671.30
Rate for Payer: Fidelis Medicare Advantage $27,819.68
Rate for Payer: Group Health Inc Commercial $27,819.68
Rate for Payer: Group Health Inc Medicare $27,819.68
Rate for Payer: Hamaspik Choice Inc Medicare $27,819.68
Rate for Payer: Healthfirst Medicare Advantage $12,936.15
Rate for Payer: Senior Whole Health Medicare Advantage $27,819.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $27,819.68
Rate for Payer: Wellcare Medicare $26,428.70
Service Code MS-DRG 288
Min. Negotiated Rate $20,127.98
Max. Negotiated Rate $44,778.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $38,233.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $43,285.97
Rate for Payer: Aetna Government $43,285.97
Rate for Payer: Brighton Health Commercial $37,598.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $44,151.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $44,778.52
Rate for Payer: Cigna LocalPlus Benefit Plan $36,953.15
Rate for Payer: Elderplan Medicare Advantage $41,121.67
Rate for Payer: EmblemHealth Commercial $22,235.00
Rate for Payer: Fidelis Medicare Advantage $43,285.97
Rate for Payer: Group Health Inc Commercial $43,285.97
Rate for Payer: Group Health Inc Medicare $43,285.97
Rate for Payer: Hamaspik Choice Inc Medicare $43,285.97
Rate for Payer: Healthfirst Medicare Advantage $20,127.98
Rate for Payer: Senior Whole Health Medicare Advantage $43,285.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $43,285.97
Rate for Payer: Wellcare Medicare $41,121.67