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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 64903975
Hospital Revenue Code 278
Min. Negotiated Rate $1,920.00
Max. Negotiated Rate $1,920.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,920.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,920.00
Service Code HCPCS C1776
Hospital Charge Code 64907168
Hospital Revenue Code 278
Min. Negotiated Rate $4,225.00
Max. Negotiated Rate $4,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,225.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,225.00
Service Code HCPCS C1776
Hospital Charge Code 64907168
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $8,872.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,647.50
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 $4,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,858.75
Rate for Payer: Fidelis Medicare Advantage $8,872.50
Rate for Payer: Group Health Inc Commercial $4,225.00
Rate for Payer: Group Health Inc Medicare $2,957.50
Rate for Payer: Hamaspik Choice Inc Medicaid $4,225.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,492.50
Service Code HCPCS C1713
Hospital Charge Code 64905300
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $7,948.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,163.50
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 $3,785.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,352.75
Rate for Payer: Fidelis Medicare Advantage $7,948.50
Rate for Payer: Group Health Inc Commercial $3,785.00
Rate for Payer: Group Health Inc Medicare $2,649.50
Rate for Payer: Hamaspik Choice Inc Medicaid $3,785.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,785.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,920.50
Service Code HCPCS C1713
Hospital Charge Code 64905300
Hospital Revenue Code 278
Min. Negotiated Rate $3,785.00
Max. Negotiated Rate $3,785.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,785.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,785.00
Service Code HCPCS C1713
Hospital Charge Code 64905298
Hospital Revenue Code 278
Min. Negotiated Rate $2,301.25
Max. Negotiated Rate $2,301.25
Rate for Payer: Hamaspik Choice Inc Medicaid $2,301.25
Rate for Payer: Hamaspik Choice Inc Medicare $2,301.25
Service Code HCPCS C1713
Hospital Charge Code 64905298
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,832.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,531.38
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 $2,301.25
Rate for Payer: Cigna LocalPlus Benefit Plan $2,646.44
Rate for Payer: Fidelis Medicare Advantage $4,832.62
Rate for Payer: Group Health Inc Commercial $2,301.25
Rate for Payer: Group Health Inc Medicare $1,610.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,301.25
Rate for Payer: Hamaspik Choice Inc Medicare $2,301.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,991.62
Service Code HCPCS C1776
Hospital Charge Code 64903546
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $16,466.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8,625.17
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 $7,841.06
Rate for Payer: Cigna LocalPlus Benefit Plan $9,017.22
Rate for Payer: Fidelis Medicare Advantage $16,466.24
Rate for Payer: Group Health Inc Commercial $7,841.06
Rate for Payer: Group Health Inc Medicare $5,488.75
Rate for Payer: Hamaspik Choice Inc Medicaid $7,841.06
Rate for Payer: Hamaspik Choice Inc Medicare $7,841.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $10,193.38
Service Code HCPCS C1776
Hospital Charge Code 64903546
Hospital Revenue Code 278
Min. Negotiated Rate $7,841.06
Max. Negotiated Rate $7,841.06
Rate for Payer: Hamaspik Choice Inc Medicaid $7,841.06
Rate for Payer: Hamaspik Choice Inc Medicare $7,841.06
Service Code HCPCS C1776
Hospital Charge Code 64906413
Hospital Revenue Code 278
Min. Negotiated Rate $2,912.00
Max. Negotiated Rate $2,912.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,912.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,912.00
Service Code HCPCS C1776
Hospital Charge Code 64906413
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,115.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,203.20
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 $2,912.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,348.80
Rate for Payer: Fidelis Medicare Advantage $6,115.20
Rate for Payer: Group Health Inc Commercial $2,912.00
Rate for Payer: Group Health Inc Medicare $2,038.40
Rate for Payer: Hamaspik Choice Inc Medicaid $2,912.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,912.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,785.60
Service Code HCPCS C1776
Hospital Charge Code 64901784
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $17,116.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8,965.69
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 $8,150.62
Rate for Payer: Cigna LocalPlus Benefit Plan $9,373.22
Rate for Payer: Fidelis Medicare Advantage $17,116.31
Rate for Payer: Group Health Inc Commercial $8,150.62
Rate for Payer: Group Health Inc Medicare $5,705.44
Rate for Payer: Hamaspik Choice Inc Medicaid $8,150.62
Rate for Payer: Hamaspik Choice Inc Medicare $8,150.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $10,595.81
Service Code HCPCS C1776
Hospital Charge Code 64901784
Hospital Revenue Code 278
Min. Negotiated Rate $8,150.62
Max. Negotiated Rate $8,150.62
Rate for Payer: Hamaspik Choice Inc Medicaid $8,150.62
Rate for Payer: Hamaspik Choice Inc Medicare $8,150.62
Service Code HCPCS C1776
Hospital Charge Code 64906972
Hospital Revenue Code 278
Min. Negotiated Rate $4,250.00
Max. Negotiated Rate $4,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,250.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,250.00
Service Code HCPCS C1776
Hospital Charge Code 64906972
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $8,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,675.00
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 $4,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan $4,887.50
Rate for Payer: Fidelis Medicare Advantage $8,925.00
Rate for Payer: Group Health Inc Commercial $4,250.00
Rate for Payer: Group Health Inc Medicare $2,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,250.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,525.00
Service Code HCPCS C1776
Hospital Charge Code 64905740
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $17,971.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial $9,413.66
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 $8,557.88
Rate for Payer: Cigna LocalPlus Benefit Plan $9,841.56
Rate for Payer: Fidelis Medicare Advantage $17,971.54
Rate for Payer: Group Health Inc Commercial $8,557.88
Rate for Payer: Group Health Inc Medicare $5,990.51
Rate for Payer: Hamaspik Choice Inc Medicaid $8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare $8,557.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $11,125.24
Service Code HCPCS C1776
Hospital Charge Code 64905740
Hospital Revenue Code 278
Min. Negotiated Rate $8,557.88
Max. Negotiated Rate $8,557.88
Rate for Payer: Hamaspik Choice Inc Medicaid $8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare $8,557.88
Service Code HCPCS C1713
Hospital Charge Code 64903640
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $10,499.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,499.59
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 $4,999.62
Rate for Payer: Cigna LocalPlus Benefit Plan $5,749.57
Rate for Payer: Fidelis Medicare Advantage $10,499.21
Rate for Payer: Group Health Inc Commercial $4,999.62
Rate for Payer: Group Health Inc Medicare $3,499.74
Rate for Payer: Hamaspik Choice Inc Medicaid $4,999.62
Rate for Payer: Hamaspik Choice Inc Medicare $4,999.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,499.51
Service Code HCPCS C1713
Hospital Charge Code 64903640
Hospital Revenue Code 278
Min. Negotiated Rate $4,999.62
Max. Negotiated Rate $4,999.62
Rate for Payer: Hamaspik Choice Inc Medicaid $4,999.62
Rate for Payer: Hamaspik Choice Inc Medicare $4,999.62
Service Code HCPCS C1776
Hospital Charge Code 64906408
Hospital Revenue Code 278
Min. Negotiated Rate $2,334.00
Max. Negotiated Rate $2,334.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,334.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,334.00
Service Code HCPCS C1776
Hospital Charge Code 64906408
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,901.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,567.40
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 $2,334.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,684.10
Rate for Payer: Fidelis Medicare Advantage $4,901.40
Rate for Payer: Group Health Inc Commercial $2,334.00
Rate for Payer: Group Health Inc Medicare $1,633.80
Rate for Payer: Hamaspik Choice Inc Medicaid $2,334.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,034.20
Service Code HCPCS C1713
Hospital Charge Code 64905888
Hospital Revenue Code 278
Min. Negotiated Rate $2,230.00
Max. Negotiated Rate $2,230.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,230.00
Service Code HCPCS C1713
Hospital Charge Code 64905888
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,683.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,453.00
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 $2,230.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,564.50
Rate for Payer: Fidelis Medicare Advantage $4,683.00
Rate for Payer: Group Health Inc Commercial $2,230.00
Rate for Payer: Group Health Inc Medicare $1,561.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,899.00
Hospital Charge Code 64906707
Hospital Revenue Code 279
Min. Negotiated Rate $3,483.20
Max. Negotiated Rate $7,961.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,473.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,976.00
Rate for Payer: Aetna Government $4,976.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $7,961.60
Rate for Payer: Cigna LocalPlus Benefit Plan $6,767.36
Rate for Payer: Group Health Inc Commercial $4,976.00
Rate for Payer: Group Health Inc Medicare $3,483.20
Rate for Payer: Hamaspik Choice Inc Medicaid $4,976.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,976.00
Service Code HCPCS C1776
Hospital Charge Code 64907130
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $13,062.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6,842.00
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 $6,220.00
Rate for Payer: Cigna LocalPlus Benefit Plan $7,153.00
Rate for Payer: Fidelis Medicare Advantage $13,062.00
Rate for Payer: Group Health Inc Commercial $6,220.00
Rate for Payer: Group Health Inc Medicare $4,354.00
Rate for Payer: Hamaspik Choice Inc Medicaid $6,220.00
Rate for Payer: Hamaspik Choice Inc Medicare $6,220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8,086.00