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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40205342
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $716.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $375.10
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 $341.00
Rate for Payer: Cigna LocalPlus Benefit Plan $392.15
Rate for Payer: Fidelis Medicare Advantage $716.10
Rate for Payer: Group Health Inc Commercial $341.00
Rate for Payer: Group Health Inc Medicare $238.70
Rate for Payer: Hamaspik Choice Inc Medicaid $341.00
Rate for Payer: Hamaspik Choice Inc Medicare $341.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $443.30
Service Code HCPCS C1713
Hospital Charge Code 40205399
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,011.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $529.76
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 $481.60
Rate for Payer: Cigna LocalPlus Benefit Plan $553.84
Rate for Payer: Fidelis Medicare Advantage $1,011.36
Rate for Payer: Group Health Inc Commercial $481.60
Rate for Payer: Group Health Inc Medicare $337.12
Rate for Payer: Hamaspik Choice Inc Medicaid $481.60
Rate for Payer: Hamaspik Choice Inc Medicare $481.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $626.08
Service Code HCPCS C1713
Hospital Charge Code 40205399
Hospital Revenue Code 278
Min. Negotiated Rate $481.60
Max. Negotiated Rate $481.60
Rate for Payer: Hamaspik Choice Inc Medicaid $481.60
Rate for Payer: Hamaspik Choice Inc Medicare $481.60
Service Code HCPCS C1713
Hospital Charge Code 40209949
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $962.50
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 $875.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,006.25
Rate for Payer: Fidelis Medicare Advantage $1,837.50
Rate for Payer: Group Health Inc Commercial $875.00
Rate for Payer: Group Health Inc Medicare $612.50
Rate for Payer: Hamaspik Choice Inc Medicaid $875.00
Rate for Payer: Hamaspik Choice Inc Medicare $875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,137.50
Service Code HCPCS C1713
Hospital Charge Code 40209949
Hospital Revenue Code 278
Min. Negotiated Rate $875.00
Max. Negotiated Rate $875.00
Rate for Payer: Hamaspik Choice Inc Medicaid $875.00
Rate for Payer: Hamaspik Choice Inc Medicare $875.00
Service Code HCPCS C1713
Hospital Charge Code 40208515
Hospital Revenue Code 278
Min. Negotiated Rate $464.45
Max. Negotiated Rate $464.45
Rate for Payer: Hamaspik Choice Inc Medicaid $464.45
Rate for Payer: Hamaspik Choice Inc Medicare $464.45
Service Code HCPCS C1713
Hospital Charge Code 40208515
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $975.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $510.90
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 $464.45
Rate for Payer: Cigna LocalPlus Benefit Plan $534.12
Rate for Payer: Fidelis Medicare Advantage $975.34
Rate for Payer: Group Health Inc Commercial $464.45
Rate for Payer: Group Health Inc Medicare $325.12
Rate for Payer: Hamaspik Choice Inc Medicaid $464.45
Rate for Payer: Hamaspik Choice Inc Medicare $464.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $603.78
Service Code HCPCS C1776
Hospital Charge Code 40200710
Hospital Revenue Code 278
Min. Negotiated Rate $122.50
Max. Negotiated Rate $367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $192.50
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 $175.00
Rate for Payer: Cigna LocalPlus Benefit Plan $201.25
Rate for Payer: Fidelis Medicare Advantage $367.50
Rate for Payer: Group Health Inc Commercial $175.00
Rate for Payer: Group Health Inc Medicare $122.50
Rate for Payer: Hamaspik Choice Inc Medicaid $175.00
Rate for Payer: Hamaspik Choice Inc Medicare $175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $227.50
Service Code HCPCS C1776
Hospital Charge Code 40200710
Hospital Revenue Code 278
Min. Negotiated Rate $175.00
Max. Negotiated Rate $175.00
Rate for Payer: Hamaspik Choice Inc Medicaid $175.00
Rate for Payer: Hamaspik Choice Inc Medicare $175.00
Hospital Charge Code 40208012
Hospital Revenue Code 270
Min. Negotiated Rate $270.55
Max. Negotiated Rate $618.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $425.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $386.50
Rate for Payer: Aetna Government $386.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $618.40
Rate for Payer: Cigna LocalPlus Benefit Plan $525.64
Rate for Payer: Group Health Inc Commercial $386.50
Rate for Payer: Group Health Inc Medicare $270.55
Rate for Payer: Hamaspik Choice Inc Medicaid $386.50
Rate for Payer: Hamaspik Choice Inc Medicare $386.50
Service Code HCPCS C1713
Hospital Charge Code 40206262
Hospital Revenue Code 278
Min. Negotiated Rate $1,697.50
Max. Negotiated Rate $1,697.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,697.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,697.50
Service Code HCPCS C1713
Hospital Charge Code 40206262
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,564.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,867.25
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 $1,697.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,952.12
Rate for Payer: Fidelis Medicare Advantage $3,564.75
Rate for Payer: Group Health Inc Commercial $1,697.50
Rate for Payer: Group Health Inc Medicare $1,188.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1,697.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,697.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,206.75
Service Code HCPCS C1713
Hospital Charge Code 40205628
Hospital Revenue Code 278
Min. Negotiated Rate $2,116.10
Max. Negotiated Rate $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Service Code HCPCS C1713
Hospital Charge Code 40205628
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,443.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,327.71
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 $2,116.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,433.52
Rate for Payer: Fidelis Medicare Advantage $4,443.81
Rate for Payer: Group Health Inc Commercial $2,116.10
Rate for Payer: Group Health Inc Medicare $1,481.27
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,750.93
Service Code HCPCS C1713
Hospital Charge Code 40205724
Hospital Revenue Code 278
Min. Negotiated Rate $2,116.10
Max. Negotiated Rate $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Service Code HCPCS C1713
Hospital Charge Code 40205724
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,443.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,327.71
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 $2,116.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,433.52
Rate for Payer: Fidelis Medicare Advantage $4,443.81
Rate for Payer: Group Health Inc Commercial $2,116.10
Rate for Payer: Group Health Inc Medicare $1,481.27
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,750.93
Service Code HCPCS C1713
Hospital Charge Code 40205781
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,443.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,327.60
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 $2,116.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,433.40
Rate for Payer: Fidelis Medicare Advantage $4,443.60
Rate for Payer: Group Health Inc Commercial $2,116.00
Rate for Payer: Group Health Inc Medicare $1,481.20
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,750.80
Service Code HCPCS C1713
Hospital Charge Code 40205781
Hospital Revenue Code 278
Min. Negotiated Rate $2,116.00
Max. Negotiated Rate $2,116.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.00
Service Code HCPCS C1713
Hospital Charge Code 40208175
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,656.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,391.39
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 $1,264.90
Rate for Payer: Cigna LocalPlus Benefit Plan $1,454.64
Rate for Payer: Fidelis Medicare Advantage $2,656.29
Rate for Payer: Group Health Inc Commercial $1,264.90
Rate for Payer: Group Health Inc Medicare $885.43
Rate for Payer: Hamaspik Choice Inc Medicaid $1,264.90
Rate for Payer: Hamaspik Choice Inc Medicare $1,264.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,644.37
Service Code HCPCS C1713
Hospital Charge Code 40208175
Hospital Revenue Code 278
Min. Negotiated Rate $1,264.90
Max. Negotiated Rate $1,264.90
Rate for Payer: Hamaspik Choice Inc Medicaid $1,264.90
Rate for Payer: Hamaspik Choice Inc Medicare $1,264.90
Service Code HCPCS C1713
Hospital Charge Code 40205668
Hospital Revenue Code 278
Min. Negotiated Rate $2,116.10
Max. Negotiated Rate $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Service Code HCPCS C1713
Hospital Charge Code 40205668
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,443.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,327.71
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 $2,116.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,433.52
Rate for Payer: Fidelis Medicare Advantage $4,443.81
Rate for Payer: Group Health Inc Commercial $2,116.10
Rate for Payer: Group Health Inc Medicare $1,481.27
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,750.93
Service Code HCPCS C1713
Hospital Charge Code 40205727
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,443.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,327.71
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 $2,116.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,433.52
Rate for Payer: Fidelis Medicare Advantage $4,443.81
Rate for Payer: Group Health Inc Commercial $2,116.10
Rate for Payer: Group Health Inc Medicare $1,481.27
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,750.93
Service Code HCPCS C1713
Hospital Charge Code 40205727
Hospital Revenue Code 278
Min. Negotiated Rate $2,116.10
Max. Negotiated Rate $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicaid $2,116.10
Rate for Payer: Hamaspik Choice Inc Medicare $2,116.10
Service Code HCPCS C1713
Hospital Charge Code 40205790
Hospital Revenue Code 278
Min. Negotiated Rate $2,264.50
Max. Negotiated Rate $2,264.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,264.50
Rate for Payer: Hamaspik Choice Inc Medicare $2,264.50