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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40205521
Hospital Revenue Code 278
Min. Negotiated Rate $36.75
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $57.75
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 $52.50
Rate for Payer: Cigna LocalPlus Benefit Plan $60.38
Rate for Payer: Fidelis Medicare Advantage $110.25
Rate for Payer: Group Health Inc Commercial $52.50
Rate for Payer: Group Health Inc Medicare $36.75
Rate for Payer: Hamaspik Choice Inc Medicaid $52.50
Rate for Payer: Hamaspik Choice Inc Medicare $52.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $68.25
Service Code HCPCS C1713
Hospital Charge Code 40205521
Hospital Revenue Code 278
Min. Negotiated Rate $52.50
Max. Negotiated Rate $52.50
Rate for Payer: Hamaspik Choice Inc Medicaid $52.50
Rate for Payer: Hamaspik Choice Inc Medicare $52.50
Service Code HCPCS C1713
Hospital Charge Code 40205473
Hospital Revenue Code 278
Min. Negotiated Rate $54.60
Max. Negotiated Rate $54.60
Rate for Payer: Hamaspik Choice Inc Medicaid $54.60
Rate for Payer: Hamaspik Choice Inc Medicare $54.60
Service Code HCPCS C1713
Hospital Charge Code 40205473
Hospital Revenue Code 278
Min. Negotiated Rate $38.22
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $60.06
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 $54.60
Rate for Payer: Cigna LocalPlus Benefit Plan $62.79
Rate for Payer: Fidelis Medicare Advantage $114.66
Rate for Payer: Group Health Inc Commercial $54.60
Rate for Payer: Group Health Inc Medicare $38.22
Rate for Payer: Hamaspik Choice Inc Medicaid $54.60
Rate for Payer: Hamaspik Choice Inc Medicare $54.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $70.98
Service Code HCPCS C1713
Hospital Charge Code 40205474
Hospital Revenue Code 278
Min. Negotiated Rate $40.18
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $63.14
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 $57.40
Rate for Payer: Cigna LocalPlus Benefit Plan $66.01
Rate for Payer: Fidelis Medicare Advantage $120.54
Rate for Payer: Group Health Inc Commercial $57.40
Rate for Payer: Group Health Inc Medicare $40.18
Rate for Payer: Hamaspik Choice Inc Medicaid $57.40
Rate for Payer: Hamaspik Choice Inc Medicare $57.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $74.62
Service Code HCPCS C1713
Hospital Charge Code 40205474
Hospital Revenue Code 278
Min. Negotiated Rate $57.40
Max. Negotiated Rate $57.40
Rate for Payer: Hamaspik Choice Inc Medicaid $57.40
Rate for Payer: Hamaspik Choice Inc Medicare $57.40
Service Code HCPCS C1713
Hospital Charge Code 40205520
Hospital Revenue Code 278
Min. Negotiated Rate $57.40
Max. Negotiated Rate $57.40
Rate for Payer: Hamaspik Choice Inc Medicaid $57.40
Rate for Payer: Hamaspik Choice Inc Medicare $57.40
Service Code HCPCS C1713
Hospital Charge Code 40205520
Hospital Revenue Code 278
Min. Negotiated Rate $40.18
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $63.14
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 $57.40
Rate for Payer: Cigna LocalPlus Benefit Plan $66.01
Rate for Payer: Fidelis Medicare Advantage $120.54
Rate for Payer: Group Health Inc Commercial $57.40
Rate for Payer: Group Health Inc Medicare $40.18
Rate for Payer: Hamaspik Choice Inc Medicaid $57.40
Rate for Payer: Hamaspik Choice Inc Medicare $57.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $74.62
Service Code HCPCS C1713
Hospital Charge Code 40205333
Hospital Revenue Code 278
Min. Negotiated Rate $100.00
Max. Negotiated Rate $100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $100.00
Rate for Payer: Hamaspik Choice Inc Medicare $100.00
Service Code HCPCS C1713
Hospital Charge Code 40205333
Hospital Revenue Code 278
Min. Negotiated Rate $70.00
Max. Negotiated Rate $210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $110.00
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 $100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $115.00
Rate for Payer: Fidelis Medicare Advantage $210.00
Rate for Payer: Group Health Inc Commercial $100.00
Rate for Payer: Group Health Inc Medicare $70.00
Rate for Payer: Hamaspik Choice Inc Medicaid $100.00
Rate for Payer: Hamaspik Choice Inc Medicare $100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $130.00
Service Code HCPCS C1713
Hospital Charge Code 40205777
Hospital Revenue Code 278
Min. Negotiated Rate $130.20
Max. Negotiated Rate $130.20
Rate for Payer: Hamaspik Choice Inc Medicaid $130.20
Rate for Payer: Hamaspik Choice Inc Medicare $130.20
Service Code HCPCS C1713
Hospital Charge Code 40205777
Hospital Revenue Code 278
Min. Negotiated Rate $91.14
Max. Negotiated Rate $273.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $143.22
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 $130.20
Rate for Payer: Cigna LocalPlus Benefit Plan $149.73
Rate for Payer: Fidelis Medicare Advantage $273.42
Rate for Payer: Group Health Inc Commercial $130.20
Rate for Payer: Group Health Inc Medicare $91.14
Rate for Payer: Hamaspik Choice Inc Medicaid $130.20
Rate for Payer: Hamaspik Choice Inc Medicare $130.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $169.26
Service Code HCPCS C1713
Hospital Charge Code 40204461
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $453.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $237.54
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 $215.95
Rate for Payer: Cigna LocalPlus Benefit Plan $248.34
Rate for Payer: Fidelis Medicare Advantage $453.50
Rate for Payer: Group Health Inc Commercial $215.95
Rate for Payer: Group Health Inc Medicare $151.16
Rate for Payer: Hamaspik Choice Inc Medicaid $215.95
Rate for Payer: Hamaspik Choice Inc Medicare $215.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $280.74
Service Code HCPCS C1713
Hospital Charge Code 40204461
Hospital Revenue Code 278
Min. Negotiated Rate $215.95
Max. Negotiated Rate $215.95
Rate for Payer: Hamaspik Choice Inc Medicaid $215.95
Rate for Payer: Hamaspik Choice Inc Medicare $215.95
Service Code HCPCS C1713
Hospital Charge Code 40204462
Hospital Revenue Code 278
Min. Negotiated Rate $237.14
Max. Negotiated Rate $237.14
Rate for Payer: Hamaspik Choice Inc Medicaid $237.14
Rate for Payer: Hamaspik Choice Inc Medicare $237.14
Service Code HCPCS C1713
Hospital Charge Code 40204462
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $497.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial $260.85
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 $237.14
Rate for Payer: Cigna LocalPlus Benefit Plan $272.71
Rate for Payer: Fidelis Medicare Advantage $497.99
Rate for Payer: Group Health Inc Commercial $237.14
Rate for Payer: Group Health Inc Medicare $166.00
Rate for Payer: Hamaspik Choice Inc Medicaid $237.14
Rate for Payer: Hamaspik Choice Inc Medicare $237.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $308.28
Service Code HCPCS C1713
Hospital Charge Code 40209983
Hospital Revenue Code 278
Min. Negotiated Rate $12.25
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $19.25
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 $17.50
Rate for Payer: Cigna LocalPlus Benefit Plan $20.12
Rate for Payer: Fidelis Medicare Advantage $36.75
Rate for Payer: Group Health Inc Commercial $17.50
Rate for Payer: Group Health Inc Medicare $12.25
Rate for Payer: Hamaspik Choice Inc Medicaid $17.50
Rate for Payer: Hamaspik Choice Inc Medicare $17.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $22.75
Service Code HCPCS C1713
Hospital Charge Code 40209983
Hospital Revenue Code 278
Min. Negotiated Rate $17.50
Max. Negotiated Rate $17.50
Rate for Payer: Hamaspik Choice Inc Medicaid $17.50
Rate for Payer: Hamaspik Choice Inc Medicare $17.50
Service Code HCPCS C1713
Hospital Charge Code 40207453
Hospital Revenue Code 278
Min. Negotiated Rate $90.00
Max. Negotiated Rate $90.00
Rate for Payer: Hamaspik Choice Inc Medicaid $90.00
Rate for Payer: Hamaspik Choice Inc Medicare $90.00
Service Code HCPCS C1713
Hospital Charge Code 40207453
Hospital Revenue Code 278
Min. Negotiated Rate $63.00
Max. Negotiated Rate $189.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $99.00
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 $90.00
Rate for Payer: Cigna LocalPlus Benefit Plan $103.50
Rate for Payer: Fidelis Medicare Advantage $189.00
Rate for Payer: Group Health Inc Commercial $90.00
Rate for Payer: Group Health Inc Medicare $63.00
Rate for Payer: Hamaspik Choice Inc Medicaid $90.00
Rate for Payer: Hamaspik Choice Inc Medicare $90.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $117.00
Service Code HCPCS C1713
Hospital Charge Code 40205584
Hospital Revenue Code 278
Min. Negotiated Rate $128.38
Max. Negotiated Rate $385.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $201.74
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 $183.40
Rate for Payer: Cigna LocalPlus Benefit Plan $210.91
Rate for Payer: Fidelis Medicare Advantage $385.14
Rate for Payer: Group Health Inc Commercial $183.40
Rate for Payer: Group Health Inc Medicare $128.38
Rate for Payer: Hamaspik Choice Inc Medicaid $183.40
Rate for Payer: Hamaspik Choice Inc Medicare $183.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $238.42
Service Code HCPCS C1713
Hospital Charge Code 40205584
Hospital Revenue Code 278
Min. Negotiated Rate $183.40
Max. Negotiated Rate $183.40
Rate for Payer: Hamaspik Choice Inc Medicaid $183.40
Rate for Payer: Hamaspik Choice Inc Medicare $183.40
Service Code HCPCS C1713
Hospital Charge Code 40205373
Hospital Revenue Code 278
Min. Negotiated Rate $357.00
Max. Negotiated Rate $357.00
Rate for Payer: Hamaspik Choice Inc Medicaid $357.00
Rate for Payer: Hamaspik Choice Inc Medicare $357.00
Service Code HCPCS C1713
Hospital Charge Code 40205373
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $749.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $392.70
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 $357.00
Rate for Payer: Cigna LocalPlus Benefit Plan $410.55
Rate for Payer: Fidelis Medicare Advantage $749.70
Rate for Payer: Group Health Inc Commercial $357.00
Rate for Payer: Group Health Inc Medicare $249.90
Rate for Payer: Hamaspik Choice Inc Medicaid $357.00
Rate for Payer: Hamaspik Choice Inc Medicare $357.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $464.10
Service Code HCPCS C1713
Hospital Charge Code 40205403
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $636.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $333.41
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 $303.10
Rate for Payer: Cigna LocalPlus Benefit Plan $348.56
Rate for Payer: Fidelis Medicare Advantage $636.51
Rate for Payer: Group Health Inc Commercial $303.10
Rate for Payer: Group Health Inc Medicare $212.17
Rate for Payer: Hamaspik Choice Inc Medicaid $303.10
Rate for Payer: Hamaspik Choice Inc Medicare $303.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $394.03