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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40205366
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $627.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial $328.79
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 $298.90
Rate for Payer: Cigna LocalPlus Benefit Plan $343.74
Rate for Payer: Fidelis Medicare Advantage $627.69
Rate for Payer: Group Health Inc Commercial $298.90
Rate for Payer: Group Health Inc Medicare $209.23
Rate for Payer: Hamaspik Choice Inc Medicaid $298.90
Rate for Payer: Hamaspik Choice Inc Medicare $298.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $388.57
Service Code HCPCS C1713
Hospital Charge Code 40205366
Hospital Revenue Code 278
Min. Negotiated Rate $298.90
Max. Negotiated Rate $298.90
Rate for Payer: Hamaspik Choice Inc Medicaid $298.90
Rate for Payer: Hamaspik Choice Inc Medicare $298.90
Service Code HCPCS C1776
Hospital Charge Code 40208146
Hospital Revenue Code 278
Min. Negotiated Rate $58.10
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $91.30
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 $83.00
Rate for Payer: Cigna LocalPlus Benefit Plan $95.45
Rate for Payer: Fidelis Medicare Advantage $174.30
Rate for Payer: Group Health Inc Commercial $83.00
Rate for Payer: Group Health Inc Medicare $58.10
Rate for Payer: Hamaspik Choice Inc Medicaid $83.00
Rate for Payer: Hamaspik Choice Inc Medicare $83.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $107.90
Service Code HCPCS C1776
Hospital Charge Code 40208146
Hospital Revenue Code 278
Min. Negotiated Rate $83.00
Max. Negotiated Rate $83.00
Rate for Payer: Hamaspik Choice Inc Medicaid $83.00
Rate for Payer: Hamaspik Choice Inc Medicare $83.00
Service Code HCPCS C1713
Hospital Charge Code 40205144
Hospital Revenue Code 278
Min. Negotiated Rate $104.50
Max. Negotiated Rate $104.50
Rate for Payer: Hamaspik Choice Inc Medicaid $104.50
Rate for Payer: Hamaspik Choice Inc Medicare $104.50
Service Code HCPCS C1713
Hospital Charge Code 40205144
Hospital Revenue Code 278
Min. Negotiated Rate $73.15
Max. Negotiated Rate $219.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial $114.95
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 $104.50
Rate for Payer: Cigna LocalPlus Benefit Plan $120.18
Rate for Payer: Fidelis Medicare Advantage $219.45
Rate for Payer: Group Health Inc Commercial $104.50
Rate for Payer: Group Health Inc Medicare $73.15
Rate for Payer: Hamaspik Choice Inc Medicaid $104.50
Rate for Payer: Hamaspik Choice Inc Medicare $104.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $135.85
Service Code HCPCS C1776
Hospital Charge Code 40205254
Hospital Revenue Code 278
Min. Negotiated Rate $31.50
Max. Negotiated Rate $31.50
Rate for Payer: Hamaspik Choice Inc Medicaid $31.50
Rate for Payer: Hamaspik Choice Inc Medicare $31.50
Service Code HCPCS C1776
Hospital Charge Code 40205254
Hospital Revenue Code 278
Min. Negotiated Rate $22.05
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $34.65
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 $31.50
Rate for Payer: Cigna LocalPlus Benefit Plan $36.22
Rate for Payer: Fidelis Medicare Advantage $66.15
Rate for Payer: Group Health Inc Commercial $31.50
Rate for Payer: Group Health Inc Medicare $22.05
Rate for Payer: Hamaspik Choice Inc Medicaid $31.50
Rate for Payer: Hamaspik Choice Inc Medicare $31.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $40.95
Service Code HCPCS C1776
Hospital Charge Code 40208147
Hospital Revenue Code 278
Min. Negotiated Rate $38.00
Max. Negotiated Rate $38.00
Rate for Payer: Hamaspik Choice Inc Medicaid $38.00
Rate for Payer: Hamaspik Choice Inc Medicare $38.00
Service Code HCPCS C1776
Hospital Charge Code 40208147
Hospital Revenue Code 278
Min. Negotiated Rate $26.60
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $41.80
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 $38.00
Rate for Payer: Cigna LocalPlus Benefit Plan $43.70
Rate for Payer: Fidelis Medicare Advantage $79.80
Rate for Payer: Group Health Inc Commercial $38.00
Rate for Payer: Group Health Inc Medicare $26.60
Rate for Payer: Hamaspik Choice Inc Medicaid $38.00
Rate for Payer: Hamaspik Choice Inc Medicare $38.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $49.40
Service Code HCPCS C1713
Hospital Charge Code 40005356
Hospital Revenue Code 278
Min. Negotiated Rate $280.00
Max. Negotiated Rate $280.00
Rate for Payer: Hamaspik Choice Inc Medicaid $280.00
Rate for Payer: Hamaspik Choice Inc Medicare $280.00
Service Code HCPCS C1713
Hospital Charge Code 40005356
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $588.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $308.00
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 $280.00
Rate for Payer: Cigna LocalPlus Benefit Plan $322.00
Rate for Payer: Fidelis Medicare Advantage $588.00
Rate for Payer: Group Health Inc Commercial $280.00
Rate for Payer: Group Health Inc Medicare $196.00
Rate for Payer: Hamaspik Choice Inc Medicaid $280.00
Rate for Payer: Hamaspik Choice Inc Medicare $280.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $364.00
Service Code HCPCS C1713
Hospital Charge Code 40209940
Hospital Revenue Code 278
Min. Negotiated Rate $999.60
Max. Negotiated Rate $999.60
Rate for Payer: Hamaspik Choice Inc Medicaid $999.60
Rate for Payer: Hamaspik Choice Inc Medicare $999.60
Service Code HCPCS C1713
Hospital Charge Code 40209940
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,099.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,099.56
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 $999.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,149.54
Rate for Payer: Fidelis Medicare Advantage $2,099.16
Rate for Payer: Group Health Inc Commercial $999.60
Rate for Payer: Group Health Inc Medicare $699.72
Rate for Payer: Hamaspik Choice Inc Medicaid $999.60
Rate for Payer: Hamaspik Choice Inc Medicare $999.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,299.48
Service Code HCPCS C1713
Hospital Charge Code 40029596
Hospital Revenue Code 278
Min. Negotiated Rate $80.00
Max. Negotiated Rate $80.00
Rate for Payer: Hamaspik Choice Inc Medicaid $80.00
Rate for Payer: Hamaspik Choice Inc Medicare $80.00
Service Code HCPCS C1713
Hospital Charge Code 40029596
Hospital Revenue Code 278
Min. Negotiated Rate $56.00
Max. Negotiated Rate $168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $88.00
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 $80.00
Rate for Payer: Cigna LocalPlus Benefit Plan $92.00
Rate for Payer: Fidelis Medicare Advantage $168.00
Rate for Payer: Group Health Inc Commercial $80.00
Rate for Payer: Group Health Inc Medicare $56.00
Rate for Payer: Hamaspik Choice Inc Medicaid $80.00
Rate for Payer: Hamaspik Choice Inc Medicare $80.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $104.00
Service Code HCPCS C1713
Hospital Charge Code 40209612
Hospital Revenue Code 278
Min. Negotiated Rate $114.56
Max. Negotiated Rate $114.56
Rate for Payer: Hamaspik Choice Inc Medicaid $114.56
Rate for Payer: Hamaspik Choice Inc Medicare $114.56
Service Code HCPCS C1713
Hospital Charge Code 40209612
Hospital Revenue Code 278
Min. Negotiated Rate $80.20
Max. Negotiated Rate $240.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial $126.02
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 $114.56
Rate for Payer: Cigna LocalPlus Benefit Plan $131.75
Rate for Payer: Fidelis Medicare Advantage $240.59
Rate for Payer: Group Health Inc Commercial $114.56
Rate for Payer: Group Health Inc Medicare $80.20
Rate for Payer: Hamaspik Choice Inc Medicaid $114.56
Rate for Payer: Hamaspik Choice Inc Medicare $114.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $148.93
Service Code HCPCS C1776
Hospital Charge Code 40205249
Hospital Revenue Code 278
Min. Negotiated Rate $47.60
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $74.80
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 $68.00
Rate for Payer: Cigna LocalPlus Benefit Plan $78.20
Rate for Payer: Fidelis Medicare Advantage $142.80
Rate for Payer: Group Health Inc Commercial $68.00
Rate for Payer: Group Health Inc Medicare $47.60
Rate for Payer: Hamaspik Choice Inc Medicaid $68.00
Rate for Payer: Hamaspik Choice Inc Medicare $68.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $88.40
Service Code HCPCS C1776
Hospital Charge Code 40205249
Hospital Revenue Code 278
Min. Negotiated Rate $68.00
Max. Negotiated Rate $68.00
Rate for Payer: Hamaspik Choice Inc Medicaid $68.00
Rate for Payer: Hamaspik Choice Inc Medicare $68.00
Service Code HCPCS C1776
Hospital Charge Code 40205250
Hospital Revenue Code 278
Min. Negotiated Rate $56.84
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $89.32
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 $81.20
Rate for Payer: Cigna LocalPlus Benefit Plan $93.38
Rate for Payer: Fidelis Medicare Advantage $170.52
Rate for Payer: Group Health Inc Commercial $81.20
Rate for Payer: Group Health Inc Medicare $56.84
Rate for Payer: Hamaspik Choice Inc Medicaid $81.20
Rate for Payer: Hamaspik Choice Inc Medicare $81.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $105.56
Service Code HCPCS C1776
Hospital Charge Code 40205250
Hospital Revenue Code 278
Min. Negotiated Rate $81.20
Max. Negotiated Rate $81.20
Rate for Payer: Hamaspik Choice Inc Medicaid $81.20
Rate for Payer: Hamaspik Choice Inc Medicare $81.20
Service Code HCPCS C1713
Hospital Charge Code 40205251
Hospital Revenue Code 278
Min. Negotiated Rate $41.16
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $64.68
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 $58.80
Rate for Payer: Cigna LocalPlus Benefit Plan $67.62
Rate for Payer: Fidelis Medicare Advantage $123.48
Rate for Payer: Group Health Inc Commercial $58.80
Rate for Payer: Group Health Inc Medicare $41.16
Rate for Payer: Hamaspik Choice Inc Medicaid $58.80
Rate for Payer: Hamaspik Choice Inc Medicare $58.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $76.44
Service Code HCPCS C1713
Hospital Charge Code 40205251
Hospital Revenue Code 278
Min. Negotiated Rate $58.80
Max. Negotiated Rate $58.80
Rate for Payer: Hamaspik Choice Inc Medicaid $58.80
Rate for Payer: Hamaspik Choice Inc Medicare $58.80
Service Code HCPCS C1776
Hospital Charge Code 40205252
Hospital Revenue Code 278
Min. Negotiated Rate $62.30
Max. Negotiated Rate $62.30
Rate for Payer: Hamaspik Choice Inc Medicaid $62.30
Rate for Payer: Hamaspik Choice Inc Medicare $62.30