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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40206226
Hospital Revenue Code 278
Min. Negotiated Rate $61.25
Max. Negotiated Rate $183.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $96.25
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 $87.50
Rate for Payer: Cigna LocalPlus Benefit Plan $100.62
Rate for Payer: Fidelis Medicare Advantage $183.75
Rate for Payer: Group Health Inc Commercial $87.50
Rate for Payer: Group Health Inc Medicare $61.25
Rate for Payer: Hamaspik Choice Inc Medicaid $87.50
Rate for Payer: Hamaspik Choice Inc Medicare $87.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $113.75
Service Code HCPCS C1713
Hospital Charge Code 40206226
Hospital Revenue Code 278
Min. Negotiated Rate $87.50
Max. Negotiated Rate $87.50
Rate for Payer: Hamaspik Choice Inc Medicaid $87.50
Rate for Payer: Hamaspik Choice Inc Medicare $87.50
Service Code HCPCS C1713
Hospital Charge Code 40205747
Hospital Revenue Code 278
Min. Negotiated Rate $113.68
Max. Negotiated Rate $341.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $178.64
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 $162.40
Rate for Payer: Cigna LocalPlus Benefit Plan $186.76
Rate for Payer: Fidelis Medicare Advantage $341.04
Rate for Payer: Group Health Inc Commercial $162.40
Rate for Payer: Group Health Inc Medicare $113.68
Rate for Payer: Hamaspik Choice Inc Medicaid $162.40
Rate for Payer: Hamaspik Choice Inc Medicare $162.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $211.12
Service Code HCPCS C1713
Hospital Charge Code 40205747
Hospital Revenue Code 278
Min. Negotiated Rate $162.40
Max. Negotiated Rate $162.40
Rate for Payer: Hamaspik Choice Inc Medicaid $162.40
Rate for Payer: Hamaspik Choice Inc Medicare $162.40
Service Code HCPCS C1776
Hospital Charge Code 40205148
Hospital Revenue Code 278
Min. Negotiated Rate $138.60
Max. Negotiated Rate $138.60
Rate for Payer: Hamaspik Choice Inc Medicaid $138.60
Rate for Payer: Hamaspik Choice Inc Medicare $138.60
Service Code HCPCS C1776
Hospital Charge Code 40205148
Hospital Revenue Code 278
Min. Negotiated Rate $97.02
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $152.46
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 $138.60
Rate for Payer: Cigna LocalPlus Benefit Plan $159.39
Rate for Payer: Fidelis Medicare Advantage $291.06
Rate for Payer: Group Health Inc Commercial $138.60
Rate for Payer: Group Health Inc Medicare $97.02
Rate for Payer: Hamaspik Choice Inc Medicaid $138.60
Rate for Payer: Hamaspik Choice Inc Medicare $138.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $180.18
Service Code HCPCS C1713
Hospital Charge Code 40205465
Hospital Revenue Code 278
Min. Negotiated Rate $97.02
Max. Negotiated Rate $291.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $152.46
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 $138.60
Rate for Payer: Cigna LocalPlus Benefit Plan $159.39
Rate for Payer: Fidelis Medicare Advantage $291.06
Rate for Payer: Group Health Inc Commercial $138.60
Rate for Payer: Group Health Inc Medicare $97.02
Rate for Payer: Hamaspik Choice Inc Medicaid $138.60
Rate for Payer: Hamaspik Choice Inc Medicare $138.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $180.18
Service Code HCPCS C1713
Hospital Charge Code 40205465
Hospital Revenue Code 278
Min. Negotiated Rate $138.60
Max. Negotiated Rate $138.60
Rate for Payer: Hamaspik Choice Inc Medicaid $138.60
Rate for Payer: Hamaspik Choice Inc Medicare $138.60
Service Code HCPCS C1713
Hospital Charge Code 40205273
Hospital Revenue Code 278
Min. Negotiated Rate $101.50
Max. Negotiated Rate $101.50
Rate for Payer: Hamaspik Choice Inc Medicaid $101.50
Rate for Payer: Hamaspik Choice Inc Medicare $101.50
Service Code HCPCS C1713
Hospital Charge Code 40207036
Hospital Revenue Code 278
Min. Negotiated Rate $65.10
Max. Negotiated Rate $195.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $102.30
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 $93.00
Rate for Payer: Cigna LocalPlus Benefit Plan $106.95
Rate for Payer: Fidelis Medicare Advantage $195.30
Rate for Payer: Group Health Inc Commercial $93.00
Rate for Payer: Group Health Inc Medicare $65.10
Rate for Payer: Hamaspik Choice Inc Medicaid $93.00
Rate for Payer: Hamaspik Choice Inc Medicare $93.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $120.90
Service Code HCPCS C1713
Hospital Charge Code 40205273
Hospital Revenue Code 278
Min. Negotiated Rate $71.05
Max. Negotiated Rate $213.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $111.65
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 $101.50
Rate for Payer: Cigna LocalPlus Benefit Plan $116.72
Rate for Payer: Fidelis Medicare Advantage $213.15
Rate for Payer: Group Health Inc Commercial $101.50
Rate for Payer: Group Health Inc Medicare $71.05
Rate for Payer: Hamaspik Choice Inc Medicaid $101.50
Rate for Payer: Hamaspik Choice Inc Medicare $101.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $131.95
Service Code HCPCS C1713
Hospital Charge Code 40207036
Hospital Revenue Code 278
Min. Negotiated Rate $93.00
Max. Negotiated Rate $93.00
Rate for Payer: Hamaspik Choice Inc Medicaid $93.00
Rate for Payer: Hamaspik Choice Inc Medicare $93.00
Service Code HCPCS C1713
Hospital Charge Code 40206224
Hospital Revenue Code 278
Min. Negotiated Rate $122.99
Max. Negotiated Rate $368.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial $193.27
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 $175.70
Rate for Payer: Cigna LocalPlus Benefit Plan $202.06
Rate for Payer: Fidelis Medicare Advantage $368.97
Rate for Payer: Group Health Inc Commercial $175.70
Rate for Payer: Group Health Inc Medicare $122.99
Rate for Payer: Hamaspik Choice Inc Medicaid $175.70
Rate for Payer: Hamaspik Choice Inc Medicare $175.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $228.41
Service Code HCPCS C1713
Hospital Charge Code 40206224
Hospital Revenue Code 278
Min. Negotiated Rate $175.70
Max. Negotiated Rate $175.70
Rate for Payer: Hamaspik Choice Inc Medicaid $175.70
Rate for Payer: Hamaspik Choice Inc Medicare $175.70
Service Code HCPCS C1713
Hospital Charge Code 40205442
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $450.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial $235.95
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 $214.50
Rate for Payer: Cigna LocalPlus Benefit Plan $246.68
Rate for Payer: Fidelis Medicare Advantage $450.45
Rate for Payer: Group Health Inc Commercial $214.50
Rate for Payer: Group Health Inc Medicare $150.15
Rate for Payer: Hamaspik Choice Inc Medicaid $214.50
Rate for Payer: Hamaspik Choice Inc Medicare $214.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $278.85
Service Code HCPCS C1713
Hospital Charge Code 40205442
Hospital Revenue Code 278
Min. Negotiated Rate $214.50
Max. Negotiated Rate $214.50
Rate for Payer: Hamaspik Choice Inc Medicaid $214.50
Rate for Payer: Hamaspik Choice Inc Medicare $214.50
Service Code HCPCS C1713
Hospital Charge Code 40208075
Hospital Revenue Code 278
Min. Negotiated Rate $123.90
Max. Negotiated Rate $123.90
Rate for Payer: Hamaspik Choice Inc Medicaid $123.90
Rate for Payer: Hamaspik Choice Inc Medicare $123.90
Service Code HCPCS C1713
Hospital Charge Code 40208075
Hospital Revenue Code 278
Min. Negotiated Rate $86.73
Max. Negotiated Rate $260.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial $136.29
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 $123.90
Rate for Payer: Cigna LocalPlus Benefit Plan $142.48
Rate for Payer: Fidelis Medicare Advantage $260.19
Rate for Payer: Group Health Inc Commercial $123.90
Rate for Payer: Group Health Inc Medicare $86.73
Rate for Payer: Hamaspik Choice Inc Medicaid $123.90
Rate for Payer: Hamaspik Choice Inc Medicare $123.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $161.07
Service Code HCPCS C1713
Hospital Charge Code 40206076
Hospital Revenue Code 278
Min. Negotiated Rate $111.23
Max. Negotiated Rate $333.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial $174.79
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 $158.90
Rate for Payer: Cigna LocalPlus Benefit Plan $182.74
Rate for Payer: Fidelis Medicare Advantage $333.69
Rate for Payer: Group Health Inc Commercial $158.90
Rate for Payer: Group Health Inc Medicare $111.23
Rate for Payer: Hamaspik Choice Inc Medicaid $158.90
Rate for Payer: Hamaspik Choice Inc Medicare $158.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $206.57
Service Code HCPCS C1713
Hospital Charge Code 40206076
Hospital Revenue Code 278
Min. Negotiated Rate $158.90
Max. Negotiated Rate $158.90
Rate for Payer: Hamaspik Choice Inc Medicaid $158.90
Rate for Payer: Hamaspik Choice Inc Medicare $158.90
Service Code HCPCS C1713
Hospital Charge Code 40005867
Hospital Revenue Code 278
Min. Negotiated Rate $171.60
Max. Negotiated Rate $171.60
Rate for Payer: Hamaspik Choice Inc Medicaid $171.60
Rate for Payer: Hamaspik Choice Inc Medicare $171.60
Service Code HCPCS C1713
Hospital Charge Code 40005867
Hospital Revenue Code 278
Min. Negotiated Rate $120.12
Max. Negotiated Rate $360.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $188.76
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 $171.60
Rate for Payer: Cigna LocalPlus Benefit Plan $197.34
Rate for Payer: Fidelis Medicare Advantage $360.36
Rate for Payer: Group Health Inc Commercial $171.60
Rate for Payer: Group Health Inc Medicare $120.12
Rate for Payer: Hamaspik Choice Inc Medicaid $171.60
Rate for Payer: Hamaspik Choice Inc Medicare $171.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $223.08
Service Code HCPCS C1713
Hospital Charge Code 40005360
Hospital Revenue Code 278
Min. Negotiated Rate $175.50
Max. Negotiated Rate $175.50
Rate for Payer: Hamaspik Choice Inc Medicaid $175.50
Rate for Payer: Hamaspik Choice Inc Medicare $175.50
Service Code HCPCS C1713
Hospital Charge Code 40005360
Hospital Revenue Code 278
Min. Negotiated Rate $122.85
Max. Negotiated Rate $368.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $193.05
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 $175.50
Rate for Payer: Cigna LocalPlus Benefit Plan $201.82
Rate for Payer: Fidelis Medicare Advantage $368.55
Rate for Payer: Group Health Inc Commercial $175.50
Rate for Payer: Group Health Inc Medicare $122.85
Rate for Payer: Hamaspik Choice Inc Medicaid $175.50
Rate for Payer: Hamaspik Choice Inc Medicare $175.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $228.15
Service Code HCPCS C1713
Hospital Charge Code 40205199
Hospital Revenue Code 278
Min. Negotiated Rate $1,841.70
Max. Negotiated Rate $1,841.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1,841.70
Rate for Payer: Hamaspik Choice Inc Medicare $1,841.70