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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40004625
Hospital Revenue Code 278
Min. Negotiated Rate $154.00
Max. Negotiated Rate $154.00
Rate for Payer: Hamaspik Choice Inc Medicaid $154.00
Rate for Payer: Hamaspik Choice Inc Medicare $154.00
Service Code HCPCS C1713
Hospital Charge Code 40004625
Hospital Revenue Code 278
Min. Negotiated Rate $107.80
Max. Negotiated Rate $323.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $169.40
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 $154.00
Rate for Payer: Cigna LocalPlus Benefit Plan $177.10
Rate for Payer: Fidelis Medicare Advantage $323.40
Rate for Payer: Group Health Inc Commercial $154.00
Rate for Payer: Group Health Inc Medicare $107.80
Rate for Payer: Hamaspik Choice Inc Medicaid $154.00
Rate for Payer: Hamaspik Choice Inc Medicare $154.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $200.20
Service Code HCPCS C1713
Hospital Charge Code 40004632
Hospital Revenue Code 278
Min. Negotiated Rate $47.52
Max. Negotiated Rate $47.52
Rate for Payer: Hamaspik Choice Inc Medicaid $47.52
Rate for Payer: Hamaspik Choice Inc Medicare $47.52
Service Code HCPCS C1713
Hospital Charge Code 40004632
Hospital Revenue Code 278
Min. Negotiated Rate $33.26
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $52.27
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 $47.52
Rate for Payer: Cigna LocalPlus Benefit Plan $54.65
Rate for Payer: Fidelis Medicare Advantage $99.79
Rate for Payer: Group Health Inc Commercial $47.52
Rate for Payer: Group Health Inc Medicare $33.26
Rate for Payer: Hamaspik Choice Inc Medicaid $47.52
Rate for Payer: Hamaspik Choice Inc Medicare $47.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $61.78
Service Code HCPCS C1713
Hospital Charge Code 40005359
Hospital Revenue Code 278
Min. Negotiated Rate $150.00
Max. Negotiated Rate $150.00
Rate for Payer: Hamaspik Choice Inc Medicaid $150.00
Rate for Payer: Hamaspik Choice Inc Medicare $150.00
Service Code HCPCS C1713
Hospital Charge Code 40005359
Hospital Revenue Code 278
Min. Negotiated Rate $105.00
Max. Negotiated Rate $315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $165.00
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 $150.00
Rate for Payer: Cigna LocalPlus Benefit Plan $172.50
Rate for Payer: Fidelis Medicare Advantage $315.00
Rate for Payer: Group Health Inc Commercial $150.00
Rate for Payer: Group Health Inc Medicare $105.00
Rate for Payer: Hamaspik Choice Inc Medicaid $150.00
Rate for Payer: Hamaspik Choice Inc Medicare $150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $195.00
Service Code HCPCS C1713
Hospital Charge Code 40205367
Hospital Revenue Code 278
Min. Negotiated Rate $87.18
Max. Negotiated Rate $87.18
Rate for Payer: Hamaspik Choice Inc Medicaid $87.18
Rate for Payer: Hamaspik Choice Inc Medicare $87.18
Service Code HCPCS C1713
Hospital Charge Code 40205367
Hospital Revenue Code 278
Min. Negotiated Rate $61.02
Max. Negotiated Rate $183.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $95.89
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 $87.18
Rate for Payer: Cigna LocalPlus Benefit Plan $100.25
Rate for Payer: Fidelis Medicare Advantage $183.07
Rate for Payer: Group Health Inc Commercial $87.18
Rate for Payer: Group Health Inc Medicare $61.02
Rate for Payer: Hamaspik Choice Inc Medicaid $87.18
Rate for Payer: Hamaspik Choice Inc Medicare $87.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $113.33
Service Code HCPCS C1713
Hospital Charge Code 40207039
Hospital Revenue Code 278
Min. Negotiated Rate $23.10
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $36.30
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 $33.00
Rate for Payer: Cigna LocalPlus Benefit Plan $37.95
Rate for Payer: Fidelis Medicare Advantage $69.30
Rate for Payer: Group Health Inc Commercial $33.00
Rate for Payer: Group Health Inc Medicare $23.10
Rate for Payer: Hamaspik Choice Inc Medicaid $33.00
Rate for Payer: Hamaspik Choice Inc Medicare $33.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $42.90
Service Code HCPCS C1713
Hospital Charge Code 40207039
Hospital Revenue Code 278
Min. Negotiated Rate $33.00
Max. Negotiated Rate $33.00
Rate for Payer: Hamaspik Choice Inc Medicaid $33.00
Rate for Payer: Hamaspik Choice Inc Medicare $33.00
Service Code HCPCS C1776
Hospital Charge Code 40205133
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 C1776
Hospital Charge Code 40205133
Hospital Revenue Code 278
Min. Negotiated Rate $12.25
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $19.25
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 $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 40205489
Hospital Revenue Code 278
Min. Negotiated Rate $104.30
Max. Negotiated Rate $312.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $163.90
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 $149.00
Rate for Payer: Cigna LocalPlus Benefit Plan $171.35
Rate for Payer: Fidelis Medicare Advantage $312.90
Rate for Payer: Group Health Inc Commercial $149.00
Rate for Payer: Group Health Inc Medicare $104.30
Rate for Payer: Hamaspik Choice Inc Medicaid $149.00
Rate for Payer: Hamaspik Choice Inc Medicare $149.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $193.70
Service Code HCPCS C1713
Hospital Charge Code 40205489
Hospital Revenue Code 278
Min. Negotiated Rate $149.00
Max. Negotiated Rate $149.00
Rate for Payer: Hamaspik Choice Inc Medicaid $149.00
Rate for Payer: Hamaspik Choice Inc Medicare $149.00
Service Code HCPCS C1713
Hospital Charge Code 40205405
Hospital Revenue Code 278
Min. Negotiated Rate $18.90
Max. Negotiated Rate $18.90
Rate for Payer: Hamaspik Choice Inc Medicaid $18.90
Rate for Payer: Hamaspik Choice Inc Medicare $18.90
Service Code HCPCS C1713
Hospital Charge Code 40205405
Hospital Revenue Code 278
Min. Negotiated Rate $13.23
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $20.79
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 $18.90
Rate for Payer: Cigna LocalPlus Benefit Plan $21.74
Rate for Payer: Fidelis Medicare Advantage $39.69
Rate for Payer: Group Health Inc Commercial $18.90
Rate for Payer: Group Health Inc Medicare $13.23
Rate for Payer: Hamaspik Choice Inc Medicaid $18.90
Rate for Payer: Hamaspik Choice Inc Medicare $18.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $24.57
Service Code HCPCS C1776
Hospital Charge Code 40208170
Hospital Revenue Code 278
Min. Negotiated Rate $20.30
Max. Negotiated Rate $20.30
Rate for Payer: Hamaspik Choice Inc Medicaid $20.30
Rate for Payer: Hamaspik Choice Inc Medicare $20.30
Service Code HCPCS C1776
Hospital Charge Code 40208170
Hospital Revenue Code 278
Min. Negotiated Rate $14.21
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $22.33
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 $20.30
Rate for Payer: Cigna LocalPlus Benefit Plan $23.34
Rate for Payer: Fidelis Medicare Advantage $42.63
Rate for Payer: Group Health Inc Commercial $20.30
Rate for Payer: Group Health Inc Medicare $14.21
Rate for Payer: Hamaspik Choice Inc Medicaid $20.30
Rate for Payer: Hamaspik Choice Inc Medicare $20.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $26.39
Service Code HCPCS C1776
Hospital Charge Code 40205280
Hospital Revenue Code 278
Min. Negotiated Rate $21.70
Max. Negotiated Rate $21.70
Rate for Payer: Hamaspik Choice Inc Medicaid $21.70
Rate for Payer: Hamaspik Choice Inc Medicare $21.70
Service Code HCPCS C1776
Hospital Charge Code 40205280
Hospital Revenue Code 278
Min. Negotiated Rate $15.19
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.87
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 $21.70
Rate for Payer: Cigna LocalPlus Benefit Plan $24.96
Rate for Payer: Fidelis Medicare Advantage $45.57
Rate for Payer: Group Health Inc Commercial $21.70
Rate for Payer: Group Health Inc Medicare $15.19
Rate for Payer: Hamaspik Choice Inc Medicaid $21.70
Rate for Payer: Hamaspik Choice Inc Medicare $21.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $28.21
Service Code HCPCS C1713
Hospital Charge Code 40205407
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 40205407
Hospital Revenue Code 278
Min. Negotiated Rate $58.10
Max. Negotiated Rate $174.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $91.30
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 $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 40029618
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $11,164.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,847.93
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 $5,316.30
Rate for Payer: Cigna LocalPlus Benefit Plan $6,113.74
Rate for Payer: Fidelis Medicare Advantage $11,164.23
Rate for Payer: Group Health Inc Commercial $5,316.30
Rate for Payer: Group Health Inc Medicare $3,721.41
Rate for Payer: Hamaspik Choice Inc Medicaid $5,316.30
Rate for Payer: Hamaspik Choice Inc Medicare $5,316.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,911.19
Service Code HCPCS C1776
Hospital Charge Code 40029618
Hospital Revenue Code 278
Min. Negotiated Rate $5,316.30
Max. Negotiated Rate $5,316.30
Rate for Payer: Hamaspik Choice Inc Medicaid $5,316.30
Rate for Payer: Hamaspik Choice Inc Medicare $5,316.30
Hospital Charge Code 40204499
Hospital Revenue Code 272
Min. Negotiated Rate $153.58
Max. Negotiated Rate $351.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $241.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $219.40
Rate for Payer: Aetna Government $219.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $351.04
Rate for Payer: Cigna LocalPlus Benefit Plan $298.38
Rate for Payer: Group Health Inc Commercial $219.40
Rate for Payer: Group Health Inc Medicare $153.58
Rate for Payer: Hamaspik Choice Inc Medicaid $219.40
Rate for Payer: Hamaspik Choice Inc Medicare $219.40