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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40204728
Hospital Revenue Code 278
Min. Negotiated Rate $98.00
Max. Negotiated Rate $98.00
Rate for Payer: Hamaspik Choice Inc Medicaid $98.00
Rate for Payer: Hamaspik Choice Inc Medicare $98.00
Service Code HCPCS C1713
Hospital Charge Code 40005202
Hospital Revenue Code 278
Min. Negotiated Rate $1,901.90
Max. Negotiated Rate $1,901.90
Rate for Payer: Hamaspik Choice Inc Medicaid $1,901.90
Rate for Payer: Hamaspik Choice Inc Medicare $1,901.90
Service Code HCPCS C1713
Hospital Charge Code 40005202
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,993.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,092.09
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 $1,901.90
Rate for Payer: Cigna LocalPlus Benefit Plan $2,187.18
Rate for Payer: Fidelis Medicare Advantage $3,993.99
Rate for Payer: Group Health Inc Commercial $1,901.90
Rate for Payer: Group Health Inc Medicare $1,331.33
Rate for Payer: Hamaspik Choice Inc Medicaid $1,901.90
Rate for Payer: Hamaspik Choice Inc Medicare $1,901.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,472.47
Service Code HCPCS C1713
Hospital Charge Code 40204220
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 40204220
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 40009285
Hospital Revenue Code 278
Min. Negotiated Rate $3,349.00
Max. Negotiated Rate $3,349.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,349.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,349.00
Service Code HCPCS C1713
Hospital Charge Code 40009285
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $7,032.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,683.90
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 $3,349.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,851.35
Rate for Payer: Fidelis Medicare Advantage $7,032.90
Rate for Payer: Group Health Inc Commercial $3,349.00
Rate for Payer: Group Health Inc Medicare $2,344.30
Rate for Payer: Hamaspik Choice Inc Medicaid $3,349.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,349.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,353.70
Service Code HCPCS C1713
Hospital Charge Code 40009748
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $6,575.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,444.32
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 $3,131.20
Rate for Payer: Cigna LocalPlus Benefit Plan $3,600.88
Rate for Payer: Fidelis Medicare Advantage $6,575.52
Rate for Payer: Group Health Inc Commercial $3,131.20
Rate for Payer: Group Health Inc Medicare $2,191.84
Rate for Payer: Hamaspik Choice Inc Medicaid $3,131.20
Rate for Payer: Hamaspik Choice Inc Medicare $3,131.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,070.56
Service Code HCPCS C1713
Hospital Charge Code 40009748
Hospital Revenue Code 278
Min. Negotiated Rate $3,131.20
Max. Negotiated Rate $3,131.20
Rate for Payer: Hamaspik Choice Inc Medicaid $3,131.20
Rate for Payer: Hamaspik Choice Inc Medicare $3,131.20
Service Code HCPCS C1776
Hospital Charge Code 40208013
Hospital Revenue Code 278
Min. Negotiated Rate $193.55
Max. Negotiated Rate $580.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $304.15
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 $276.50
Rate for Payer: Cigna LocalPlus Benefit Plan $317.98
Rate for Payer: Fidelis Medicare Advantage $580.65
Rate for Payer: Group Health Inc Commercial $276.50
Rate for Payer: Group Health Inc Medicare $193.55
Rate for Payer: Hamaspik Choice Inc Medicaid $276.50
Rate for Payer: Hamaspik Choice Inc Medicare $276.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $359.45
Service Code HCPCS C1776
Hospital Charge Code 40208013
Hospital Revenue Code 278
Min. Negotiated Rate $276.50
Max. Negotiated Rate $276.50
Rate for Payer: Hamaspik Choice Inc Medicaid $276.50
Rate for Payer: Hamaspik Choice Inc Medicare $276.50
Service Code HCPCS C1713
Hospital Charge Code 40009291
Hospital Revenue Code 278
Min. Negotiated Rate $1,873.30
Max. Negotiated Rate $1,873.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,873.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,873.30
Service Code HCPCS C1713
Hospital Charge Code 40009291
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,933.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,060.63
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 $1,873.30
Rate for Payer: Cigna LocalPlus Benefit Plan $2,154.30
Rate for Payer: Fidelis Medicare Advantage $3,933.93
Rate for Payer: Group Health Inc Commercial $1,873.30
Rate for Payer: Group Health Inc Medicare $1,311.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1,873.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,873.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,435.29
Service Code HCPCS C1713
Hospital Charge Code 40008289
Hospital Revenue Code 278
Min. Negotiated Rate $224.40
Max. Negotiated Rate $224.40
Rate for Payer: Hamaspik Choice Inc Medicaid $224.40
Rate for Payer: Hamaspik Choice Inc Medicare $224.40
Service Code HCPCS C1713
Hospital Charge Code 40008289
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $471.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $246.84
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 $224.40
Rate for Payer: Cigna LocalPlus Benefit Plan $258.06
Rate for Payer: Fidelis Medicare Advantage $471.24
Rate for Payer: Group Health Inc Commercial $224.40
Rate for Payer: Group Health Inc Medicare $157.08
Rate for Payer: Hamaspik Choice Inc Medicaid $224.40
Rate for Payer: Hamaspik Choice Inc Medicare $224.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $291.72
Service Code HCPCS C1713
Hospital Charge Code 40203419
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $616.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial $322.81
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 $293.46
Rate for Payer: Cigna LocalPlus Benefit Plan $337.48
Rate for Payer: Fidelis Medicare Advantage $616.27
Rate for Payer: Group Health Inc Commercial $293.46
Rate for Payer: Group Health Inc Medicare $205.42
Rate for Payer: Hamaspik Choice Inc Medicaid $293.46
Rate for Payer: Hamaspik Choice Inc Medicare $293.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $381.50
Service Code HCPCS C1713
Hospital Charge Code 40203419
Hospital Revenue Code 278
Min. Negotiated Rate $293.46
Max. Negotiated Rate $293.46
Rate for Payer: Hamaspik Choice Inc Medicaid $293.46
Rate for Payer: Hamaspik Choice Inc Medicare $293.46
Service Code HCPCS C1713
Hospital Charge Code 40004611
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $779.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $408.26
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 $371.15
Rate for Payer: Cigna LocalPlus Benefit Plan $426.82
Rate for Payer: Fidelis Medicare Advantage $779.42
Rate for Payer: Group Health Inc Commercial $371.15
Rate for Payer: Group Health Inc Medicare $259.80
Rate for Payer: Hamaspik Choice Inc Medicaid $371.15
Rate for Payer: Hamaspik Choice Inc Medicare $371.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $482.50
Service Code HCPCS C1713
Hospital Charge Code 40004611
Hospital Revenue Code 278
Min. Negotiated Rate $371.15
Max. Negotiated Rate $371.15
Rate for Payer: Hamaspik Choice Inc Medicaid $371.15
Rate for Payer: Hamaspik Choice Inc Medicare $371.15
Service Code HCPCS C1713
Hospital Charge Code 40008256
Hospital Revenue Code 278
Min. Negotiated Rate $354.00
Max. Negotiated Rate $354.00
Rate for Payer: Hamaspik Choice Inc Medicaid $354.00
Rate for Payer: Hamaspik Choice Inc Medicare $354.00
Service Code HCPCS C1713
Hospital Charge Code 40008256
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $743.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $389.40
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 $354.00
Rate for Payer: Cigna LocalPlus Benefit Plan $407.10
Rate for Payer: Fidelis Medicare Advantage $743.40
Rate for Payer: Group Health Inc Commercial $354.00
Rate for Payer: Group Health Inc Medicare $247.80
Rate for Payer: Hamaspik Choice Inc Medicaid $354.00
Rate for Payer: Hamaspik Choice Inc Medicare $354.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $460.20
Service Code HCPCS C1713
Hospital Charge Code 40005246
Hospital Revenue Code 278
Min. Negotiated Rate $1,582.00
Max. Negotiated Rate $1,582.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,582.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,582.00
Service Code HCPCS C1713
Hospital Charge Code 40005246
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,322.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,740.20
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 $1,582.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,819.30
Rate for Payer: Fidelis Medicare Advantage $3,322.20
Rate for Payer: Group Health Inc Commercial $1,582.00
Rate for Payer: Group Health Inc Medicare $1,107.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,582.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,582.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,056.60
Service Code HCPCS C1713
Hospital Charge Code 40204211
Hospital Revenue Code 278
Min. Negotiated Rate $49.21
Max. Negotiated Rate $49.21
Rate for Payer: Hamaspik Choice Inc Medicaid $49.21
Rate for Payer: Hamaspik Choice Inc Medicare $49.21
Service Code HCPCS C1713
Hospital Charge Code 40204211
Hospital Revenue Code 278
Min. Negotiated Rate $34.45
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $54.13
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 $49.21
Rate for Payer: Cigna LocalPlus Benefit Plan $56.59
Rate for Payer: Fidelis Medicare Advantage $103.34
Rate for Payer: Group Health Inc Commercial $49.21
Rate for Payer: Group Health Inc Medicare $34.45
Rate for Payer: Hamaspik Choice Inc Medicaid $49.21
Rate for Payer: Hamaspik Choice Inc Medicare $49.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $63.97