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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 64907232
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $477.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $250.25
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 $227.50
Rate for Payer: Cigna LocalPlus Benefit Plan $261.62
Rate for Payer: Fidelis Medicare Advantage $477.75
Rate for Payer: Group Health Inc Commercial $227.50
Rate for Payer: Group Health Inc Medicare $159.25
Rate for Payer: Hamaspik Choice Inc Medicaid $227.50
Rate for Payer: Hamaspik Choice Inc Medicare $227.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $295.75
Service Code HCPCS C1713
Hospital Charge Code 64906520
Hospital Revenue Code 278
Min. Negotiated Rate $35.00
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.00
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 $50.00
Rate for Payer: Cigna LocalPlus Benefit Plan $57.50
Rate for Payer: Fidelis Medicare Advantage $105.00
Rate for Payer: Group Health Inc Commercial $50.00
Rate for Payer: Group Health Inc Medicare $35.00
Rate for Payer: Hamaspik Choice Inc Medicaid $50.00
Rate for Payer: Hamaspik Choice Inc Medicare $50.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.00
Service Code HCPCS C1713
Hospital Charge Code 64906520
Hospital Revenue Code 278
Min. Negotiated Rate $50.00
Max. Negotiated Rate $50.00
Rate for Payer: Hamaspik Choice Inc Medicaid $50.00
Rate for Payer: Hamaspik Choice Inc Medicare $50.00
Service Code HCPCS C1713
Hospital Charge Code 64906695
Hospital Revenue Code 278
Min. Negotiated Rate $76.73
Max. Negotiated Rate $230.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $120.57
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 $109.61
Rate for Payer: Cigna LocalPlus Benefit Plan $126.05
Rate for Payer: Fidelis Medicare Advantage $230.18
Rate for Payer: Group Health Inc Commercial $109.61
Rate for Payer: Group Health Inc Medicare $76.73
Rate for Payer: Hamaspik Choice Inc Medicaid $109.61
Rate for Payer: Hamaspik Choice Inc Medicare $109.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $142.49
Service Code HCPCS C1713
Hospital Charge Code 64906695
Hospital Revenue Code 278
Min. Negotiated Rate $109.61
Max. Negotiated Rate $109.61
Rate for Payer: Hamaspik Choice Inc Medicaid $109.61
Rate for Payer: Hamaspik Choice Inc Medicare $109.61
Service Code HCPCS C1713
Hospital Charge Code 64906466
Hospital Revenue Code 278
Min. Negotiated Rate $50.50
Max. Negotiated Rate $50.50
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Service Code HCPCS C1713
Hospital Charge Code 64906466
Hospital Revenue Code 278
Min. Negotiated Rate $35.35
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.55
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 $50.50
Rate for Payer: Cigna LocalPlus Benefit Plan $58.08
Rate for Payer: Fidelis Medicare Advantage $106.05
Rate for Payer: Group Health Inc Commercial $50.50
Rate for Payer: Group Health Inc Medicare $35.35
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.65
Service Code HCPCS C1776
Hospital Charge Code 40202437
Hospital Revenue Code 278
Min. Negotiated Rate $136.00
Max. Negotiated Rate $136.00
Rate for Payer: Hamaspik Choice Inc Medicaid $136.00
Rate for Payer: Hamaspik Choice Inc Medicare $136.00
Service Code HCPCS C1776
Hospital Charge Code 40202437
Hospital Revenue Code 278
Min. Negotiated Rate $95.20
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $149.60
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 $136.00
Rate for Payer: Cigna LocalPlus Benefit Plan $156.40
Rate for Payer: Fidelis Medicare Advantage $285.60
Rate for Payer: Group Health Inc Commercial $136.00
Rate for Payer: Group Health Inc Medicare $95.20
Rate for Payer: Hamaspik Choice Inc Medicaid $136.00
Rate for Payer: Hamaspik Choice Inc Medicare $136.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $176.80
Service Code HCPCS C1776
Hospital Charge Code 40202446
Hospital Revenue Code 278
Min. Negotiated Rate $318.00
Max. Negotiated Rate $318.00
Rate for Payer: Hamaspik Choice Inc Medicaid $318.00
Rate for Payer: Hamaspik Choice Inc Medicare $318.00
Service Code HCPCS C1776
Hospital Charge Code 40202446
Hospital Revenue Code 278
Min. Negotiated Rate $222.60
Max. Negotiated Rate $667.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $349.80
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 $318.00
Rate for Payer: Cigna LocalPlus Benefit Plan $365.70
Rate for Payer: Fidelis Medicare Advantage $667.80
Rate for Payer: Group Health Inc Commercial $318.00
Rate for Payer: Group Health Inc Medicare $222.60
Rate for Payer: Hamaspik Choice Inc Medicaid $318.00
Rate for Payer: Hamaspik Choice Inc Medicare $318.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $413.40
Service Code HCPCS C1713
Hospital Charge Code 64906404
Hospital Revenue Code 278
Min. Negotiated Rate $63.36
Max. Negotiated Rate $63.36
Rate for Payer: Hamaspik Choice Inc Medicaid $63.36
Rate for Payer: Hamaspik Choice Inc Medicare $63.36
Service Code HCPCS C1713
Hospital Charge Code 64906404
Hospital Revenue Code 278
Min. Negotiated Rate $44.35
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $69.70
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 $63.36
Rate for Payer: Cigna LocalPlus Benefit Plan $72.86
Rate for Payer: Fidelis Medicare Advantage $133.06
Rate for Payer: Group Health Inc Commercial $63.36
Rate for Payer: Group Health Inc Medicare $44.35
Rate for Payer: Hamaspik Choice Inc Medicaid $63.36
Rate for Payer: Hamaspik Choice Inc Medicare $63.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $82.37
Service Code HCPCS C1713
Hospital Charge Code 64906772
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $460.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $241.22
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 $219.29
Rate for Payer: Cigna LocalPlus Benefit Plan $252.18
Rate for Payer: Fidelis Medicare Advantage $460.51
Rate for Payer: Group Health Inc Commercial $219.29
Rate for Payer: Group Health Inc Medicare $153.50
Rate for Payer: Hamaspik Choice Inc Medicaid $219.29
Rate for Payer: Hamaspik Choice Inc Medicare $219.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $285.08
Service Code HCPCS C1713
Hospital Charge Code 64906772
Hospital Revenue Code 278
Min. Negotiated Rate $219.29
Max. Negotiated Rate $219.29
Rate for Payer: Hamaspik Choice Inc Medicaid $219.29
Rate for Payer: Hamaspik Choice Inc Medicare $219.29
Service Code HCPCS C1776
Hospital Charge Code 40205074
Hospital Revenue Code 278
Min. Negotiated Rate $125.30
Max. Negotiated Rate $375.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $196.90
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 $179.00
Rate for Payer: Cigna LocalPlus Benefit Plan $205.85
Rate for Payer: Fidelis Medicare Advantage $375.90
Rate for Payer: Group Health Inc Commercial $179.00
Rate for Payer: Group Health Inc Medicare $125.30
Rate for Payer: Hamaspik Choice Inc Medicaid $179.00
Rate for Payer: Hamaspik Choice Inc Medicare $179.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $232.70
Service Code HCPCS C1776
Hospital Charge Code 40205074
Hospital Revenue Code 278
Min. Negotiated Rate $179.00
Max. Negotiated Rate $179.00
Rate for Payer: Hamaspik Choice Inc Medicaid $179.00
Rate for Payer: Hamaspik Choice Inc Medicare $179.00
Service Code HCPCS C1713
Hospital Charge Code 64906646
Hospital Revenue Code 278
Min. Negotiated Rate $59.50
Max. Negotiated Rate $178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $93.50
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 $85.00
Rate for Payer: Cigna LocalPlus Benefit Plan $97.75
Rate for Payer: Fidelis Medicare Advantage $178.50
Rate for Payer: Group Health Inc Commercial $85.00
Rate for Payer: Group Health Inc Medicare $59.50
Rate for Payer: Hamaspik Choice Inc Medicaid $85.00
Rate for Payer: Hamaspik Choice Inc Medicare $85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $110.50
Service Code HCPCS C1713
Hospital Charge Code 64906646
Hospital Revenue Code 278
Min. Negotiated Rate $85.00
Max. Negotiated Rate $85.00
Rate for Payer: Hamaspik Choice Inc Medicaid $85.00
Rate for Payer: Hamaspik Choice Inc Medicare $85.00
Service Code HCPCS C1713
Hospital Charge Code 64906652
Hospital Revenue Code 278
Min. Negotiated Rate $95.00
Max. Negotiated Rate $95.00
Rate for Payer: Hamaspik Choice Inc Medicaid $95.00
Rate for Payer: Hamaspik Choice Inc Medicare $95.00
Service Code HCPCS C1713
Hospital Charge Code 64906652
Hospital Revenue Code 278
Min. Negotiated Rate $66.50
Max. Negotiated Rate $199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $104.50
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 $95.00
Rate for Payer: Cigna LocalPlus Benefit Plan $109.25
Rate for Payer: Fidelis Medicare Advantage $199.50
Rate for Payer: Group Health Inc Commercial $95.00
Rate for Payer: Group Health Inc Medicare $66.50
Rate for Payer: Hamaspik Choice Inc Medicaid $95.00
Rate for Payer: Hamaspik Choice Inc Medicare $95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $123.50
Service Code HCPCS C1713
Hospital Charge Code 64906901
Hospital Revenue Code 278
Min. Negotiated Rate $195.00
Max. Negotiated Rate $195.00
Rate for Payer: Hamaspik Choice Inc Medicaid $195.00
Rate for Payer: Hamaspik Choice Inc Medicare $195.00
Service Code HCPCS C1713
Hospital Charge Code 64906901
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $409.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $214.50
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 $195.00
Rate for Payer: Cigna LocalPlus Benefit Plan $224.25
Rate for Payer: Fidelis Medicare Advantage $409.50
Rate for Payer: Group Health Inc Commercial $195.00
Rate for Payer: Group Health Inc Medicare $136.50
Rate for Payer: Hamaspik Choice Inc Medicaid $195.00
Rate for Payer: Hamaspik Choice Inc Medicare $195.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $253.50
Service Code HCPCS C1713
Hospital Charge Code 64906560
Hospital Revenue Code 278
Min. Negotiated Rate $76.00
Max. Negotiated Rate $76.00
Rate for Payer: Hamaspik Choice Inc Medicaid $76.00
Rate for Payer: Hamaspik Choice Inc Medicare $76.00
Service Code HCPCS C1713
Hospital Charge Code 64906560
Hospital Revenue Code 278
Min. Negotiated Rate $53.20
Max. Negotiated Rate $159.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $83.60
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 $76.00
Rate for Payer: Cigna LocalPlus Benefit Plan $87.40
Rate for Payer: Fidelis Medicare Advantage $159.60
Rate for Payer: Group Health Inc Commercial $76.00
Rate for Payer: Group Health Inc Medicare $53.20
Rate for Payer: Hamaspik Choice Inc Medicaid $76.00
Rate for Payer: Hamaspik Choice Inc Medicare $76.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $98.80