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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40007232
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007232
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006968
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006968
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007233
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007233
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006969
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006969
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007234
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007234
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006970
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006970
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007235
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007235
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006971
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40006971
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40007236
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007236
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006972
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006972
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007237
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007237
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006973
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31
Service Code HCPCS C1713
Hospital Charge Code 40006973
Hospital Revenue Code 278
Min. Negotiated Rate $200.24
Max. Negotiated Rate $200.24
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Service Code HCPCS C1713
Hospital Charge Code 40007238
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $420.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.26
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 $200.24
Rate for Payer: Cigna LocalPlus Benefit Plan $230.28
Rate for Payer: Fidelis Medicare Advantage $420.50
Rate for Payer: Group Health Inc Commercial $200.24
Rate for Payer: Group Health Inc Medicare $140.17
Rate for Payer: Hamaspik Choice Inc Medicaid $200.24
Rate for Payer: Hamaspik Choice Inc Medicare $200.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $260.31