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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 64903235
Hospital Revenue Code 278
Min. Negotiated Rate $68.75
Max. Negotiated Rate $68.75
Rate for Payer: Hamaspik Choice Inc Medicaid $68.75
Rate for Payer: Hamaspik Choice Inc Medicare $68.75
Service Code HCPCS C1713
Hospital Charge Code 64903237
Hospital Revenue Code 278
Min. Negotiated Rate $68.75
Max. Negotiated Rate $68.75
Rate for Payer: Hamaspik Choice Inc Medicaid $68.75
Rate for Payer: Hamaspik Choice Inc Medicare $68.75
Service Code HCPCS C1713
Hospital Charge Code 64903237
Hospital Revenue Code 278
Min. Negotiated Rate $48.12
Max. Negotiated Rate $144.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $75.62
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 $68.75
Rate for Payer: Cigna LocalPlus Benefit Plan $79.06
Rate for Payer: Fidelis Medicare Advantage $144.38
Rate for Payer: Group Health Inc Commercial $68.75
Rate for Payer: Group Health Inc Medicare $48.12
Rate for Payer: Hamaspik Choice Inc Medicaid $68.75
Rate for Payer: Hamaspik Choice Inc Medicare $68.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $89.38
Service Code HCPCS C1713
Hospital Charge Code 64901959
Hospital Revenue Code 278
Min. Negotiated Rate $58.01
Max. Negotiated Rate $174.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $91.16
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 $82.88
Rate for Payer: Cigna LocalPlus Benefit Plan $95.31
Rate for Payer: Fidelis Medicare Advantage $174.04
Rate for Payer: Group Health Inc Commercial $82.88
Rate for Payer: Group Health Inc Medicare $58.01
Rate for Payer: Hamaspik Choice Inc Medicaid $82.88
Rate for Payer: Hamaspik Choice Inc Medicare $82.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $107.74
Service Code HCPCS C1713
Hospital Charge Code 64901959
Hospital Revenue Code 278
Min. Negotiated Rate $82.88
Max. Negotiated Rate $82.88
Rate for Payer: Hamaspik Choice Inc Medicaid $82.88
Rate for Payer: Hamaspik Choice Inc Medicare $82.88
Service Code HCPCS C1713
Hospital Charge Code 40205077
Hospital Revenue Code 278
Min. Negotiated Rate $25.20
Max. Negotiated Rate $25.20
Rate for Payer: Hamaspik Choice Inc Medicaid $25.20
Rate for Payer: Hamaspik Choice Inc Medicare $25.20
Service Code HCPCS C1713
Hospital Charge Code 40205077
Hospital Revenue Code 278
Min. Negotiated Rate $17.64
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $27.72
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 $25.20
Rate for Payer: Cigna LocalPlus Benefit Plan $28.98
Rate for Payer: Fidelis Medicare Advantage $52.92
Rate for Payer: Group Health Inc Commercial $25.20
Rate for Payer: Group Health Inc Medicare $17.64
Rate for Payer: Hamaspik Choice Inc Medicaid $25.20
Rate for Payer: Hamaspik Choice Inc Medicare $25.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $32.76
Service Code HCPCS C1713
Hospital Charge Code 64901686
Hospital Revenue Code 278
Min. Negotiated Rate $30.06
Max. Negotiated Rate $30.06
Rate for Payer: Hamaspik Choice Inc Medicaid $30.06
Rate for Payer: Hamaspik Choice Inc Medicare $30.06
Service Code HCPCS C1713
Hospital Charge Code 64901686
Hospital Revenue Code 278
Min. Negotiated Rate $21.05
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $33.07
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 $30.06
Rate for Payer: Cigna LocalPlus Benefit Plan $34.57
Rate for Payer: Fidelis Medicare Advantage $63.14
Rate for Payer: Group Health Inc Commercial $30.06
Rate for Payer: Group Health Inc Medicare $21.05
Rate for Payer: Hamaspik Choice Inc Medicaid $30.06
Rate for Payer: Hamaspik Choice Inc Medicare $30.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $39.08
Service Code HCPCS C1713
Hospital Charge Code 64902481
Hospital Revenue Code 278
Min. Negotiated Rate $27.30
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $42.90
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 $39.00
Rate for Payer: Cigna LocalPlus Benefit Plan $44.85
Rate for Payer: Fidelis Medicare Advantage $81.90
Rate for Payer: Group Health Inc Commercial $39.00
Rate for Payer: Group Health Inc Medicare $27.30
Rate for Payer: Hamaspik Choice Inc Medicaid $39.00
Rate for Payer: Hamaspik Choice Inc Medicare $39.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $50.70
Service Code HCPCS C1713
Hospital Charge Code 64902481
Hospital Revenue Code 278
Min. Negotiated Rate $39.00
Max. Negotiated Rate $39.00
Rate for Payer: Hamaspik Choice Inc Medicaid $39.00
Rate for Payer: Hamaspik Choice Inc Medicare $39.00
Service Code HCPCS C1713
Hospital Charge Code 64901286
Hospital Revenue Code 278
Min. Negotiated Rate $23.27
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $36.56
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 $33.24
Rate for Payer: Cigna LocalPlus Benefit Plan $38.23
Rate for Payer: Fidelis Medicare Advantage $69.80
Rate for Payer: Group Health Inc Commercial $33.24
Rate for Payer: Group Health Inc Medicare $23.27
Rate for Payer: Hamaspik Choice Inc Medicaid $33.24
Rate for Payer: Hamaspik Choice Inc Medicare $33.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $43.21
Service Code HCPCS C1713
Hospital Charge Code 64901286
Hospital Revenue Code 278
Min. Negotiated Rate $33.24
Max. Negotiated Rate $33.24
Rate for Payer: Hamaspik Choice Inc Medicaid $33.24
Rate for Payer: Hamaspik Choice Inc Medicare $33.24
Service Code HCPCS C1713
Hospital Charge Code 40200146
Hospital Revenue Code 278
Min. Negotiated Rate $27.50
Max. Negotiated Rate $27.50
Rate for Payer: Hamaspik Choice Inc Medicaid $27.50
Rate for Payer: Hamaspik Choice Inc Medicare $27.50
Service Code HCPCS C1713
Hospital Charge Code 40200146
Hospital Revenue Code 278
Min. Negotiated Rate $19.25
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $30.25
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 $27.50
Rate for Payer: Cigna LocalPlus Benefit Plan $31.62
Rate for Payer: Fidelis Medicare Advantage $57.75
Rate for Payer: Group Health Inc Commercial $27.50
Rate for Payer: Group Health Inc Medicare $19.25
Rate for Payer: Hamaspik Choice Inc Medicaid $27.50
Rate for Payer: Hamaspik Choice Inc Medicare $27.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $35.75
Service Code HCPCS C1713
Hospital Charge Code 40004885
Hospital Revenue Code 278
Min. Negotiated Rate $50.05
Max. Negotiated Rate $150.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $78.65
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 $71.50
Rate for Payer: Cigna LocalPlus Benefit Plan $82.22
Rate for Payer: Fidelis Medicare Advantage $150.15
Rate for Payer: Group Health Inc Commercial $71.50
Rate for Payer: Group Health Inc Medicare $50.05
Rate for Payer: Hamaspik Choice Inc Medicaid $71.50
Rate for Payer: Hamaspik Choice Inc Medicare $71.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $92.95
Service Code HCPCS C1713
Hospital Charge Code 40004885
Hospital Revenue Code 278
Min. Negotiated Rate $71.50
Max. Negotiated Rate $71.50
Rate for Payer: Hamaspik Choice Inc Medicaid $71.50
Rate for Payer: Hamaspik Choice Inc Medicare $71.50
Service Code HCPCS C1713
Hospital Charge Code 64906862
Hospital Revenue Code 278
Min. Negotiated Rate $87.50
Max. Negotiated Rate $262.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $137.50
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 $125.00
Rate for Payer: Cigna LocalPlus Benefit Plan $143.75
Rate for Payer: Fidelis Medicare Advantage $262.50
Rate for Payer: Group Health Inc Commercial $125.00
Rate for Payer: Group Health Inc Medicare $87.50
Rate for Payer: Hamaspik Choice Inc Medicaid $125.00
Rate for Payer: Hamaspik Choice Inc Medicare $125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $162.50
Service Code HCPCS C1713
Hospital Charge Code 64906862
Hospital Revenue Code 278
Min. Negotiated Rate $125.00
Max. Negotiated Rate $125.00
Rate for Payer: Hamaspik Choice Inc Medicaid $125.00
Rate for Payer: Hamaspik Choice Inc Medicare $125.00
Service Code HCPCS J2357 JW
Hospital Charge Code 41649980
Hospital Revenue Code 636
Min. Negotiated Rate $10.31
Max. Negotiated Rate $19.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $14.73
Rate for Payer: Aetna Government $14.73
Rate for Payer: Cash Price $39.46
Rate for Payer: Cash Price $39.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $14.73
Rate for Payer: Cigna LocalPlus Benefit Plan $16.94
Rate for Payer: Group Health Inc Commercial $14.73
Rate for Payer: Group Health Inc Medicare $10.31
Rate for Payer: Hamaspik Choice Inc Medicaid $14.73
Rate for Payer: Hamaspik Choice Inc Medicare $14.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $19.15
Service Code HCPCS J2357 JW
Hospital Charge Code 41649980
Hospital Revenue Code 636
Min. Negotiated Rate $14.73
Max. Negotiated Rate $14.73
Rate for Payer: Cash Price $39.46
Rate for Payer: Hamaspik Choice Inc Medicaid $14.73
Rate for Payer: Hamaspik Choice Inc Medicare $14.73
Hospital Charge Code 40200860
Hospital Revenue Code 270
Min. Negotiated Rate $24.56
Max. Negotiated Rate $56.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $38.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $35.08
Rate for Payer: Aetna Government $35.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $56.14
Rate for Payer: Cigna LocalPlus Benefit Plan $47.72
Rate for Payer: Group Health Inc Commercial $35.08
Rate for Payer: Group Health Inc Medicare $24.56
Rate for Payer: Hamaspik Choice Inc Medicaid $35.08
Rate for Payer: Hamaspik Choice Inc Medicare $35.08
Service Code HCPCS A4216
Hospital Charge Code 41654208
Hospital Revenue Code 272
Min. Negotiated Rate $0.25
Max. Negotiated Rate $1.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.25
Rate for Payer: Aetna Government $0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.18
Rate for Payer: Cigna LocalPlus Benefit Plan $1.00
Rate for Payer: Group Health Inc Commercial $0.74
Rate for Payer: Group Health Inc Medicare $0.51
Rate for Payer: Hamaspik Choice Inc Medicaid $0.74
Rate for Payer: Hamaspik Choice Inc Medicare $0.74
Service Code HCPCS A4216
Hospital Charge Code 41644208
Hospital Revenue Code 272
Min. Negotiated Rate $0.25
Max. Negotiated Rate $1.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.25
Rate for Payer: Aetna Government $0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.18
Rate for Payer: Cigna LocalPlus Benefit Plan $1.00
Rate for Payer: Group Health Inc Commercial $0.74
Rate for Payer: Group Health Inc Medicare $0.51
Rate for Payer: Hamaspik Choice Inc Medicaid $0.74
Rate for Payer: Hamaspik Choice Inc Medicare $0.74
Service Code HCPCS A4216
Hospital Charge Code 41654209
Hospital Revenue Code 272
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.25
Rate for Payer: Aetna Government $0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.53
Rate for Payer: Cigna LocalPlus Benefit Plan $0.45
Rate for Payer: Group Health Inc Commercial $0.33
Rate for Payer: Group Health Inc Medicare $0.23
Rate for Payer: Hamaspik Choice Inc Medicaid $0.33
Rate for Payer: Hamaspik Choice Inc Medicare $0.33