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Service Code HCPCS C1713
Hospital Charge Code 64906247
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 C1769
Hospital Charge Code 40202406
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $13.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.30
Rate for Payer: Cigna LocalPlus Benefit Plan $7.24
Rate for Payer: Fidelis Medicare Advantage $13.23
Rate for Payer: Group Health Inc Commercial $6.30
Rate for Payer: Group Health Inc Medicare $4.41
Rate for Payer: Hamaspik Choice Inc Medicaid $6.30
Rate for Payer: Hamaspik Choice Inc Medicare $6.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8.19
Service Code HCPCS C1769
Hospital Charge Code 40202406
Hospital Revenue Code 278
Min. Negotiated Rate $6.30
Max. Negotiated Rate $6.30
Rate for Payer: Hamaspik Choice Inc Medicaid $6.30
Rate for Payer: Hamaspik Choice Inc Medicare $6.30
Hospital Charge Code 64904488
Hospital Revenue Code 270
Min. Negotiated Rate $5.69
Max. Negotiated Rate $13.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $8.12
Rate for Payer: Aetna Government $8.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $13.00
Rate for Payer: Cigna LocalPlus Benefit Plan $11.05
Rate for Payer: Group Health Inc Commercial $8.12
Rate for Payer: Group Health Inc Medicare $5.69
Rate for Payer: Hamaspik Choice Inc Medicaid $8.12
Rate for Payer: Hamaspik Choice Inc Medicare $8.12
Service Code HCPCS C1713
Hospital Charge Code 64906803
Hospital Revenue Code 278
Min. Negotiated Rate $21.50
Max. Negotiated Rate $21.50
Rate for Payer: Hamaspik Choice Inc Medicaid $21.50
Rate for Payer: Hamaspik Choice Inc Medicare $21.50
Service Code HCPCS C1713
Hospital Charge Code 64906803
Hospital Revenue Code 278
Min. Negotiated Rate $15.05
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.65
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 $21.50
Rate for Payer: Cigna LocalPlus Benefit Plan $24.72
Rate for Payer: Fidelis Medicare Advantage $45.15
Rate for Payer: Group Health Inc Commercial $21.50
Rate for Payer: Group Health Inc Medicare $15.05
Rate for Payer: Hamaspik Choice Inc Medicaid $21.50
Rate for Payer: Hamaspik Choice Inc Medicare $21.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $27.95
Service Code HCPCS C1713
Hospital Charge Code 40200148
Hospital Revenue Code 278
Min. Negotiated Rate $90.00
Max. Negotiated Rate $90.00
Rate for Payer: Hamaspik Choice Inc Medicaid $90.00
Rate for Payer: Hamaspik Choice Inc Medicare $90.00
Service Code HCPCS C1713
Hospital Charge Code 40200148
Hospital Revenue Code 278
Min. Negotiated Rate $63.00
Max. Negotiated Rate $189.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $99.00
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 $90.00
Rate for Payer: Cigna LocalPlus Benefit Plan $103.50
Rate for Payer: Fidelis Medicare Advantage $189.00
Rate for Payer: Group Health Inc Commercial $90.00
Rate for Payer: Group Health Inc Medicare $63.00
Rate for Payer: Hamaspik Choice Inc Medicaid $90.00
Rate for Payer: Hamaspik Choice Inc Medicare $90.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $117.00
Service Code HCPCS C1713
Hospital Charge Code 64906249
Hospital Revenue Code 278
Min. Negotiated Rate $37.50
Max. Negotiated Rate $37.50
Rate for Payer: Hamaspik Choice Inc Medicaid $37.50
Rate for Payer: Hamaspik Choice Inc Medicare $37.50
Service Code HCPCS C1713
Hospital Charge Code 64906249
Hospital Revenue Code 278
Min. Negotiated Rate $26.25
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $41.25
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 $37.50
Rate for Payer: Cigna LocalPlus Benefit Plan $43.12
Rate for Payer: Fidelis Medicare Advantage $78.75
Rate for Payer: Group Health Inc Commercial $37.50
Rate for Payer: Group Health Inc Medicare $26.25
Rate for Payer: Hamaspik Choice Inc Medicaid $37.50
Rate for Payer: Hamaspik Choice Inc Medicare $37.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $48.75
Hospital Charge Code 64906172
Hospital Revenue Code 270
Min. Negotiated Rate $182.88
Max. Negotiated Rate $418.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $287.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $261.25
Rate for Payer: Aetna Government $261.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $418.00
Rate for Payer: Cigna LocalPlus Benefit Plan $355.30
Rate for Payer: Group Health Inc Commercial $261.25
Rate for Payer: Group Health Inc Medicare $182.88
Rate for Payer: Hamaspik Choice Inc Medicaid $261.25
Rate for Payer: Hamaspik Choice Inc Medicare $261.25
Hospital Charge Code 64904046
Hospital Revenue Code 270
Min. Negotiated Rate $81.38
Max. Negotiated Rate $186.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $127.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $116.25
Rate for Payer: Aetna Government $116.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $186.00
Rate for Payer: Cigna LocalPlus Benefit Plan $158.10
Rate for Payer: Group Health Inc Commercial $116.25
Rate for Payer: Group Health Inc Medicare $81.38
Rate for Payer: Hamaspik Choice Inc Medicaid $116.25
Rate for Payer: Hamaspik Choice Inc Medicare $116.25
Hospital Charge Code 64904048
Hospital Revenue Code 270
Min. Negotiated Rate $78.31
Max. Negotiated Rate $179.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $123.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $111.88
Rate for Payer: Aetna Government $111.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $179.00
Rate for Payer: Cigna LocalPlus Benefit Plan $152.15
Rate for Payer: Group Health Inc Commercial $111.88
Rate for Payer: Group Health Inc Medicare $78.31
Rate for Payer: Hamaspik Choice Inc Medicaid $111.88
Rate for Payer: Hamaspik Choice Inc Medicare $111.88
Hospital Charge Code 64903012
Hospital Revenue Code 270
Min. Negotiated Rate $14.73
Max. Negotiated Rate $33.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $21.04
Rate for Payer: Aetna Government $21.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $33.66
Rate for Payer: Cigna LocalPlus Benefit Plan $28.61
Rate for Payer: Group Health Inc Commercial $21.04
Rate for Payer: Group Health Inc Medicare $14.73
Rate for Payer: Hamaspik Choice Inc Medicaid $21.04
Rate for Payer: Hamaspik Choice Inc Medicare $21.04
Hospital Charge Code 40004430
Hospital Revenue Code 272
Min. Negotiated Rate $21.03
Max. Negotiated Rate $48.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $33.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $30.04
Rate for Payer: Aetna Government $30.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $48.07
Rate for Payer: Cigna LocalPlus Benefit Plan $40.86
Rate for Payer: Group Health Inc Commercial $30.04
Rate for Payer: Group Health Inc Medicare $21.03
Rate for Payer: Hamaspik Choice Inc Medicaid $30.04
Rate for Payer: Hamaspik Choice Inc Medicare $30.04
Hospital Charge Code 40004431
Hospital Revenue Code 272
Min. Negotiated Rate $21.03
Max. Negotiated Rate $48.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $33.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $30.04
Rate for Payer: Aetna Government $30.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $48.07
Rate for Payer: Cigna LocalPlus Benefit Plan $40.86
Rate for Payer: Group Health Inc Commercial $30.04
Rate for Payer: Group Health Inc Medicare $21.03
Rate for Payer: Hamaspik Choice Inc Medicaid $30.04
Rate for Payer: Hamaspik Choice Inc Medicare $30.04
Service Code HCPCS C1713
Hospital Charge Code 64906681
Hospital Revenue Code 278
Min. Negotiated Rate $9.10
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $14.30
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 $13.00
Rate for Payer: Cigna LocalPlus Benefit Plan $14.95
Rate for Payer: Fidelis Medicare Advantage $27.30
Rate for Payer: Group Health Inc Commercial $13.00
Rate for Payer: Group Health Inc Medicare $9.10
Rate for Payer: Hamaspik Choice Inc Medicaid $13.00
Rate for Payer: Hamaspik Choice Inc Medicare $13.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $16.90
Service Code HCPCS C1713
Hospital Charge Code 64906681
Hospital Revenue Code 278
Min. Negotiated Rate $13.00
Max. Negotiated Rate $13.00
Rate for Payer: Hamaspik Choice Inc Medicaid $13.00
Rate for Payer: Hamaspik Choice Inc Medicare $13.00
Service Code HCPCS C1713
Hospital Charge Code 40200153
Hospital Revenue Code 278
Min. Negotiated Rate $0.16
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.25
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 $0.23
Rate for Payer: Cigna LocalPlus Benefit Plan $0.26
Rate for Payer: Fidelis Medicare Advantage $0.48
Rate for Payer: Group Health Inc Commercial $0.23
Rate for Payer: Group Health Inc Medicare $0.16
Rate for Payer: Hamaspik Choice Inc Medicaid $0.23
Rate for Payer: Hamaspik Choice Inc Medicare $0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.30
Service Code HCPCS C1713
Hospital Charge Code 40200153
Hospital Revenue Code 278
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.23
Rate for Payer: Hamaspik Choice Inc Medicaid $0.23
Rate for Payer: Hamaspik Choice Inc Medicare $0.23
Service Code HCPCS C1713
Hospital Charge Code 64906246
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 64906246
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
Hospital Charge Code 40007544
Hospital Revenue Code 272
Min. Negotiated Rate $16.62
Max. Negotiated Rate $37.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $26.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $23.74
Rate for Payer: Aetna Government $23.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $37.98
Rate for Payer: Cigna LocalPlus Benefit Plan $32.29
Rate for Payer: Group Health Inc Commercial $23.74
Rate for Payer: Group Health Inc Medicare $16.62
Rate for Payer: Hamaspik Choice Inc Medicaid $23.74
Rate for Payer: Hamaspik Choice Inc Medicare $23.74
Hospital Charge Code 40204625
Hospital Revenue Code 272
Min. Negotiated Rate $16.62
Max. Negotiated Rate $37.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $26.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $23.74
Rate for Payer: Aetna Government $23.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $37.98
Rate for Payer: Cigna LocalPlus Benefit Plan $32.29
Rate for Payer: Group Health Inc Commercial $23.74
Rate for Payer: Group Health Inc Medicare $16.62
Rate for Payer: Hamaspik Choice Inc Medicaid $23.74
Rate for Payer: Hamaspik Choice Inc Medicare $23.74
Service Code HCPCS C1769
Hospital Charge Code 64907428
Hospital Revenue Code 278
Min. Negotiated Rate $11.92
Max. Negotiated Rate $11.92
Rate for Payer: Hamaspik Choice Inc Medicaid $11.92
Rate for Payer: Hamaspik Choice Inc Medicare $11.92