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Charge Type Price  
Hospital Charge Code 64905400
Hospital Revenue Code 270
Min. Negotiated Rate $33.00
Max. Negotiated Rate $75.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $51.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $47.15
Rate for Payer: Aetna Government $47.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $75.44
Rate for Payer: Cigna LocalPlus Benefit Plan $64.12
Rate for Payer: Group Health Inc Commercial $47.15
Rate for Payer: Group Health Inc Medicare $33.00
Rate for Payer: Hamaspik Choice Inc Medicaid $47.15
Rate for Payer: Hamaspik Choice Inc Medicare $47.15
Hospital Charge Code 64905398
Hospital Revenue Code 270
Min. Negotiated Rate $35.02
Max. Negotiated Rate $80.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.02
Rate for Payer: Aetna Government $50.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.04
Rate for Payer: Cigna LocalPlus Benefit Plan $68.03
Rate for Payer: Group Health Inc Commercial $50.02
Rate for Payer: Group Health Inc Medicare $35.02
Rate for Payer: Hamaspik Choice Inc Medicaid $50.02
Rate for Payer: Hamaspik Choice Inc Medicare $50.02
Hospital Charge Code 64905404
Hospital Revenue Code 270
Min. Negotiated Rate $35.02
Max. Negotiated Rate $80.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.02
Rate for Payer: Aetna Government $50.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.04
Rate for Payer: Cigna LocalPlus Benefit Plan $68.03
Rate for Payer: Group Health Inc Commercial $50.02
Rate for Payer: Group Health Inc Medicare $35.02
Rate for Payer: Hamaspik Choice Inc Medicaid $50.02
Rate for Payer: Hamaspik Choice Inc Medicare $50.02
Hospital Charge Code 64905402
Hospital Revenue Code 270
Min. Negotiated Rate $35.02
Max. Negotiated Rate $80.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.02
Rate for Payer: Aetna Government $50.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.04
Rate for Payer: Cigna LocalPlus Benefit Plan $68.03
Rate for Payer: Group Health Inc Commercial $50.02
Rate for Payer: Group Health Inc Medicare $35.02
Rate for Payer: Hamaspik Choice Inc Medicaid $50.02
Rate for Payer: Hamaspik Choice Inc Medicare $50.02
Service Code HCPCS C1713
Hospital Charge Code 64906747
Hospital Revenue Code 278
Min. Negotiated Rate $188.59
Max. Negotiated Rate $188.59
Rate for Payer: Hamaspik Choice Inc Medicaid $188.59
Rate for Payer: Hamaspik Choice Inc Medicare $188.59
Service Code HCPCS C1713
Hospital Charge Code 64906747
Hospital Revenue Code 278
Min. Negotiated Rate $132.01
Max. Negotiated Rate $396.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $207.45
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 $188.59
Rate for Payer: Cigna LocalPlus Benefit Plan $216.88
Rate for Payer: Fidelis Medicare Advantage $396.04
Rate for Payer: Group Health Inc Commercial $188.59
Rate for Payer: Group Health Inc Medicare $132.01
Rate for Payer: Hamaspik Choice Inc Medicaid $188.59
Rate for Payer: Hamaspik Choice Inc Medicare $188.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $245.17
Service Code HCPCS C1776
Hospital Charge Code 40008264
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1776
Hospital Charge Code 40008264
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
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 $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1713
Hospital Charge Code 40006452
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006452
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006379
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006379
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006390
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006390
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006299
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006299
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006392
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006392
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006303
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006303
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006394
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006394
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006307
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94
Service Code HCPCS C1713
Hospital Charge Code 40006307
Hospital Revenue Code 278
Min. Negotiated Rate $207.65
Max. Negotiated Rate $207.65
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Service Code HCPCS C1713
Hospital Charge Code 40006396
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $436.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $228.42
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 $207.65
Rate for Payer: Cigna LocalPlus Benefit Plan $238.80
Rate for Payer: Fidelis Medicare Advantage $436.06
Rate for Payer: Group Health Inc Commercial $207.65
Rate for Payer: Group Health Inc Medicare $145.36
Rate for Payer: Hamaspik Choice Inc Medicaid $207.65
Rate for Payer: Hamaspik Choice Inc Medicare $207.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $269.94