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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40006415
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006415
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006420
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006420
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006347
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $482.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $252.89
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 $229.90
Rate for Payer: Cigna LocalPlus Benefit Plan $264.38
Rate for Payer: Fidelis Medicare Advantage $482.79
Rate for Payer: Group Health Inc Commercial $229.90
Rate for Payer: Group Health Inc Medicare $160.93
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $298.87
Service Code HCPCS C1713
Hospital Charge Code 40006347
Hospital Revenue Code 278
Min. Negotiated Rate $229.90
Max. Negotiated Rate $229.90
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Service Code HCPCS C1713
Hospital Charge Code 40006425
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006425
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006352
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $482.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $252.89
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 $229.90
Rate for Payer: Cigna LocalPlus Benefit Plan $264.38
Rate for Payer: Fidelis Medicare Advantage $482.79
Rate for Payer: Group Health Inc Commercial $229.90
Rate for Payer: Group Health Inc Medicare $160.93
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $298.87
Service Code HCPCS C1713
Hospital Charge Code 40006352
Hospital Revenue Code 278
Min. Negotiated Rate $229.90
Max. Negotiated Rate $229.90
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Service Code HCPCS C1713
Hospital Charge Code 40006430
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006430
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006357
Hospital Revenue Code 278
Min. Negotiated Rate $229.90
Max. Negotiated Rate $229.90
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Service Code HCPCS C1713
Hospital Charge Code 40006357
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $482.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $252.89
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 $229.90
Rate for Payer: Cigna LocalPlus Benefit Plan $264.38
Rate for Payer: Fidelis Medicare Advantage $482.79
Rate for Payer: Group Health Inc Commercial $229.90
Rate for Payer: Group Health Inc Medicare $160.93
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $298.87
Service Code HCPCS C1713
Hospital Charge Code 40006433
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006433
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006360
Hospital Revenue Code 278
Min. Negotiated Rate $229.90
Max. Negotiated Rate $229.90
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Service Code HCPCS C1713
Hospital Charge Code 40006360
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $482.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $252.89
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 $229.90
Rate for Payer: Cigna LocalPlus Benefit Plan $264.38
Rate for Payer: Fidelis Medicare Advantage $482.79
Rate for Payer: Group Health Inc Commercial $229.90
Rate for Payer: Group Health Inc Medicare $160.93
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $298.87
Service Code HCPCS C1713
Hospital Charge Code 40006436
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006436
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006363
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $482.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $252.89
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 $229.90
Rate for Payer: Cigna LocalPlus Benefit Plan $264.38
Rate for Payer: Fidelis Medicare Advantage $482.79
Rate for Payer: Group Health Inc Commercial $229.90
Rate for Payer: Group Health Inc Medicare $160.93
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $298.87
Service Code HCPCS C1713
Hospital Charge Code 40006363
Hospital Revenue Code 278
Min. Negotiated Rate $229.90
Max. Negotiated Rate $229.90
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Service Code HCPCS C1713
Hospital Charge Code 40006439
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $451.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $236.58
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 $215.07
Rate for Payer: Cigna LocalPlus Benefit Plan $247.33
Rate for Payer: Fidelis Medicare Advantage $451.65
Rate for Payer: Group Health Inc Commercial $215.07
Rate for Payer: Group Health Inc Medicare $150.55
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $279.59
Service Code HCPCS C1713
Hospital Charge Code 40006439
Hospital Revenue Code 278
Min. Negotiated Rate $215.07
Max. Negotiated Rate $215.07
Rate for Payer: Hamaspik Choice Inc Medicaid $215.07
Rate for Payer: Hamaspik Choice Inc Medicare $215.07
Service Code HCPCS C1713
Hospital Charge Code 40006366
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $482.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial $252.89
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 $229.90
Rate for Payer: Cigna LocalPlus Benefit Plan $264.38
Rate for Payer: Fidelis Medicare Advantage $482.79
Rate for Payer: Group Health Inc Commercial $229.90
Rate for Payer: Group Health Inc Medicare $160.93
Rate for Payer: Hamaspik Choice Inc Medicaid $229.90
Rate for Payer: Hamaspik Choice Inc Medicare $229.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $298.87