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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40006275
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006275
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006278
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006278
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006281
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006281
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006284
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006284
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006287
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006287
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006290
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006290
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006293
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006293
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006296
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006296
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006264
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006264
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006267
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006267
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006270
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006270
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006273
Hospital Revenue Code 278
Min. Negotiated Rate $2,261.88
Max. Negotiated Rate $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Service Code HCPCS C1713
Hospital Charge Code 40006273
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44
Service Code HCPCS C1713
Hospital Charge Code 40006279
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,749.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,488.07
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 $2,261.88
Rate for Payer: Cigna LocalPlus Benefit Plan $2,601.16
Rate for Payer: Fidelis Medicare Advantage $4,749.95
Rate for Payer: Group Health Inc Commercial $2,261.88
Rate for Payer: Group Health Inc Medicare $1,583.32
Rate for Payer: Hamaspik Choice Inc Medicaid $2,261.88
Rate for Payer: Hamaspik Choice Inc Medicare $2,261.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,940.44