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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 64904988
Hospital Revenue Code 278
Min. Negotiated Rate $193.75
Max. Negotiated Rate $193.75
Rate for Payer: Hamaspik Choice Inc Medicaid $193.75
Rate for Payer: Hamaspik Choice Inc Medicare $193.75
Service Code HCPCS C1713
Hospital Charge Code 64904988
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $406.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $213.12
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 $193.75
Rate for Payer: Cigna LocalPlus Benefit Plan $222.81
Rate for Payer: Fidelis Medicare Advantage $406.88
Rate for Payer: Group Health Inc Commercial $193.75
Rate for Payer: Group Health Inc Medicare $135.62
Rate for Payer: Hamaspik Choice Inc Medicaid $193.75
Rate for Payer: Hamaspik Choice Inc Medicare $193.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $251.88
Service Code HCPCS C1713
Hospital Charge Code 64904421
Hospital Revenue Code 278
Min. Negotiated Rate $193.75
Max. Negotiated Rate $193.75
Rate for Payer: Hamaspik Choice Inc Medicaid $193.75
Rate for Payer: Hamaspik Choice Inc Medicare $193.75
Service Code HCPCS C1713
Hospital Charge Code 64904421
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $406.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $213.12
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 $193.75
Rate for Payer: Cigna LocalPlus Benefit Plan $222.81
Rate for Payer: Fidelis Medicare Advantage $406.88
Rate for Payer: Group Health Inc Commercial $193.75
Rate for Payer: Group Health Inc Medicare $135.62
Rate for Payer: Hamaspik Choice Inc Medicaid $193.75
Rate for Payer: Hamaspik Choice Inc Medicare $193.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $251.88
Service Code HCPCS C1713
Hospital Charge Code 64904409
Hospital Revenue Code 278
Min. Negotiated Rate $187.50
Max. Negotiated Rate $187.50
Rate for Payer: Hamaspik Choice Inc Medicaid $187.50
Rate for Payer: Hamaspik Choice Inc Medicare $187.50
Service Code HCPCS C1713
Hospital Charge Code 64904409
Hospital Revenue Code 278
Min. Negotiated Rate $131.25
Max. Negotiated Rate $393.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $206.25
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 $187.50
Rate for Payer: Cigna LocalPlus Benefit Plan $215.62
Rate for Payer: Fidelis Medicare Advantage $393.75
Rate for Payer: Group Health Inc Commercial $187.50
Rate for Payer: Group Health Inc Medicare $131.25
Rate for Payer: Hamaspik Choice Inc Medicaid $187.50
Rate for Payer: Hamaspik Choice Inc Medicare $187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $243.75
Service Code HCPCS C1713
Hospital Charge Code 64904407
Hospital Revenue Code 278
Min. Negotiated Rate $131.25
Max. Negotiated Rate $393.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $206.25
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 $187.50
Rate for Payer: Cigna LocalPlus Benefit Plan $215.62
Rate for Payer: Fidelis Medicare Advantage $393.75
Rate for Payer: Group Health Inc Commercial $187.50
Rate for Payer: Group Health Inc Medicare $131.25
Rate for Payer: Hamaspik Choice Inc Medicaid $187.50
Rate for Payer: Hamaspik Choice Inc Medicare $187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $243.75
Service Code HCPCS C1713
Hospital Charge Code 64904407
Hospital Revenue Code 278
Min. Negotiated Rate $187.50
Max. Negotiated Rate $187.50
Rate for Payer: Hamaspik Choice Inc Medicaid $187.50
Rate for Payer: Hamaspik Choice Inc Medicare $187.50
Service Code HCPCS C1713
Hospital Charge Code 64904519
Hospital Revenue Code 278
Min. Negotiated Rate $164.69
Max. Negotiated Rate $164.69
Rate for Payer: Hamaspik Choice Inc Medicaid $164.69
Rate for Payer: Hamaspik Choice Inc Medicare $164.69
Service Code HCPCS C1713
Hospital Charge Code 64904519
Hospital Revenue Code 278
Min. Negotiated Rate $115.28
Max. Negotiated Rate $345.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial $181.16
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 $164.69
Rate for Payer: Cigna LocalPlus Benefit Plan $189.39
Rate for Payer: Fidelis Medicare Advantage $345.85
Rate for Payer: Group Health Inc Commercial $164.69
Rate for Payer: Group Health Inc Medicare $115.28
Rate for Payer: Hamaspik Choice Inc Medicaid $164.69
Rate for Payer: Hamaspik Choice Inc Medicare $164.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $214.10
Service Code HCPCS C1713
Hospital Charge Code 64904796
Hospital Revenue Code 278
Min. Negotiated Rate $115.28
Max. Negotiated Rate $345.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial $181.16
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 $164.69
Rate for Payer: Cigna LocalPlus Benefit Plan $189.39
Rate for Payer: Fidelis Medicare Advantage $345.85
Rate for Payer: Group Health Inc Commercial $164.69
Rate for Payer: Group Health Inc Medicare $115.28
Rate for Payer: Hamaspik Choice Inc Medicaid $164.69
Rate for Payer: Hamaspik Choice Inc Medicare $164.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $214.10
Service Code HCPCS C1713
Hospital Charge Code 64904796
Hospital Revenue Code 278
Min. Negotiated Rate $164.69
Max. Negotiated Rate $164.69
Rate for Payer: Hamaspik Choice Inc Medicaid $164.69
Rate for Payer: Hamaspik Choice Inc Medicare $164.69
Service Code HCPCS C1713
Hospital Charge Code 64904628
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $406.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $213.12
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 $193.75
Rate for Payer: Cigna LocalPlus Benefit Plan $222.81
Rate for Payer: Fidelis Medicare Advantage $406.88
Rate for Payer: Group Health Inc Commercial $193.75
Rate for Payer: Group Health Inc Medicare $135.62
Rate for Payer: Hamaspik Choice Inc Medicaid $193.75
Rate for Payer: Hamaspik Choice Inc Medicare $193.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $251.88
Service Code HCPCS C1713
Hospital Charge Code 64904628
Hospital Revenue Code 278
Min. Negotiated Rate $193.75
Max. Negotiated Rate $193.75
Rate for Payer: Hamaspik Choice Inc Medicaid $193.75
Rate for Payer: Hamaspik Choice Inc Medicare $193.75
Service Code HCPCS C1713
Hospital Charge Code 64904630
Hospital Revenue Code 278
Min. Negotiated Rate $115.28
Max. Negotiated Rate $345.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial $181.16
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 $164.69
Rate for Payer: Cigna LocalPlus Benefit Plan $189.39
Rate for Payer: Fidelis Medicare Advantage $345.85
Rate for Payer: Group Health Inc Commercial $164.69
Rate for Payer: Group Health Inc Medicare $115.28
Rate for Payer: Hamaspik Choice Inc Medicaid $164.69
Rate for Payer: Hamaspik Choice Inc Medicare $164.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $214.10
Service Code HCPCS C1713
Hospital Charge Code 64904630
Hospital Revenue Code 278
Min. Negotiated Rate $164.69
Max. Negotiated Rate $164.69
Rate for Payer: Hamaspik Choice Inc Medicaid $164.69
Rate for Payer: Hamaspik Choice Inc Medicare $164.69
Service Code HCPCS C1713
Hospital Charge Code 40009115
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $6,615.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,465.00
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 $3,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,622.50
Rate for Payer: Fidelis Medicare Advantage $6,615.00
Rate for Payer: Group Health Inc Commercial $3,150.00
Rate for Payer: Group Health Inc Medicare $2,205.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,150.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,095.00
Service Code HCPCS C1713
Hospital Charge Code 40009115
Hospital Revenue Code 278
Min. Negotiated Rate $3,150.00
Max. Negotiated Rate $3,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,150.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,150.00
Service Code HCPCS C1713
Hospital Charge Code 40203151
Hospital Revenue Code 278
Min. Negotiated Rate $411.30
Max. Negotiated Rate $411.30
Rate for Payer: Hamaspik Choice Inc Medicaid $411.30
Rate for Payer: Hamaspik Choice Inc Medicare $411.30
Service Code HCPCS C1713
Hospital Charge Code 40203151
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $863.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial $452.43
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 $411.30
Rate for Payer: Cigna LocalPlus Benefit Plan $473.00
Rate for Payer: Fidelis Medicare Advantage $863.73
Rate for Payer: Group Health Inc Commercial $411.30
Rate for Payer: Group Health Inc Medicare $287.91
Rate for Payer: Hamaspik Choice Inc Medicaid $411.30
Rate for Payer: Hamaspik Choice Inc Medicare $411.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $534.69
Service Code HCPCS C1713
Hospital Charge Code 40200072
Hospital Revenue Code 278
Min. Negotiated Rate $1,038.00
Max. Negotiated Rate $1,038.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,038.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,038.00
Service Code HCPCS C1713
Hospital Charge Code 40200072
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,179.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,141.80
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 $1,038.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,193.70
Rate for Payer: Fidelis Medicare Advantage $2,179.80
Rate for Payer: Group Health Inc Commercial $1,038.00
Rate for Payer: Group Health Inc Medicare $726.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,038.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,038.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,349.40
Hospital Charge Code 64903644
Hospital Revenue Code 270
Min. Negotiated Rate $17.60
Max. Negotiated Rate $40.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $27.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $25.14
Rate for Payer: Aetna Government $25.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $40.22
Rate for Payer: Cigna LocalPlus Benefit Plan $34.19
Rate for Payer: Group Health Inc Commercial $25.14
Rate for Payer: Group Health Inc Medicare $17.60
Rate for Payer: Hamaspik Choice Inc Medicaid $25.14
Rate for Payer: Hamaspik Choice Inc Medicare $25.14
Service Code HCPCS C1785
Hospital Charge Code 66572892
Hospital Revenue Code 275
Min. Negotiated Rate $275.42
Max. Negotiated Rate $13,965.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7,315.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $275.42
Rate for Payer: Aetna Government $275.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6,650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $7,647.50
Rate for Payer: Fidelis Medicare Advantage $13,965.00
Rate for Payer: Group Health Inc Commercial $6,650.00
Rate for Payer: Group Health Inc Medicare $4,655.00
Rate for Payer: Hamaspik Choice Inc Medicaid $6,650.00
Rate for Payer: Hamaspik Choice Inc Medicare $6,650.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8,645.00
Hospital Charge Code 64901795
Hospital Revenue Code 270
Min. Negotiated Rate $16.51
Max. Negotiated Rate $37.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial $25.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $23.58
Rate for Payer: Aetna Government $23.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $37.74
Rate for Payer: Cigna LocalPlus Benefit Plan $32.08
Rate for Payer: Group Health Inc Commercial $23.58
Rate for Payer: Group Health Inc Medicare $16.51
Rate for Payer: Hamaspik Choice Inc Medicaid $23.58
Rate for Payer: Hamaspik Choice Inc Medicare $23.58