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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40203003
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,626.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,899.59
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 $1,726.90
Rate for Payer: Cigna LocalPlus Benefit Plan $1,985.94
Rate for Payer: Fidelis Medicare Advantage $3,626.49
Rate for Payer: Group Health Inc Commercial $1,726.90
Rate for Payer: Group Health Inc Medicare $1,208.83
Rate for Payer: Hamaspik Choice Inc Medicaid $1,726.90
Rate for Payer: Hamaspik Choice Inc Medicare $1,726.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,244.97
Service Code HCPCS C1713
Hospital Charge Code 40203003
Hospital Revenue Code 278
Min. Negotiated Rate $1,726.90
Max. Negotiated Rate $1,726.90
Rate for Payer: Hamaspik Choice Inc Medicaid $1,726.90
Rate for Payer: Hamaspik Choice Inc Medicare $1,726.90
Service Code HCPCS C1713
Hospital Charge Code 40005311
Hospital Revenue Code 278
Min. Negotiated Rate $2,639.00
Max. Negotiated Rate $2,639.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,639.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,639.00
Service Code HCPCS C1713
Hospital Charge Code 40005311
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $5,541.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,902.90
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 $2,639.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,034.85
Rate for Payer: Fidelis Medicare Advantage $5,541.90
Rate for Payer: Group Health Inc Commercial $2,639.00
Rate for Payer: Group Health Inc Medicare $1,847.30
Rate for Payer: Hamaspik Choice Inc Medicaid $2,639.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,639.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,430.70
Service Code HCPCS C1713
Hospital Charge Code 40005309
Hospital Revenue Code 278
Min. Negotiated Rate $46.33
Max. Negotiated Rate $139.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $72.81
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 $66.19
Rate for Payer: Cigna LocalPlus Benefit Plan $76.12
Rate for Payer: Fidelis Medicare Advantage $139.00
Rate for Payer: Group Health Inc Commercial $66.19
Rate for Payer: Group Health Inc Medicare $46.33
Rate for Payer: Hamaspik Choice Inc Medicaid $66.19
Rate for Payer: Hamaspik Choice Inc Medicare $66.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $86.05
Service Code HCPCS C1713
Hospital Charge Code 40005309
Hospital Revenue Code 278
Min. Negotiated Rate $66.19
Max. Negotiated Rate $66.19
Rate for Payer: Hamaspik Choice Inc Medicaid $66.19
Rate for Payer: Hamaspik Choice Inc Medicare $66.19
Hospital Charge Code 40200585
Hospital Revenue Code 270
Min. Negotiated Rate $399.00
Max. Negotiated Rate $912.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $627.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $570.00
Rate for Payer: Aetna Government $570.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $912.00
Rate for Payer: Cigna LocalPlus Benefit Plan $775.20
Rate for Payer: Group Health Inc Commercial $570.00
Rate for Payer: Group Health Inc Medicare $399.00
Rate for Payer: Hamaspik Choice Inc Medicaid $570.00
Rate for Payer: Hamaspik Choice Inc Medicare $570.00
Hospital Charge Code 40200586
Hospital Revenue Code 270
Min. Negotiated Rate $281.40
Max. Negotiated Rate $643.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $442.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $402.00
Rate for Payer: Aetna Government $402.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $643.20
Rate for Payer: Cigna LocalPlus Benefit Plan $546.72
Rate for Payer: Group Health Inc Commercial $402.00
Rate for Payer: Group Health Inc Medicare $281.40
Rate for Payer: Hamaspik Choice Inc Medicaid $402.00
Rate for Payer: Hamaspik Choice Inc Medicare $402.00
Service Code HCPCS C1713
Hospital Charge Code 40009116
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $5,292.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,772.00
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 $2,520.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,898.00
Rate for Payer: Fidelis Medicare Advantage $5,292.00
Rate for Payer: Group Health Inc Commercial $2,520.00
Rate for Payer: Group Health Inc Medicare $1,764.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,520.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,520.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,276.00
Service Code HCPCS C1713
Hospital Charge Code 40009116
Hospital Revenue Code 278
Min. Negotiated Rate $2,520.00
Max. Negotiated Rate $2,520.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,520.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,520.00
Service Code HCPCS C1713
Hospital Charge Code 40202316
Hospital Revenue Code 278
Min. Negotiated Rate $40.60
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $63.80
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 $58.00
Rate for Payer: Cigna LocalPlus Benefit Plan $66.70
Rate for Payer: Fidelis Medicare Advantage $121.80
Rate for Payer: Group Health Inc Commercial $58.00
Rate for Payer: Group Health Inc Medicare $40.60
Rate for Payer: Hamaspik Choice Inc Medicaid $58.00
Rate for Payer: Hamaspik Choice Inc Medicare $58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $75.40
Service Code HCPCS C1713
Hospital Charge Code 40202316
Hospital Revenue Code 278
Min. Negotiated Rate $58.00
Max. Negotiated Rate $58.00
Rate for Payer: Hamaspik Choice Inc Medicaid $58.00
Rate for Payer: Hamaspik Choice Inc Medicare $58.00
Service Code HCPCS C1713
Hospital Charge Code 40202317
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $753.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $394.90
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 $359.00
Rate for Payer: Cigna LocalPlus Benefit Plan $412.85
Rate for Payer: Fidelis Medicare Advantage $753.90
Rate for Payer: Group Health Inc Commercial $359.00
Rate for Payer: Group Health Inc Medicare $251.30
Rate for Payer: Hamaspik Choice Inc Medicaid $359.00
Rate for Payer: Hamaspik Choice Inc Medicare $359.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $466.70
Service Code HCPCS C1713
Hospital Charge Code 40202317
Hospital Revenue Code 278
Min. Negotiated Rate $359.00
Max. Negotiated Rate $359.00
Rate for Payer: Hamaspik Choice Inc Medicaid $359.00
Rate for Payer: Hamaspik Choice Inc Medicare $359.00
Service Code HCPCS C1781
Hospital Charge Code 40209810
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $833.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $436.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $397.00
Rate for Payer: Cigna LocalPlus Benefit Plan $456.55
Rate for Payer: Fidelis Medicare Advantage $833.70
Rate for Payer: Group Health Inc Commercial $397.00
Rate for Payer: Group Health Inc Medicare $277.90
Rate for Payer: Hamaspik Choice Inc Medicaid $397.00
Rate for Payer: Hamaspik Choice Inc Medicare $397.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $516.10
Service Code HCPCS C1781
Hospital Charge Code 40209810
Hospital Revenue Code 278
Min. Negotiated Rate $397.00
Max. Negotiated Rate $397.00
Rate for Payer: Hamaspik Choice Inc Medicaid $397.00
Rate for Payer: Hamaspik Choice Inc Medicare $397.00
Service Code HCPCS C1781
Hospital Charge Code 40209811
Hospital Revenue Code 278
Min. Negotiated Rate $328.00
Max. Negotiated Rate $328.00
Rate for Payer: Hamaspik Choice Inc Medicaid $328.00
Rate for Payer: Hamaspik Choice Inc Medicare $328.00
Service Code HCPCS C1781
Hospital Charge Code 40209811
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $360.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $328.00
Rate for Payer: Cigna LocalPlus Benefit Plan $377.20
Rate for Payer: Fidelis Medicare Advantage $688.80
Rate for Payer: Group Health Inc Commercial $328.00
Rate for Payer: Group Health Inc Medicare $229.60
Rate for Payer: Hamaspik Choice Inc Medicaid $328.00
Rate for Payer: Hamaspik Choice Inc Medicare $328.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $426.40
Service Code HCPCS C1713
Hospital Charge Code 40200063
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $577.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $302.50
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 $275.00
Rate for Payer: Cigna LocalPlus Benefit Plan $316.25
Rate for Payer: Fidelis Medicare Advantage $577.50
Rate for Payer: Group Health Inc Commercial $275.00
Rate for Payer: Group Health Inc Medicare $192.50
Rate for Payer: Hamaspik Choice Inc Medicaid $275.00
Rate for Payer: Hamaspik Choice Inc Medicare $275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $357.50
Service Code HCPCS C1713
Hospital Charge Code 40200063
Hospital Revenue Code 278
Min. Negotiated Rate $275.00
Max. Negotiated Rate $275.00
Rate for Payer: Hamaspik Choice Inc Medicaid $275.00
Rate for Payer: Hamaspik Choice Inc Medicare $275.00
Service Code HCPCS C1781
Hospital Charge Code 40209812
Hospital Revenue Code 278
Min. Negotiated Rate $312.00
Max. Negotiated Rate $312.00
Rate for Payer: Hamaspik Choice Inc Medicaid $312.00
Rate for Payer: Hamaspik Choice Inc Medicare $312.00
Service Code HCPCS C1781
Hospital Charge Code 40209812
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $655.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $343.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $312.00
Rate for Payer: Cigna LocalPlus Benefit Plan $358.80
Rate for Payer: Fidelis Medicare Advantage $655.20
Rate for Payer: Group Health Inc Commercial $312.00
Rate for Payer: Group Health Inc Medicare $218.40
Rate for Payer: Hamaspik Choice Inc Medicaid $312.00
Rate for Payer: Hamaspik Choice Inc Medicare $312.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $405.60
Hospital Charge Code 40504100
Hospital Revenue Code 260
Min. Negotiated Rate $5.71
Max. Negotiated Rate $13.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $8.16
Rate for Payer: Aetna Government $8.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $13.05
Rate for Payer: Cigna LocalPlus Benefit Plan $11.09
Rate for Payer: Group Health Inc Commercial $8.16
Rate for Payer: Group Health Inc Medicare $5.71
Rate for Payer: Hamaspik Choice Inc Medicaid $8.16
Rate for Payer: Hamaspik Choice Inc Medicare $8.16
Service Code HCPCS C1713
Hospital Charge Code 40202318
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $735.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $385.00
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 $350.00
Rate for Payer: Cigna LocalPlus Benefit Plan $402.50
Rate for Payer: Fidelis Medicare Advantage $735.00
Rate for Payer: Group Health Inc Commercial $350.00
Rate for Payer: Group Health Inc Medicare $245.00
Rate for Payer: Hamaspik Choice Inc Medicaid $350.00
Rate for Payer: Hamaspik Choice Inc Medicare $350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $455.00
Service Code HCPCS C1713
Hospital Charge Code 40202318
Hospital Revenue Code 278
Min. Negotiated Rate $350.00
Max. Negotiated Rate $350.00
Rate for Payer: Hamaspik Choice Inc Medicaid $350.00
Rate for Payer: Hamaspik Choice Inc Medicare $350.00