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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40209639
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 64902736
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,174.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $615.19
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 $559.26
Rate for Payer: Cigna LocalPlus Benefit Plan $643.15
Rate for Payer: Fidelis Medicare Advantage $1,174.46
Rate for Payer: Group Health Inc Commercial $559.26
Rate for Payer: Group Health Inc Medicare $391.49
Rate for Payer: Hamaspik Choice Inc Medicaid $559.26
Rate for Payer: Hamaspik Choice Inc Medicare $559.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $727.04
Service Code HCPCS C1713
Hospital Charge Code 64902736
Hospital Revenue Code 278
Min. Negotiated Rate $559.26
Max. Negotiated Rate $559.26
Rate for Payer: Hamaspik Choice Inc Medicaid $559.26
Rate for Payer: Hamaspik Choice Inc Medicare $559.26
Service Code HCPCS C1713
Hospital Charge Code 40005918
Hospital Revenue Code 278
Min. Negotiated Rate $1,786.00
Max. Negotiated Rate $1,786.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,786.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,786.00
Service Code HCPCS C1713
Hospital Charge Code 40005918
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,750.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,964.60
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 $1,786.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,053.90
Rate for Payer: Fidelis Medicare Advantage $3,750.60
Rate for Payer: Group Health Inc Commercial $1,786.00
Rate for Payer: Group Health Inc Medicare $1,250.20
Rate for Payer: Hamaspik Choice Inc Medicaid $1,786.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,786.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,321.80
Service Code HCPCS C1713
Hospital Charge Code 64906588
Hospital Revenue Code 279
Min. Negotiated Rate $134.20
Max. Negotiated Rate $7,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,950.00
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 $7,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan $6,120.00
Rate for Payer: Group Health Inc Commercial $4,500.00
Rate for Payer: Group Health Inc Medicare $3,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,500.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,500.00
Service Code HCPCS C1713
Hospital Charge Code 40200247
Hospital Revenue Code 278
Min. Negotiated Rate $395.00
Max. Negotiated Rate $395.00
Rate for Payer: Hamaspik Choice Inc Medicaid $395.00
Rate for Payer: Hamaspik Choice Inc Medicare $395.00
Service Code HCPCS C1713
Hospital Charge Code 40200247
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $829.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $434.50
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 $395.00
Rate for Payer: Cigna LocalPlus Benefit Plan $454.25
Rate for Payer: Fidelis Medicare Advantage $829.50
Rate for Payer: Group Health Inc Commercial $395.00
Rate for Payer: Group Health Inc Medicare $276.50
Rate for Payer: Hamaspik Choice Inc Medicaid $395.00
Rate for Payer: Hamaspik Choice Inc Medicare $395.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $513.50
Service Code HCPCS C1713
Hospital Charge Code 64905080
Hospital Revenue Code 278
Min. Negotiated Rate $11,610.00
Max. Negotiated Rate $11,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid $11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare $11,610.00
Service Code HCPCS C1713
Hospital Charge Code 64905080
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $24,381.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12,771.00
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 $11,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan $13,351.50
Rate for Payer: Fidelis Medicare Advantage $24,381.00
Rate for Payer: Group Health Inc Commercial $11,610.00
Rate for Payer: Group Health Inc Medicare $8,127.00
Rate for Payer: Hamaspik Choice Inc Medicaid $11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare $11,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $15,093.00
Service Code HCPCS C1713
Hospital Charge Code 64902440
Hospital Revenue Code 278
Min. Negotiated Rate $455.00
Max. Negotiated Rate $455.00
Rate for Payer: Hamaspik Choice Inc Medicaid $455.00
Rate for Payer: Hamaspik Choice Inc Medicare $455.00
Service Code HCPCS C1713
Hospital Charge Code 64902440
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $955.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $500.50
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 $455.00
Rate for Payer: Cigna LocalPlus Benefit Plan $523.25
Rate for Payer: Fidelis Medicare Advantage $955.50
Rate for Payer: Group Health Inc Commercial $455.00
Rate for Payer: Group Health Inc Medicare $318.50
Rate for Payer: Hamaspik Choice Inc Medicaid $455.00
Rate for Payer: Hamaspik Choice Inc Medicare $455.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $591.50
Service Code HCPCS C1713
Hospital Charge Code 64902436
Hospital Revenue Code 278
Min. Negotiated Rate $455.00
Max. Negotiated Rate $455.00
Rate for Payer: Hamaspik Choice Inc Medicaid $455.00
Rate for Payer: Hamaspik Choice Inc Medicare $455.00
Service Code HCPCS C1713
Hospital Charge Code 64902436
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $955.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $500.50
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 $455.00
Rate for Payer: Cigna LocalPlus Benefit Plan $523.25
Rate for Payer: Fidelis Medicare Advantage $955.50
Rate for Payer: Group Health Inc Commercial $455.00
Rate for Payer: Group Health Inc Medicare $318.50
Rate for Payer: Hamaspik Choice Inc Medicaid $455.00
Rate for Payer: Hamaspik Choice Inc Medicare $455.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $591.50
Service Code HCPCS C1713
Hospital Charge Code 64902438
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $918.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $481.25
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 $437.50
Rate for Payer: Cigna LocalPlus Benefit Plan $503.12
Rate for Payer: Fidelis Medicare Advantage $918.75
Rate for Payer: Group Health Inc Commercial $437.50
Rate for Payer: Group Health Inc Medicare $306.25
Rate for Payer: Hamaspik Choice Inc Medicaid $437.50
Rate for Payer: Hamaspik Choice Inc Medicare $437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $568.75
Service Code HCPCS C1713
Hospital Charge Code 64902438
Hospital Revenue Code 278
Min. Negotiated Rate $437.50
Max. Negotiated Rate $437.50
Rate for Payer: Hamaspik Choice Inc Medicaid $437.50
Rate for Payer: Hamaspik Choice Inc Medicare $437.50
Service Code HCPCS C1713
Hospital Charge Code 64902319
Hospital Revenue Code 278
Min. Negotiated Rate $605.00
Max. Negotiated Rate $605.00
Rate for Payer: Hamaspik Choice Inc Medicaid $605.00
Rate for Payer: Hamaspik Choice Inc Medicare $605.00
Service Code HCPCS C1713
Hospital Charge Code 64902319
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,270.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $665.50
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 $605.00
Rate for Payer: Cigna LocalPlus Benefit Plan $695.75
Rate for Payer: Fidelis Medicare Advantage $1,270.50
Rate for Payer: Group Health Inc Commercial $605.00
Rate for Payer: Group Health Inc Medicare $423.50
Rate for Payer: Hamaspik Choice Inc Medicaid $605.00
Rate for Payer: Hamaspik Choice Inc Medicare $605.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $786.50
Service Code HCPCS C1713
Hospital Charge Code 64905609
Hospital Revenue Code 278
Min. Negotiated Rate $606.25
Max. Negotiated Rate $606.25
Rate for Payer: Hamaspik Choice Inc Medicaid $606.25
Rate for Payer: Hamaspik Choice Inc Medicare $606.25
Service Code HCPCS C1713
Hospital Charge Code 64905609
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $666.88
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 $606.25
Rate for Payer: Cigna LocalPlus Benefit Plan $697.19
Rate for Payer: Fidelis Medicare Advantage $1,273.12
Rate for Payer: Group Health Inc Commercial $606.25
Rate for Payer: Group Health Inc Medicare $424.38
Rate for Payer: Hamaspik Choice Inc Medicaid $606.25
Rate for Payer: Hamaspik Choice Inc Medicare $606.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $788.12
Service Code HCPCS C1713
Hospital Charge Code 64901606
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $666.88
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 $606.25
Rate for Payer: Cigna LocalPlus Benefit Plan $697.19
Rate for Payer: Fidelis Medicare Advantage $1,273.12
Rate for Payer: Group Health Inc Commercial $606.25
Rate for Payer: Group Health Inc Medicare $424.38
Rate for Payer: Hamaspik Choice Inc Medicaid $606.25
Rate for Payer: Hamaspik Choice Inc Medicare $606.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $788.12
Service Code HCPCS C1713
Hospital Charge Code 64901606
Hospital Revenue Code 278
Min. Negotiated Rate $606.25
Max. Negotiated Rate $606.25
Rate for Payer: Hamaspik Choice Inc Medicaid $606.25
Rate for Payer: Hamaspik Choice Inc Medicare $606.25
Service Code HCPCS C1713
Hospital Charge Code 64905608
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $666.88
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 $606.25
Rate for Payer: Cigna LocalPlus Benefit Plan $697.19
Rate for Payer: Fidelis Medicare Advantage $1,273.12
Rate for Payer: Group Health Inc Commercial $606.25
Rate for Payer: Group Health Inc Medicare $424.38
Rate for Payer: Hamaspik Choice Inc Medicaid $606.25
Rate for Payer: Hamaspik Choice Inc Medicare $606.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $788.12
Service Code HCPCS C1713
Hospital Charge Code 64905608
Hospital Revenue Code 278
Min. Negotiated Rate $606.25
Max. Negotiated Rate $606.25
Rate for Payer: Hamaspik Choice Inc Medicaid $606.25
Rate for Payer: Hamaspik Choice Inc Medicare $606.25
Hospital Charge Code 40200338
Hospital Revenue Code 270
Min. Negotiated Rate $31.51
Max. Negotiated Rate $72.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $49.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $45.01
Rate for Payer: Aetna Government $45.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $72.02
Rate for Payer: Cigna LocalPlus Benefit Plan $61.21
Rate for Payer: Group Health Inc Commercial $45.01
Rate for Payer: Group Health Inc Medicare $31.51
Rate for Payer: Hamaspik Choice Inc Medicaid $45.01
Rate for Payer: Hamaspik Choice Inc Medicare $45.01