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Charge Type Price  
Hospital Charge Code 40006772
Hospital Revenue Code 272
Min. Negotiated Rate $111.62
Max. Negotiated Rate $255.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $175.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $159.45
Rate for Payer: Aetna Government $159.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $255.12
Rate for Payer: Cigna LocalPlus Benefit Plan $216.85
Rate for Payer: Group Health Inc Commercial $159.45
Rate for Payer: Group Health Inc Medicare $111.62
Rate for Payer: Hamaspik Choice Inc Medicaid $159.45
Rate for Payer: Hamaspik Choice Inc Medicare $159.45
Service Code HCPCS C1713
Hospital Charge Code 40006146
Hospital Revenue Code 278
Min. Negotiated Rate $400.00
Max. Negotiated Rate $400.00
Rate for Payer: Hamaspik Choice Inc Medicaid $400.00
Rate for Payer: Hamaspik Choice Inc Medicare $400.00
Service Code HCPCS C1713
Hospital Charge Code 40006146
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $440.00
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 $400.00
Rate for Payer: Cigna LocalPlus Benefit Plan $460.00
Rate for Payer: Fidelis Medicare Advantage $840.00
Rate for Payer: Group Health Inc Commercial $400.00
Rate for Payer: Group Health Inc Medicare $280.00
Rate for Payer: Hamaspik Choice Inc Medicaid $400.00
Rate for Payer: Hamaspik Choice Inc Medicare $400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $520.00
Service Code HCPCS C1713
Hospital Charge Code 40202051
Hospital Revenue Code 278
Min. Negotiated Rate $451.17
Max. Negotiated Rate $451.17
Rate for Payer: Hamaspik Choice Inc Medicaid $451.17
Rate for Payer: Hamaspik Choice Inc Medicare $451.17
Service Code HCPCS C1713
Hospital Charge Code 40202051
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $947.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $496.29
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 $451.17
Rate for Payer: Cigna LocalPlus Benefit Plan $518.85
Rate for Payer: Fidelis Medicare Advantage $947.46
Rate for Payer: Group Health Inc Commercial $451.17
Rate for Payer: Group Health Inc Medicare $315.82
Rate for Payer: Hamaspik Choice Inc Medicaid $451.17
Rate for Payer: Hamaspik Choice Inc Medicare $451.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $586.52
Hospital Charge Code 40202392
Hospital Revenue Code 270
Min. Negotiated Rate $11.20
Max. Negotiated Rate $25.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $16.00
Rate for Payer: Aetna Government $16.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $25.60
Rate for Payer: Cigna LocalPlus Benefit Plan $21.76
Rate for Payer: Group Health Inc Commercial $16.00
Rate for Payer: Group Health Inc Medicare $11.20
Rate for Payer: Hamaspik Choice Inc Medicaid $16.00
Rate for Payer: Hamaspik Choice Inc Medicare $16.00
Service Code HCPCS C1713
Hospital Charge Code 40202750
Hospital Revenue Code 278
Min. Negotiated Rate $94.50
Max. Negotiated Rate $283.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $148.50
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 $135.00
Rate for Payer: Cigna LocalPlus Benefit Plan $155.25
Rate for Payer: Fidelis Medicare Advantage $283.50
Rate for Payer: Group Health Inc Commercial $135.00
Rate for Payer: Group Health Inc Medicare $94.50
Rate for Payer: Hamaspik Choice Inc Medicaid $135.00
Rate for Payer: Hamaspik Choice Inc Medicare $135.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $175.50
Service Code HCPCS C1713
Hospital Charge Code 40202750
Hospital Revenue Code 278
Min. Negotiated Rate $135.00
Max. Negotiated Rate $135.00
Rate for Payer: Hamaspik Choice Inc Medicaid $135.00
Rate for Payer: Hamaspik Choice Inc Medicare $135.00
Service Code HCPCS C1713
Hospital Charge Code 40201064
Hospital Revenue Code 278
Min. Negotiated Rate $128.10
Max. Negotiated Rate $384.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $201.30
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 $183.00
Rate for Payer: Cigna LocalPlus Benefit Plan $210.45
Rate for Payer: Fidelis Medicare Advantage $384.30
Rate for Payer: Group Health Inc Commercial $183.00
Rate for Payer: Group Health Inc Medicare $128.10
Rate for Payer: Hamaspik Choice Inc Medicaid $183.00
Rate for Payer: Hamaspik Choice Inc Medicare $183.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $237.90
Service Code HCPCS C1713
Hospital Charge Code 40201064
Hospital Revenue Code 278
Min. Negotiated Rate $183.00
Max. Negotiated Rate $183.00
Rate for Payer: Hamaspik Choice Inc Medicaid $183.00
Rate for Payer: Hamaspik Choice Inc Medicare $183.00
Service Code HCPCS C1713
Hospital Charge Code 40201061
Hospital Revenue Code 278
Min. Negotiated Rate $183.00
Max. Negotiated Rate $183.00
Rate for Payer: Hamaspik Choice Inc Medicaid $183.00
Rate for Payer: Hamaspik Choice Inc Medicare $183.00
Service Code HCPCS C1713
Hospital Charge Code 40201061
Hospital Revenue Code 278
Min. Negotiated Rate $128.10
Max. Negotiated Rate $384.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $201.30
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 $183.00
Rate for Payer: Cigna LocalPlus Benefit Plan $210.45
Rate for Payer: Fidelis Medicare Advantage $384.30
Rate for Payer: Group Health Inc Commercial $183.00
Rate for Payer: Group Health Inc Medicare $128.10
Rate for Payer: Hamaspik Choice Inc Medicaid $183.00
Rate for Payer: Hamaspik Choice Inc Medicare $183.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $237.90
Service Code HCPCS C1713
Hospital Charge Code 40201068
Hospital Revenue Code 278
Min. Negotiated Rate $260.00
Max. Negotiated Rate $260.00
Rate for Payer: Hamaspik Choice Inc Medicaid $260.00
Rate for Payer: Hamaspik Choice Inc Medicare $260.00
Service Code HCPCS C1713
Hospital Charge Code 40201068
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $546.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $286.00
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 $260.00
Rate for Payer: Cigna LocalPlus Benefit Plan $299.00
Rate for Payer: Fidelis Medicare Advantage $546.00
Rate for Payer: Group Health Inc Commercial $260.00
Rate for Payer: Group Health Inc Medicare $182.00
Rate for Payer: Hamaspik Choice Inc Medicaid $260.00
Rate for Payer: Hamaspik Choice Inc Medicare $260.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $338.00
Service Code HCPCS C1713
Hospital Charge Code 40201069
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $611.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $320.10
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 $291.00
Rate for Payer: Cigna LocalPlus Benefit Plan $334.65
Rate for Payer: Fidelis Medicare Advantage $611.10
Rate for Payer: Group Health Inc Commercial $291.00
Rate for Payer: Group Health Inc Medicare $203.70
Rate for Payer: Hamaspik Choice Inc Medicaid $291.00
Rate for Payer: Hamaspik Choice Inc Medicare $291.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $378.30
Service Code HCPCS C1713
Hospital Charge Code 40201069
Hospital Revenue Code 278
Min. Negotiated Rate $291.00
Max. Negotiated Rate $291.00
Rate for Payer: Hamaspik Choice Inc Medicaid $291.00
Rate for Payer: Hamaspik Choice Inc Medicare $291.00
Service Code HCPCS C1713
Hospital Charge Code 40209833
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $613.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $321.20
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 $292.00
Rate for Payer: Cigna LocalPlus Benefit Plan $335.80
Rate for Payer: Fidelis Medicare Advantage $613.20
Rate for Payer: Group Health Inc Commercial $292.00
Rate for Payer: Group Health Inc Medicare $204.40
Rate for Payer: Hamaspik Choice Inc Medicaid $292.00
Rate for Payer: Hamaspik Choice Inc Medicare $292.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $379.60
Service Code HCPCS C1713
Hospital Charge Code 40209833
Hospital Revenue Code 278
Min. Negotiated Rate $292.00
Max. Negotiated Rate $292.00
Rate for Payer: Hamaspik Choice Inc Medicaid $292.00
Rate for Payer: Hamaspik Choice Inc Medicare $292.00
Service Code HCPCS C1713
Hospital Charge Code 40209834
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 C1713
Hospital Charge Code 40209834
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $360.80
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 $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 40201070
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 C1713
Hospital Charge Code 40201070
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $688.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $360.80
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 $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 40201067
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $428.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $224.40
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 $204.00
Rate for Payer: Cigna LocalPlus Benefit Plan $234.60
Rate for Payer: Fidelis Medicare Advantage $428.40
Rate for Payer: Group Health Inc Commercial $204.00
Rate for Payer: Group Health Inc Medicare $142.80
Rate for Payer: Hamaspik Choice Inc Medicaid $204.00
Rate for Payer: Hamaspik Choice Inc Medicare $204.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $265.20
Service Code HCPCS C1713
Hospital Charge Code 40201067
Hospital Revenue Code 278
Min. Negotiated Rate $204.00
Max. Negotiated Rate $204.00
Rate for Payer: Hamaspik Choice Inc Medicaid $204.00
Rate for Payer: Hamaspik Choice Inc Medicare $204.00
Service Code HCPCS C1713
Hospital Charge Code 40201063
Hospital Revenue Code 278
Min. Negotiated Rate $182.50
Max. Negotiated Rate $182.50
Rate for Payer: Hamaspik Choice Inc Medicaid $182.50
Rate for Payer: Hamaspik Choice Inc Medicare $182.50