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Charge Type Price  
Hospital Charge Code 64906271
Hospital Revenue Code 270
Min. Negotiated Rate $595.00
Max. Negotiated Rate $1,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $850.00
Rate for Payer: Aetna Government $850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,156.00
Rate for Payer: Group Health Inc Commercial $850.00
Rate for Payer: Group Health Inc Medicare $595.00
Rate for Payer: Hamaspik Choice Inc Medicaid $850.00
Rate for Payer: Hamaspik Choice Inc Medicare $850.00
Service Code HCPCS C1776
Hospital Charge Code 64906657
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,955.00
Rate for Payer: Fidelis Medicare Advantage $3,570.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,210.00
Service Code HCPCS C1776
Hospital Charge Code 64906657
Hospital Revenue Code 278
Min. Negotiated Rate $1,700.00
Max. Negotiated Rate $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Hospital Charge Code 64906734
Hospital Revenue Code 279
Min. Negotiated Rate $1,190.00
Max. Negotiated Rate $2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,700.00
Rate for Payer: Aetna Government $1,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,312.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Hospital Charge Code 64906713
Hospital Revenue Code 279
Min. Negotiated Rate $1,190.00
Max. Negotiated Rate $2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,700.00
Rate for Payer: Aetna Government $1,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,312.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Service Code HCPCS C1776
Hospital Charge Code 64906659
Hospital Revenue Code 278
Min. Negotiated Rate $1,700.00
Max. Negotiated Rate $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Service Code HCPCS C1776
Hospital Charge Code 64906659
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,955.00
Rate for Payer: Fidelis Medicare Advantage $3,570.00
Rate for Payer: Group Health Inc Commercial $1,700.00
Rate for Payer: Group Health Inc Medicare $1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,210.00
Service Code HCPCS C1776
Hospital Charge Code 64906971
Hospital Revenue Code 278
Min. Negotiated Rate $2,310.00
Max. Negotiated Rate $2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,310.00
Service Code HCPCS C1776
Hospital Charge Code 64906971
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,851.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,541.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,656.50
Rate for Payer: Fidelis Medicare Advantage $4,851.00
Rate for Payer: Group Health Inc Commercial $2,310.00
Rate for Payer: Group Health Inc Medicare $1,617.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,003.00
Service Code HCPCS C1776
Hospital Charge Code 64907256
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $10,500.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5,500.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,750.00
Rate for Payer: Fidelis Medicare Advantage $10,500.00
Rate for Payer: Group Health Inc Commercial $5,000.00
Rate for Payer: Group Health Inc Medicare $3,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid $5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare $5,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $6,500.00
Service Code HCPCS C1776
Hospital Charge Code 64907256
Hospital Revenue Code 278
Min. Negotiated Rate $5,000.00
Max. Negotiated Rate $5,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid $5,000.00
Rate for Payer: Hamaspik Choice Inc Medicare $5,000.00
Service Code HCPCS C1776
Hospital Charge Code 64907003
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,851.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,541.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,310.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,656.50
Rate for Payer: Fidelis Medicare Advantage $4,851.00
Rate for Payer: Group Health Inc Commercial $2,310.00
Rate for Payer: Group Health Inc Medicare $1,617.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,310.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,003.00
Service Code HCPCS C1776
Hospital Charge Code 64907003
Hospital Revenue Code 278
Min. Negotiated Rate $2,310.00
Max. Negotiated Rate $2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,310.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,310.00
Service Code HCPCS J3490
Hospital Charge Code 41640333
Hospital Revenue Code 636
Max. Negotiated Rate $0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.01
Rate for Payer: Aetna Government $0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.01
Rate for Payer: Cigna LocalPlus Benefit Plan $0.01
Rate for Payer: Group Health Inc Commercial $0.01
Rate for Payer: Group Health Inc Medicare $0.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.01
Service Code HCPCS J3490
Hospital Charge Code 41650333
Hospital Revenue Code 636
Max. Negotiated Rate $0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.01
Rate for Payer: Aetna Government $0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.01
Rate for Payer: Cigna LocalPlus Benefit Plan $0.01
Rate for Payer: Group Health Inc Commercial $0.01
Rate for Payer: Group Health Inc Medicare $0.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.01
Service Code HCPCS J3490
Hospital Charge Code 41640333
Hospital Revenue Code 636
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Service Code HCPCS J3490
Hospital Charge Code 41650333
Hospital Revenue Code 636
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Hospital Charge Code 41644328
Hospital Revenue Code 250
Min. Negotiated Rate $67.55
Max. Negotiated Rate $154.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $96.50
Rate for Payer: Aetna Government $96.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $154.40
Rate for Payer: Cigna LocalPlus Benefit Plan $131.24
Rate for Payer: Group Health Inc Commercial $96.50
Rate for Payer: Group Health Inc Medicare $67.55
Rate for Payer: Hamaspik Choice Inc Medicaid $96.50
Rate for Payer: Hamaspik Choice Inc Medicare $96.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $125.45
Hospital Charge Code 41654328
Hospital Revenue Code 250
Min. Negotiated Rate $67.55
Max. Negotiated Rate $154.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $106.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $96.50
Rate for Payer: Aetna Government $96.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $154.40
Rate for Payer: Cigna LocalPlus Benefit Plan $131.24
Rate for Payer: Group Health Inc Commercial $96.50
Rate for Payer: Group Health Inc Medicare $67.55
Rate for Payer: Hamaspik Choice Inc Medicaid $96.50
Rate for Payer: Hamaspik Choice Inc Medicare $96.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $125.45
Hospital Charge Code 64902954
Hospital Revenue Code 270
Min. Negotiated Rate $122.45
Max. Negotiated Rate $279.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $192.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $174.92
Rate for Payer: Aetna Government $174.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $279.88
Rate for Payer: Cigna LocalPlus Benefit Plan $237.90
Rate for Payer: Group Health Inc Commercial $174.92
Rate for Payer: Group Health Inc Medicare $122.45
Rate for Payer: Hamaspik Choice Inc Medicaid $174.92
Rate for Payer: Hamaspik Choice Inc Medicare $174.92
Hospital Charge Code 64902966
Hospital Revenue Code 270
Min. Negotiated Rate $120.75
Max. Negotiated Rate $276.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $189.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $172.50
Rate for Payer: Aetna Government $172.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $276.00
Rate for Payer: Cigna LocalPlus Benefit Plan $234.60
Rate for Payer: Group Health Inc Commercial $172.50
Rate for Payer: Group Health Inc Medicare $120.75
Rate for Payer: Hamaspik Choice Inc Medicaid $172.50
Rate for Payer: Hamaspik Choice Inc Medicare $172.50
Hospital Charge Code 64902952
Hospital Revenue Code 270
Min. Negotiated Rate $65.17
Max. Negotiated Rate $148.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial $102.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $93.10
Rate for Payer: Aetna Government $93.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $148.96
Rate for Payer: Cigna LocalPlus Benefit Plan $126.62
Rate for Payer: Group Health Inc Commercial $93.10
Rate for Payer: Group Health Inc Medicare $65.17
Rate for Payer: Hamaspik Choice Inc Medicaid $93.10
Rate for Payer: Hamaspik Choice Inc Medicare $93.10
Hospital Charge Code 40209461
Hospital Revenue Code 270
Min. Negotiated Rate $0.52
Max. Negotiated Rate $1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.75
Rate for Payer: Aetna Government $0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.19
Rate for Payer: Cigna LocalPlus Benefit Plan $1.01
Rate for Payer: Group Health Inc Commercial $0.75
Rate for Payer: Group Health Inc Medicare $0.52
Rate for Payer: Hamaspik Choice Inc Medicaid $0.75
Rate for Payer: Hamaspik Choice Inc Medicare $0.75
Hospital Charge Code 64901856
Hospital Revenue Code 270
Min. Negotiated Rate $0.60
Max. Negotiated Rate $1.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.85
Rate for Payer: Aetna Government $0.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.36
Rate for Payer: Cigna LocalPlus Benefit Plan $1.16
Rate for Payer: Group Health Inc Commercial $0.85
Rate for Payer: Group Health Inc Medicare $0.60
Rate for Payer: Hamaspik Choice Inc Medicaid $0.85
Rate for Payer: Hamaspik Choice Inc Medicare $0.85
Hospital Charge Code 64902956
Hospital Revenue Code 270
Min. Negotiated Rate $56.88
Max. Negotiated Rate $130.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $89.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $81.25
Rate for Payer: Aetna Government $81.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $130.00
Rate for Payer: Cigna LocalPlus Benefit Plan $110.50
Rate for Payer: Group Health Inc Commercial $81.25
Rate for Payer: Group Health Inc Medicare $56.88
Rate for Payer: Hamaspik Choice Inc Medicaid $81.25
Rate for Payer: Hamaspik Choice Inc Medicare $81.25