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Charge Type Price  
Hospital Charge Code 64906292
Hospital Revenue Code 270
Min. Negotiated Rate $946.40
Max. Negotiated Rate $2,163.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,487.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,352.00
Rate for Payer: Aetna Government $1,352.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,163.20
Rate for Payer: Cigna LocalPlus Benefit Plan $1,838.72
Rate for Payer: Group Health Inc Commercial $1,352.00
Rate for Payer: Group Health Inc Medicare $946.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,352.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,352.00
Hospital Charge Code 64904758
Hospital Revenue Code 270
Min. Negotiated Rate $295.70
Max. Negotiated Rate $675.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $464.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $422.44
Rate for Payer: Aetna Government $422.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $675.90
Rate for Payer: Cigna LocalPlus Benefit Plan $574.51
Rate for Payer: Group Health Inc Commercial $422.44
Rate for Payer: Group Health Inc Medicare $295.70
Rate for Payer: Hamaspik Choice Inc Medicaid $422.44
Rate for Payer: Hamaspik Choice Inc Medicare $422.44
Hospital Charge Code 64907072
Hospital Revenue Code 270
Min. Negotiated Rate $149.36
Max. Negotiated Rate $341.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $234.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $213.36
Rate for Payer: Aetna Government $213.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $341.38
Rate for Payer: Cigna LocalPlus Benefit Plan $290.18
Rate for Payer: Group Health Inc Commercial $213.36
Rate for Payer: Group Health Inc Medicare $149.36
Rate for Payer: Hamaspik Choice Inc Medicaid $213.36
Rate for Payer: Hamaspik Choice Inc Medicare $213.36
Hospital Charge Code 40206014
Hospital Revenue Code 270
Min. Negotiated Rate $68.25
Max. Negotiated Rate $156.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $107.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $97.50
Rate for Payer: Aetna Government $97.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $156.00
Rate for Payer: Cigna LocalPlus Benefit Plan $132.60
Rate for Payer: Group Health Inc Commercial $97.50
Rate for Payer: Group Health Inc Medicare $68.25
Rate for Payer: Hamaspik Choice Inc Medicaid $97.50
Rate for Payer: Hamaspik Choice Inc Medicare $97.50
Hospital Charge Code 40206015
Hospital Revenue Code 270
Min. Negotiated Rate $75.75
Max. Negotiated Rate $173.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $119.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $108.21
Rate for Payer: Aetna Government $108.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $173.14
Rate for Payer: Cigna LocalPlus Benefit Plan $147.17
Rate for Payer: Group Health Inc Commercial $108.21
Rate for Payer: Group Health Inc Medicare $75.75
Rate for Payer: Hamaspik Choice Inc Medicaid $108.21
Rate for Payer: Hamaspik Choice Inc Medicare $108.21
Hospital Charge Code 64905151
Hospital Revenue Code 270
Min. Negotiated Rate $280.71
Max. Negotiated Rate $641.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $441.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $401.02
Rate for Payer: Aetna Government $401.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $641.62
Rate for Payer: Cigna LocalPlus Benefit Plan $545.38
Rate for Payer: Group Health Inc Commercial $401.02
Rate for Payer: Group Health Inc Medicare $280.71
Rate for Payer: Hamaspik Choice Inc Medicaid $401.02
Rate for Payer: Hamaspik Choice Inc Medicare $401.02
Hospital Charge Code 64905623
Hospital Revenue Code 270
Min. Negotiated Rate $6.12
Max. Negotiated Rate $14.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $9.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $8.75
Rate for Payer: Aetna Government $8.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $14.00
Rate for Payer: Cigna LocalPlus Benefit Plan $11.90
Rate for Payer: Group Health Inc Commercial $8.75
Rate for Payer: Group Health Inc Medicare $6.12
Rate for Payer: Hamaspik Choice Inc Medicaid $8.75
Rate for Payer: Hamaspik Choice Inc Medicare $8.75
Hospital Charge Code 64902930
Hospital Revenue Code 270
Min. Negotiated Rate $80.63
Max. Negotiated Rate $184.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $126.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $115.19
Rate for Payer: Aetna Government $115.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $184.30
Rate for Payer: Cigna LocalPlus Benefit Plan $156.66
Rate for Payer: Group Health Inc Commercial $115.19
Rate for Payer: Group Health Inc Medicare $80.63
Rate for Payer: Hamaspik Choice Inc Medicaid $115.19
Rate for Payer: Hamaspik Choice Inc Medicare $115.19
Hospital Charge Code 64905173
Hospital Revenue Code 270
Min. Negotiated Rate $348.34
Max. Negotiated Rate $796.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $547.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $497.62
Rate for Payer: Aetna Government $497.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $796.20
Rate for Payer: Cigna LocalPlus Benefit Plan $676.77
Rate for Payer: Group Health Inc Commercial $497.62
Rate for Payer: Group Health Inc Medicare $348.34
Rate for Payer: Hamaspik Choice Inc Medicaid $497.62
Rate for Payer: Hamaspik Choice Inc Medicare $497.62
Hospital Charge Code 64902925
Hospital Revenue Code 270
Min. Negotiated Rate $79.48
Max. Negotiated Rate $181.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $124.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $113.55
Rate for Payer: Aetna Government $113.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $181.68
Rate for Payer: Cigna LocalPlus Benefit Plan $154.43
Rate for Payer: Group Health Inc Commercial $113.55
Rate for Payer: Group Health Inc Medicare $79.48
Rate for Payer: Hamaspik Choice Inc Medicaid $113.55
Rate for Payer: Hamaspik Choice Inc Medicare $113.55
Hospital Charge Code 64902927
Hospital Revenue Code 270
Min. Negotiated Rate $37.43
Max. Negotiated Rate $85.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $58.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $53.47
Rate for Payer: Aetna Government $53.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $85.55
Rate for Payer: Cigna LocalPlus Benefit Plan $72.72
Rate for Payer: Group Health Inc Commercial $53.47
Rate for Payer: Group Health Inc Medicare $37.43
Rate for Payer: Hamaspik Choice Inc Medicaid $53.47
Rate for Payer: Hamaspik Choice Inc Medicare $53.47
Hospital Charge Code 64902928
Hospital Revenue Code 270
Min. Negotiated Rate $37.43
Max. Negotiated Rate $85.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $58.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $53.47
Rate for Payer: Aetna Government $53.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $85.55
Rate for Payer: Cigna LocalPlus Benefit Plan $72.72
Rate for Payer: Group Health Inc Commercial $53.47
Rate for Payer: Group Health Inc Medicare $37.43
Rate for Payer: Hamaspik Choice Inc Medicaid $53.47
Rate for Payer: Hamaspik Choice Inc Medicare $53.47
Hospital Charge Code 64905141
Hospital Revenue Code 270
Min. Negotiated Rate $88.77
Max. Negotiated Rate $202.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $139.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $126.82
Rate for Payer: Aetna Government $126.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $202.90
Rate for Payer: Cigna LocalPlus Benefit Plan $172.47
Rate for Payer: Group Health Inc Commercial $126.82
Rate for Payer: Group Health Inc Medicare $88.77
Rate for Payer: Hamaspik Choice Inc Medicaid $126.82
Rate for Payer: Hamaspik Choice Inc Medicare $126.82
Hospital Charge Code 64902712
Hospital Revenue Code 270
Min. Negotiated Rate $80.63
Max. Negotiated Rate $184.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $126.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $115.19
Rate for Payer: Aetna Government $115.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $184.30
Rate for Payer: Cigna LocalPlus Benefit Plan $156.66
Rate for Payer: Group Health Inc Commercial $115.19
Rate for Payer: Group Health Inc Medicare $80.63
Rate for Payer: Hamaspik Choice Inc Medicaid $115.19
Rate for Payer: Hamaspik Choice Inc Medicare $115.19
Hospital Charge Code 64907098
Hospital Revenue Code 270
Min. Negotiated Rate $4.84
Max. Negotiated Rate $11.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.92
Rate for Payer: Aetna Government $6.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.06
Rate for Payer: Cigna LocalPlus Benefit Plan $9.40
Rate for Payer: Group Health Inc Commercial $6.92
Rate for Payer: Group Health Inc Medicare $4.84
Rate for Payer: Hamaspik Choice Inc Medicaid $6.92
Rate for Payer: Hamaspik Choice Inc Medicare $6.92
Hospital Charge Code 64901533
Hospital Revenue Code 270
Min. Negotiated Rate $9.85
Max. Negotiated Rate $22.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $15.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $14.06
Rate for Payer: Aetna Government $14.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $22.50
Rate for Payer: Cigna LocalPlus Benefit Plan $19.13
Rate for Payer: Group Health Inc Commercial $14.06
Rate for Payer: Group Health Inc Medicare $9.85
Rate for Payer: Hamaspik Choice Inc Medicaid $14.06
Rate for Payer: Hamaspik Choice Inc Medicare $14.06
Hospital Charge Code 64907099
Hospital Revenue Code 270
Min. Negotiated Rate $7.55
Max. Negotiated Rate $17.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.79
Rate for Payer: Aetna Government $10.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $17.26
Rate for Payer: Cigna LocalPlus Benefit Plan $14.67
Rate for Payer: Group Health Inc Commercial $10.79
Rate for Payer: Group Health Inc Medicare $7.55
Rate for Payer: Hamaspik Choice Inc Medicaid $10.79
Rate for Payer: Hamaspik Choice Inc Medicare $10.79
Hospital Charge Code 40205116
Hospital Revenue Code 270
Min. Negotiated Rate $558.94
Max. Negotiated Rate $1,277.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial $878.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $798.48
Rate for Payer: Aetna Government $798.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,277.57
Rate for Payer: Cigna LocalPlus Benefit Plan $1,085.93
Rate for Payer: Group Health Inc Commercial $798.48
Rate for Payer: Group Health Inc Medicare $558.94
Rate for Payer: Hamaspik Choice Inc Medicaid $798.48
Rate for Payer: Hamaspik Choice Inc Medicare $798.48
Hospital Charge Code 64902923
Hospital Revenue Code 270
Min. Negotiated Rate $4.38
Max. Negotiated Rate $10.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.25
Rate for Payer: Aetna Government $6.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.00
Rate for Payer: Cigna LocalPlus Benefit Plan $8.50
Rate for Payer: Group Health Inc Commercial $6.25
Rate for Payer: Group Health Inc Medicare $4.38
Rate for Payer: Hamaspik Choice Inc Medicaid $6.25
Rate for Payer: Hamaspik Choice Inc Medicare $6.25
Hospital Charge Code 40206042
Hospital Revenue Code 270
Min. Negotiated Rate $66.50
Max. Negotiated Rate $152.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $95.00
Rate for Payer: Aetna Government $95.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $152.00
Rate for Payer: Cigna LocalPlus Benefit Plan $129.20
Rate for Payer: Group Health Inc Commercial $95.00
Rate for Payer: Group Health Inc Medicare $66.50
Rate for Payer: Hamaspik Choice Inc Medicaid $95.00
Rate for Payer: Hamaspik Choice Inc Medicare $95.00
Hospital Charge Code 64901840
Hospital Revenue Code 279
Min. Negotiated Rate $284.38
Max. Negotiated Rate $650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $406.25
Rate for Payer: Aetna Government $406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $552.50
Rate for Payer: Group Health Inc Commercial $406.25
Rate for Payer: Group Health Inc Medicare $284.38
Rate for Payer: Hamaspik Choice Inc Medicaid $406.25
Rate for Payer: Hamaspik Choice Inc Medicare $406.25
Hospital Charge Code 64901841
Hospital Revenue Code 279
Min. Negotiated Rate $284.38
Max. Negotiated Rate $650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $406.25
Rate for Payer: Aetna Government $406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $552.50
Rate for Payer: Group Health Inc Commercial $406.25
Rate for Payer: Group Health Inc Medicare $284.38
Rate for Payer: Hamaspik Choice Inc Medicaid $406.25
Rate for Payer: Hamaspik Choice Inc Medicare $406.25
Hospital Charge Code 64904706
Hospital Revenue Code 270
Min. Negotiated Rate $271.25
Max. Negotiated Rate $620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $426.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $387.50
Rate for Payer: Aetna Government $387.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $620.00
Rate for Payer: Cigna LocalPlus Benefit Plan $527.00
Rate for Payer: Group Health Inc Commercial $387.50
Rate for Payer: Group Health Inc Medicare $271.25
Rate for Payer: Hamaspik Choice Inc Medicaid $387.50
Rate for Payer: Hamaspik Choice Inc Medicare $387.50
Hospital Charge Code 64901836
Hospital Revenue Code 279
Min. Negotiated Rate $284.38
Max. Negotiated Rate $650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $406.25
Rate for Payer: Aetna Government $406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $552.50
Rate for Payer: Group Health Inc Commercial $406.25
Rate for Payer: Group Health Inc Medicare $284.38
Rate for Payer: Hamaspik Choice Inc Medicaid $406.25
Rate for Payer: Hamaspik Choice Inc Medicare $406.25
Hospital Charge Code 64901838
Hospital Revenue Code 279
Min. Negotiated Rate $284.38
Max. Negotiated Rate $650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $406.25
Rate for Payer: Aetna Government $406.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $552.50
Rate for Payer: Group Health Inc Commercial $406.25
Rate for Payer: Group Health Inc Medicare $284.38
Rate for Payer: Hamaspik Choice Inc Medicaid $406.25
Rate for Payer: Hamaspik Choice Inc Medicare $406.25