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Charge Type Price  
Hospital Charge Code 64902127
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 64906558
Hospital Revenue Code 279
Min. Negotiated Rate $326.88
Max. Negotiated Rate $747.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $513.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $466.97
Rate for Payer: Aetna Government $466.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $747.15
Rate for Payer: Cigna LocalPlus Benefit Plan $635.08
Rate for Payer: Group Health Inc Commercial $466.97
Rate for Payer: Group Health Inc Medicare $326.88
Rate for Payer: Hamaspik Choice Inc Medicaid $466.97
Rate for Payer: Hamaspik Choice Inc Medicare $466.97
Hospital Charge Code 64906702
Hospital Revenue Code 279
Min. Negotiated Rate $541.24
Max. Negotiated Rate $1,237.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $850.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $773.20
Rate for Payer: Aetna Government $773.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,237.12
Rate for Payer: Cigna LocalPlus Benefit Plan $1,051.55
Rate for Payer: Group Health Inc Commercial $773.20
Rate for Payer: Group Health Inc Medicare $541.24
Rate for Payer: Hamaspik Choice Inc Medicaid $773.20
Rate for Payer: Hamaspik Choice Inc Medicare $773.20
Hospital Charge Code 64902129
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
Service Code HCPCS C1713
Hospital Charge Code 64904680
Hospital Revenue Code 278
Min. Negotiated Rate $2,225.00
Max. Negotiated Rate $2,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,225.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,225.00
Service Code HCPCS C1713
Hospital Charge Code 64904680
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,672.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,447.50
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 $2,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,558.75
Rate for Payer: Fidelis Medicare Advantage $4,672.50
Rate for Payer: Group Health Inc Commercial $2,225.00
Rate for Payer: Group Health Inc Medicare $1,557.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,225.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,892.50
Service Code HCPCS C1713
Hospital Charge Code 64904124
Hospital Revenue Code 278
Min. Negotiated Rate $2,162.50
Max. Negotiated Rate $2,162.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,162.50
Rate for Payer: Hamaspik Choice Inc Medicare $2,162.50
Service Code HCPCS C1713
Hospital Charge Code 64904124
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,541.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,378.75
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 $2,162.50
Rate for Payer: Cigna LocalPlus Benefit Plan $2,486.88
Rate for Payer: Fidelis Medicare Advantage $4,541.25
Rate for Payer: Group Health Inc Commercial $2,162.50
Rate for Payer: Group Health Inc Medicare $1,513.75
Rate for Payer: Hamaspik Choice Inc Medicaid $2,162.50
Rate for Payer: Hamaspik Choice Inc Medicare $2,162.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,811.25
Service Code HCPCS 4013F
Hospital Charge Code 30300373
Hospital Revenue Code 969
Max. Negotiated Rate $2,915.00
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 $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
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
Hospital Charge Code 64902516
Hospital Revenue Code 270
Min. Negotiated Rate $10.16
Max. Negotiated Rate $23.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial $15.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $14.52
Rate for Payer: Aetna Government $14.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $23.23
Rate for Payer: Cigna LocalPlus Benefit Plan $19.75
Rate for Payer: Group Health Inc Commercial $14.52
Rate for Payer: Group Health Inc Medicare $10.16
Rate for Payer: Hamaspik Choice Inc Medicaid $14.52
Rate for Payer: Hamaspik Choice Inc Medicare $14.52
Hospital Charge Code 64901909
Hospital Revenue Code 270
Min. Negotiated Rate $2.58
Max. Negotiated Rate $5.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.69
Rate for Payer: Aetna Government $3.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.90
Rate for Payer: Cigna LocalPlus Benefit Plan $5.02
Rate for Payer: Group Health Inc Commercial $3.69
Rate for Payer: Group Health Inc Medicare $2.58
Rate for Payer: Hamaspik Choice Inc Medicaid $3.69
Rate for Payer: Hamaspik Choice Inc Medicare $3.69
Hospital Charge Code 41641069
Hospital Revenue Code 250
Min. Negotiated Rate $0.85
Max. Negotiated Rate $1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.22
Rate for Payer: Aetna Government $1.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.94
Rate for Payer: Cigna LocalPlus Benefit Plan $1.65
Rate for Payer: Group Health Inc Commercial $1.22
Rate for Payer: Group Health Inc Medicare $0.85
Rate for Payer: Hamaspik Choice Inc Medicaid $1.22
Rate for Payer: Hamaspik Choice Inc Medicare $1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.58
Hospital Charge Code 41651069
Hospital Revenue Code 250
Min. Negotiated Rate $0.85
Max. Negotiated Rate $1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.22
Rate for Payer: Aetna Government $1.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.94
Rate for Payer: Cigna LocalPlus Benefit Plan $1.65
Rate for Payer: Group Health Inc Commercial $1.22
Rate for Payer: Group Health Inc Medicare $0.85
Rate for Payer: Hamaspik Choice Inc Medicaid $1.22
Rate for Payer: Hamaspik Choice Inc Medicare $1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.58
Hospital Charge Code 41642445
Hospital Revenue Code 250
Min. Negotiated Rate $0.27
Max. Negotiated Rate $0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.38
Rate for Payer: Aetna Government $0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.61
Rate for Payer: Cigna LocalPlus Benefit Plan $0.52
Rate for Payer: Group Health Inc Commercial $0.38
Rate for Payer: Group Health Inc Medicare $0.27
Rate for Payer: Hamaspik Choice Inc Medicaid $0.38
Rate for Payer: Hamaspik Choice Inc Medicare $0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.49
Hospital Charge Code 41652445
Hospital Revenue Code 250
Min. Negotiated Rate $0.27
Max. Negotiated Rate $0.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.38
Rate for Payer: Aetna Government $0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.61
Rate for Payer: Cigna LocalPlus Benefit Plan $0.52
Rate for Payer: Group Health Inc Commercial $0.38
Rate for Payer: Group Health Inc Medicare $0.27
Rate for Payer: Hamaspik Choice Inc Medicaid $0.38
Rate for Payer: Hamaspik Choice Inc Medicare $0.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.49
Hospital Charge Code 41640222
Hospital Revenue Code 250
Min. Negotiated Rate $4.20
Max. Negotiated Rate $9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.00
Rate for Payer: Aetna Government $6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.60
Rate for Payer: Cigna LocalPlus Benefit Plan $8.16
Rate for Payer: Group Health Inc Commercial $6.00
Rate for Payer: Group Health Inc Medicare $4.20
Rate for Payer: Hamaspik Choice Inc Medicaid $6.00
Rate for Payer: Hamaspik Choice Inc Medicare $6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $7.80
Hospital Charge Code 41650222
Hospital Revenue Code 250
Min. Negotiated Rate $4.20
Max. Negotiated Rate $9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.00
Rate for Payer: Aetna Government $6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.60
Rate for Payer: Cigna LocalPlus Benefit Plan $8.16
Rate for Payer: Group Health Inc Commercial $6.00
Rate for Payer: Group Health Inc Medicare $4.20
Rate for Payer: Hamaspik Choice Inc Medicaid $6.00
Rate for Payer: Hamaspik Choice Inc Medicare $6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $7.80
Hospital Charge Code 41650250
Hospital Revenue Code 250
Min. Negotiated Rate $1.05
Max. Negotiated Rate $2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.50
Rate for Payer: Aetna Government $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2.04
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95
Hospital Charge Code 41640250
Hospital Revenue Code 250
Min. Negotiated Rate $1.05
Max. Negotiated Rate $2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.50
Rate for Payer: Aetna Government $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2.04
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95
Hospital Charge Code 41651534
Hospital Revenue Code 250
Min. Negotiated Rate $0.81
Max. Negotiated Rate $1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.15
Rate for Payer: Aetna Government $1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.84
Rate for Payer: Cigna LocalPlus Benefit Plan $1.56
Rate for Payer: Group Health Inc Commercial $1.15
Rate for Payer: Group Health Inc Medicare $0.81
Rate for Payer: Hamaspik Choice Inc Medicaid $1.15
Rate for Payer: Hamaspik Choice Inc Medicare $1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.50
Hospital Charge Code 41641534
Hospital Revenue Code 250
Min. Negotiated Rate $0.81
Max. Negotiated Rate $1.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.15
Rate for Payer: Aetna Government $1.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.84
Rate for Payer: Cigna LocalPlus Benefit Plan $1.56
Rate for Payer: Group Health Inc Commercial $1.15
Rate for Payer: Group Health Inc Medicare $0.81
Rate for Payer: Hamaspik Choice Inc Medicaid $1.15
Rate for Payer: Hamaspik Choice Inc Medicare $1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.50
Hospital Charge Code 40209841
Hospital Revenue Code 270
Min. Negotiated Rate $20.09
Max. Negotiated Rate $45.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial $31.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $28.70
Rate for Payer: Aetna Government $28.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $45.92
Rate for Payer: Cigna LocalPlus Benefit Plan $39.03
Rate for Payer: Group Health Inc Commercial $28.70
Rate for Payer: Group Health Inc Medicare $20.09
Rate for Payer: Hamaspik Choice Inc Medicaid $28.70
Rate for Payer: Hamaspik Choice Inc Medicare $28.70
Service Code HCPCS C1713
Hospital Charge Code 40202046
Hospital Revenue Code 278
Min. Negotiated Rate $77.00
Max. Negotiated Rate $77.00
Rate for Payer: Hamaspik Choice Inc Medicaid $77.00
Rate for Payer: Hamaspik Choice Inc Medicare $77.00
Service Code HCPCS C1713
Hospital Charge Code 40202046
Hospital Revenue Code 278
Min. Negotiated Rate $53.90
Max. Negotiated Rate $161.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $84.70
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 $77.00
Rate for Payer: Cigna LocalPlus Benefit Plan $88.55
Rate for Payer: Fidelis Medicare Advantage $161.70
Rate for Payer: Group Health Inc Commercial $77.00
Rate for Payer: Group Health Inc Medicare $53.90
Rate for Payer: Hamaspik Choice Inc Medicaid $77.00
Rate for Payer: Hamaspik Choice Inc Medicare $77.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $100.10
Service Code HCPCS C1776
Hospital Charge Code 64905556
Hospital Revenue Code 278
Min. Negotiated Rate $5,835.00
Max. Negotiated Rate $5,835.00
Rate for Payer: Hamaspik Choice Inc Medicaid $5,835.00
Rate for Payer: Hamaspik Choice Inc Medicare $5,835.00