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Charge Type Price  
Hospital Charge Code 40008268
Hospital Revenue Code 279
Min. Negotiated Rate $1,617.00
Max. Negotiated Rate $3,696.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,541.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2,310.00
Rate for Payer: Aetna Government $2,310.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3,696.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,141.60
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
Service Code HCPCS C1776
Hospital Charge Code 40206081
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,287.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $674.30
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 $613.00
Rate for Payer: Cigna LocalPlus Benefit Plan $704.95
Rate for Payer: Fidelis Medicare Advantage $1,287.30
Rate for Payer: Group Health Inc Commercial $613.00
Rate for Payer: Group Health Inc Medicare $429.10
Rate for Payer: Hamaspik Choice Inc Medicaid $613.00
Rate for Payer: Hamaspik Choice Inc Medicare $613.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $796.90
Service Code HCPCS C1776
Hospital Charge Code 40206081
Hospital Revenue Code 278
Min. Negotiated Rate $613.00
Max. Negotiated Rate $613.00
Rate for Payer: Hamaspik Choice Inc Medicaid $613.00
Rate for Payer: Hamaspik Choice Inc Medicare $613.00
Service Code HCPCS C1713
Hospital Charge Code 40203425
Hospital Revenue Code 278
Min. Negotiated Rate $295.68
Max. Negotiated Rate $295.68
Rate for Payer: Hamaspik Choice Inc Medicaid $295.68
Rate for Payer: Hamaspik Choice Inc Medicare $295.68
Service Code HCPCS C1713
Hospital Charge Code 40203425
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $620.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $325.25
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 $295.68
Rate for Payer: Cigna LocalPlus Benefit Plan $340.03
Rate for Payer: Fidelis Medicare Advantage $620.93
Rate for Payer: Group Health Inc Commercial $295.68
Rate for Payer: Group Health Inc Medicare $206.98
Rate for Payer: Hamaspik Choice Inc Medicaid $295.68
Rate for Payer: Hamaspik Choice Inc Medicare $295.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $384.38
Service Code HCPCS C1769
Hospital Charge Code 40203696
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $105.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $50.22
Rate for Payer: Cigna LocalPlus Benefit Plan $57.76
Rate for Payer: Fidelis Medicare Advantage $105.47
Rate for Payer: Group Health Inc Commercial $50.22
Rate for Payer: Group Health Inc Medicare $35.16
Rate for Payer: Hamaspik Choice Inc Medicaid $50.22
Rate for Payer: Hamaspik Choice Inc Medicare $50.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.29
Service Code HCPCS C1769
Hospital Charge Code 40203696
Hospital Revenue Code 278
Min. Negotiated Rate $50.22
Max. Negotiated Rate $50.22
Rate for Payer: Hamaspik Choice Inc Medicaid $50.22
Rate for Payer: Hamaspik Choice Inc Medicare $50.22
Service Code HCPCS C1713
Hospital Charge Code 40204244
Hospital Revenue Code 278
Min. Negotiated Rate $250.00
Max. Negotiated Rate $250.00
Rate for Payer: Hamaspik Choice Inc Medicaid $250.00
Rate for Payer: Hamaspik Choice Inc Medicare $250.00
Service Code HCPCS C1713
Hospital Charge Code 40204244
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $275.00
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 $250.00
Rate for Payer: Cigna LocalPlus Benefit Plan $287.50
Rate for Payer: Fidelis Medicare Advantage $525.00
Rate for Payer: Group Health Inc Commercial $250.00
Rate for Payer: Group Health Inc Medicare $175.00
Rate for Payer: Hamaspik Choice Inc Medicaid $250.00
Rate for Payer: Hamaspik Choice Inc Medicare $250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $325.00
Service Code HCPCS C1713
Hospital Charge Code 40009286
Hospital Revenue Code 278
Min. Negotiated Rate $1,070.00
Max. Negotiated Rate $1,070.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,070.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,070.00
Service Code HCPCS C1713
Hospital Charge Code 40009286
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,247.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,177.00
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 $1,070.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,230.50
Rate for Payer: Fidelis Medicare Advantage $2,247.00
Rate for Payer: Group Health Inc Commercial $1,070.00
Rate for Payer: Group Health Inc Medicare $749.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,070.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,070.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,391.00
Hospital Charge Code 40009734
Hospital Revenue Code 272
Min. Negotiated Rate $1,824.20
Max. Negotiated Rate $4,169.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,866.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2,606.00
Rate for Payer: Aetna Government $2,606.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4,169.60
Rate for Payer: Cigna LocalPlus Benefit Plan $3,544.16
Rate for Payer: Group Health Inc Commercial $2,606.00
Rate for Payer: Group Health Inc Medicare $1,824.20
Rate for Payer: Hamaspik Choice Inc Medicaid $2,606.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,606.00
Service Code HCPCS C1713
Hospital Charge Code 40203437
Hospital Revenue Code 278
Min. Negotiated Rate $1,444.00
Max. Negotiated Rate $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Service Code HCPCS C1713
Hospital Charge Code 40203437
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,032.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,588.40
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 $1,444.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,660.60
Rate for Payer: Fidelis Medicare Advantage $3,032.40
Rate for Payer: Group Health Inc Commercial $1,444.00
Rate for Payer: Group Health Inc Medicare $1,010.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,444.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,444.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,877.20
Service Code HCPCS C1713
Hospital Charge Code 40204208
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,920.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,529.55
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 $1,390.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,599.08
Rate for Payer: Fidelis Medicare Advantage $2,920.05
Rate for Payer: Group Health Inc Commercial $1,390.50
Rate for Payer: Group Health Inc Medicare $973.35
Rate for Payer: Hamaspik Choice Inc Medicaid $1,390.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,390.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,807.65
Service Code HCPCS C1713
Hospital Charge Code 40204208
Hospital Revenue Code 278
Min. Negotiated Rate $1,390.50
Max. Negotiated Rate $1,390.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,390.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,390.50
Service Code HCPCS C1713
Hospital Charge Code 40008271
Hospital Revenue Code 278
Min. Negotiated Rate $2,447.15
Max. Negotiated Rate $2,447.15
Rate for Payer: Hamaspik Choice Inc Medicaid $2,447.15
Rate for Payer: Hamaspik Choice Inc Medicare $2,447.15
Service Code HCPCS C1713
Hospital Charge Code 40008271
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $5,139.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,691.86
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 $2,447.15
Rate for Payer: Cigna LocalPlus Benefit Plan $2,814.22
Rate for Payer: Fidelis Medicare Advantage $5,139.02
Rate for Payer: Group Health Inc Commercial $2,447.15
Rate for Payer: Group Health Inc Medicare $1,713.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,447.15
Rate for Payer: Hamaspik Choice Inc Medicare $2,447.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,181.30
Service Code HCPCS C1713
Hospital Charge Code 40204472
Hospital Revenue Code 278
Min. Negotiated Rate $109.20
Max. Negotiated Rate $327.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $171.60
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 $156.00
Rate for Payer: Cigna LocalPlus Benefit Plan $179.40
Rate for Payer: Fidelis Medicare Advantage $327.60
Rate for Payer: Group Health Inc Commercial $156.00
Rate for Payer: Group Health Inc Medicare $109.20
Rate for Payer: Hamaspik Choice Inc Medicaid $156.00
Rate for Payer: Hamaspik Choice Inc Medicare $156.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $202.80
Service Code HCPCS C1713
Hospital Charge Code 40204472
Hospital Revenue Code 278
Min. Negotiated Rate $156.00
Max. Negotiated Rate $156.00
Rate for Payer: Hamaspik Choice Inc Medicaid $156.00
Rate for Payer: Hamaspik Choice Inc Medicare $156.00
Service Code HCPCS C1713
Hospital Charge Code 40204704
Hospital Revenue Code 278
Min. Negotiated Rate $32.00
Max. Negotiated Rate $32.00
Rate for Payer: Hamaspik Choice Inc Medicaid $32.00
Rate for Payer: Hamaspik Choice Inc Medicare $32.00
Service Code HCPCS C1713
Hospital Charge Code 40204704
Hospital Revenue Code 278
Min. Negotiated Rate $22.40
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $35.20
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 $32.00
Rate for Payer: Cigna LocalPlus Benefit Plan $36.80
Rate for Payer: Fidelis Medicare Advantage $67.20
Rate for Payer: Group Health Inc Commercial $32.00
Rate for Payer: Group Health Inc Medicare $22.40
Rate for Payer: Hamaspik Choice Inc Medicaid $32.00
Rate for Payer: Hamaspik Choice Inc Medicare $32.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $41.60
Service Code HCPCS C1713
Hospital Charge Code 40202745
Hospital Revenue Code 278
Min. Negotiated Rate $93.59
Max. Negotiated Rate $280.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial $147.07
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 $133.70
Rate for Payer: Cigna LocalPlus Benefit Plan $153.76
Rate for Payer: Fidelis Medicare Advantage $280.77
Rate for Payer: Group Health Inc Commercial $133.70
Rate for Payer: Group Health Inc Medicare $93.59
Rate for Payer: Hamaspik Choice Inc Medicaid $133.70
Rate for Payer: Hamaspik Choice Inc Medicare $133.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $173.81
Service Code HCPCS C1713
Hospital Charge Code 40202745
Hospital Revenue Code 278
Min. Negotiated Rate $133.70
Max. Negotiated Rate $133.70
Rate for Payer: Hamaspik Choice Inc Medicaid $133.70
Rate for Payer: Hamaspik Choice Inc Medicare $133.70
Service Code HCPCS C1713
Hospital Charge Code 40205342
Hospital Revenue Code 278
Min. Negotiated Rate $341.00
Max. Negotiated Rate $341.00
Rate for Payer: Hamaspik Choice Inc Medicaid $341.00
Rate for Payer: Hamaspik Choice Inc Medicare $341.00