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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40205319
Hospital Revenue Code 278
Min. Negotiated Rate $1,336.00
Max. Negotiated Rate $1,336.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,336.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,336.00
Service Code HCPCS C1776
Hospital Charge Code 40208086
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,183.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,191.20
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 $1,992.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,290.80
Rate for Payer: Fidelis Medicare Advantage $4,183.20
Rate for Payer: Group Health Inc Commercial $1,992.00
Rate for Payer: Group Health Inc Medicare $1,394.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,992.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,992.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,589.60
Service Code HCPCS C1776
Hospital Charge Code 40208086
Hospital Revenue Code 278
Min. Negotiated Rate $1,992.00
Max. Negotiated Rate $1,992.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,992.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,992.00
Service Code HCPCS C1713
Hospital Charge Code 40006560
Hospital Revenue Code 278
Min. Negotiated Rate $1,524.00
Max. Negotiated Rate $1,524.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,524.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,524.00
Service Code HCPCS C1713
Hospital Charge Code 40006560
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,200.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,676.40
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 $1,524.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,752.60
Rate for Payer: Fidelis Medicare Advantage $3,200.40
Rate for Payer: Group Health Inc Commercial $1,524.00
Rate for Payer: Group Health Inc Medicare $1,066.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,524.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,524.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,981.20
Service Code HCPCS C1713
Hospital Charge Code 40009294
Hospital Revenue Code 278
Min. Negotiated Rate $2,921.17
Max. Negotiated Rate $2,921.17
Rate for Payer: Hamaspik Choice Inc Medicaid $2,921.17
Rate for Payer: Hamaspik Choice Inc Medicare $2,921.17
Service Code HCPCS C1713
Hospital Charge Code 40009294
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $6,134.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,213.29
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 $2,921.17
Rate for Payer: Cigna LocalPlus Benefit Plan $3,359.35
Rate for Payer: Fidelis Medicare Advantage $6,134.46
Rate for Payer: Group Health Inc Commercial $2,921.17
Rate for Payer: Group Health Inc Medicare $2,044.82
Rate for Payer: Hamaspik Choice Inc Medicaid $2,921.17
Rate for Payer: Hamaspik Choice Inc Medicare $2,921.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,797.52
Service Code HCPCS C1713
Hospital Charge Code 40004617
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,251.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,179.20
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 $1,072.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,232.80
Rate for Payer: Fidelis Medicare Advantage $2,251.20
Rate for Payer: Group Health Inc Commercial $1,072.00
Rate for Payer: Group Health Inc Medicare $750.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,072.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,072.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,393.60
Service Code HCPCS C1713
Hospital Charge Code 40004617
Hospital Revenue Code 278
Min. Negotiated Rate $1,072.00
Max. Negotiated Rate $1,072.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,072.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,072.00
Service Code HCPCS C1713
Hospital Charge Code 40205562
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,155.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $605.00
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 $550.00
Rate for Payer: Cigna LocalPlus Benefit Plan $632.50
Rate for Payer: Fidelis Medicare Advantage $1,155.00
Rate for Payer: Group Health Inc Commercial $550.00
Rate for Payer: Group Health Inc Medicare $385.00
Rate for Payer: Hamaspik Choice Inc Medicaid $550.00
Rate for Payer: Hamaspik Choice Inc Medicare $550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $715.00
Service Code HCPCS C1713
Hospital Charge Code 40205562
Hospital Revenue Code 278
Min. Negotiated Rate $550.00
Max. Negotiated Rate $550.00
Rate for Payer: Hamaspik Choice Inc Medicaid $550.00
Rate for Payer: Hamaspik Choice Inc Medicare $550.00
Service Code HCPCS C1713
Hospital Charge Code 40204480
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 40204480
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 40209431
Hospital Revenue Code 278
Min. Negotiated Rate $100.94
Max. Negotiated Rate $302.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $158.62
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 $144.20
Rate for Payer: Cigna LocalPlus Benefit Plan $165.83
Rate for Payer: Fidelis Medicare Advantage $302.82
Rate for Payer: Group Health Inc Commercial $144.20
Rate for Payer: Group Health Inc Medicare $100.94
Rate for Payer: Hamaspik Choice Inc Medicaid $144.20
Rate for Payer: Hamaspik Choice Inc Medicare $144.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $187.46
Service Code HCPCS C1713
Hospital Charge Code 40006504
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $446.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $233.64
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 $212.40
Rate for Payer: Cigna LocalPlus Benefit Plan $244.26
Rate for Payer: Fidelis Medicare Advantage $446.04
Rate for Payer: Group Health Inc Commercial $212.40
Rate for Payer: Group Health Inc Medicare $148.68
Rate for Payer: Hamaspik Choice Inc Medicaid $212.40
Rate for Payer: Hamaspik Choice Inc Medicare $212.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $276.12
Service Code HCPCS C1713
Hospital Charge Code 40006504
Hospital Revenue Code 278
Min. Negotiated Rate $212.40
Max. Negotiated Rate $212.40
Rate for Payer: Hamaspik Choice Inc Medicaid $212.40
Rate for Payer: Hamaspik Choice Inc Medicare $212.40
Service Code HCPCS C1713
Hospital Charge Code 40209431
Hospital Revenue Code 278
Min. Negotiated Rate $144.20
Max. Negotiated Rate $144.20
Rate for Payer: Hamaspik Choice Inc Medicaid $144.20
Rate for Payer: Hamaspik Choice Inc Medicare $144.20
Service Code HCPCS C1713
Hospital Charge Code 40205723
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,679.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,927.31
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 $1,752.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,014.92
Rate for Payer: Fidelis Medicare Advantage $3,679.41
Rate for Payer: Group Health Inc Commercial $1,752.10
Rate for Payer: Group Health Inc Medicare $1,226.47
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,277.73
Service Code HCPCS C1713
Hospital Charge Code 40205723
Hospital Revenue Code 278
Min. Negotiated Rate $1,752.10
Max. Negotiated Rate $1,752.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.10
Service Code HCPCS C1713
Hospital Charge Code 40205748
Hospital Revenue Code 278
Min. Negotiated Rate $1,752.10
Max. Negotiated Rate $1,752.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.10
Service Code HCPCS C1713
Hospital Charge Code 40205748
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,679.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,927.31
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 $1,752.10
Rate for Payer: Cigna LocalPlus Benefit Plan $2,014.92
Rate for Payer: Fidelis Medicare Advantage $3,679.41
Rate for Payer: Group Health Inc Commercial $1,752.10
Rate for Payer: Group Health Inc Medicare $1,226.47
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,277.73
Service Code HCPCS C1713
Hospital Charge Code 40205206
Hospital Revenue Code 278
Min. Negotiated Rate $720.30
Max. Negotiated Rate $720.30
Rate for Payer: Hamaspik Choice Inc Medicaid $720.30
Rate for Payer: Hamaspik Choice Inc Medicare $720.30
Service Code HCPCS C1713
Hospital Charge Code 40205206
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,512.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $792.33
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 $720.30
Rate for Payer: Cigna LocalPlus Benefit Plan $828.34
Rate for Payer: Fidelis Medicare Advantage $1,512.63
Rate for Payer: Group Health Inc Commercial $720.30
Rate for Payer: Group Health Inc Medicare $504.21
Rate for Payer: Hamaspik Choice Inc Medicaid $720.30
Rate for Payer: Hamaspik Choice Inc Medicare $720.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $936.39
Service Code HCPCS C1713
Hospital Charge Code 40200701
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $413.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $216.70
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 $197.00
Rate for Payer: Cigna LocalPlus Benefit Plan $226.55
Rate for Payer: Fidelis Medicare Advantage $413.70
Rate for Payer: Group Health Inc Commercial $197.00
Rate for Payer: Group Health Inc Medicare $137.90
Rate for Payer: Hamaspik Choice Inc Medicaid $197.00
Rate for Payer: Hamaspik Choice Inc Medicare $197.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $256.10
Service Code HCPCS C1713
Hospital Charge Code 40200701
Hospital Revenue Code 278
Min. Negotiated Rate $197.00
Max. Negotiated Rate $197.00
Rate for Payer: Hamaspik Choice Inc Medicaid $197.00
Rate for Payer: Hamaspik Choice Inc Medicare $197.00