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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40203831
Hospital Revenue Code 278
Min. Negotiated Rate $121.80
Max. Negotiated Rate $365.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $191.40
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 $174.00
Rate for Payer: Cigna LocalPlus Benefit Plan $200.10
Rate for Payer: Fidelis Medicare Advantage $365.40
Rate for Payer: Group Health Inc Commercial $174.00
Rate for Payer: Group Health Inc Medicare $121.80
Rate for Payer: Hamaspik Choice Inc Medicaid $174.00
Rate for Payer: Hamaspik Choice Inc Medicare $174.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $226.20
Service Code HCPCS C1713
Hospital Charge Code 40203831
Hospital Revenue Code 278
Min. Negotiated Rate $174.00
Max. Negotiated Rate $174.00
Rate for Payer: Hamaspik Choice Inc Medicaid $174.00
Rate for Payer: Hamaspik Choice Inc Medicare $174.00
Service Code HCPCS C1713
Hospital Charge Code 40205754
Hospital Revenue Code 278
Min. Negotiated Rate $1,341.20
Max. Negotiated Rate $1,341.20
Rate for Payer: Hamaspik Choice Inc Medicaid $1,341.20
Rate for Payer: Hamaspik Choice Inc Medicare $1,341.20
Service Code HCPCS C1713
Hospital Charge Code 40205754
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,816.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,475.32
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 $1,341.20
Rate for Payer: Cigna LocalPlus Benefit Plan $1,542.38
Rate for Payer: Fidelis Medicare Advantage $2,816.52
Rate for Payer: Group Health Inc Commercial $1,341.20
Rate for Payer: Group Health Inc Medicare $938.84
Rate for Payer: Hamaspik Choice Inc Medicaid $1,341.20
Rate for Payer: Hamaspik Choice Inc Medicare $1,341.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,743.56
Service Code HCPCS C1713
Hospital Charge Code 40206251
Hospital Revenue Code 278
Min. Negotiated Rate $78.26
Max. Negotiated Rate $78.26
Rate for Payer: Hamaspik Choice Inc Medicaid $78.26
Rate for Payer: Hamaspik Choice Inc Medicare $78.26
Service Code HCPCS C1713
Hospital Charge Code 40206251
Hospital Revenue Code 278
Min. Negotiated Rate $54.78
Max. Negotiated Rate $164.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial $86.09
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 $78.26
Rate for Payer: Cigna LocalPlus Benefit Plan $90.00
Rate for Payer: Fidelis Medicare Advantage $164.35
Rate for Payer: Group Health Inc Commercial $78.26
Rate for Payer: Group Health Inc Medicare $54.78
Rate for Payer: Hamaspik Choice Inc Medicaid $78.26
Rate for Payer: Hamaspik Choice Inc Medicare $78.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $101.74
Service Code HCPCS C1713
Hospital Charge Code 40206252
Hospital Revenue Code 278
Min. Negotiated Rate $81.00
Max. Negotiated Rate $81.00
Rate for Payer: Hamaspik Choice Inc Medicaid $81.00
Rate for Payer: Hamaspik Choice Inc Medicare $81.00
Service Code HCPCS C1713
Hospital Charge Code 40206252
Hospital Revenue Code 278
Min. Negotiated Rate $56.70
Max. Negotiated Rate $170.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $89.10
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 $81.00
Rate for Payer: Cigna LocalPlus Benefit Plan $93.15
Rate for Payer: Fidelis Medicare Advantage $170.10
Rate for Payer: Group Health Inc Commercial $81.00
Rate for Payer: Group Health Inc Medicare $56.70
Rate for Payer: Hamaspik Choice Inc Medicaid $81.00
Rate for Payer: Hamaspik Choice Inc Medicare $81.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $105.30
Service Code HCPCS C9355
Hospital Charge Code 40004712
Hospital Revenue Code 636
Min. Negotiated Rate $1,538.22
Max. Negotiated Rate $1,538.22
Rate for Payer: Hamaspik Choice Inc Medicaid $1,538.22
Rate for Payer: Hamaspik Choice Inc Medicare $1,538.22
Service Code HCPCS C9355
Hospital Charge Code 40004712
Hospital Revenue Code 636
Min. Negotiated Rate $147.94
Max. Negotiated Rate $1,999.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,692.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $147.94
Rate for Payer: Aetna Government $147.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,538.22
Rate for Payer: Cigna LocalPlus Benefit Plan $1,768.95
Rate for Payer: Group Health Inc Commercial $1,538.22
Rate for Payer: Group Health Inc Medicare $1,076.75
Rate for Payer: Hamaspik Choice Inc Medicaid $1,538.22
Rate for Payer: Hamaspik Choice Inc Medicare $1,538.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,999.69
Service Code HCPCS C1713
Hospital Charge Code 40203830
Hospital Revenue Code 278
Min. Negotiated Rate $38.22
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $60.06
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 $54.60
Rate for Payer: Cigna LocalPlus Benefit Plan $62.79
Rate for Payer: Fidelis Medicare Advantage $114.66
Rate for Payer: Group Health Inc Commercial $54.60
Rate for Payer: Group Health Inc Medicare $38.22
Rate for Payer: Hamaspik Choice Inc Medicaid $54.60
Rate for Payer: Hamaspik Choice Inc Medicare $54.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $70.98
Service Code HCPCS C1713
Hospital Charge Code 40203830
Hospital Revenue Code 278
Min. Negotiated Rate $54.60
Max. Negotiated Rate $54.60
Rate for Payer: Hamaspik Choice Inc Medicaid $54.60
Rate for Payer: Hamaspik Choice Inc Medicare $54.60
Service Code HCPCS C1713
Hospital Charge Code 40204468
Hospital Revenue Code 278
Min. Negotiated Rate $116.85
Max. Negotiated Rate $350.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $183.62
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 $166.93
Rate for Payer: Cigna LocalPlus Benefit Plan $191.97
Rate for Payer: Fidelis Medicare Advantage $350.55
Rate for Payer: Group Health Inc Commercial $166.93
Rate for Payer: Group Health Inc Medicare $116.85
Rate for Payer: Hamaspik Choice Inc Medicaid $166.93
Rate for Payer: Hamaspik Choice Inc Medicare $166.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $217.01
Service Code HCPCS C1713
Hospital Charge Code 40204468
Hospital Revenue Code 278
Min. Negotiated Rate $166.93
Max. Negotiated Rate $166.93
Rate for Payer: Hamaspik Choice Inc Medicaid $166.93
Rate for Payer: Hamaspik Choice Inc Medicare $166.93
Service Code HCPCS C1713
Hospital Charge Code 40204460
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $11,535.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6,042.46
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 $5,493.15
Rate for Payer: Cigna LocalPlus Benefit Plan $6,317.12
Rate for Payer: Fidelis Medicare Advantage $11,535.62
Rate for Payer: Group Health Inc Commercial $5,493.15
Rate for Payer: Group Health Inc Medicare $3,845.20
Rate for Payer: Hamaspik Choice Inc Medicaid $5,493.15
Rate for Payer: Hamaspik Choice Inc Medicare $5,493.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $7,141.10
Service Code HCPCS C1713
Hospital Charge Code 40204460
Hospital Revenue Code 278
Min. Negotiated Rate $5,493.15
Max. Negotiated Rate $5,493.15
Rate for Payer: Hamaspik Choice Inc Medicaid $5,493.15
Rate for Payer: Hamaspik Choice Inc Medicare $5,493.15
Hospital Charge Code 40204475
Hospital Revenue Code 272
Min. Negotiated Rate $175.52
Max. Negotiated Rate $401.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $275.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $250.75
Rate for Payer: Aetna Government $250.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $401.20
Rate for Payer: Cigna LocalPlus Benefit Plan $341.02
Rate for Payer: Group Health Inc Commercial $250.75
Rate for Payer: Group Health Inc Medicare $175.52
Rate for Payer: Hamaspik Choice Inc Medicaid $250.75
Rate for Payer: Hamaspik Choice Inc Medicare $250.75
Service Code HCPCS C1713
Hospital Charge Code 40205937
Hospital Revenue Code 278
Min. Negotiated Rate $109.27
Max. Negotiated Rate $327.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $171.71
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 $156.10
Rate for Payer: Cigna LocalPlus Benefit Plan $179.52
Rate for Payer: Fidelis Medicare Advantage $327.81
Rate for Payer: Group Health Inc Commercial $156.10
Rate for Payer: Group Health Inc Medicare $109.27
Rate for Payer: Hamaspik Choice Inc Medicaid $156.10
Rate for Payer: Hamaspik Choice Inc Medicare $156.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $202.93
Service Code HCPCS C1713
Hospital Charge Code 40205937
Hospital Revenue Code 278
Min. Negotiated Rate $156.10
Max. Negotiated Rate $156.10
Rate for Payer: Hamaspik Choice Inc Medicaid $156.10
Rate for Payer: Hamaspik Choice Inc Medicare $156.10
Service Code HCPCS C1713
Hospital Charge Code 40204670
Hospital Revenue Code 278
Min. Negotiated Rate $72.80
Max. Negotiated Rate $72.80
Rate for Payer: Hamaspik Choice Inc Medicaid $72.80
Rate for Payer: Hamaspik Choice Inc Medicare $72.80
Service Code HCPCS C1713
Hospital Charge Code 40204670
Hospital Revenue Code 278
Min. Negotiated Rate $50.96
Max. Negotiated Rate $152.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $80.08
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 $72.80
Rate for Payer: Cigna LocalPlus Benefit Plan $83.72
Rate for Payer: Fidelis Medicare Advantage $152.88
Rate for Payer: Group Health Inc Commercial $72.80
Rate for Payer: Group Health Inc Medicare $50.96
Rate for Payer: Hamaspik Choice Inc Medicaid $72.80
Rate for Payer: Hamaspik Choice Inc Medicare $72.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $94.64
Service Code HCPCS C1713
Hospital Charge Code 40205634
Hospital Revenue Code 278
Min. Negotiated Rate $29.50
Max. Negotiated Rate $29.50
Rate for Payer: Hamaspik Choice Inc Medicaid $29.50
Rate for Payer: Hamaspik Choice Inc Medicare $29.50
Service Code HCPCS C1713
Hospital Charge Code 40205634
Hospital Revenue Code 278
Min. Negotiated Rate $20.65
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $32.45
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 $29.50
Rate for Payer: Cigna LocalPlus Benefit Plan $33.92
Rate for Payer: Fidelis Medicare Advantage $61.95
Rate for Payer: Group Health Inc Commercial $29.50
Rate for Payer: Group Health Inc Medicare $20.65
Rate for Payer: Hamaspik Choice Inc Medicaid $29.50
Rate for Payer: Hamaspik Choice Inc Medicare $29.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $38.35
Service Code HCPCS C1776
Hospital Charge Code 40205337
Hospital Revenue Code 278
Min. Negotiated Rate $1,440.00
Max. Negotiated Rate $1,440.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,440.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,440.00
Service Code HCPCS C1776
Hospital Charge Code 40205337
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,024.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,584.00
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 $1,440.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,656.00
Rate for Payer: Fidelis Medicare Advantage $3,024.00
Rate for Payer: Group Health Inc Commercial $1,440.00
Rate for Payer: Group Health Inc Medicare $1,008.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,440.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,440.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,872.00