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Charge Type Price  
Hospital Charge Code 40009343
Hospital Revenue Code 272
Min. Negotiated Rate $252.00
Max. Negotiated Rate $576.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $396.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $360.00
Rate for Payer: Aetna Government $360.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $576.00
Rate for Payer: Cigna LocalPlus Benefit Plan $489.60
Rate for Payer: Group Health Inc Commercial $360.00
Rate for Payer: Group Health Inc Medicare $252.00
Rate for Payer: Hamaspik Choice Inc Medicaid $360.00
Rate for Payer: Hamaspik Choice Inc Medicare $360.00
Service Code HCPCS C1713
Hospital Charge Code 40203360
Hospital Revenue Code 278
Min. Negotiated Rate $360.00
Max. Negotiated Rate $360.00
Rate for Payer: Hamaspik Choice Inc Medicaid $360.00
Rate for Payer: Hamaspik Choice Inc Medicare $360.00
Service Code HCPCS C1713
Hospital Charge Code 40205554
Hospital Revenue Code 278
Min. Negotiated Rate $70.04
Max. Negotiated Rate $210.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $110.06
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 $100.05
Rate for Payer: Cigna LocalPlus Benefit Plan $115.06
Rate for Payer: Fidelis Medicare Advantage $210.10
Rate for Payer: Group Health Inc Commercial $100.05
Rate for Payer: Group Health Inc Medicare $70.04
Rate for Payer: Hamaspik Choice Inc Medicaid $100.05
Rate for Payer: Hamaspik Choice Inc Medicare $100.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $130.06
Service Code HCPCS C1713
Hospital Charge Code 40205554
Hospital Revenue Code 278
Min. Negotiated Rate $100.05
Max. Negotiated Rate $100.05
Rate for Payer: Hamaspik Choice Inc Medicaid $100.05
Rate for Payer: Hamaspik Choice Inc Medicare $100.05
Service Code HCPCS C1713
Hospital Charge Code 40206225
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,929.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,010.90
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 $919.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,056.85
Rate for Payer: Fidelis Medicare Advantage $1,929.90
Rate for Payer: Group Health Inc Commercial $919.00
Rate for Payer: Group Health Inc Medicare $643.30
Rate for Payer: Hamaspik Choice Inc Medicaid $919.00
Rate for Payer: Hamaspik Choice Inc Medicare $919.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,194.70
Service Code HCPCS C1713
Hospital Charge Code 40206225
Hospital Revenue Code 278
Min. Negotiated Rate $919.00
Max. Negotiated Rate $919.00
Rate for Payer: Hamaspik Choice Inc Medicaid $919.00
Rate for Payer: Hamaspik Choice Inc Medicare $919.00
Service Code HCPCS C1713
Hospital Charge Code 40209412
Hospital Revenue Code 278
Min. Negotiated Rate $133.80
Max. Negotiated Rate $133.80
Rate for Payer: Hamaspik Choice Inc Medicaid $133.80
Rate for Payer: Hamaspik Choice Inc Medicare $133.80
Service Code HCPCS C1713
Hospital Charge Code 40209412
Hospital Revenue Code 278
Min. Negotiated Rate $93.66
Max. Negotiated Rate $280.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $147.18
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 $133.80
Rate for Payer: Cigna LocalPlus Benefit Plan $153.87
Rate for Payer: Fidelis Medicare Advantage $280.98
Rate for Payer: Group Health Inc Commercial $133.80
Rate for Payer: Group Health Inc Medicare $93.66
Rate for Payer: Hamaspik Choice Inc Medicaid $133.80
Rate for Payer: Hamaspik Choice Inc Medicare $133.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $173.94
Service Code HCPCS C1776
Hospital Charge Code 40205374
Hospital Revenue Code 278
Min. Negotiated Rate $298.90
Max. Negotiated Rate $298.90
Rate for Payer: Hamaspik Choice Inc Medicaid $298.90
Rate for Payer: Hamaspik Choice Inc Medicare $298.90
Service Code HCPCS C1776
Hospital Charge Code 40205374
Hospital Revenue Code 278
Min. Negotiated Rate $209.23
Max. Negotiated Rate $627.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial $328.79
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 $298.90
Rate for Payer: Cigna LocalPlus Benefit Plan $343.74
Rate for Payer: Fidelis Medicare Advantage $627.69
Rate for Payer: Group Health Inc Commercial $298.90
Rate for Payer: Group Health Inc Medicare $209.23
Rate for Payer: Hamaspik Choice Inc Medicaid $298.90
Rate for Payer: Hamaspik Choice Inc Medicare $298.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $388.57
Service Code HCPCS C1713
Hospital Charge Code 40205760
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $732.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $383.46
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 $348.60
Rate for Payer: Cigna LocalPlus Benefit Plan $400.89
Rate for Payer: Fidelis Medicare Advantage $732.06
Rate for Payer: Group Health Inc Commercial $348.60
Rate for Payer: Group Health Inc Medicare $244.02
Rate for Payer: Hamaspik Choice Inc Medicaid $348.60
Rate for Payer: Hamaspik Choice Inc Medicare $348.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $453.18
Service Code HCPCS C1713
Hospital Charge Code 40205760
Hospital Revenue Code 278
Min. Negotiated Rate $348.60
Max. Negotiated Rate $348.60
Rate for Payer: Hamaspik Choice Inc Medicaid $348.60
Rate for Payer: Hamaspik Choice Inc Medicare $348.60
Service Code HCPCS C1713
Hospital Charge Code 40205365
Hospital Revenue Code 278
Min. Negotiated Rate $336.70
Max. Negotiated Rate $336.70
Rate for Payer: Hamaspik Choice Inc Medicaid $336.70
Rate for Payer: Hamaspik Choice Inc Medicare $336.70
Service Code HCPCS C1713
Hospital Charge Code 40205365
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $707.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $370.37
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 $336.70
Rate for Payer: Cigna LocalPlus Benefit Plan $387.20
Rate for Payer: Fidelis Medicare Advantage $707.07
Rate for Payer: Group Health Inc Commercial $336.70
Rate for Payer: Group Health Inc Medicare $235.69
Rate for Payer: Hamaspik Choice Inc Medicaid $336.70
Rate for Payer: Hamaspik Choice Inc Medicare $336.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $437.71
Service Code HCPCS C1713
Hospital Charge Code 40209982
Hospital Revenue Code 278
Min. Negotiated Rate $462.60
Max. Negotiated Rate $462.60
Rate for Payer: Hamaspik Choice Inc Medicaid $462.60
Rate for Payer: Hamaspik Choice Inc Medicare $462.60
Service Code HCPCS C1713
Hospital Charge Code 40209982
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $971.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $508.86
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 $462.60
Rate for Payer: Cigna LocalPlus Benefit Plan $531.99
Rate for Payer: Fidelis Medicare Advantage $971.46
Rate for Payer: Group Health Inc Commercial $462.60
Rate for Payer: Group Health Inc Medicare $323.82
Rate for Payer: Hamaspik Choice Inc Medicaid $462.60
Rate for Payer: Hamaspik Choice Inc Medicare $462.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $601.38
Service Code HCPCS C1713
Hospital Charge Code 40206838
Hospital Revenue Code 278
Min. Negotiated Rate $137.20
Max. Negotiated Rate $137.20
Rate for Payer: Hamaspik Choice Inc Medicaid $137.20
Rate for Payer: Hamaspik Choice Inc Medicare $137.20
Service Code HCPCS C1713
Hospital Charge Code 40206838
Hospital Revenue Code 278
Min. Negotiated Rate $96.04
Max. Negotiated Rate $288.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $150.92
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 $137.20
Rate for Payer: Cigna LocalPlus Benefit Plan $157.78
Rate for Payer: Fidelis Medicare Advantage $288.12
Rate for Payer: Group Health Inc Commercial $137.20
Rate for Payer: Group Health Inc Medicare $96.04
Rate for Payer: Hamaspik Choice Inc Medicaid $137.20
Rate for Payer: Hamaspik Choice Inc Medicare $137.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $178.36
Service Code HCPCS C1713
Hospital Charge Code 40204700
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,106.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $579.70
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 $527.00
Rate for Payer: Cigna LocalPlus Benefit Plan $606.05
Rate for Payer: Fidelis Medicare Advantage $1,106.70
Rate for Payer: Group Health Inc Commercial $527.00
Rate for Payer: Group Health Inc Medicare $368.90
Rate for Payer: Hamaspik Choice Inc Medicaid $527.00
Rate for Payer: Hamaspik Choice Inc Medicare $527.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $685.10
Service Code HCPCS C1713
Hospital Charge Code 40204700
Hospital Revenue Code 278
Min. Negotiated Rate $527.00
Max. Negotiated Rate $527.00
Rate for Payer: Hamaspik Choice Inc Medicaid $527.00
Rate for Payer: Hamaspik Choice Inc Medicare $527.00
Service Code HCPCS C1713
Hospital Charge Code 40205536
Hospital Revenue Code 278
Min. Negotiated Rate $1,203.00
Max. Negotiated Rate $1,203.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,203.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,203.00
Service Code HCPCS C1713
Hospital Charge Code 40205536
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,526.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,323.30
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 $1,203.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,383.45
Rate for Payer: Fidelis Medicare Advantage $2,526.30
Rate for Payer: Group Health Inc Commercial $1,203.00
Rate for Payer: Group Health Inc Medicare $842.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1,203.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,203.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,563.90
Service Code HCPCS C1713
Hospital Charge Code 40205713
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $679.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $355.74
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 $323.40
Rate for Payer: Cigna LocalPlus Benefit Plan $371.91
Rate for Payer: Fidelis Medicare Advantage $679.14
Rate for Payer: Group Health Inc Commercial $323.40
Rate for Payer: Group Health Inc Medicare $226.38
Rate for Payer: Hamaspik Choice Inc Medicaid $323.40
Rate for Payer: Hamaspik Choice Inc Medicare $323.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $420.42
Service Code HCPCS C1713
Hospital Charge Code 40205713
Hospital Revenue Code 278
Min. Negotiated Rate $323.40
Max. Negotiated Rate $323.40
Rate for Payer: Hamaspik Choice Inc Medicaid $323.40
Rate for Payer: Hamaspik Choice Inc Medicare $323.40
Service Code HCPCS C1713
Hospital Charge Code 40205564
Hospital Revenue Code 278
Min. Negotiated Rate $1,379.00
Max. Negotiated Rate $1,379.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,379.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,379.00