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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40205564
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,895.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,516.90
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 $1,379.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,585.85
Rate for Payer: Fidelis Medicare Advantage $2,895.90
Rate for Payer: Group Health Inc Commercial $1,379.00
Rate for Payer: Group Health Inc Medicare $965.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,379.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,379.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,792.70
Service Code HCPCS C1713
Hospital Charge Code 40209434
Hospital Revenue Code 278
Min. Negotiated Rate $47.25
Max. Negotiated Rate $141.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $74.25
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 $67.50
Rate for Payer: Cigna LocalPlus Benefit Plan $77.62
Rate for Payer: Fidelis Medicare Advantage $141.75
Rate for Payer: Group Health Inc Commercial $67.50
Rate for Payer: Group Health Inc Medicare $47.25
Rate for Payer: Hamaspik Choice Inc Medicaid $67.50
Rate for Payer: Hamaspik Choice Inc Medicare $67.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $87.75
Service Code HCPCS C1713
Hospital Charge Code 40209434
Hospital Revenue Code 278
Min. Negotiated Rate $67.50
Max. Negotiated Rate $67.50
Rate for Payer: Hamaspik Choice Inc Medicaid $67.50
Rate for Payer: Hamaspik Choice Inc Medicare $67.50
Service Code HCPCS C1713
Hospital Charge Code 40205719
Hospital Revenue Code 278
Min. Negotiated Rate $40.60
Max. Negotiated Rate $40.60
Rate for Payer: Hamaspik Choice Inc Medicaid $40.60
Rate for Payer: Hamaspik Choice Inc Medicare $40.60
Service Code HCPCS C1713
Hospital Charge Code 40205719
Hospital Revenue Code 278
Min. Negotiated Rate $28.42
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $44.66
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 $40.60
Rate for Payer: Cigna LocalPlus Benefit Plan $46.69
Rate for Payer: Fidelis Medicare Advantage $85.26
Rate for Payer: Group Health Inc Commercial $40.60
Rate for Payer: Group Health Inc Medicare $28.42
Rate for Payer: Hamaspik Choice Inc Medicaid $40.60
Rate for Payer: Hamaspik Choice Inc Medicare $40.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $52.78
Service Code HCPCS C1713
Hospital Charge Code 40209443
Hospital Revenue Code 278
Min. Negotiated Rate $60.75
Max. Negotiated Rate $60.75
Rate for Payer: Hamaspik Choice Inc Medicaid $60.75
Rate for Payer: Hamaspik Choice Inc Medicare $60.75
Service Code HCPCS C1713
Hospital Charge Code 40209443
Hospital Revenue Code 278
Min. Negotiated Rate $42.52
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $66.82
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 $60.75
Rate for Payer: Cigna LocalPlus Benefit Plan $69.86
Rate for Payer: Fidelis Medicare Advantage $127.58
Rate for Payer: Group Health Inc Commercial $60.75
Rate for Payer: Group Health Inc Medicare $42.52
Rate for Payer: Hamaspik Choice Inc Medicaid $60.75
Rate for Payer: Hamaspik Choice Inc Medicare $60.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $78.98
Service Code HCPCS C1713
Hospital Charge Code 40209444
Hospital Revenue Code 278
Min. Negotiated Rate $60.75
Max. Negotiated Rate $60.75
Rate for Payer: Hamaspik Choice Inc Medicaid $60.75
Rate for Payer: Hamaspik Choice Inc Medicare $60.75
Service Code HCPCS C1713
Hospital Charge Code 40209444
Hospital Revenue Code 278
Min. Negotiated Rate $42.52
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $66.82
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 $60.75
Rate for Payer: Cigna LocalPlus Benefit Plan $69.86
Rate for Payer: Fidelis Medicare Advantage $127.58
Rate for Payer: Group Health Inc Commercial $60.75
Rate for Payer: Group Health Inc Medicare $42.52
Rate for Payer: Hamaspik Choice Inc Medicaid $60.75
Rate for Payer: Hamaspik Choice Inc Medicare $60.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $78.98
Hospital Charge Code 40205491
Hospital Revenue Code 270
Min. Negotiated Rate $236.95
Max. Negotiated Rate $541.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $372.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $338.50
Rate for Payer: Aetna Government $338.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $541.60
Rate for Payer: Cigna LocalPlus Benefit Plan $460.36
Rate for Payer: Group Health Inc Commercial $338.50
Rate for Payer: Group Health Inc Medicare $236.95
Rate for Payer: Hamaspik Choice Inc Medicaid $338.50
Rate for Payer: Hamaspik Choice Inc Medicare $338.50
Service Code HCPCS C1776
Hospital Charge Code 40207045
Hospital Revenue Code 278
Min. Negotiated Rate $3,162.00
Max. Negotiated Rate $3,162.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,162.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,162.00
Service Code HCPCS C1776
Hospital Charge Code 40207045
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,640.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,478.20
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 $3,162.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,636.30
Rate for Payer: Fidelis Medicare Advantage $6,640.20
Rate for Payer: Group Health Inc Commercial $3,162.00
Rate for Payer: Group Health Inc Medicare $2,213.40
Rate for Payer: Hamaspik Choice Inc Medicaid $3,162.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,162.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,110.60
Service Code HCPCS C1776
Hospital Charge Code 40205143
Hospital Revenue Code 278
Min. Negotiated Rate $1,581.00
Max. Negotiated Rate $1,581.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,581.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,581.00
Service Code HCPCS C1776
Hospital Charge Code 40205143
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,320.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,739.10
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 $1,581.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,818.15
Rate for Payer: Fidelis Medicare Advantage $3,320.10
Rate for Payer: Group Health Inc Commercial $1,581.00
Rate for Payer: Group Health Inc Medicare $1,106.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1,581.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,581.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,055.30
Service Code HCPCS C1776
Hospital Charge Code 40205218
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $5,619.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,943.60
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 $2,676.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,077.40
Rate for Payer: Fidelis Medicare Advantage $5,619.60
Rate for Payer: Group Health Inc Commercial $2,676.00
Rate for Payer: Group Health Inc Medicare $1,873.20
Rate for Payer: Hamaspik Choice Inc Medicaid $2,676.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,676.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,478.80
Service Code HCPCS C1776
Hospital Charge Code 40205218
Hospital Revenue Code 278
Min. Negotiated Rate $2,676.00
Max. Negotiated Rate $2,676.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,676.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,676.00
Service Code HCPCS C1776
Hospital Charge Code 40205205
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,098.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,194.40
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 $2,904.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,339.60
Rate for Payer: Fidelis Medicare Advantage $6,098.40
Rate for Payer: Group Health Inc Commercial $2,904.00
Rate for Payer: Group Health Inc Medicare $2,032.80
Rate for Payer: Hamaspik Choice Inc Medicaid $2,904.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,904.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,775.20
Service Code HCPCS C1776
Hospital Charge Code 40205205
Hospital Revenue Code 278
Min. Negotiated Rate $2,904.00
Max. Negotiated Rate $2,904.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,904.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,904.00
Service Code HCPCS C1713
Hospital Charge Code 40205275
Hospital Revenue Code 278
Min. Negotiated Rate $18.62
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $29.26
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 $26.60
Rate for Payer: Cigna LocalPlus Benefit Plan $30.59
Rate for Payer: Fidelis Medicare Advantage $55.86
Rate for Payer: Group Health Inc Commercial $26.60
Rate for Payer: Group Health Inc Medicare $18.62
Rate for Payer: Hamaspik Choice Inc Medicaid $26.60
Rate for Payer: Hamaspik Choice Inc Medicare $26.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $34.58
Service Code HCPCS C1713
Hospital Charge Code 40205275
Hospital Revenue Code 278
Min. Negotiated Rate $26.60
Max. Negotiated Rate $26.60
Rate for Payer: Hamaspik Choice Inc Medicaid $26.60
Rate for Payer: Hamaspik Choice Inc Medicare $26.60
Service Code HCPCS C1713
Hospital Charge Code 40205274
Hospital Revenue Code 278
Min. Negotiated Rate $23.10
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $36.30
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 $33.00
Rate for Payer: Cigna LocalPlus Benefit Plan $37.95
Rate for Payer: Fidelis Medicare Advantage $69.30
Rate for Payer: Group Health Inc Commercial $33.00
Rate for Payer: Group Health Inc Medicare $23.10
Rate for Payer: Hamaspik Choice Inc Medicaid $33.00
Rate for Payer: Hamaspik Choice Inc Medicare $33.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $42.90
Service Code HCPCS C1713
Hospital Charge Code 40205274
Hospital Revenue Code 278
Min. Negotiated Rate $33.00
Max. Negotiated Rate $33.00
Rate for Payer: Hamaspik Choice Inc Medicaid $33.00
Rate for Payer: Hamaspik Choice Inc Medicare $33.00
Service Code HCPCS C1713
Hospital Charge Code 40205682
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $574.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial $301.07
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 $273.70
Rate for Payer: Cigna LocalPlus Benefit Plan $314.76
Rate for Payer: Fidelis Medicare Advantage $574.77
Rate for Payer: Group Health Inc Commercial $273.70
Rate for Payer: Group Health Inc Medicare $191.59
Rate for Payer: Hamaspik Choice Inc Medicaid $273.70
Rate for Payer: Hamaspik Choice Inc Medicare $273.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $355.81
Service Code HCPCS C1713
Hospital Charge Code 40205682
Hospital Revenue Code 278
Min. Negotiated Rate $273.70
Max. Negotiated Rate $273.70
Rate for Payer: Hamaspik Choice Inc Medicaid $273.70
Rate for Payer: Hamaspik Choice Inc Medicare $273.70
Service Code HCPCS C1713
Hospital Charge Code 40205683
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