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Charge Type Price  
Service Code HCPCS C1776
Hospital Charge Code 40205219
Hospital Revenue Code 278
Min. Negotiated Rate $3,020.00
Max. Negotiated Rate $3,020.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,020.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,020.00
Service Code HCPCS C1776
Hospital Charge Code 40205288
Hospital Revenue Code 278
Min. Negotiated Rate $3,020.00
Max. Negotiated Rate $3,020.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,020.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,020.00
Service Code HCPCS C1776
Hospital Charge Code 40205288
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $6,342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,322.00
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 $3,020.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,473.00
Rate for Payer: Fidelis Medicare Advantage $6,342.00
Rate for Payer: Group Health Inc Commercial $3,020.00
Rate for Payer: Group Health Inc Medicare $2,114.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3,020.00
Rate for Payer: Hamaspik Choice Inc Medicare $3,020.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,926.00
Service Code HCPCS C1776
Hospital Charge Code 40029617
Hospital Revenue Code 278
Min. Negotiated Rate $2,307.00
Max. Negotiated Rate $2,307.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,307.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,307.00
Service Code HCPCS C1776
Hospital Charge Code 40029617
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,844.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,537.70
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 $2,307.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,653.05
Rate for Payer: Fidelis Medicare Advantage $4,844.70
Rate for Payer: Group Health Inc Commercial $2,307.00
Rate for Payer: Group Health Inc Medicare $1,614.90
Rate for Payer: Hamaspik Choice Inc Medicaid $2,307.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,307.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,999.10
Service Code HCPCS C1776
Hospital Charge Code 40205609
Hospital Revenue Code 278
Min. Negotiated Rate $4,428.00
Max. Negotiated Rate $4,428.00
Rate for Payer: Hamaspik Choice Inc Medicaid $4,428.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,428.00
Service Code HCPCS C1776
Hospital Charge Code 40205609
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $9,298.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,870.80
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 $4,428.00
Rate for Payer: Cigna LocalPlus Benefit Plan $5,092.20
Rate for Payer: Fidelis Medicare Advantage $9,298.80
Rate for Payer: Group Health Inc Commercial $4,428.00
Rate for Payer: Group Health Inc Medicare $3,099.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4,428.00
Rate for Payer: Hamaspik Choice Inc Medicare $4,428.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5,756.40
Service Code HCPCS C1776
Hospital Charge Code 40206073
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $4,895.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,564.10
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 $2,331.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,680.65
Rate for Payer: Fidelis Medicare Advantage $4,895.10
Rate for Payer: Group Health Inc Commercial $2,331.00
Rate for Payer: Group Health Inc Medicare $1,631.70
Rate for Payer: Hamaspik Choice Inc Medicaid $2,331.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,331.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,030.30
Service Code HCPCS C1776
Hospital Charge Code 40206073
Hospital Revenue Code 278
Min. Negotiated Rate $2,331.00
Max. Negotiated Rate $2,331.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,331.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,331.00
Service Code HCPCS C1713
Hospital Charge Code 40205194
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,654.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,390.40
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 $1,264.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,453.60
Rate for Payer: Fidelis Medicare Advantage $2,654.40
Rate for Payer: Group Health Inc Commercial $1,264.00
Rate for Payer: Group Health Inc Medicare $884.80
Rate for Payer: Hamaspik Choice Inc Medicaid $1,264.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,264.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,643.20
Service Code HCPCS C1713
Hospital Charge Code 40205194
Hospital Revenue Code 278
Min. Negotiated Rate $1,264.00
Max. Negotiated Rate $1,264.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,264.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,264.00
Hospital Charge Code 40204686
Hospital Revenue Code 272
Min. Negotiated Rate $186.87
Max. Negotiated Rate $427.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $293.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $266.96
Rate for Payer: Aetna Government $266.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $427.14
Rate for Payer: Cigna LocalPlus Benefit Plan $363.07
Rate for Payer: Group Health Inc Commercial $266.96
Rate for Payer: Group Health Inc Medicare $186.87
Rate for Payer: Hamaspik Choice Inc Medicaid $266.96
Rate for Payer: Hamaspik Choice Inc Medicare $266.96
Service Code HCPCS C1713
Hospital Charge Code 40205953
Hospital Revenue Code 278
Min. Negotiated Rate $1,074.50
Max. Negotiated Rate $1,074.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,074.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,074.50
Service Code HCPCS C1713
Hospital Charge Code 40205953
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $2,256.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,181.95
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 $1,074.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,235.68
Rate for Payer: Fidelis Medicare Advantage $2,256.45
Rate for Payer: Group Health Inc Commercial $1,074.50
Rate for Payer: Group Health Inc Medicare $752.15
Rate for Payer: Hamaspik Choice Inc Medicaid $1,074.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,074.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,396.85
Service Code HCPCS C1776
Hospital Charge Code 40205784
Hospital Revenue Code 278
Min. Negotiated Rate $1,505.00
Max. Negotiated Rate $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,505.00
Service Code HCPCS C1776
Hospital Charge Code 40205784
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $3,160.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,655.50
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 $1,505.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,730.75
Rate for Payer: Fidelis Medicare Advantage $3,160.50
Rate for Payer: Group Health Inc Commercial $1,505.00
Rate for Payer: Group Health Inc Medicare $1,053.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,505.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,956.50
Service Code HCPCS C1713
Hospital Charge Code 40205913
Hospital Revenue Code 278
Min. Negotiated Rate $1,505.00
Max. Negotiated Rate $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,505.00
Service Code HCPCS C1713
Hospital Charge Code 40205913
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,160.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,655.50
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 $1,505.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,730.75
Rate for Payer: Fidelis Medicare Advantage $3,160.50
Rate for Payer: Group Health Inc Commercial $1,505.00
Rate for Payer: Group Health Inc Medicare $1,053.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,505.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,956.50
Service Code HCPCS C1713
Hospital Charge Code 40205791
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,223.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,688.50
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 $1,535.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,765.25
Rate for Payer: Fidelis Medicare Advantage $3,223.50
Rate for Payer: Group Health Inc Commercial $1,535.00
Rate for Payer: Group Health Inc Medicare $1,074.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,535.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,535.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,995.50
Service Code HCPCS C1713
Hospital Charge Code 40205791
Hospital Revenue Code 278
Min. Negotiated Rate $1,535.00
Max. Negotiated Rate $1,535.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,535.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,535.00
Service Code HCPCS C1713
Hospital Charge Code 40203407
Hospital Revenue Code 278
Min. Negotiated Rate $203.65
Max. Negotiated Rate $203.65
Rate for Payer: Hamaspik Choice Inc Medicaid $203.65
Rate for Payer: Hamaspik Choice Inc Medicare $203.65
Service Code HCPCS C1713
Hospital Charge Code 40203407
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $427.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $224.02
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 $203.65
Rate for Payer: Cigna LocalPlus Benefit Plan $234.20
Rate for Payer: Fidelis Medicare Advantage $427.66
Rate for Payer: Group Health Inc Commercial $203.65
Rate for Payer: Group Health Inc Medicare $142.56
Rate for Payer: Hamaspik Choice Inc Medicaid $203.65
Rate for Payer: Hamaspik Choice Inc Medicare $203.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $264.74
Service Code HCPCS C1713
Hospital Charge Code 40203426
Hospital Revenue Code 278
Min. Negotiated Rate $257.71
Max. Negotiated Rate $257.71
Rate for Payer: Hamaspik Choice Inc Medicaid $257.71
Rate for Payer: Hamaspik Choice Inc Medicare $257.71
Service Code HCPCS C1713
Hospital Charge Code 40203426
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $541.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial $283.48
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 $257.71
Rate for Payer: Cigna LocalPlus Benefit Plan $296.37
Rate for Payer: Fidelis Medicare Advantage $541.19
Rate for Payer: Group Health Inc Commercial $257.71
Rate for Payer: Group Health Inc Medicare $180.40
Rate for Payer: Hamaspik Choice Inc Medicaid $257.71
Rate for Payer: Hamaspik Choice Inc Medicare $257.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $335.02
Service Code HCPCS C1776
Hospital Charge Code 40029619
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,455.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,286.01
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 $1,169.10
Rate for Payer: Cigna LocalPlus Benefit Plan $1,344.46
Rate for Payer: Fidelis Medicare Advantage $2,455.11
Rate for Payer: Group Health Inc Commercial $1,169.10
Rate for Payer: Group Health Inc Medicare $818.37
Rate for Payer: Hamaspik Choice Inc Medicaid $1,169.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,169.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,519.83