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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40204249
Hospital Revenue Code 278
Min. Negotiated Rate $225.00
Max. Negotiated Rate $225.00
Rate for Payer: Hamaspik Choice Inc Medicaid $225.00
Rate for Payer: Hamaspik Choice Inc Medicare $225.00
Service Code HCPCS C1713
Hospital Charge Code 40204246
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $247.50
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 $225.00
Rate for Payer: Cigna LocalPlus Benefit Plan $258.75
Rate for Payer: Fidelis Medicare Advantage $472.50
Rate for Payer: Group Health Inc Commercial $225.00
Rate for Payer: Group Health Inc Medicare $157.50
Rate for Payer: Hamaspik Choice Inc Medicaid $225.00
Rate for Payer: Hamaspik Choice Inc Medicare $225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $292.50
Service Code HCPCS C1713
Hospital Charge Code 40204246
Hospital Revenue Code 278
Min. Negotiated Rate $225.00
Max. Negotiated Rate $225.00
Rate for Payer: Hamaspik Choice Inc Medicaid $225.00
Rate for Payer: Hamaspik Choice Inc Medicare $225.00
Service Code HCPCS C1713
Hospital Charge Code 40008317
Hospital Revenue Code 278
Min. Negotiated Rate $2,332.79
Max. Negotiated Rate $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare $2,332.79
Service Code HCPCS C1713
Hospital Charge Code 40008317
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,566.07
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 $2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan $2,682.71
Rate for Payer: Fidelis Medicare Advantage $4,898.86
Rate for Payer: Group Health Inc Commercial $2,332.79
Rate for Payer: Group Health Inc Medicare $1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare $2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,032.63
Service Code HCPCS C1713
Hospital Charge Code 40203408
Hospital Revenue Code 278
Min. Negotiated Rate $82.00
Max. Negotiated Rate $82.00
Rate for Payer: Hamaspik Choice Inc Medicaid $82.00
Rate for Payer: Hamaspik Choice Inc Medicare $82.00
Service Code HCPCS C1713
Hospital Charge Code 40203408
Hospital Revenue Code 278
Min. Negotiated Rate $57.40
Max. Negotiated Rate $172.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $90.20
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 $82.00
Rate for Payer: Cigna LocalPlus Benefit Plan $94.30
Rate for Payer: Fidelis Medicare Advantage $172.20
Rate for Payer: Group Health Inc Commercial $82.00
Rate for Payer: Group Health Inc Medicare $57.40
Rate for Payer: Hamaspik Choice Inc Medicaid $82.00
Rate for Payer: Hamaspik Choice Inc Medicare $82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $106.60
Service Code HCPCS C1713
Hospital Charge Code 40204263
Hospital Revenue Code 278
Min. Negotiated Rate $199.92
Max. Negotiated Rate $199.92
Rate for Payer: Hamaspik Choice Inc Medicaid $199.92
Rate for Payer: Hamaspik Choice Inc Medicare $199.92
Service Code HCPCS C1713
Hospital Charge Code 40204263
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $419.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial $219.91
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 $199.92
Rate for Payer: Cigna LocalPlus Benefit Plan $229.91
Rate for Payer: Fidelis Medicare Advantage $419.83
Rate for Payer: Group Health Inc Commercial $199.92
Rate for Payer: Group Health Inc Medicare $139.94
Rate for Payer: Hamaspik Choice Inc Medicaid $199.92
Rate for Payer: Hamaspik Choice Inc Medicare $199.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $259.90
Service Code HCPCS C1776
Hospital Charge Code 40208007
Hospital Revenue Code 278
Min. Negotiated Rate $52.00
Max. Negotiated Rate $52.00
Rate for Payer: Hamaspik Choice Inc Medicaid $52.00
Rate for Payer: Hamaspik Choice Inc Medicare $52.00
Service Code HCPCS C1776
Hospital Charge Code 40208007
Hospital Revenue Code 278
Min. Negotiated Rate $36.40
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $57.20
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 $52.00
Rate for Payer: Cigna LocalPlus Benefit Plan $59.80
Rate for Payer: Fidelis Medicare Advantage $109.20
Rate for Payer: Group Health Inc Commercial $52.00
Rate for Payer: Group Health Inc Medicare $36.40
Rate for Payer: Hamaspik Choice Inc Medicaid $52.00
Rate for Payer: Hamaspik Choice Inc Medicare $52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $67.60
Service Code HCPCS C1776
Hospital Charge Code 40208008
Hospital Revenue Code 278
Min. Negotiated Rate $36.40
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $57.20
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 $52.00
Rate for Payer: Cigna LocalPlus Benefit Plan $59.80
Rate for Payer: Fidelis Medicare Advantage $109.20
Rate for Payer: Group Health Inc Commercial $52.00
Rate for Payer: Group Health Inc Medicare $36.40
Rate for Payer: Hamaspik Choice Inc Medicaid $52.00
Rate for Payer: Hamaspik Choice Inc Medicare $52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $67.60
Service Code HCPCS C1776
Hospital Charge Code 40208008
Hospital Revenue Code 278
Min. Negotiated Rate $52.00
Max. Negotiated Rate $52.00
Rate for Payer: Hamaspik Choice Inc Medicaid $52.00
Rate for Payer: Hamaspik Choice Inc Medicare $52.00
Service Code HCPCS C1713
Hospital Charge Code 40204221
Hospital Revenue Code 278
Min. Negotiated Rate $129.50
Max. Negotiated Rate $388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $203.50
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 $185.00
Rate for Payer: Cigna LocalPlus Benefit Plan $212.75
Rate for Payer: Fidelis Medicare Advantage $388.50
Rate for Payer: Group Health Inc Commercial $185.00
Rate for Payer: Group Health Inc Medicare $129.50
Rate for Payer: Hamaspik Choice Inc Medicaid $185.00
Rate for Payer: Hamaspik Choice Inc Medicare $185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $240.50
Service Code HCPCS C1713
Hospital Charge Code 40204221
Hospital Revenue Code 278
Min. Negotiated Rate $185.00
Max. Negotiated Rate $185.00
Rate for Payer: Hamaspik Choice Inc Medicaid $185.00
Rate for Payer: Hamaspik Choice Inc Medicare $185.00
Service Code HCPCS C1713
Hospital Charge Code 40008316
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,566.07
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 $2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan $2,682.71
Rate for Payer: Fidelis Medicare Advantage $4,898.86
Rate for Payer: Group Health Inc Commercial $2,332.79
Rate for Payer: Group Health Inc Medicare $1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare $2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,032.63
Service Code HCPCS C1713
Hospital Charge Code 40008316
Hospital Revenue Code 278
Min. Negotiated Rate $2,332.79
Max. Negotiated Rate $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare $2,332.79
Service Code HCPCS C1713
Hospital Charge Code 40008315
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,898.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,566.07
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 $2,332.79
Rate for Payer: Cigna LocalPlus Benefit Plan $2,682.71
Rate for Payer: Fidelis Medicare Advantage $4,898.86
Rate for Payer: Group Health Inc Commercial $2,332.79
Rate for Payer: Group Health Inc Medicare $1,632.95
Rate for Payer: Hamaspik Choice Inc Medicaid $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare $2,332.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,032.63
Service Code HCPCS C1713
Hospital Charge Code 40008315
Hospital Revenue Code 278
Min. Negotiated Rate $2,332.79
Max. Negotiated Rate $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicaid $2,332.79
Rate for Payer: Hamaspik Choice Inc Medicare $2,332.79
Service Code HCPCS C1713
Hospital Charge Code 40204254
Hospital Revenue Code 278
Min. Negotiated Rate $512.90
Max. Negotiated Rate $512.90
Rate for Payer: Hamaspik Choice Inc Medicaid $512.90
Rate for Payer: Hamaspik Choice Inc Medicare $512.90
Service Code HCPCS C1713
Hospital Charge Code 40204254
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,077.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial $564.19
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 $512.90
Rate for Payer: Cigna LocalPlus Benefit Plan $589.84
Rate for Payer: Fidelis Medicare Advantage $1,077.09
Rate for Payer: Group Health Inc Commercial $512.90
Rate for Payer: Group Health Inc Medicare $359.03
Rate for Payer: Hamaspik Choice Inc Medicaid $512.90
Rate for Payer: Hamaspik Choice Inc Medicare $512.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $666.77
Service Code HCPCS C1713
Hospital Charge Code 40003441
Hospital Revenue Code 278
Min. Negotiated Rate $360.08
Max. Negotiated Rate $360.08
Rate for Payer: Hamaspik Choice Inc Medicaid $360.08
Rate for Payer: Hamaspik Choice Inc Medicare $360.08
Service Code HCPCS C1713
Hospital Charge Code 40003441
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $756.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $396.09
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 $360.08
Rate for Payer: Cigna LocalPlus Benefit Plan $414.09
Rate for Payer: Fidelis Medicare Advantage $756.17
Rate for Payer: Group Health Inc Commercial $360.08
Rate for Payer: Group Health Inc Medicare $252.06
Rate for Payer: Hamaspik Choice Inc Medicaid $360.08
Rate for Payer: Hamaspik Choice Inc Medicare $360.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $468.10
Service Code HCPCS C1713
Hospital Charge Code 40204207
Hospital Revenue Code 278
Min. Negotiated Rate $1,602.00
Max. Negotiated Rate $1,602.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,602.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,602.00
Service Code HCPCS C1713
Hospital Charge Code 40204207
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,364.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,762.20
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 $1,602.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,842.30
Rate for Payer: Fidelis Medicare Advantage $3,364.20
Rate for Payer: Group Health Inc Commercial $1,602.00
Rate for Payer: Group Health Inc Medicare $1,121.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,602.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,602.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,082.60