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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 40003444
Hospital Revenue Code 278
Min. Negotiated Rate $3,736.33
Max. Negotiated Rate $3,736.33
Rate for Payer: Hamaspik Choice Inc Medicaid $3,736.33
Rate for Payer: Hamaspik Choice Inc Medicare $3,736.33
Service Code HCPCS C1713
Hospital Charge Code 40204252
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,210.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,205.35
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 $2,004.86
Rate for Payer: Cigna LocalPlus Benefit Plan $2,305.59
Rate for Payer: Fidelis Medicare Advantage $4,210.21
Rate for Payer: Group Health Inc Commercial $2,004.86
Rate for Payer: Group Health Inc Medicare $1,403.40
Rate for Payer: Hamaspik Choice Inc Medicaid $2,004.86
Rate for Payer: Hamaspik Choice Inc Medicare $2,004.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,606.32
Service Code HCPCS C1713
Hospital Charge Code 40204252
Hospital Revenue Code 278
Min. Negotiated Rate $2,004.86
Max. Negotiated Rate $2,004.86
Rate for Payer: Hamaspik Choice Inc Medicaid $2,004.86
Rate for Payer: Hamaspik Choice Inc Medicare $2,004.86
Service Code HCPCS C1713
Hospital Charge Code 40003440
Hospital Revenue Code 278
Min. Negotiated Rate $2,028.51
Max. Negotiated Rate $2,028.51
Rate for Payer: Hamaspik Choice Inc Medicaid $2,028.51
Rate for Payer: Hamaspik Choice Inc Medicare $2,028.51
Service Code HCPCS C1713
Hospital Charge Code 40003440
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,259.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,231.36
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 $2,028.51
Rate for Payer: Cigna LocalPlus Benefit Plan $2,332.79
Rate for Payer: Fidelis Medicare Advantage $4,259.87
Rate for Payer: Group Health Inc Commercial $2,028.51
Rate for Payer: Group Health Inc Medicare $1,419.96
Rate for Payer: Hamaspik Choice Inc Medicaid $2,028.51
Rate for Payer: Hamaspik Choice Inc Medicare $2,028.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,637.06
Service Code HCPCS C1713
Hospital Charge Code 40008318
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,584.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $829.80
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 $754.36
Rate for Payer: Cigna LocalPlus Benefit Plan $867.51
Rate for Payer: Fidelis Medicare Advantage $1,584.16
Rate for Payer: Group Health Inc Commercial $754.36
Rate for Payer: Group Health Inc Medicare $528.05
Rate for Payer: Hamaspik Choice Inc Medicaid $754.36
Rate for Payer: Hamaspik Choice Inc Medicare $754.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $980.67
Service Code HCPCS C1713
Hospital Charge Code 40008318
Hospital Revenue Code 278
Min. Negotiated Rate $754.36
Max. Negotiated Rate $754.36
Rate for Payer: Hamaspik Choice Inc Medicaid $754.36
Rate for Payer: Hamaspik Choice Inc Medicare $754.36
Service Code HCPCS 94060 TC
Hospital Charge Code 40401500
Hospital Revenue Code 460
Min. Negotiated Rate $31.75
Max. Negotiated Rate $613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial $421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $383.29
Rate for Payer: Aetna Government $383.29
Rate for Payer: Cash Price $362.98
Rate for Payer: Cash Price $362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $613.26
Rate for Payer: Cigna LocalPlus Benefit Plan $521.27
Rate for Payer: Fidelis CHP/HARP/Medicaid $31.75
Rate for Payer: Group Health Inc Commercial $383.29
Rate for Payer: Group Health Inc Medicare $268.30
Rate for Payer: Hamaspik Choice Inc Medicaid $383.29
Rate for Payer: Hamaspik Choice Inc Medicare $383.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid $35.28
Service Code HCPCS J3490 Q0
Hospital Charge Code 41650239
Hospital Revenue Code 636
Max. Negotiated Rate $0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.01
Rate for Payer: Aetna Government $0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.01
Rate for Payer: Cigna LocalPlus Benefit Plan $0.01
Rate for Payer: Group Health Inc Commercial $0.01
Rate for Payer: Group Health Inc Medicare $0.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.01
Service Code HCPCS J3490 Q0
Hospital Charge Code 41640239
Hospital Revenue Code 636
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Service Code HCPCS J3490 Q0
Hospital Charge Code 41650239
Hospital Revenue Code 636
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Service Code HCPCS J3490 Q0
Hospital Charge Code 41640239
Hospital Revenue Code 636
Max. Negotiated Rate $0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.01
Rate for Payer: Aetna Government $0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.01
Rate for Payer: Cigna LocalPlus Benefit Plan $0.01
Rate for Payer: Group Health Inc Commercial $0.01
Rate for Payer: Group Health Inc Medicare $0.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.01
Service Code HCPCS C1713
Hospital Charge Code 40005354
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $590.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $309.10
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 $281.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.15
Rate for Payer: Fidelis Medicare Advantage $590.10
Rate for Payer: Group Health Inc Commercial $281.00
Rate for Payer: Group Health Inc Medicare $196.70
Rate for Payer: Hamaspik Choice Inc Medicaid $281.00
Rate for Payer: Hamaspik Choice Inc Medicare $281.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $365.30
Service Code HCPCS C1713
Hospital Charge Code 40005354
Hospital Revenue Code 278
Min. Negotiated Rate $281.00
Max. Negotiated Rate $281.00
Rate for Payer: Hamaspik Choice Inc Medicaid $281.00
Rate for Payer: Hamaspik Choice Inc Medicare $281.00
Service Code HCPCS C1713
Hospital Charge Code 40005352
Hospital Revenue Code 278
Min. Negotiated Rate $281.00
Max. Negotiated Rate $281.00
Rate for Payer: Hamaspik Choice Inc Medicaid $281.00
Rate for Payer: Hamaspik Choice Inc Medicare $281.00
Service Code HCPCS C1713
Hospital Charge Code 40005352
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $590.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $309.10
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 $281.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.15
Rate for Payer: Fidelis Medicare Advantage $590.10
Rate for Payer: Group Health Inc Commercial $281.00
Rate for Payer: Group Health Inc Medicare $196.70
Rate for Payer: Hamaspik Choice Inc Medicaid $281.00
Rate for Payer: Hamaspik Choice Inc Medicare $281.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $365.30
Service Code HCPCS C1776
Hospital Charge Code 40205006
Hospital Revenue Code 278
Min. Negotiated Rate $1,080.00
Max. Negotiated Rate $1,080.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,080.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,080.00
Service Code HCPCS C1776
Hospital Charge Code 40205006
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,268.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,188.00
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 $1,080.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,242.00
Rate for Payer: Fidelis Medicare Advantage $2,268.00
Rate for Payer: Group Health Inc Commercial $1,080.00
Rate for Payer: Group Health Inc Medicare $756.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,080.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,080.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,404.00
Service Code HCPCS C1713
Hospital Charge Code 40205083
Hospital Revenue Code 278
Min. Negotiated Rate $120.05
Max. Negotiated Rate $360.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $188.65
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 $171.50
Rate for Payer: Cigna LocalPlus Benefit Plan $197.22
Rate for Payer: Fidelis Medicare Advantage $360.15
Rate for Payer: Group Health Inc Commercial $171.50
Rate for Payer: Group Health Inc Medicare $120.05
Rate for Payer: Hamaspik Choice Inc Medicaid $171.50
Rate for Payer: Hamaspik Choice Inc Medicare $171.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $222.95
Service Code HCPCS C1713
Hospital Charge Code 40205083
Hospital Revenue Code 278
Min. Negotiated Rate $171.50
Max. Negotiated Rate $171.50
Rate for Payer: Hamaspik Choice Inc Medicaid $171.50
Rate for Payer: Hamaspik Choice Inc Medicare $171.50
Service Code HCPCS C1713
Hospital Charge Code 40205547
Hospital Revenue Code 278
Min. Negotiated Rate $121.80
Max. Negotiated Rate $121.80
Rate for Payer: Hamaspik Choice Inc Medicaid $121.80
Rate for Payer: Hamaspik Choice Inc Medicare $121.80
Service Code HCPCS C1713
Hospital Charge Code 40205547
Hospital Revenue Code 278
Min. Negotiated Rate $85.26
Max. Negotiated Rate $255.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $133.98
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 $121.80
Rate for Payer: Cigna LocalPlus Benefit Plan $140.07
Rate for Payer: Fidelis Medicare Advantage $255.78
Rate for Payer: Group Health Inc Commercial $121.80
Rate for Payer: Group Health Inc Medicare $85.26
Rate for Payer: Hamaspik Choice Inc Medicaid $121.80
Rate for Payer: Hamaspik Choice Inc Medicare $121.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $158.34
Hospital Charge Code 64902644
Hospital Revenue Code 270
Min. Negotiated Rate $43.75
Max. Negotiated Rate $100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $68.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $62.50
Rate for Payer: Aetna Government $62.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $85.00
Rate for Payer: Group Health Inc Commercial $62.50
Rate for Payer: Group Health Inc Medicare $43.75
Rate for Payer: Hamaspik Choice Inc Medicaid $62.50
Rate for Payer: Hamaspik Choice Inc Medicare $62.50
Hospital Charge Code 64902431
Hospital Revenue Code 270
Min. Negotiated Rate $2.36
Max. Negotiated Rate $5.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.38
Rate for Payer: Aetna Government $3.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.40
Rate for Payer: Cigna LocalPlus Benefit Plan $4.59
Rate for Payer: Group Health Inc Commercial $3.38
Rate for Payer: Group Health Inc Medicare $2.36
Rate for Payer: Hamaspik Choice Inc Medicaid $3.38
Rate for Payer: Hamaspik Choice Inc Medicare $3.38
Hospital Charge Code 64904081
Hospital Revenue Code 270
Min. Negotiated Rate $1.61
Max. Negotiated Rate $3.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.30
Rate for Payer: Aetna Government $2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.68
Rate for Payer: Cigna LocalPlus Benefit Plan $3.13
Rate for Payer: Group Health Inc Commercial $2.30
Rate for Payer: Group Health Inc Medicare $1.61
Rate for Payer: Hamaspik Choice Inc Medicaid $2.30
Rate for Payer: Hamaspik Choice Inc Medicare $2.30