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Charge Type Price  
Hospital Charge Code 40009329
Hospital Revenue Code 272
Min. Negotiated Rate $410.20
Max. Negotiated Rate $937.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $644.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $586.00
Rate for Payer: Aetna Government $586.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $937.60
Rate for Payer: Cigna LocalPlus Benefit Plan $796.96
Rate for Payer: Group Health Inc Commercial $586.00
Rate for Payer: Group Health Inc Medicare $410.20
Rate for Payer: Hamaspik Choice Inc Medicaid $586.00
Rate for Payer: Hamaspik Choice Inc Medicare $586.00
Service Code HCPCS C1769
Hospital Charge Code 40205216
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $153.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $80.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $73.00
Rate for Payer: Cigna LocalPlus Benefit Plan $83.95
Rate for Payer: Fidelis Medicare Advantage $153.30
Rate for Payer: Group Health Inc Commercial $73.00
Rate for Payer: Group Health Inc Medicare $51.10
Rate for Payer: Hamaspik Choice Inc Medicaid $73.00
Rate for Payer: Hamaspik Choice Inc Medicare $73.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $94.90
Service Code HCPCS C1769
Hospital Charge Code 40205216
Hospital Revenue Code 278
Min. Negotiated Rate $73.00
Max. Negotiated Rate $73.00
Rate for Payer: Hamaspik Choice Inc Medicaid $73.00
Rate for Payer: Hamaspik Choice Inc Medicare $73.00
Service Code HCPCS C1713
Hospital Charge Code 40205772
Hospital Revenue Code 278
Min. Negotiated Rate $264.00
Max. Negotiated Rate $264.00
Rate for Payer: Hamaspik Choice Inc Medicaid $264.00
Rate for Payer: Hamaspik Choice Inc Medicare $264.00
Service Code HCPCS C1713
Hospital Charge Code 40205772
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $554.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $290.40
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 $264.00
Rate for Payer: Cigna LocalPlus Benefit Plan $303.60
Rate for Payer: Fidelis Medicare Advantage $554.40
Rate for Payer: Group Health Inc Commercial $264.00
Rate for Payer: Group Health Inc Medicare $184.80
Rate for Payer: Hamaspik Choice Inc Medicaid $264.00
Rate for Payer: Hamaspik Choice Inc Medicare $264.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $343.20
Service Code HCPCS C1713
Hospital Charge Code 40206333
Hospital Revenue Code 278
Min. Negotiated Rate $93.80
Max. Negotiated Rate $281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $147.40
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 $134.00
Rate for Payer: Cigna LocalPlus Benefit Plan $154.10
Rate for Payer: Fidelis Medicare Advantage $281.40
Rate for Payer: Group Health Inc Commercial $134.00
Rate for Payer: Group Health Inc Medicare $93.80
Rate for Payer: Hamaspik Choice Inc Medicaid $134.00
Rate for Payer: Hamaspik Choice Inc Medicare $134.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $174.20
Service Code HCPCS C1713
Hospital Charge Code 40206333
Hospital Revenue Code 278
Min. Negotiated Rate $134.00
Max. Negotiated Rate $134.00
Rate for Payer: Hamaspik Choice Inc Medicaid $134.00
Rate for Payer: Hamaspik Choice Inc Medicare $134.00
Service Code HCPCS C1713
Hospital Charge Code 40208149
Hospital Revenue Code 278
Min. Negotiated Rate $152.10
Max. Negotiated Rate $152.10
Rate for Payer: Hamaspik Choice Inc Medicaid $152.10
Rate for Payer: Hamaspik Choice Inc Medicare $152.10
Service Code HCPCS C1713
Hospital Charge Code 40208149
Hospital Revenue Code 278
Min. Negotiated Rate $106.47
Max. Negotiated Rate $319.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial $167.31
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 $152.10
Rate for Payer: Cigna LocalPlus Benefit Plan $174.92
Rate for Payer: Fidelis Medicare Advantage $319.41
Rate for Payer: Group Health Inc Commercial $152.10
Rate for Payer: Group Health Inc Medicare $106.47
Rate for Payer: Hamaspik Choice Inc Medicaid $152.10
Rate for Payer: Hamaspik Choice Inc Medicare $152.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $197.73
Service Code HCPCS C1713
Hospital Charge Code 40205810
Hospital Revenue Code 278
Min. Negotiated Rate $127.00
Max. Negotiated Rate $127.00
Rate for Payer: Hamaspik Choice Inc Medicaid $127.00
Rate for Payer: Hamaspik Choice Inc Medicare $127.00
Service Code HCPCS C1713
Hospital Charge Code 40205810
Hospital Revenue Code 278
Min. Negotiated Rate $88.90
Max. Negotiated Rate $266.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $139.70
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 $127.00
Rate for Payer: Cigna LocalPlus Benefit Plan $146.05
Rate for Payer: Fidelis Medicare Advantage $266.70
Rate for Payer: Group Health Inc Commercial $127.00
Rate for Payer: Group Health Inc Medicare $88.90
Rate for Payer: Hamaspik Choice Inc Medicaid $127.00
Rate for Payer: Hamaspik Choice Inc Medicare $127.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $165.10
Service Code HCPCS C1713
Hospital Charge Code 40200716
Hospital Revenue Code 278
Min. Negotiated Rate $148.50
Max. Negotiated Rate $148.50
Rate for Payer: Hamaspik Choice Inc Medicaid $148.50
Rate for Payer: Hamaspik Choice Inc Medicare $148.50
Service Code HCPCS C1713
Hospital Charge Code 40200716
Hospital Revenue Code 278
Min. Negotiated Rate $103.95
Max. Negotiated Rate $311.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial $163.35
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 $148.50
Rate for Payer: Cigna LocalPlus Benefit Plan $170.78
Rate for Payer: Fidelis Medicare Advantage $311.85
Rate for Payer: Group Health Inc Commercial $148.50
Rate for Payer: Group Health Inc Medicare $103.95
Rate for Payer: Hamaspik Choice Inc Medicaid $148.50
Rate for Payer: Hamaspik Choice Inc Medicare $148.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $193.05
Service Code HCPCS C1713
Hospital Charge Code 40205700
Hospital Revenue Code 278
Min. Negotiated Rate $74.25
Max. Negotiated Rate $74.25
Rate for Payer: Hamaspik Choice Inc Medicaid $74.25
Rate for Payer: Hamaspik Choice Inc Medicare $74.25
Service Code HCPCS C1713
Hospital Charge Code 40205700
Hospital Revenue Code 278
Min. Negotiated Rate $51.98
Max. Negotiated Rate $155.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial $81.68
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 $74.25
Rate for Payer: Cigna LocalPlus Benefit Plan $85.39
Rate for Payer: Fidelis Medicare Advantage $155.92
Rate for Payer: Group Health Inc Commercial $74.25
Rate for Payer: Group Health Inc Medicare $51.98
Rate for Payer: Hamaspik Choice Inc Medicaid $74.25
Rate for Payer: Hamaspik Choice Inc Medicare $74.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $96.52
Service Code HCPCS C1713
Hospital Charge Code 40206245
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $407.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $213.40
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 $194.00
Rate for Payer: Cigna LocalPlus Benefit Plan $223.10
Rate for Payer: Fidelis Medicare Advantage $407.40
Rate for Payer: Group Health Inc Commercial $194.00
Rate for Payer: Group Health Inc Medicare $135.80
Rate for Payer: Hamaspik Choice Inc Medicaid $194.00
Rate for Payer: Hamaspik Choice Inc Medicare $194.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $252.20
Service Code HCPCS C1713
Hospital Charge Code 40206245
Hospital Revenue Code 278
Min. Negotiated Rate $194.00
Max. Negotiated Rate $194.00
Rate for Payer: Hamaspik Choice Inc Medicaid $194.00
Rate for Payer: Hamaspik Choice Inc Medicare $194.00
Service Code HCPCS C1713
Hospital Charge Code 40205793
Hospital Revenue Code 278
Min. Negotiated Rate $148.50
Max. Negotiated Rate $148.50
Rate for Payer: Hamaspik Choice Inc Medicaid $148.50
Rate for Payer: Hamaspik Choice Inc Medicare $148.50
Service Code HCPCS C1713
Hospital Charge Code 40205793
Hospital Revenue Code 278
Min. Negotiated Rate $103.95
Max. Negotiated Rate $311.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial $163.35
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 $148.50
Rate for Payer: Cigna LocalPlus Benefit Plan $170.78
Rate for Payer: Fidelis Medicare Advantage $311.85
Rate for Payer: Group Health Inc Commercial $148.50
Rate for Payer: Group Health Inc Medicare $103.95
Rate for Payer: Hamaspik Choice Inc Medicaid $148.50
Rate for Payer: Hamaspik Choice Inc Medicare $148.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $193.05
Service Code HCPCS C1713
Hospital Charge Code 40205946
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $487.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $255.20
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 $232.00
Rate for Payer: Cigna LocalPlus Benefit Plan $266.80
Rate for Payer: Fidelis Medicare Advantage $487.20
Rate for Payer: Group Health Inc Commercial $232.00
Rate for Payer: Group Health Inc Medicare $162.40
Rate for Payer: Hamaspik Choice Inc Medicaid $232.00
Rate for Payer: Hamaspik Choice Inc Medicare $232.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $301.60
Service Code HCPCS C1713
Hospital Charge Code 40205946
Hospital Revenue Code 278
Min. Negotiated Rate $232.00
Max. Negotiated Rate $232.00
Rate for Payer: Hamaspik Choice Inc Medicaid $232.00
Rate for Payer: Hamaspik Choice Inc Medicare $232.00
Service Code HCPCS C1713
Hospital Charge Code 40209600
Hospital Revenue Code 278
Min. Negotiated Rate $239.40
Max. Negotiated Rate $239.40
Rate for Payer: Hamaspik Choice Inc Medicaid $239.40
Rate for Payer: Hamaspik Choice Inc Medicare $239.40
Service Code HCPCS C1713
Hospital Charge Code 40209600
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $502.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial $263.34
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 $239.40
Rate for Payer: Cigna LocalPlus Benefit Plan $275.31
Rate for Payer: Fidelis Medicare Advantage $502.74
Rate for Payer: Group Health Inc Commercial $239.40
Rate for Payer: Group Health Inc Medicare $167.58
Rate for Payer: Hamaspik Choice Inc Medicaid $239.40
Rate for Payer: Hamaspik Choice Inc Medicare $239.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $311.22
Service Code HCPCS C1713
Hospital Charge Code 40206064
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,018.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $533.50
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 $485.00
Rate for Payer: Cigna LocalPlus Benefit Plan $557.75
Rate for Payer: Fidelis Medicare Advantage $1,018.50
Rate for Payer: Group Health Inc Commercial $485.00
Rate for Payer: Group Health Inc Medicare $339.50
Rate for Payer: Hamaspik Choice Inc Medicaid $485.00
Rate for Payer: Hamaspik Choice Inc Medicare $485.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $630.50
Service Code HCPCS C1713
Hospital Charge Code 40206064
Hospital Revenue Code 278
Min. Negotiated Rate $485.00
Max. Negotiated Rate $485.00
Rate for Payer: Hamaspik Choice Inc Medicaid $485.00
Rate for Payer: Hamaspik Choice Inc Medicare $485.00