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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 64906718
Hospital Revenue Code 278
Min. Negotiated Rate $105.00
Max. Negotiated Rate $315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $165.00
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 $150.00
Rate for Payer: Cigna LocalPlus Benefit Plan $172.50
Rate for Payer: Fidelis Medicare Advantage $315.00
Rate for Payer: Group Health Inc Commercial $150.00
Rate for Payer: Group Health Inc Medicare $105.00
Rate for Payer: Hamaspik Choice Inc Medicaid $150.00
Rate for Payer: Hamaspik Choice Inc Medicare $150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $195.00
Service Code HCPCS C1713
Hospital Charge Code 64906718
Hospital Revenue Code 278
Min. Negotiated Rate $150.00
Max. Negotiated Rate $150.00
Rate for Payer: Hamaspik Choice Inc Medicaid $150.00
Rate for Payer: Hamaspik Choice Inc Medicare $150.00
Service Code HCPCS C1776
Hospital Charge Code 40209005
Hospital Revenue Code 278
Min. Negotiated Rate $114.00
Max. Negotiated Rate $114.00
Rate for Payer: Hamaspik Choice Inc Medicaid $114.00
Rate for Payer: Hamaspik Choice Inc Medicare $114.00
Service Code HCPCS C1776
Hospital Charge Code 40209005
Hospital Revenue Code 278
Min. Negotiated Rate $79.80
Max. Negotiated Rate $339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $125.40
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 $114.00
Rate for Payer: Cigna LocalPlus Benefit Plan $131.10
Rate for Payer: Fidelis Medicare Advantage $239.40
Rate for Payer: Group Health Inc Commercial $114.00
Rate for Payer: Group Health Inc Medicare $79.80
Rate for Payer: Hamaspik Choice Inc Medicaid $114.00
Rate for Payer: Hamaspik Choice Inc Medicare $114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $148.20
Service Code HCPCS C1713
Hospital Charge Code 64906929
Hospital Revenue Code 278
Min. Negotiated Rate $67.86
Max. Negotiated Rate $203.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial $106.63
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 $96.94
Rate for Payer: Cigna LocalPlus Benefit Plan $111.48
Rate for Payer: Fidelis Medicare Advantage $203.57
Rate for Payer: Group Health Inc Commercial $96.94
Rate for Payer: Group Health Inc Medicare $67.86
Rate for Payer: Hamaspik Choice Inc Medicaid $96.94
Rate for Payer: Hamaspik Choice Inc Medicare $96.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $126.02
Service Code HCPCS C1713
Hospital Charge Code 64906929
Hospital Revenue Code 278
Min. Negotiated Rate $96.94
Max. Negotiated Rate $96.94
Rate for Payer: Hamaspik Choice Inc Medicaid $96.94
Rate for Payer: Hamaspik Choice Inc Medicare $96.94
Service Code HCPCS C1713
Hospital Charge Code 64901342
Hospital Revenue Code 278
Min. Negotiated Rate $183.75
Max. Negotiated Rate $183.75
Rate for Payer: Hamaspik Choice Inc Medicaid $183.75
Rate for Payer: Hamaspik Choice Inc Medicare $183.75
Service Code HCPCS C1713
Hospital Charge Code 64901342
Hospital Revenue Code 278
Min. Negotiated Rate $128.62
Max. Negotiated Rate $385.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $202.12
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 $183.75
Rate for Payer: Cigna LocalPlus Benefit Plan $211.31
Rate for Payer: Fidelis Medicare Advantage $385.88
Rate for Payer: Group Health Inc Commercial $183.75
Rate for Payer: Group Health Inc Medicare $128.62
Rate for Payer: Hamaspik Choice Inc Medicaid $183.75
Rate for Payer: Hamaspik Choice Inc Medicare $183.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $238.88
Service Code HCPCS C1713
Hospital Charge Code 64903219
Hospital Revenue Code 278
Min. Negotiated Rate $96.96
Max. Negotiated Rate $290.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $152.37
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 $138.52
Rate for Payer: Cigna LocalPlus Benefit Plan $159.29
Rate for Payer: Fidelis Medicare Advantage $290.88
Rate for Payer: Group Health Inc Commercial $138.52
Rate for Payer: Group Health Inc Medicare $96.96
Rate for Payer: Hamaspik Choice Inc Medicaid $138.52
Rate for Payer: Hamaspik Choice Inc Medicare $138.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $180.07
Service Code HCPCS C1713
Hospital Charge Code 64903219
Hospital Revenue Code 278
Min. Negotiated Rate $138.52
Max. Negotiated Rate $138.52
Rate for Payer: Hamaspik Choice Inc Medicaid $138.52
Rate for Payer: Hamaspik Choice Inc Medicare $138.52
Service Code HCPCS C1713
Hospital Charge Code 64902566
Hospital Revenue Code 278
Min. Negotiated Rate $93.75
Max. Negotiated Rate $93.75
Rate for Payer: Hamaspik Choice Inc Medicaid $93.75
Rate for Payer: Hamaspik Choice Inc Medicare $93.75
Service Code HCPCS C1713
Hospital Charge Code 64902566
Hospital Revenue Code 278
Min. Negotiated Rate $65.62
Max. Negotiated Rate $196.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $103.12
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 $93.75
Rate for Payer: Cigna LocalPlus Benefit Plan $107.81
Rate for Payer: Fidelis Medicare Advantage $196.88
Rate for Payer: Group Health Inc Commercial $93.75
Rate for Payer: Group Health Inc Medicare $65.62
Rate for Payer: Hamaspik Choice Inc Medicaid $93.75
Rate for Payer: Hamaspik Choice Inc Medicare $93.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $121.88
Service Code HCPCS C1713
Hospital Charge Code 64904969
Hospital Revenue Code 278
Min. Negotiated Rate $261.36
Max. Negotiated Rate $261.36
Rate for Payer: Hamaspik Choice Inc Medicaid $261.36
Rate for Payer: Hamaspik Choice Inc Medicare $261.36
Service Code HCPCS C1713
Hospital Charge Code 64904969
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $548.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial $287.50
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 $261.36
Rate for Payer: Cigna LocalPlus Benefit Plan $300.57
Rate for Payer: Fidelis Medicare Advantage $548.87
Rate for Payer: Group Health Inc Commercial $261.36
Rate for Payer: Group Health Inc Medicare $182.96
Rate for Payer: Hamaspik Choice Inc Medicaid $261.36
Rate for Payer: Hamaspik Choice Inc Medicare $261.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $339.77
Service Code HCPCS C1713
Hospital Charge Code 64901339
Hospital Revenue Code 278
Min. Negotiated Rate $128.62
Max. Negotiated Rate $385.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $202.12
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 $183.75
Rate for Payer: Cigna LocalPlus Benefit Plan $211.31
Rate for Payer: Fidelis Medicare Advantage $385.88
Rate for Payer: Group Health Inc Commercial $183.75
Rate for Payer: Group Health Inc Medicare $128.62
Rate for Payer: Hamaspik Choice Inc Medicaid $183.75
Rate for Payer: Hamaspik Choice Inc Medicare $183.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $238.88
Service Code HCPCS C1713
Hospital Charge Code 64901339
Hospital Revenue Code 278
Min. Negotiated Rate $183.75
Max. Negotiated Rate $183.75
Rate for Payer: Hamaspik Choice Inc Medicaid $183.75
Rate for Payer: Hamaspik Choice Inc Medicare $183.75
Service Code HCPCS C1713
Hospital Charge Code 64903636
Hospital Revenue Code 278
Min. Negotiated Rate $65.62
Max. Negotiated Rate $196.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $103.12
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 $93.75
Rate for Payer: Cigna LocalPlus Benefit Plan $107.81
Rate for Payer: Fidelis Medicare Advantage $196.88
Rate for Payer: Group Health Inc Commercial $93.75
Rate for Payer: Group Health Inc Medicare $65.62
Rate for Payer: Hamaspik Choice Inc Medicaid $93.75
Rate for Payer: Hamaspik Choice Inc Medicare $93.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $121.88
Service Code HCPCS C1713
Hospital Charge Code 64903636
Hospital Revenue Code 278
Min. Negotiated Rate $93.75
Max. Negotiated Rate $93.75
Rate for Payer: Hamaspik Choice Inc Medicaid $93.75
Rate for Payer: Hamaspik Choice Inc Medicare $93.75
Service Code HCPCS C1713
Hospital Charge Code 64902815
Hospital Revenue Code 278
Min. Negotiated Rate $114.19
Max. Negotiated Rate $342.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $179.44
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 $163.12
Rate for Payer: Cigna LocalPlus Benefit Plan $187.59
Rate for Payer: Fidelis Medicare Advantage $342.56
Rate for Payer: Group Health Inc Commercial $163.12
Rate for Payer: Group Health Inc Medicare $114.19
Rate for Payer: Hamaspik Choice Inc Medicaid $163.12
Rate for Payer: Hamaspik Choice Inc Medicare $163.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $212.06
Service Code HCPCS C1713
Hospital Charge Code 64902815
Hospital Revenue Code 278
Min. Negotiated Rate $163.12
Max. Negotiated Rate $163.12
Rate for Payer: Hamaspik Choice Inc Medicaid $163.12
Rate for Payer: Hamaspik Choice Inc Medicare $163.12
Service Code HCPCS C1713
Hospital Charge Code 64902634
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $404.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $211.75
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 $192.50
Rate for Payer: Cigna LocalPlus Benefit Plan $221.38
Rate for Payer: Fidelis Medicare Advantage $404.25
Rate for Payer: Group Health Inc Commercial $192.50
Rate for Payer: Group Health Inc Medicare $134.75
Rate for Payer: Hamaspik Choice Inc Medicaid $192.50
Rate for Payer: Hamaspik Choice Inc Medicare $192.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $250.25
Service Code HCPCS C1713
Hospital Charge Code 64902634
Hospital Revenue Code 278
Min. Negotiated Rate $192.50
Max. Negotiated Rate $192.50
Rate for Payer: Hamaspik Choice Inc Medicaid $192.50
Rate for Payer: Hamaspik Choice Inc Medicare $192.50
Service Code HCPCS C1713
Hospital Charge Code 64901918
Hospital Revenue Code 278
Min. Negotiated Rate $106.88
Max. Negotiated Rate $106.88
Rate for Payer: Hamaspik Choice Inc Medicaid $106.88
Rate for Payer: Hamaspik Choice Inc Medicare $106.88
Service Code HCPCS C1713
Hospital Charge Code 64901918
Hospital Revenue Code 278
Min. Negotiated Rate $74.81
Max. Negotiated Rate $224.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $117.56
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 $106.88
Rate for Payer: Cigna LocalPlus Benefit Plan $122.91
Rate for Payer: Fidelis Medicare Advantage $224.44
Rate for Payer: Group Health Inc Commercial $106.88
Rate for Payer: Group Health Inc Medicare $74.81
Rate for Payer: Hamaspik Choice Inc Medicaid $106.88
Rate for Payer: Hamaspik Choice Inc Medicare $106.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $138.94
Service Code HCPCS C1713
Hospital Charge Code 64902541
Hospital Revenue Code 278
Min. Negotiated Rate $91.88
Max. Negotiated Rate $275.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $144.38
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 $131.25
Rate for Payer: Cigna LocalPlus Benefit Plan $150.94
Rate for Payer: Fidelis Medicare Advantage $275.62
Rate for Payer: Group Health Inc Commercial $131.25
Rate for Payer: Group Health Inc Medicare $91.88
Rate for Payer: Hamaspik Choice Inc Medicaid $131.25
Rate for Payer: Hamaspik Choice Inc Medicare $131.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $170.62