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Service Code HCPCS C1725
Hospital Charge Code 64906283
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $341.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $44.85
Rate for Payer: Aetna Government $44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $162.50
Rate for Payer: Cigna LocalPlus Benefit Plan $186.88
Rate for Payer: Fidelis Medicare Advantage $341.25
Rate for Payer: Group Health Inc Commercial $162.50
Rate for Payer: Group Health Inc Medicare $113.75
Rate for Payer: Hamaspik Choice Inc Medicaid $162.50
Rate for Payer: Hamaspik Choice Inc Medicare $162.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $211.25
Service Code HCPCS C1725
Hospital Charge Code 64906283
Hospital Revenue Code 278
Min. Negotiated Rate $162.50
Max. Negotiated Rate $162.50
Rate for Payer: Hamaspik Choice Inc Medicaid $162.50
Rate for Payer: Hamaspik Choice Inc Medicare $162.50
Hospital Charge Code 64906752
Hospital Revenue Code 279
Min. Negotiated Rate $192.50
Max. Negotiated Rate $440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $275.00
Rate for Payer: Aetna Government $275.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $440.00
Rate for Payer: Cigna LocalPlus Benefit Plan $374.00
Rate for Payer: Group Health Inc Commercial $275.00
Rate for Payer: Group Health Inc Medicare $192.50
Rate for Payer: Hamaspik Choice Inc Medicaid $275.00
Rate for Payer: Hamaspik Choice Inc Medicare $275.00
Service Code HCPCS C1725
Hospital Charge Code 64907057
Hospital Revenue Code 278
Min. Negotiated Rate $454.78
Max. Negotiated Rate $454.78
Rate for Payer: Hamaspik Choice Inc Medicaid $454.78
Rate for Payer: Hamaspik Choice Inc Medicare $454.78
Service Code HCPCS C1725
Hospital Charge Code 64907057
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $955.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial $500.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $44.85
Rate for Payer: Aetna Government $44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $454.78
Rate for Payer: Cigna LocalPlus Benefit Plan $522.99
Rate for Payer: Fidelis Medicare Advantage $955.03
Rate for Payer: Group Health Inc Commercial $454.78
Rate for Payer: Group Health Inc Medicare $318.34
Rate for Payer: Hamaspik Choice Inc Medicaid $454.78
Rate for Payer: Hamaspik Choice Inc Medicare $454.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $591.21
Hospital Charge Code 64906260
Hospital Revenue Code 279
Min. Negotiated Rate $38.50
Max. Negotiated Rate $88.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $60.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $55.00
Rate for Payer: Aetna Government $55.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $88.00
Rate for Payer: Cigna LocalPlus Benefit Plan $74.80
Rate for Payer: Group Health Inc Commercial $55.00
Rate for Payer: Group Health Inc Medicare $38.50
Rate for Payer: Hamaspik Choice Inc Medicaid $55.00
Rate for Payer: Hamaspik Choice Inc Medicare $55.00
Hospital Charge Code 64903814
Hospital Revenue Code 279
Min. Negotiated Rate $190.46
Max. Negotiated Rate $435.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $299.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $272.09
Rate for Payer: Aetna Government $272.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $435.34
Rate for Payer: Cigna LocalPlus Benefit Plan $370.04
Rate for Payer: Group Health Inc Commercial $272.09
Rate for Payer: Group Health Inc Medicare $190.46
Rate for Payer: Hamaspik Choice Inc Medicaid $272.09
Rate for Payer: Hamaspik Choice Inc Medicare $272.09
Hospital Charge Code 64906112
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64906113
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64906109
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64906108
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64906110
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64906111
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64905039
Hospital Revenue Code 279
Min. Negotiated Rate $161.88
Max. Negotiated Rate $370.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $254.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $231.25
Rate for Payer: Aetna Government $231.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $370.00
Rate for Payer: Cigna LocalPlus Benefit Plan $314.50
Rate for Payer: Group Health Inc Commercial $231.25
Rate for Payer: Group Health Inc Medicare $161.88
Rate for Payer: Hamaspik Choice Inc Medicaid $231.25
Rate for Payer: Hamaspik Choice Inc Medicare $231.25
Hospital Charge Code 64905037
Hospital Revenue Code 279
Min. Negotiated Rate $161.88
Max. Negotiated Rate $370.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $254.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $231.25
Rate for Payer: Aetna Government $231.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $370.00
Rate for Payer: Cigna LocalPlus Benefit Plan $314.50
Rate for Payer: Group Health Inc Commercial $231.25
Rate for Payer: Group Health Inc Medicare $161.88
Rate for Payer: Hamaspik Choice Inc Medicaid $231.25
Rate for Payer: Hamaspik Choice Inc Medicare $231.25
Hospital Charge Code 64904248
Hospital Revenue Code 279
Min. Negotiated Rate $450.12
Max. Negotiated Rate $1,028.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $707.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $643.04
Rate for Payer: Aetna Government $643.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,028.86
Rate for Payer: Cigna LocalPlus Benefit Plan $874.53
Rate for Payer: Group Health Inc Commercial $643.04
Rate for Payer: Group Health Inc Medicare $450.12
Rate for Payer: Hamaspik Choice Inc Medicaid $643.04
Rate for Payer: Hamaspik Choice Inc Medicare $643.04
Hospital Charge Code 64903905
Hospital Revenue Code 279
Min. Negotiated Rate $166.25
Max. Negotiated Rate $380.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $261.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $237.50
Rate for Payer: Aetna Government $237.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $380.00
Rate for Payer: Cigna LocalPlus Benefit Plan $323.00
Rate for Payer: Group Health Inc Commercial $237.50
Rate for Payer: Group Health Inc Medicare $166.25
Rate for Payer: Hamaspik Choice Inc Medicaid $237.50
Rate for Payer: Hamaspik Choice Inc Medicare $237.50
Hospital Charge Code 64905124
Hospital Revenue Code 279
Min. Negotiated Rate $157.50
Max. Negotiated Rate $360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $225.00
Rate for Payer: Aetna Government $225.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $360.00
Rate for Payer: Cigna LocalPlus Benefit Plan $306.00
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
Hospital Charge Code 64904395
Hospital Revenue Code 279
Min. Negotiated Rate $227.50
Max. Negotiated Rate $520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $325.00
Rate for Payer: Aetna Government $325.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $520.00
Rate for Payer: Cigna LocalPlus Benefit Plan $442.00
Rate for Payer: Group Health Inc Commercial $325.00
Rate for Payer: Group Health Inc Medicare $227.50
Rate for Payer: Hamaspik Choice Inc Medicaid $325.00
Rate for Payer: Hamaspik Choice Inc Medicare $325.00
Hospital Charge Code 64905750
Hospital Revenue Code 279
Min. Negotiated Rate $68.36
Max. Negotiated Rate $156.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $107.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $97.65
Rate for Payer: Aetna Government $97.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $156.24
Rate for Payer: Cigna LocalPlus Benefit Plan $132.80
Rate for Payer: Group Health Inc Commercial $97.65
Rate for Payer: Group Health Inc Medicare $68.36
Rate for Payer: Hamaspik Choice Inc Medicaid $97.65
Rate for Payer: Hamaspik Choice Inc Medicare $97.65
Service Code HCPCS C1884
Hospital Charge Code 64902751
Hospital Revenue Code 279
Min. Negotiated Rate $53.38
Max. Negotiated Rate $180.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $83.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $180.07
Rate for Payer: Aetna Government $180.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $122.00
Rate for Payer: Cigna LocalPlus Benefit Plan $103.70
Rate for Payer: Group Health Inc Commercial $76.25
Rate for Payer: Group Health Inc Medicare $53.38
Rate for Payer: Hamaspik Choice Inc Medicaid $76.25
Rate for Payer: Hamaspik Choice Inc Medicare $76.25
Service Code HCPCS 30802
Hospital Charge Code 40109050
Hospital Revenue Code 360
Min. Negotiated Rate $226.75
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,763.60
Rate for Payer: Aetna Government $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,763.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,763.60
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $226.75
Rate for Payer: Fidelis Essential Plan Aliesa $1,499.06
Rate for Payer: Fidelis Essential Plan QHP $1,569.60
Rate for Payer: Fidelis Medicare Advantage $1,763.60
Rate for Payer: Fidelis Qualified Health Plan $1,569.60
Rate for Payer: Group Health Inc Commercial $1,763.60
Rate for Payer: Group Health Inc Medicare $1,763.60
Rate for Payer: Hamaspik Choice Inc Medicaid $2,043.42
Rate for Payer: Hamaspik Choice Inc Medicare $1,763.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid $251.94
Rate for Payer: Healthfirst Medicare Advantage $1,499.06
Rate for Payer: Healthfirst QHP $1,763.60
Rate for Payer: Senior Whole Health Medicare Advantage $1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,410.88
Rate for Payer: Wellcare Medicare $1,675.42
Hospital Charge Code 64904322
Hospital Revenue Code 279
Min. Negotiated Rate $8.32
Max. Negotiated Rate $19.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $13.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.88
Rate for Payer: Aetna Government $11.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $19.02
Rate for Payer: Cigna LocalPlus Benefit Plan $16.16
Rate for Payer: Group Health Inc Commercial $11.88
Rate for Payer: Group Health Inc Medicare $8.32
Rate for Payer: Hamaspik Choice Inc Medicaid $11.88
Rate for Payer: Hamaspik Choice Inc Medicare $11.88
Hospital Charge Code 64904288
Hospital Revenue Code 279
Min. Negotiated Rate $8.16
Max. Negotiated Rate $18.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.66
Rate for Payer: Aetna Government $11.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.66
Rate for Payer: Cigna LocalPlus Benefit Plan $15.86
Rate for Payer: Group Health Inc Commercial $11.66
Rate for Payer: Group Health Inc Medicare $8.16
Rate for Payer: Hamaspik Choice Inc Medicaid $11.66
Rate for Payer: Hamaspik Choice Inc Medicare $11.66
Hospital Charge Code 64903143
Hospital Revenue Code 279
Min. Negotiated Rate $3.71
Max. Negotiated Rate $8.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $5.30
Rate for Payer: Aetna Government $5.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $8.49
Rate for Payer: Cigna LocalPlus Benefit Plan $7.21
Rate for Payer: Group Health Inc Commercial $5.30
Rate for Payer: Group Health Inc Medicare $3.71
Rate for Payer: Hamaspik Choice Inc Medicaid $5.30
Rate for Payer: Hamaspik Choice Inc Medicare $5.30