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Charge Type Price  
Service Code HCPCS C1713
Hospital Charge Code 64906810
Hospital Revenue Code 278
Min. Negotiated Rate $345.00
Max. Negotiated Rate $345.00
Rate for Payer: Hamaspik Choice Inc Medicaid $345.00
Rate for Payer: Hamaspik Choice Inc Medicare $345.00
Hospital Charge Code 64901652
Hospital Revenue Code 279
Min. Negotiated Rate $98.39
Max. Negotiated Rate $224.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $154.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $140.56
Rate for Payer: Aetna Government $140.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $224.90
Rate for Payer: Cigna LocalPlus Benefit Plan $191.16
Rate for Payer: Group Health Inc Commercial $140.56
Rate for Payer: Group Health Inc Medicare $98.39
Rate for Payer: Hamaspik Choice Inc Medicaid $140.56
Rate for Payer: Hamaspik Choice Inc Medicare $140.56
Hospital Charge Code 64901805
Hospital Revenue Code 279
Min. Negotiated Rate $1.54
Max. Negotiated Rate $3.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.20
Rate for Payer: Aetna Government $2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.52
Rate for Payer: Cigna LocalPlus Benefit Plan $2.99
Rate for Payer: Group Health Inc Commercial $2.20
Rate for Payer: Group Health Inc Medicare $1.54
Rate for Payer: Hamaspik Choice Inc Medicaid $2.20
Rate for Payer: Hamaspik Choice Inc Medicare $2.20
Hospital Charge Code 40202176
Hospital Revenue Code 270
Min. Negotiated Rate $33.42
Max. Negotiated Rate $76.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $52.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $47.75
Rate for Payer: Aetna Government $47.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $76.40
Rate for Payer: Cigna LocalPlus Benefit Plan $64.94
Rate for Payer: Group Health Inc Commercial $47.75
Rate for Payer: Group Health Inc Medicare $33.42
Rate for Payer: Hamaspik Choice Inc Medicaid $47.75
Rate for Payer: Hamaspik Choice Inc Medicare $47.75
Hospital Charge Code 40202177
Hospital Revenue Code 270
Min. Negotiated Rate $35.43
Max. Negotiated Rate $80.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.62
Rate for Payer: Aetna Government $50.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.99
Rate for Payer: Cigna LocalPlus Benefit Plan $68.84
Rate for Payer: Group Health Inc Commercial $50.62
Rate for Payer: Group Health Inc Medicare $35.43
Rate for Payer: Hamaspik Choice Inc Medicaid $50.62
Rate for Payer: Hamaspik Choice Inc Medicare $50.62
Hospital Charge Code 40202175
Hospital Revenue Code 270
Min. Negotiated Rate $33.42
Max. Negotiated Rate $76.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $52.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $47.75
Rate for Payer: Aetna Government $47.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $76.40
Rate for Payer: Cigna LocalPlus Benefit Plan $64.94
Rate for Payer: Group Health Inc Commercial $47.75
Rate for Payer: Group Health Inc Medicare $33.42
Rate for Payer: Hamaspik Choice Inc Medicaid $47.75
Rate for Payer: Hamaspik Choice Inc Medicare $47.75
Service Code HCPCS C1758
Hospital Charge Code 64902391
Hospital Revenue Code 279
Min. Negotiated Rate $2.97
Max. Negotiated Rate $10.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.35
Rate for Payer: Cigna LocalPlus Benefit Plan $8.80
Rate for Payer: Group Health Inc Commercial $6.47
Rate for Payer: Group Health Inc Medicare $4.53
Rate for Payer: Hamaspik Choice Inc Medicaid $6.47
Rate for Payer: Hamaspik Choice Inc Medicare $6.47
Service Code HCPCS C1758
Hospital Charge Code 64902393
Hospital Revenue Code 279
Min. Negotiated Rate $1.31
Max. Negotiated Rate $2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.98
Rate for Payer: Cigna LocalPlus Benefit Plan $2.54
Rate for Payer: Group Health Inc Commercial $1.86
Rate for Payer: Group Health Inc Medicare $1.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1.86
Rate for Payer: Hamaspik Choice Inc Medicare $1.86
Hospital Charge Code 40201037
Hospital Revenue Code 270
Min. Negotiated Rate $0.70
Max. Negotiated Rate $1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.00
Rate for Payer: Aetna Government $1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1.36
Rate for Payer: Group Health Inc Commercial $1.00
Rate for Payer: Group Health Inc Medicare $0.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1.00
Rate for Payer: Hamaspik Choice Inc Medicare $1.00
Service Code HCPCS C1758
Hospital Charge Code 64902102
Hospital Revenue Code 279
Min. Negotiated Rate $1.31
Max. Negotiated Rate $2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.98
Rate for Payer: Cigna LocalPlus Benefit Plan $2.54
Rate for Payer: Group Health Inc Commercial $1.86
Rate for Payer: Group Health Inc Medicare $1.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1.86
Rate for Payer: Hamaspik Choice Inc Medicare $1.86
Hospital Charge Code 40201038
Hospital Revenue Code 270
Min. Negotiated Rate $0.78
Max. Negotiated Rate $1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.11
Rate for Payer: Aetna Government $1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.78
Rate for Payer: Cigna LocalPlus Benefit Plan $1.51
Rate for Payer: Group Health Inc Commercial $1.11
Rate for Payer: Group Health Inc Medicare $0.78
Rate for Payer: Hamaspik Choice Inc Medicaid $1.11
Rate for Payer: Hamaspik Choice Inc Medicare $1.11
Service Code HCPCS C1758
Hospital Charge Code 64902095
Hospital Revenue Code 279
Min. Negotiated Rate $2.44
Max. Negotiated Rate $5.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.58
Rate for Payer: Cigna LocalPlus Benefit Plan $4.74
Rate for Payer: Group Health Inc Commercial $3.48
Rate for Payer: Group Health Inc Medicare $2.44
Rate for Payer: Hamaspik Choice Inc Medicaid $3.48
Rate for Payer: Hamaspik Choice Inc Medicare $3.48
Hospital Charge Code 40201040
Hospital Revenue Code 270
Min. Negotiated Rate $0.83
Max. Negotiated Rate $1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.18
Rate for Payer: Aetna Government $1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.89
Rate for Payer: Cigna LocalPlus Benefit Plan $1.60
Rate for Payer: Group Health Inc Commercial $1.18
Rate for Payer: Group Health Inc Medicare $0.83
Rate for Payer: Hamaspik Choice Inc Medicaid $1.18
Rate for Payer: Hamaspik Choice Inc Medicare $1.18
Service Code HCPCS C1758
Hospital Charge Code 64902104
Hospital Revenue Code 279
Min. Negotiated Rate $2.32
Max. Negotiated Rate $5.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.31
Rate for Payer: Cigna LocalPlus Benefit Plan $4.52
Rate for Payer: Group Health Inc Commercial $3.32
Rate for Payer: Group Health Inc Medicare $2.32
Rate for Payer: Hamaspik Choice Inc Medicaid $3.32
Rate for Payer: Hamaspik Choice Inc Medicare $3.32
Service Code HCPCS C1758
Hospital Charge Code 64902106
Hospital Revenue Code 279
Min. Negotiated Rate $1.31
Max. Negotiated Rate $2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.98
Rate for Payer: Cigna LocalPlus Benefit Plan $2.54
Rate for Payer: Group Health Inc Commercial $1.86
Rate for Payer: Group Health Inc Medicare $1.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1.86
Rate for Payer: Hamaspik Choice Inc Medicare $1.86
Hospital Charge Code 40201041
Hospital Revenue Code 270
Min. Negotiated Rate $0.78
Max. Negotiated Rate $1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.11
Rate for Payer: Aetna Government $1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.78
Rate for Payer: Cigna LocalPlus Benefit Plan $1.51
Rate for Payer: Group Health Inc Commercial $1.11
Rate for Payer: Group Health Inc Medicare $0.78
Rate for Payer: Hamaspik Choice Inc Medicaid $1.11
Rate for Payer: Hamaspik Choice Inc Medicare $1.11
Hospital Charge Code 40201042
Hospital Revenue Code 270
Min. Negotiated Rate $0.72
Max. Negotiated Rate $1.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.03
Rate for Payer: Aetna Government $1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.65
Rate for Payer: Cigna LocalPlus Benefit Plan $1.40
Rate for Payer: Group Health Inc Commercial $1.03
Rate for Payer: Group Health Inc Medicare $0.72
Rate for Payer: Hamaspik Choice Inc Medicaid $1.03
Rate for Payer: Hamaspik Choice Inc Medicare $1.03
Service Code HCPCS C1758
Hospital Charge Code 64902097
Hospital Revenue Code 279
Min. Negotiated Rate $2.75
Max. Negotiated Rate $6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.28
Rate for Payer: Cigna LocalPlus Benefit Plan $5.34
Rate for Payer: Group Health Inc Commercial $3.92
Rate for Payer: Group Health Inc Medicare $2.75
Rate for Payer: Hamaspik Choice Inc Medicaid $3.92
Rate for Payer: Hamaspik Choice Inc Medicare $3.92
Hospital Charge Code 40201043
Hospital Revenue Code 270
Min. Negotiated Rate $0.78
Max. Negotiated Rate $1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.11
Rate for Payer: Aetna Government $1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.78
Rate for Payer: Cigna LocalPlus Benefit Plan $1.51
Rate for Payer: Group Health Inc Commercial $1.11
Rate for Payer: Group Health Inc Medicare $0.78
Rate for Payer: Hamaspik Choice Inc Medicaid $1.11
Rate for Payer: Hamaspik Choice Inc Medicare $1.11
Service Code HCPCS C1758
Hospital Charge Code 64902108
Hospital Revenue Code 279
Min. Negotiated Rate $1.31
Max. Negotiated Rate $2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.98
Rate for Payer: Cigna LocalPlus Benefit Plan $2.54
Rate for Payer: Group Health Inc Commercial $1.86
Rate for Payer: Group Health Inc Medicare $1.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1.86
Rate for Payer: Hamaspik Choice Inc Medicare $1.86
Service Code HCPCS C1758
Hospital Charge Code 64902098
Hospital Revenue Code 279
Min. Negotiated Rate $2.44
Max. Negotiated Rate $5.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.58
Rate for Payer: Cigna LocalPlus Benefit Plan $4.74
Rate for Payer: Group Health Inc Commercial $3.48
Rate for Payer: Group Health Inc Medicare $2.44
Rate for Payer: Hamaspik Choice Inc Medicaid $3.48
Rate for Payer: Hamaspik Choice Inc Medicare $3.48
Hospital Charge Code 40201044
Hospital Revenue Code 270
Min. Negotiated Rate $0.83
Max. Negotiated Rate $1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.18
Rate for Payer: Aetna Government $1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.89
Rate for Payer: Cigna LocalPlus Benefit Plan $1.60
Rate for Payer: Group Health Inc Commercial $1.18
Rate for Payer: Group Health Inc Medicare $0.83
Rate for Payer: Hamaspik Choice Inc Medicaid $1.18
Rate for Payer: Hamaspik Choice Inc Medicare $1.18
Service Code HCPCS C1758
Hospital Charge Code 64902110
Hospital Revenue Code 279
Min. Negotiated Rate $1.31
Max. Negotiated Rate $2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.98
Rate for Payer: Cigna LocalPlus Benefit Plan $2.54
Rate for Payer: Group Health Inc Commercial $1.86
Rate for Payer: Group Health Inc Medicare $1.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1.86
Rate for Payer: Hamaspik Choice Inc Medicare $1.86
Hospital Charge Code 40201045
Hospital Revenue Code 270
Min. Negotiated Rate $1.06
Max. Negotiated Rate $2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.52
Rate for Payer: Aetna Government $1.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.43
Rate for Payer: Cigna LocalPlus Benefit Plan $2.07
Rate for Payer: Group Health Inc Commercial $1.52
Rate for Payer: Group Health Inc Medicare $1.06
Rate for Payer: Hamaspik Choice Inc Medicaid $1.52
Rate for Payer: Hamaspik Choice Inc Medicare $1.52
Hospital Charge Code 40201046
Hospital Revenue Code 270
Min. Negotiated Rate $0.83
Max. Negotiated Rate $1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.18
Rate for Payer: Aetna Government $1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.89
Rate for Payer: Cigna LocalPlus Benefit Plan $1.60
Rate for Payer: Group Health Inc Commercial $1.18
Rate for Payer: Group Health Inc Medicare $0.83
Rate for Payer: Hamaspik Choice Inc Medicaid $1.18
Rate for Payer: Hamaspik Choice Inc Medicare $1.18