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Charge Type Price  
Service Code HCPCS C1876
Hospital Charge Code 66528557
Hospital Revenue Code 278
Min. Negotiated Rate $123.97
Max. Negotiated Rate $398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $177.10
Rate for Payer: Cigna LocalPlus Benefit Plan $203.66
Rate for Payer: Fidelis Medicare Advantage $371.91
Rate for Payer: Group Health Inc Commercial $177.10
Rate for Payer: Group Health Inc Medicare $123.97
Rate for Payer: Hamaspik Choice Inc Medicaid $177.10
Rate for Payer: Hamaspik Choice Inc Medicare $177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $230.23
Service Code HCPCS C1876
Hospital Charge Code 66528557
Hospital Revenue Code 278
Min. Negotiated Rate $177.10
Max. Negotiated Rate $177.10
Rate for Payer: Hamaspik Choice Inc Medicaid $177.10
Rate for Payer: Hamaspik Choice Inc Medicare $177.10
Service Code HCPCS C1876
Hospital Charge Code 66528556
Hospital Revenue Code 278
Min. Negotiated Rate $177.10
Max. Negotiated Rate $177.10
Rate for Payer: Hamaspik Choice Inc Medicaid $177.10
Rate for Payer: Hamaspik Choice Inc Medicare $177.10
Service Code HCPCS C1876
Hospital Charge Code 66528556
Hospital Revenue Code 278
Min. Negotiated Rate $123.97
Max. Negotiated Rate $398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $177.10
Rate for Payer: Cigna LocalPlus Benefit Plan $203.66
Rate for Payer: Fidelis Medicare Advantage $371.91
Rate for Payer: Group Health Inc Commercial $177.10
Rate for Payer: Group Health Inc Medicare $123.97
Rate for Payer: Hamaspik Choice Inc Medicaid $177.10
Rate for Payer: Hamaspik Choice Inc Medicare $177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $230.23
Service Code HCPCS C1876
Hospital Charge Code 66528555
Hospital Revenue Code 278
Min. Negotiated Rate $177.10
Max. Negotiated Rate $177.10
Rate for Payer: Hamaspik Choice Inc Medicaid $177.10
Rate for Payer: Hamaspik Choice Inc Medicare $177.10
Service Code HCPCS C1876
Hospital Charge Code 66528555
Hospital Revenue Code 278
Min. Negotiated Rate $123.97
Max. Negotiated Rate $398.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $194.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $177.10
Rate for Payer: Cigna LocalPlus Benefit Plan $203.66
Rate for Payer: Fidelis Medicare Advantage $371.91
Rate for Payer: Group Health Inc Commercial $177.10
Rate for Payer: Group Health Inc Medicare $123.97
Rate for Payer: Hamaspik Choice Inc Medicaid $177.10
Rate for Payer: Hamaspik Choice Inc Medicare $177.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $230.23
Hospital Charge Code 66528409
Hospital Revenue Code 480
Min. Negotiated Rate $15.47
Max. Negotiated Rate $35.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $24.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $22.10
Rate for Payer: Aetna Government $22.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $35.36
Rate for Payer: Cigna LocalPlus Benefit Plan $30.06
Rate for Payer: Group Health Inc Commercial $22.10
Rate for Payer: Group Health Inc Medicare $15.47
Rate for Payer: Hamaspik Choice Inc Medicaid $22.10
Rate for Payer: Hamaspik Choice Inc Medicare $22.10
Hospital Charge Code 66529930
Hospital Revenue Code 270
Min. Negotiated Rate $15.47
Max. Negotiated Rate $35.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $24.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $22.10
Rate for Payer: Aetna Government $22.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $35.36
Rate for Payer: Cigna LocalPlus Benefit Plan $30.06
Rate for Payer: Group Health Inc Commercial $22.10
Rate for Payer: Group Health Inc Medicare $15.47
Rate for Payer: Hamaspik Choice Inc Medicaid $22.10
Rate for Payer: Hamaspik Choice Inc Medicare $22.10
Hospital Charge Code 66528259
Hospital Revenue Code 270
Min. Negotiated Rate $7.21
Max. Negotiated Rate $16.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.30
Rate for Payer: Aetna Government $10.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.48
Rate for Payer: Cigna LocalPlus Benefit Plan $14.01
Rate for Payer: Group Health Inc Commercial $10.30
Rate for Payer: Group Health Inc Medicare $7.21
Rate for Payer: Hamaspik Choice Inc Medicaid $10.30
Rate for Payer: Hamaspik Choice Inc Medicare $10.30
Service Code HCPCS C1769
Hospital Charge Code 66528502
Hospital Revenue Code 278
Min. Negotiated Rate $21.00
Max. Negotiated Rate $21.00
Rate for Payer: Hamaspik Choice Inc Medicaid $21.00
Rate for Payer: Hamaspik Choice Inc Medicare $21.00
Service Code HCPCS C1769
Hospital Charge Code 66528502
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $44.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.10
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 $21.00
Rate for Payer: Cigna LocalPlus Benefit Plan $24.15
Rate for Payer: Fidelis Medicare Advantage $44.10
Rate for Payer: Group Health Inc Commercial $21.00
Rate for Payer: Group Health Inc Medicare $14.70
Rate for Payer: Hamaspik Choice Inc Medicaid $21.00
Rate for Payer: Hamaspik Choice Inc Medicare $21.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $27.30
Service Code HCPCS C1876
Hospital Charge Code 66528554
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1876
Hospital Charge Code 66528554
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528553
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1876
Hospital Charge Code 66528553
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528552
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1876
Hospital Charge Code 66528552
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528551
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1876
Hospital Charge Code 66528551
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528550
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1876
Hospital Charge Code 66528550
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528549
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Service Code HCPCS C1876
Hospital Charge Code 66528549
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528548
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,478.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,298.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,357.00
Rate for Payer: Fidelis Medicare Advantage $2,478.00
Rate for Payer: Group Health Inc Commercial $1,180.00
Rate for Payer: Group Health Inc Medicare $826.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,534.00
Service Code HCPCS C1876
Hospital Charge Code 66528548
Hospital Revenue Code 278
Min. Negotiated Rate $1,180.00
Max. Negotiated Rate $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,180.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,180.00