|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS [4854]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 00555077902
|
| Hospital Charge Code |
00555077902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS [4854]
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 60687010521
|
| Hospital Charge Code |
60687010521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
MEDROXYPROGESTERONE ACETATE 10 MG PO TABS [4854]
|
Facility
|
OP
|
$0.49
|
|
|
Service Code
|
NDC 59762005601
|
| Hospital Charge Code |
59762005601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
67457088701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$30.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$20.64
|
| Rate for Payer: Group Health Inc Medicare |
$14.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$97.85
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
62756009040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.92
|
| Rate for Payer: Group Health Inc Medicare |
$34.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
67457088799
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$30.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$20.64
|
| Rate for Payer: Group Health Inc Medicare |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
00548540000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$27.00
|
| Rate for Payer: Group Health Inc Medicare |
$18.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$97.85
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
66993037083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.92
|
| Rate for Payer: Group Health Inc Medicare |
$34.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$97.75
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
62756009045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.87
|
| Rate for Payer: Group Health Inc Medicare |
$34.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
00548540025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$40.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$27.00
|
| Rate for Payer: Group Health Inc Medicare |
$18.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$97.75
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
66993037025
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$73.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$48.87
|
| Rate for Payer: Group Health Inc Medicare |
$34.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]
|
Facility
|
OP
|
$41.27
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
67457088700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$33.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$30.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$20.64
|
| Rate for Payer: Group Health Inc Medicare |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY [134069]
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
00548570100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$49.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$33.00
|
| Rate for Payer: Group Health Inc Medicare |
$23.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS [4855]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 00555087202
|
| Hospital Charge Code |
00555087202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
MEDROXYPROGESTERONE INJ DEPOT 150 MG (FO
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
41654722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE INJ DEPOT 150 MG (FO
|
Facility
|
OP
|
$0.45
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
41644722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.32
|
| Rate for Payer: Amida Care Medicaid |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.32
|
| Rate for Payer: Healthfirst Essential Plan |
$0.72
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: SOMOS Essential |
$0.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.35
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.32
|
|
|
MEDROXYPROGESTERONE INJ DEPOT 150 MG (FO
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
41644722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
|
|
MEDROXYPROGESTERONE INJ DEPOT 150 MG (FO
|
Facility
|
IP
|
$0.45
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
41654722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
|
|
MEDROXYPROGESTERONE INJ DEPOT 150 MG (NO
|
Facility
|
OP
|
$82.22
|
|
| Hospital Charge Code |
41644132
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$65.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.11
|
| Rate for Payer: Aetna Government |
$41.11
|
| Rate for Payer: Brighton Health Commercial |
$61.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.91
|
| Rate for Payer: Group Health Inc Commercial |
$41.11
|
| Rate for Payer: Group Health Inc Medicare |
$28.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.44
|
|
|
MEDROXYPROGESTERONE INJ DEPOT 150 MG (NO
|
Facility
|
OP
|
$82.22
|
|
| Hospital Charge Code |
41654132
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$65.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.11
|
| Rate for Payer: Aetna Government |
$41.11
|
| Rate for Payer: Brighton Health Commercial |
$61.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.91
|
| Rate for Payer: Group Health Inc Commercial |
$41.11
|
| Rate for Payer: Group Health Inc Medicare |
$28.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.44
|
|
|
MED RSN NO BRIEF COUNS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2201
|
| Hospital Charge Code |
30300329
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
MED RSN NO ETOH COUNS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2203
|
| Hospital Charge Code |
30300331
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
MED RSN NO UNHLTHY ETOH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2198
|
| Hospital Charge Code |
30300326
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
MED SERV EVE/WKEND/HOLIDAY
|
Facility
|
OP
|
$205.90
|
|
|
Service Code
|
HCPCS 99051
|
| Hospital Charge Code |
30301287
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,596.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$113.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.96
|
| Rate for Payer: Amida Care Medicaid |
$15.96
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,596.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.76
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.96
|
| Rate for Payer: Healthfirst Essential Plan |
$35.91
|
| Rate for Payer: Healthfirst QHP |
$15.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.96
|
| Rate for Payer: SOMOS Essential |
$35.91
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.56
|
| Rate for Payer: United Healthcare Medicaid |
$15.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.96
|
|
|
MED SERV, EVE/WKEND/HOLIDAY
|
Facility
|
OP
|
$205.90
|
|
|
Service Code
|
HCPCS 99051
|
| Hospital Charge Code |
30305045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,596.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$113.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.96
|
| Rate for Payer: Amida Care Medicaid |
$15.96
|
| Rate for Payer: Brighton Health Commercial |
$154.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$164.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,596.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.76
|
| Rate for Payer: Group Health Inc Commercial |
$102.95
|
| Rate for Payer: Group Health Inc Medicare |
$72.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.96
|
| Rate for Payer: Healthfirst Essential Plan |
$35.91
|
| Rate for Payer: Healthfirst QHP |
$15.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.96
|
| Rate for Payer: SOMOS Essential |
$35.91
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.56
|
| Rate for Payer: United Healthcare Medicaid |
$15.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.96
|
|
