|
QUANTITATION OF THERAPEUTIC DRUG, NOT ELSEWHERE SPECIFIED
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3018029919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 6068734901
|
| Hospital Charge Code |
6068734901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 6068734901
|
| Hospital Charge Code |
6068734901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.24
|
| Rate for Payer: Aetna Government |
$3.24
|
| Rate for Payer: Brighton Health Commercial |
$4.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.40
|
| Rate for Payer: EmblemHealth Commercial |
$3.24
|
| Rate for Payer: Group Health Inc Commercial |
$3.24
|
| Rate for Payer: Group Health Inc Medicare |
$2.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.21
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 0904664061
|
| Hospital Charge Code |
0904664061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
| Rate for Payer: Aetna Government |
$0.28
|
| Rate for Payer: Brighton Health Commercial |
$0.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.38
|
| Rate for Payer: EmblemHealth Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.37
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 0904664061
|
| Hospital Charge Code |
0904664061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
OP
|
$6.86
|
|
|
Service Code
|
NDC 6787725001
|
| Hospital Charge Code |
6787725001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.43
|
| Rate for Payer: Aetna Government |
$3.43
|
| Rate for Payer: Brighton Health Commercial |
$5.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.66
|
| Rate for Payer: EmblemHealth Commercial |
$3.43
|
| Rate for Payer: Group Health Inc Commercial |
$3.43
|
| Rate for Payer: Group Health Inc Medicare |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.46
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
IP
|
$6.86
|
|
|
Service Code
|
NDC 6787725010
|
| Hospital Charge Code |
6787725010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.43
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
IP
|
$6.86
|
|
|
Service Code
|
NDC 6787725001
|
| Hospital Charge Code |
6787725001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.43
|
|
|
QUETIAPINE FUMARATE 100 MG PO TABS
|
Facility
|
OP
|
$6.86
|
|
|
Service Code
|
NDC 6787725010
|
| Hospital Charge Code |
6787725010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.43
|
| Rate for Payer: Aetna Government |
$3.43
|
| Rate for Payer: Brighton Health Commercial |
$5.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.66
|
| Rate for Payer: EmblemHealth Commercial |
$3.43
|
| Rate for Payer: Group Health Inc Commercial |
$3.43
|
| Rate for Payer: Group Health Inc Medicare |
$2.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.46
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
IP
|
$12.94
|
|
|
Service Code
|
NDC 6586249301
|
| Hospital Charge Code |
6586249301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
NDC 6787724601
|
| Hospital Charge Code |
6787724601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.80
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.41
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
NDC 6787724601
|
| Hospital Charge Code |
6787724601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
IP
|
$12.22
|
|
|
Service Code
|
NDC 6068736011
|
| Hospital Charge Code |
6068736011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.11
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
OP
|
$12.94
|
|
|
Service Code
|
NDC 6586249301
|
| Hospital Charge Code |
6586249301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Brighton Health Commercial |
$9.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.80
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.41
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 0904664161
|
| Hospital Charge Code |
0904664161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 0904664161
|
| Hospital Charge Code |
0904664161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Brighton Health Commercial |
$0.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.74
|
|
|
QUETIAPINE FUMARATE 200 MG PO TABS
|
Facility
|
OP
|
$12.22
|
|
|
Service Code
|
NDC 6068736011
|
| Hospital Charge Code |
6068736011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.11
|
| Rate for Payer: Aetna Government |
$6.11
|
| Rate for Payer: Brighton Health Commercial |
$9.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.31
|
| Rate for Payer: EmblemHealth Commercial |
$6.11
|
| Rate for Payer: Group Health Inc Commercial |
$6.11
|
| Rate for Payer: Group Health Inc Medicare |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.94
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 0904663861
|
| Hospital Charge Code |
0904663861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 0904663861
|
| Hospital Charge Code |
0904663861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 5026863011
|
| Hospital Charge Code |
5026863011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 5026863011
|
| Hospital Charge Code |
5026863011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.86
|
| Rate for Payer: Aetna Government |
$1.86
|
| Rate for Payer: Brighton Health Commercial |
$2.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Medicare |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.41
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6787724210
|
| Hospital Charge Code |
6787724210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6787724201
|
| Hospital Charge Code |
6787724201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: EmblemHealth Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6787724201
|
| Hospital Charge Code |
6787724201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
|
|
QUETIAPINE FUMARATE 25 MG PO TABS
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6787724210
|
| Hospital Charge Code |
6787724210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: EmblemHealth Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
