|
NCB CANN CRT SCREW 4.0X20MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X20MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007160
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X22MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X22MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X24MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X24MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X26MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X26MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X28MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X28MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X30MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X30MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007165
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X32MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X32MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X34MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X34MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X36MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X36MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X38MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X38MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X40MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X40MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X42MM SLFTP
|
Facility
|
IP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.99 |
| Max. Negotiated Rate |
$177.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
|
|
NCB CANN CRT SCREW 4.0X42MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007171
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
|
NCB CANN CRT SCREW 4.0X44MM SLFTP
|
Facility
|
OP
|
$355.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$373.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$195.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$213.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.69
|
| Rate for Payer: EmblemHealth Commercial |
$177.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$373.78
|
| Rate for Payer: Group Health Inc Commercial |
$177.99
|
| Rate for Payer: Group Health Inc Medicare |
$124.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.39
|
|
