|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$22.97
|
|
|
Service Code
|
NDC 5074250524
|
| Hospital Charge Code |
5074250524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$19.26
|
|
|
Service Code
|
NDC 4580258084
|
| Hospital Charge Code |
4580258084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.63
|
| Rate for Payer: Aetna Government |
$9.63
|
| Rate for Payer: Brighton Health Commercial |
$14.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.10
|
| Rate for Payer: EmblemHealth Commercial |
$9.63
|
| Rate for Payer: Group Health Inc Commercial |
$9.63
|
| Rate for Payer: Group Health Inc Medicare |
$6.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.52
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$22.97
|
|
|
Service Code
|
NDC 5074250524
|
| Hospital Charge Code |
5074250524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.49
|
| Rate for Payer: Aetna Government |
$11.49
|
| Rate for Payer: Brighton Health Commercial |
$17.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.62
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Medicare |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.93
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 4580258062
|
| Hospital Charge Code |
4580258062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.50
|
| Rate for Payer: Aetna Government |
$11.50
|
| Rate for Payer: Brighton Health Commercial |
$17.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.64
|
| Rate for Payer: EmblemHealth Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.95
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$25.56
|
|
|
Service Code
|
NDC 1001955390
|
| Hospital Charge Code |
1001955390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$12.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.78
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 4580258062
|
| Hospital Charge Code |
4580258062
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$25.56
|
|
|
Service Code
|
NDC 1001955390
|
| Hospital Charge Code |
1001955390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.78
|
| Rate for Payer: Aetna Government |
$12.78
|
| Rate for Payer: Brighton Health Commercial |
$19.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.38
|
| Rate for Payer: EmblemHealth Commercial |
$12.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.78
|
| Rate for Payer: Group Health Inc Medicare |
$8.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.61
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$19.26
|
|
|
Service Code
|
NDC 4580258084
|
| Hospital Charge Code |
4580258084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.63
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$22.97
|
|
|
Service Code
|
NDC 0378647044
|
| Hospital Charge Code |
0378647044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$22.97
|
|
|
Service Code
|
NDC 0378647044
|
| Hospital Charge Code |
0378647044
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.49
|
| Rate for Payer: Aetna Government |
$11.49
|
| Rate for Payer: Brighton Health Commercial |
$17.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.62
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Medicare |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.93
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$22.97
|
|
|
Service Code
|
NDC 0378647097
|
| Hospital Charge Code |
0378647097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$11.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$22.97
|
|
|
Service Code
|
NDC 0378647097
|
| Hospital Charge Code |
0378647097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.49
|
| Rate for Payer: Aetna Government |
$11.49
|
| Rate for Payer: Brighton Health Commercial |
$17.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.62
|
| Rate for Payer: EmblemHealth Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Medicare |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.93
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$20.20
|
|
|
Service Code
|
NDC 0378647099
|
| Hospital Charge Code |
0378647099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$20.20
|
|
|
Service Code
|
NDC 0378647099
|
| Hospital Charge Code |
0378647099
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.10
|
| Rate for Payer: Aetna Government |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$15.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.74
|
| Rate for Payer: EmblemHealth Commercial |
$10.10
|
| Rate for Payer: Group Health Inc Commercial |
$10.10
|
| Rate for Payer: Group Health Inc Medicare |
$7.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.13
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
IP
|
$25.56
|
|
|
Service Code
|
NDC 1001955304
|
| Hospital Charge Code |
1001955304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$12.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.78
|
|
|
SCOPOLAMINE 1 MG/3DAYS TD PT72
|
Facility
|
OP
|
$25.56
|
|
|
Service Code
|
NDC 1001955304
|
| Hospital Charge Code |
1001955304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$20.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.78
|
| Rate for Payer: Aetna Government |
$12.78
|
| Rate for Payer: Brighton Health Commercial |
$19.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.38
|
| Rate for Payer: EmblemHealth Commercial |
$12.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.78
|
| Rate for Payer: Group Health Inc Medicare |
$8.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.61
|
|
|
SCREENING COLORECTAL SERVICES
|
Facility
|
OP
|
$1,346.17
|
|
|
Service Code
|
EAPG 00149
|
| Min. Negotiated Rate |
$976.63 |
| Max. Negotiated Rate |
$1,346.17 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$976.63
|
| Rate for Payer: Healthfirst Commercial |
$1,346.17
|
|
|
SCREENING FOR BEHAVIORAL CHANGE OR RISK ASSESSMENT
|
Facility
|
OP
|
$89.36
|
|
|
Service Code
|
EAPG 00324
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.80
|
| Rate for Payer: Healthfirst Commercial |
$89.36
|
|
|
SEALANT
|
Facility
|
OP
|
$65.40
|
|
|
Service Code
|
EAPG 00372
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$65.40 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.60
|
| Rate for Payer: Healthfirst Commercial |
$65.40
|
|
|
SECURE UNDERPADS MISC
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 0089111700
|
| Hospital Charge Code |
0089111700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
|
|
SECURE UNDERPADS MISC
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 0089111700
|
| Hospital Charge Code |
0089111700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: EmblemHealth Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.16
|
|
|
Seizure
|
Facility
|
IP
|
$40,599.36
|
|
|
Service Code
|
APR-DRG 0531
|
| Min. Negotiated Rate |
$5,622.00 |
| Max. Negotiated Rate |
$40,599.36 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$40,599.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$40,599.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,044.16
|
| Rate for Payer: Amida Care Medicaid |
$18,044.16
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$40,599.36
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,044.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,044.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,652.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,044.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,044.16
|
| Rate for Payer: Healthfirst Commercial |
$9,338.00
|
| Rate for Payer: Healthfirst Essential Plan |
$40,599.36
|
| Rate for Payer: Healthfirst QHP |
$5,622.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,044.16
|
| Rate for Payer: SOMOS Essential |
$40,599.36
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$40,599.36
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$40,599.36
|
| Rate for Payer: United Healthcare Medicaid |
$18,044.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,044.16
|
|
|
Seizure
|
Facility
|
IP
|
$42,254.32
|
|
|
Service Code
|
APR-DRG 0532
|
| Min. Negotiated Rate |
$6,679.00 |
| Max. Negotiated Rate |
$42,254.32 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,254.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,254.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,779.70
|
| Rate for Payer: Amida Care Medicaid |
$18,779.70
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,254.32
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,779.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,779.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,535.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,779.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,779.70
|
| Rate for Payer: Healthfirst Commercial |
$11,081.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,254.32
|
| Rate for Payer: Healthfirst QHP |
$6,679.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,779.70
|
| Rate for Payer: SOMOS Essential |
$42,254.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,254.32
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,254.32
|
| Rate for Payer: United Healthcare Medicaid |
$18,779.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,779.70
|
|
|
Seizure
|
Facility
|
IP
|
$46,436.62
|
|
|
Service Code
|
APR-DRG 0533
|
| Min. Negotiated Rate |
$9,513.00 |
| Max. Negotiated Rate |
$46,436.62 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$46,436.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$46,436.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,638.50
|
| Rate for Payer: Amida Care Medicaid |
$20,638.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$46,436.62
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,638.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,638.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,766.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,638.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,638.50
|
| Rate for Payer: Healthfirst Commercial |
$16,550.00
|
| Rate for Payer: Healthfirst Essential Plan |
$46,436.62
|
| Rate for Payer: Healthfirst QHP |
$9,513.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,638.50
|
| Rate for Payer: SOMOS Essential |
$46,436.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$46,436.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$46,436.62
|
| Rate for Payer: United Healthcare Medicaid |
$20,638.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,638.50
|
|
|
Seizure
|
Facility
|
IP
|
$79,096.54
|
|
|
Service Code
|
APR-DRG 0534
|
| Min. Negotiated Rate |
$26,686.00 |
| Max. Negotiated Rate |
$79,096.54 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$79,096.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79,096.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35,154.02
|
| Rate for Payer: Amida Care Medicaid |
$35,154.02
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$79,096.54
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$35,154.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35,154.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42,184.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35,154.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35,154.02
|
| Rate for Payer: Healthfirst Commercial |
$46,105.00
|
| Rate for Payer: Healthfirst Essential Plan |
$79,096.54
|
| Rate for Payer: Healthfirst QHP |
$26,686.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35,154.02
|
| Rate for Payer: SOMOS Essential |
$79,096.54
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79,096.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$79,096.54
|
| Rate for Payer: United Healthcare Medicaid |
$35,154.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35,154.02
|
|
