|
ASAHI GRAND SLAM 300CM
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40005242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
|
|
ASCENSION ORTHO 6.0MM NEUROLAC NG
|
Facility
OP
|
$2,090.00
|
|
| Hospital Charge Code |
40205543
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$731.50 |
| Max. Negotiated Rate |
$1,672.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,149.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,045.00
|
| Rate for Payer: Aetna Government |
$1,045.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,672.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,421.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,045.00
|
| Rate for Payer: Group Health Inc Medicare |
$731.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
|
|
ASCENT PRIMARY FEMORAL
|
Facility
OP
|
$5,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,388.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,822.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,566.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,950.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,388.60
|
| Rate for Payer: Group Health Inc Commercial |
$2,566.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,796.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,566.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,335.80
|
|
|
ASCENT PRIMARY FEMORAL
|
Facility
IP
|
$5,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,566.00 |
| Max. Negotiated Rate |
$2,566.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,566.00
|
|
|
ASCENT PRIMARY FEMORAL RT MED
|
Facility
IP
|
$5,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,566.00 |
| Max. Negotiated Rate |
$2,566.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,566.00
|
|
|
ASCENT PRIMARY FEMORAL RT MED
|
Facility
OP
|
$5,132.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,388.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,822.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,566.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,950.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,388.60
|
| Rate for Payer: Group Health Inc Commercial |
$2,566.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,796.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,566.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,335.80
|
|
|
ASCOPE3 SLIM S VIDEOSCOPE
|
Facility
OP
|
$707.50
|
|
| Hospital Charge Code |
64903732
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$247.62 |
| Max. Negotiated Rate |
$566.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$389.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$353.75
|
| Rate for Payer: Aetna Government |
$353.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$566.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$481.10
|
| Rate for Payer: Group Health Inc Commercial |
$353.75
|
| Rate for Payer: Group Health Inc Medicare |
$247.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.75
|
|
|
ASCORBIC ACID 500 MG TAB
|
Facility
OP
|
$0.06
|
|
| Hospital Charge Code |
41654028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
ASCORBIC ACID 500 MG TAB
|
Facility
OP
|
$0.06
|
|
| Hospital Charge Code |
41644028
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
ASCORBIC ACID INJ, 500MG/ML
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
41655869
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.64
|
| 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
|
|
|
ASCORBIC ACID INJ, 500MG/ML
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
41645869
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.64
|
| 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
|
|
|
ASEPTO SET
|
Facility
OP
|
$28.35
|
|
| Hospital Charge Code |
40200360
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.18
|
| Rate for Payer: Aetna Government |
$14.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.28
|
| Rate for Payer: Group Health Inc Commercial |
$14.18
|
| Rate for Payer: Group Health Inc Medicare |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.18
|
|
|
ASMANEX 110MCG
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41658140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
ASMANEX 220MCG
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41658141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASMANEX 220MCG
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41648141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASNIS 8.0MMX75MM CANN SCREW
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.50
|
|
|
ASNIS 8.0MMX75MM CANN SCREW
|
Facility
OP
|
$441.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$463.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$242.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$253.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$463.05
|
| Rate for Payer: Group Health Inc Commercial |
$220.50
|
| Rate for Payer: Group Health Inc Medicare |
$154.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.65
|
|
|
ASNIS 8.0MM X 85MM CANN SCREW
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.50
|
|
|
ASNIS 8.0MM X 85MM CANN SCREW
|
Facility
OP
|
$441.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205630
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$463.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$242.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$253.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$463.05
|
| Rate for Payer: Group Health Inc Commercial |
$220.50
|
| Rate for Payer: Group Health Inc Medicare |
$154.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.65
|
|
|
ASNIS CANN SCREW SS 8.0X80MM 25MM
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.00
|
|
|
ASNIS CANN SCREW SS 8.0X80MM 25MM
|
Facility
OP
|
$292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$306.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.60
|
| Rate for Payer: Group Health Inc Commercial |
$146.00
|
| Rate for Payer: Group Health Inc Medicare |
$102.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.80
|
|
|
ASNIS CANN SCRW SS4.0X60MM 1/3
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.00
|
|
|
ASNIS CANN SCRW SS4.0X60MM 1/3
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205174
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$149.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.90
|
| Rate for Payer: Group Health Inc Commercial |
$149.00
|
| Rate for Payer: Group Health Inc Medicare |
$104.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.70
|
|
|
ASNIS CAN SCRW 4.0X70MM 1/3 TH
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$153.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$160.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.95
|
| Rate for Payer: Group Health Inc Commercial |
$139.50
|
| Rate for Payer: Group Health Inc Medicare |
$97.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.35
|
|
|
ASNIS CAN SCRW 4.0X70MM 1/3 TH
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205475
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.50
|
|
