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Service Code HCPCS 69100
Hospital Charge Code 30300111
Hospital Revenue Code 510
Min. Negotiated Rate $50.87
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $282.47
Rate for Payer: Aetna Government $282.47
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $282.47
Rate for Payer: Cash Price $282.47
Rate for Payer: Cash Price $282.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $282.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $282.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $50.87
Rate for Payer: Fidelis Essential Plan Aliesa $240.10
Rate for Payer: Fidelis Essential Plan QHP $251.40
Rate for Payer: Fidelis Medicare Advantage $282.47
Rate for Payer: Fidelis Qualified Health Plan $251.40
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 $197.70
Rate for Payer: Hamaspik Choice Inc Medicare $282.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $56.52
Rate for Payer: Healthfirst Medicare Advantage $240.10
Rate for Payer: Healthfirst QHP $282.47
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $282.47
Rate for Payer: Senior Whole Health Medicare Advantage $282.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $282.47
Rate for Payer: Wellcare CHP/FHP/Medicaid $225.98
Rate for Payer: Wellcare Medicare $268.35
Service Code HCPCS 69110
Hospital Charge Code 30303087
Hospital Revenue Code 360
Min. Negotiated Rate $365.44
Max. Negotiated Rate $3,511.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3,285.96
Rate for Payer: Aetna Government $3,285.96
Rate for Payer: Cash Price $3,285.96
Rate for Payer: Cash Price $3,285.96
Rate for Payer: Cash Price $3,285.96
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $3,285.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $3,285.96
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $365.44
Rate for Payer: Fidelis Essential Plan Aliesa $2,793.07
Rate for Payer: Fidelis Essential Plan QHP $2,924.50
Rate for Payer: Fidelis Medicare Advantage $3,285.96
Rate for Payer: Fidelis Qualified Health Plan $2,924.50
Rate for Payer: Group Health Inc Commercial $3,285.96
Rate for Payer: Group Health Inc Medicare $3,285.96
Rate for Payer: Hamaspik Choice Inc Medicaid $3,511.68
Rate for Payer: Hamaspik Choice Inc Medicare $3,285.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid $406.05
Rate for Payer: Healthfirst Medicare Advantage $2,793.07
Rate for Payer: Healthfirst QHP $3,285.96
Rate for Payer: Senior Whole Health Medicare Advantage $3,285.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,285.96
Rate for Payer: Wellcare CHP/FHP/Medicaid $2,628.77
Rate for Payer: Wellcare Medicare $3,121.66
Service Code HCPCS 67810
Hospital Charge Code 42201729
Hospital Revenue Code 510
Min. Negotiated Rate $72.36
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $336.88
Rate for Payer: Aetna Government $336.88
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $336.88
Rate for Payer: Cash Price $336.88
Rate for Payer: Cash Price $336.88
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $336.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $336.88
Rate for Payer: Fidelis CHP/HARP/Medicaid $72.36
Rate for Payer: Fidelis Essential Plan Aliesa $286.35
Rate for Payer: Fidelis Essential Plan QHP $299.82
Rate for Payer: Fidelis Medicare Advantage $336.88
Rate for Payer: Fidelis Qualified Health Plan $299.82
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 $409.62
Rate for Payer: Hamaspik Choice Inc Medicare $336.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid $80.40
Rate for Payer: Healthfirst Medicare Advantage $286.35
Rate for Payer: Healthfirst QHP $336.88
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $336.88
Rate for Payer: Senior Whole Health Medicare Advantage $336.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $336.88
Rate for Payer: Wellcare CHP/FHP/Medicaid $269.50
Rate for Payer: Wellcare Medicare $320.04
Service Code HCPCS 41108
Hospital Charge Code 42201727
Hospital Revenue Code 510
Min. Negotiated Rate $102.10
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: Fidelis CHP/HARP/Medicaid $102.10
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
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 $2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $113.44
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15
Service Code HCPCS 40490
Hospital Charge Code 30305365
Hospital Revenue Code 510
Min. Negotiated Rate $73.98
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $282.47
Rate for Payer: Aetna Government $282.47
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $282.47
Rate for Payer: Cash Price $282.47
Rate for Payer: Cash Price $282.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $282.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $282.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $73.98
Rate for Payer: Fidelis Essential Plan Aliesa $240.10
Rate for Payer: Fidelis Essential Plan QHP $251.40
Rate for Payer: Fidelis Medicare Advantage $282.47
Rate for Payer: Fidelis Qualified Health Plan $251.40
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 $308.39
Rate for Payer: Hamaspik Choice Inc Medicare $282.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $82.20
Rate for Payer: Healthfirst Medicare Advantage $240.10
Rate for Payer: Healthfirst QHP $282.47
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $282.47
Rate for Payer: Senior Whole Health Medicare Advantage $282.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $282.47
Rate for Payer: Wellcare CHP/FHP/Medicaid $225.98
Rate for Payer: Wellcare Medicare $268.35
Service Code HCPCS 47100
Hospital Charge Code 40019707
Hospital Revenue Code 360
Min. Negotiated Rate $743.04
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,167.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,000.66
Rate for Payer: Aetna Government $1,000.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $981.70
Rate for Payer: Group Health Inc Commercial $1,061.49
Rate for Payer: Group Health Inc Medicare $743.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1,061.49
Rate for Payer: Hamaspik Choice Inc Medicare $1,061.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid $1,090.78
Service Code HCPCS 11755
Hospital Charge Code 30300183
Hospital Revenue Code 510
Min. Negotiated Rate $63.56
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $813.63
Rate for Payer: Aetna Government $813.63
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $813.63
Rate for Payer: Fidelis CHP/HARP/Medicaid $63.56
Rate for Payer: Fidelis Essential Plan Aliesa $691.59
Rate for Payer: Fidelis Essential Plan QHP $724.13
Rate for Payer: Fidelis Medicare Advantage $813.63
Rate for Payer: Fidelis Qualified Health Plan $724.13
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 $923.79
Rate for Payer: Hamaspik Choice Inc Medicare $813.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid $70.62
Rate for Payer: Healthfirst Medicare Advantage $691.59
Rate for Payer: Healthfirst QHP $813.63
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $813.63
Rate for Payer: Senior Whole Health Medicare Advantage $813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid $650.90
Rate for Payer: Wellcare Medicare $772.95
Service Code HCPCS 64795
Hospital Charge Code 40009955
Hospital Revenue Code 360
Min. Negotiated Rate $226.05
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2,232.80
Rate for Payer: Aetna Government $2,232.80
Rate for Payer: Cash Price $2,232.80
Rate for Payer: Cash Price $2,232.80
Rate for Payer: Cash Price $2,232.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $2,232.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $2,232.80
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $226.05
Rate for Payer: Fidelis Essential Plan Aliesa $1,897.88
Rate for Payer: Fidelis Essential Plan QHP $1,987.19
Rate for Payer: Fidelis Medicare Advantage $2,232.80
Rate for Payer: Fidelis Qualified Health Plan $1,987.19
Rate for Payer: Group Health Inc Commercial $2,232.80
Rate for Payer: Group Health Inc Medicare $2,232.80
Rate for Payer: Hamaspik Choice Inc Medicaid $2,603.74
Rate for Payer: Hamaspik Choice Inc Medicare $2,232.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid $251.17
Rate for Payer: Healthfirst Medicare Advantage $1,897.88
Rate for Payer: Healthfirst QHP $2,232.80
Rate for Payer: Senior Whole Health Medicare Advantage $2,232.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,232.80
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,786.24
Rate for Payer: Wellcare Medicare $2,121.16
Service Code HCPCS D7285
Hospital Charge Code 42301715
Hospital Revenue Code 361
Min. Negotiated Rate $91.00
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $257.13
Rate for Payer: Aetna Government $257.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Group Health Inc Commercial $130.00
Rate for Payer: Group Health Inc Medicare $91.00
Rate for Payer: Hamaspik Choice Inc Medicaid $130.00
Rate for Payer: Hamaspik Choice Inc Medicare $130.00
Service Code HCPCS D7286
Hospital Charge Code 42301720
Hospital Revenue Code 361
Min. Negotiated Rate $73.50
Max. Negotiated Rate $9,760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $110.12
Rate for Payer: Aetna Government $110.12
Rate for Payer: Amida Care Medicaid $97.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Fidelis CHP/HARP/Medicaid $9,760.00
Rate for Payer: Fidelis Essential Plan Aliesa $97.60
Rate for Payer: Fidelis Essential Plan QHP $97.60
Rate for Payer: Fidelis Qualified Health Plan $102.48
Rate for Payer: Group Health Inc Commercial $105.00
Rate for Payer: Group Health Inc Medicare $73.50
Rate for Payer: Hamaspik Choice Inc Medicaid $97.60
Rate for Payer: Hamaspik Choice Inc Medicare $105.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid $97.60
Rate for Payer: Healthfirst Essential Plan $219.60
Rate for Payer: Healthfirst QHP $97.60
Rate for Payer: SOMOS CHP/HARP/Medicaid $97.60
Rate for Payer: SOMOS Essential $219.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $97.60
Service Code HCPCS 54100
Hospital Charge Code 40129465
Hospital Revenue Code 360
Min. Negotiated Rate $129.97
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $129.97
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
Rate for Payer: Group Health Inc Commercial $1,874.89
Rate for Payer: Group Health Inc Medicare $1,874.89
Rate for Payer: Hamaspik Choice Inc Medicaid $2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $144.41
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15
Service Code HCPCS 54100
Hospital Charge Code 30302452
Hospital Revenue Code 510
Min. Negotiated Rate $129.97
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Cash Price $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: Fidelis CHP/HARP/Medicaid $129.97
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
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 $2,078.62
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $144.41
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15
Service Code HCPCS 42400
Hospital Charge Code 40019460
Hospital Revenue Code 360
Min. Negotiated Rate $57.00
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $813.63
Rate for Payer: Aetna Government $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $813.63
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $57.00
Rate for Payer: Fidelis Essential Plan Aliesa $691.59
Rate for Payer: Fidelis Essential Plan QHP $724.13
Rate for Payer: Fidelis Medicare Advantage $813.63
Rate for Payer: Fidelis Qualified Health Plan $724.13
Rate for Payer: Group Health Inc Commercial $813.63
Rate for Payer: Group Health Inc Medicare $813.63
Rate for Payer: Hamaspik Choice Inc Medicaid $923.79
Rate for Payer: Hamaspik Choice Inc Medicare $813.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid $63.33
Rate for Payer: Healthfirst Medicare Advantage $691.59
Rate for Payer: Healthfirst QHP $813.63
Rate for Payer: Senior Whole Health Medicare Advantage $813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid $650.90
Rate for Payer: Wellcare Medicare $772.95
Service Code HCPCS 42400
Hospital Charge Code 30302441
Hospital Revenue Code 510
Min. Negotiated Rate $57.00
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $813.63
Rate for Payer: Aetna Government $813.63
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Cash Price $813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $813.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $813.63
Rate for Payer: Fidelis CHP/HARP/Medicaid $57.00
Rate for Payer: Fidelis Essential Plan Aliesa $691.59
Rate for Payer: Fidelis Essential Plan QHP $724.13
Rate for Payer: Fidelis Medicare Advantage $813.63
Rate for Payer: Fidelis Qualified Health Plan $724.13
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 $923.79
Rate for Payer: Hamaspik Choice Inc Medicare $813.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid $63.33
Rate for Payer: Healthfirst Medicare Advantage $691.59
Rate for Payer: Healthfirst QHP $813.63
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $813.63
Rate for Payer: Senior Whole Health Medicare Advantage $813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid $650.90
Rate for Payer: Wellcare Medicare $772.95
Service Code HCPCS 42800
Hospital Charge Code 30305697
Hospital Revenue Code 510
Min. Negotiated Rate $129.20
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,763.60
Rate for Payer: Aetna Government $1,763.60
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,763.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,763.60
Rate for Payer: Fidelis CHP/HARP/Medicaid $129.20
Rate for Payer: Fidelis Essential Plan Aliesa $1,499.06
Rate for Payer: Fidelis Essential Plan QHP $1,569.60
Rate for Payer: Fidelis Medicare Advantage $1,763.60
Rate for Payer: Fidelis Qualified Health Plan $1,569.60
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 $2,043.42
Rate for Payer: Hamaspik Choice Inc Medicare $1,763.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid $143.56
Rate for Payer: Healthfirst Medicare Advantage $1,499.06
Rate for Payer: Healthfirst QHP $1,763.60
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $1,763.60
Rate for Payer: Senior Whole Health Medicare Advantage $1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,410.88
Rate for Payer: Wellcare Medicare $1,675.42
Service Code HCPCS 42800
Hospital Charge Code 40109232
Hospital Revenue Code 510
Min. Negotiated Rate $129.20
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,763.60
Rate for Payer: Aetna Government $1,763.60
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Cash Price $1,763.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,763.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,763.60
Rate for Payer: Fidelis CHP/HARP/Medicaid $129.20
Rate for Payer: Fidelis Essential Plan Aliesa $1,499.06
Rate for Payer: Fidelis Essential Plan QHP $1,569.60
Rate for Payer: Fidelis Medicare Advantage $1,763.60
Rate for Payer: Fidelis Qualified Health Plan $1,569.60
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 $2,043.42
Rate for Payer: Hamaspik Choice Inc Medicare $1,763.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid $143.56
Rate for Payer: Healthfirst Medicare Advantage $1,499.06
Rate for Payer: Healthfirst QHP $1,763.60
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $1,763.60
Rate for Payer: Senior Whole Health Medicare Advantage $1,763.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,763.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,410.88
Rate for Payer: Wellcare Medicare $1,675.42
Service Code HCPCS 42804
Hospital Charge Code 40109218
Hospital Revenue Code 360
Min. Negotiated Rate $136.97
Max. Negotiated Rate $3,966.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3,723.23
Rate for Payer: Aetna Government $3,723.23
Rate for Payer: Cash Price $3,723.23
Rate for Payer: Cash Price $3,723.23
Rate for Payer: Cash Price $3,723.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $3,723.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $3,723.23
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $136.97
Rate for Payer: Fidelis Essential Plan Aliesa $3,164.75
Rate for Payer: Fidelis Essential Plan QHP $3,313.67
Rate for Payer: Fidelis Medicare Advantage $3,723.23
Rate for Payer: Fidelis Qualified Health Plan $3,313.67
Rate for Payer: Group Health Inc Commercial $3,723.23
Rate for Payer: Group Health Inc Medicare $3,723.23
Rate for Payer: Hamaspik Choice Inc Medicaid $3,966.59
Rate for Payer: Hamaspik Choice Inc Medicare $3,723.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid $152.19
Rate for Payer: Healthfirst Medicare Advantage $3,164.75
Rate for Payer: Healthfirst QHP $3,723.23
Rate for Payer: Senior Whole Health Medicare Advantage $3,723.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,723.23
Rate for Payer: Wellcare CHP/FHP/Medicaid $2,978.58
Rate for Payer: Wellcare Medicare $3,537.07
Service Code HCPCS 57100
Hospital Charge Code 30301207
Hospital Revenue Code 510
Min. Negotiated Rate $72.34
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $929.66
Rate for Payer: Aetna Government $929.66
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $929.66
Rate for Payer: Cash Price $929.66
Rate for Payer: Cash Price $929.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $929.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $929.66
Rate for Payer: Fidelis CHP/HARP/Medicaid $72.34
Rate for Payer: Fidelis Essential Plan Aliesa $790.21
Rate for Payer: Fidelis Essential Plan QHP $827.40
Rate for Payer: Fidelis Medicare Advantage $929.66
Rate for Payer: Fidelis Qualified Health Plan $827.40
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 $966.86
Rate for Payer: Hamaspik Choice Inc Medicare $929.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid $80.38
Rate for Payer: Healthfirst Medicare Advantage $790.21
Rate for Payer: Healthfirst QHP $929.66
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $929.66
Rate for Payer: Senior Whole Health Medicare Advantage $929.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $929.66
Rate for Payer: Wellcare CHP/FHP/Medicaid $743.73
Rate for Payer: Wellcare Medicare $883.18
Service Code CPT 38505
Hospital Revenue Code 361
Min. Negotiated Rate $92.00
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: EmblemHealth Commercial $1,874.89
Rate for Payer: Fidelis CHP/HARP/Medicaid $92.00
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
Rate for Payer: Group Health Inc Commercial $1,874.89
Rate for Payer: Group Health Inc Medicare $1,874.89
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $102.22
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15
Service Code CPT 38505
Hospital Revenue Code 360
Min. Negotiated Rate $92.00
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $92.00
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
Rate for Payer: Group Health Inc Commercial $1,874.89
Rate for Payer: Group Health Inc Medicare $1,874.89
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $102.22
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15
Service Code CPT 38525
Hospital Revenue Code 360
Min. Negotiated Rate $510.51
Max. Negotiated Rate $4,407.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,407.98
Rate for Payer: Aetna Government $4,407.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $4,407.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $4,407.98
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $510.51
Rate for Payer: Fidelis Essential Plan Aliesa $3,746.78
Rate for Payer: Fidelis Essential Plan QHP $3,923.10
Rate for Payer: Fidelis Medicare Advantage $4,407.98
Rate for Payer: Fidelis Qualified Health Plan $3,923.10
Rate for Payer: Group Health Inc Commercial $4,407.98
Rate for Payer: Group Health Inc Medicare $4,407.98
Rate for Payer: Hamaspik Choice Inc Medicare $4,407.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $567.23
Rate for Payer: Healthfirst Medicare Advantage $3,746.78
Rate for Payer: Healthfirst QHP $4,407.98
Rate for Payer: Senior Whole Health Medicare Advantage $4,407.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,407.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $3,526.38
Rate for Payer: Wellcare Medicare $4,187.58
Service Code CPT 38510
Hospital Revenue Code 360
Min. Negotiated Rate $474.21
Max. Negotiated Rate $4,407.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,407.98
Rate for Payer: Aetna Government $4,407.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $4,407.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $4,407.98
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $474.21
Rate for Payer: Fidelis Essential Plan Aliesa $3,746.78
Rate for Payer: Fidelis Essential Plan QHP $3,923.10
Rate for Payer: Fidelis Medicare Advantage $4,407.98
Rate for Payer: Fidelis Qualified Health Plan $3,923.10
Rate for Payer: Group Health Inc Commercial $4,407.98
Rate for Payer: Group Health Inc Medicare $4,407.98
Rate for Payer: Hamaspik Choice Inc Medicare $4,407.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $526.90
Rate for Payer: Healthfirst Medicare Advantage $3,746.78
Rate for Payer: Healthfirst QHP $4,407.98
Rate for Payer: Senior Whole Health Medicare Advantage $4,407.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,407.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $3,526.38
Rate for Payer: Wellcare Medicare $4,187.58
Service Code CPT 38500
Hospital Revenue Code 360
Min. Negotiated Rate $294.46
Max. Negotiated Rate $4,407.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,407.98
Rate for Payer: Aetna Government $4,407.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $4,407.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $4,407.98
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $294.46
Rate for Payer: Fidelis Essential Plan Aliesa $3,746.78
Rate for Payer: Fidelis Essential Plan QHP $3,923.10
Rate for Payer: Fidelis Medicare Advantage $4,407.98
Rate for Payer: Fidelis Qualified Health Plan $3,923.10
Rate for Payer: Group Health Inc Commercial $4,407.98
Rate for Payer: Group Health Inc Medicare $4,407.98
Rate for Payer: Hamaspik Choice Inc Medicare $4,407.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $327.18
Rate for Payer: Healthfirst Medicare Advantage $3,746.78
Rate for Payer: Healthfirst QHP $4,407.98
Rate for Payer: Senior Whole Health Medicare Advantage $4,407.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,407.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $3,526.38
Rate for Payer: Wellcare Medicare $4,187.58
Service Code CPT 32400
Hospital Revenue Code 361
Min. Negotiated Rate $89.31
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: EmblemHealth Commercial $1,874.89
Rate for Payer: Fidelis CHP/HARP/Medicaid $89.31
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
Rate for Payer: Group Health Inc Commercial $1,874.89
Rate for Payer: Group Health Inc Medicare $1,874.89
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $99.23
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15
Service Code CPT 32400
Hospital Revenue Code 360
Min. Negotiated Rate $89.31
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,874.89
Rate for Payer: Aetna Government $1,874.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,874.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,874.89
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $89.31
Rate for Payer: Fidelis Essential Plan Aliesa $1,593.66
Rate for Payer: Fidelis Essential Plan QHP $1,668.65
Rate for Payer: Fidelis Medicare Advantage $1,874.89
Rate for Payer: Fidelis Qualified Health Plan $1,668.65
Rate for Payer: Group Health Inc Commercial $1,874.89
Rate for Payer: Group Health Inc Medicare $1,874.89
Rate for Payer: Hamaspik Choice Inc Medicare $1,874.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $99.23
Rate for Payer: Healthfirst Medicare Advantage $1,593.66
Rate for Payer: Healthfirst QHP $1,874.89
Rate for Payer: Senior Whole Health Medicare Advantage $1,874.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,874.89
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,499.91
Rate for Payer: Wellcare Medicare $1,781.15