|
6X6HOLE 3D PLT UPPERFACE
|
Facility
OP
|
$1,508.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,583.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$829.40
|
| 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 |
$754.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$867.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,583.40
|
| Rate for Payer: Group Health Inc Commercial |
$754.00
|
| Rate for Payer: Group Health Inc Medicare |
$527.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$754.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$754.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$980.20
|
|
|
6X6 HOLE 3D PLT UPPER FC MALLBI
|
Facility
OP
|
$1,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$858.00
|
| 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 |
$780.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$897.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,638.00
|
| Rate for Payer: Group Health Inc Commercial |
$780.00
|
| Rate for Payer: Group Health Inc Medicare |
$546.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,014.00
|
|
|
6X6 HOLE 3D PLT UPPER FC MALLBI
|
Facility
IP
|
$1,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201162
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.00
|
|
|
<6YR NEW ONSET HD ACHE
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2193
|
| Hospital Charge Code |
30300321
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$0.01 |
| 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 |
$0.01
|
| 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 |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
733334 10 DRUG-SCR
|
Facility
OP
|
$155.35
|
|
|
Service Code
|
HCPCS 80361
|
| Hospital Charge Code |
40609014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$124.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.44
|
| 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 |
$124.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.64
|
| Rate for Payer: Group Health Inc Commercial |
$77.68
|
| Rate for Payer: Group Health Inc Medicare |
$54.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.68
|
|
|
.75MM 12-LOCH STEINH PLT GEB
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.00
|
| 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 |
$290.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.00
|
| Rate for Payer: Group Health Inc Commercial |
$290.00
|
| Rate for Payer: Group Health Inc Medicare |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.00
|
|
|
.75MM 12-LOCH STEINH PLT GEB
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
|
|
.75MM 30-LOCH STEINH PLT STAND
|
Facility
IP
|
$1,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.00 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.00
|
|
|
.75MM 30-LOCH STEINH PLT STAND
|
Facility
OP
|
$1,182.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,241.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$650.10
|
| 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 |
$591.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$679.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,241.10
|
| Rate for Payer: Group Health Inc Commercial |
$591.00
|
| Rate for Payer: Group Health Inc Medicare |
$413.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.30
|
|
|
.75MM 8-LOCH STEINH PLT T-FORM
|
Facility
IP
|
$553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.50
|
|
|
.75MM 8-LOCH STEINH PLT T-FORM
|
Facility
OP
|
$553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$580.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$304.15
|
| 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 |
$276.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$317.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$580.65
|
| Rate for Payer: Group Health Inc Commercial |
$276.50
|
| Rate for Payer: Group Health Inc Medicare |
$193.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.45
|
|
|
.75MM 8-LOCH STEINH PLT Y-FORM
|
Facility
IP
|
$553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.50
|
|
|
.75MM 8-LOCH STEINH PLT Y-FORM
|
Facility
OP
|
$553.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$580.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$304.15
|
| 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 |
$276.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$317.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$580.65
|
| Rate for Payer: Group Health Inc Commercial |
$276.50
|
| Rate for Payer: Group Health Inc Medicare |
$193.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.45
|
|
|
.75MM 9-LOCH STEINH LPLT LNKS 1
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.00
|
| 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 |
$290.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.00
|
| Rate for Payer: Group Health Inc Commercial |
$290.00
|
| Rate for Payer: Group Health Inc Medicare |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.00
|
|
|
.75MM 9-LOCH STEINH LPLT LNKS 1
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
|
|
.75MM MP PLATE LOCKING L RIGHT
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.00
|
| 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 |
$290.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.00
|
| Rate for Payer: Group Health Inc Commercial |
$290.00
|
| Rate for Payer: Group Health Inc Medicare |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.00
|
|
|
.75MM MP PLATE LOCKING L RIGHT
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
|
|
7-8 REGIONS
|
Facility
OP
|
$164.83
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
30305016
|
|
Hospital Revenue Code
|
530
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$131.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.00
|
| Rate for Payer: Aetna Government |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$131.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.00
|
| Rate for Payer: EmblemHealth Commercial |
$30.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.70
|
| Rate for Payer: Group Health Inc Commercial |
$30.00
|
| Rate for Payer: Group Health Inc Medicare |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.50
|
| Rate for Payer: Healthfirst QHP |
$30.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.00
|
| Rate for Payer: Wellcare Medicare |
$28.50
|
|
|
7H DOUBLE Y PLATE UPFC MALLEABLE
|
Facility
OP
|
$292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200560
|
|
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
|
|
|
7H DOUBLE Y PLATE UPFC MALLEABLE
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200560
|
|
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
|
|
|
7 HOLE DOUBLE Y PLATE UPPERFACE
|
Facility
IP
|
$292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201164
|
|
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
|
|
|
7 HOLE DOUBLE Y PLATE UPPERFACE
|
Facility
OP
|
$292.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201164
|
|
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
|
|
|
7HOLE DOUBLE Y PLT UPFC MLBL
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
|
|
7HOLE DOUBLE Y PLT UPFC MLBL
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.20
|
| 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 |
$162.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$186.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$340.20
|
| Rate for Payer: Group Health Inc Commercial |
$162.00
|
| Rate for Payer: Group Health Inc Medicare |
$113.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.60
|
|
|
7HOLE NARROW T-PLATE
|
Facility
OP
|
$1,558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,635.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$856.90
|
| 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 |
$779.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$895.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,635.90
|
| Rate for Payer: Group Health Inc Commercial |
$779.00
|
| Rate for Payer: Group Health Inc Medicare |
$545.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$779.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$779.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,012.70
|
|
