|
CHG ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I
|
Professional
|
$357.67
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$429.48 |
| Rate for Payer: Cash Price |
$98.31
|
| Rate for Payer: Cash Price |
$98.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.08
|
| Rate for Payer: Healthfirst QHP |
$102.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.25
|
| Rate for Payer: SOMOS Essential |
$268.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.19
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
$188.65
|
|
|
Service Code
|
HCPCS 75774 26
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$308.49 |
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Cash Price |
$50.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.20
|
| Rate for Payer: Healthfirst QHP |
$53.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.49
|
| Rate for Payer: SOMOS Essential |
$141.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.90
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
$411.32
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$308.49 |
| Rate for Payer: Cash Price |
$111.19
|
| Rate for Payer: Cash Price |
$111.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.64
|
| Rate for Payer: Healthfirst QHP |
$117.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.49
|
| Rate for Payer: SOMOS Essential |
$308.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.52
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
$222.67
|
|
|
Service Code
|
HCPCS 75774 TC
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$308.49 |
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.44
|
| Rate for Payer: Healthfirst QHP |
$63.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.00
|
| Rate for Payer: SOMOS Essential |
$167.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.62
|
|
|
CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ
|
Professional
|
$95.24
|
|
|
Service Code
|
HCPCS 74425 26
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$440.03 |
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.85
|
| Rate for Payer: Healthfirst QHP |
$27.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.43
|
| Rate for Payer: SOMOS Essential |
$71.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.21
|
|
|
CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ
|
Professional
|
$491.47
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$440.03 |
| Rate for Payer: Cash Price |
$132.65
|
| Rate for Payer: Cash Price |
$132.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.40
|
| Rate for Payer: Healthfirst QHP |
$140.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.60
|
| Rate for Payer: SOMOS Essential |
$368.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.42
|
|
|
CHG ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ
|
Professional
|
$586.71
|
|
|
Service Code
|
HCPCS 74425
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$440.03 |
| Rate for Payer: Cash Price |
$158.37
|
| Rate for Payer: Cash Price |
$158.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.25
|
| Rate for Payer: Healthfirst QHP |
$167.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$440.03
|
| Rate for Payer: SOMOS Essential |
$440.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.63
|
|
|
CHG ANTISTREPTOLYSIN O TITER
|
Professional
|
$18.00
|
|
|
Service Code
|
HCPCS 86060
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.94
|
| Rate for Payer: Healthfirst QHP |
$7.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.50
|
| Rate for Payer: SOMOS Essential |
$13.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.30
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
$385.74
|
|
|
Service Code
|
HCPCS 75630 26
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$498.33 |
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.70
|
| Rate for Payer: Healthfirst QHP |
$110.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.30
|
| Rate for Payer: SOMOS Essential |
$289.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.21
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
$278.74
|
|
|
Service Code
|
HCPCS 75630 TC
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$498.33 |
| Rate for Payer: Cash Price |
$76.69
|
| Rate for Payer: Cash Price |
$76.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.66
|
| Rate for Payer: Healthfirst QHP |
$79.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.06
|
| Rate for Payer: SOMOS Essential |
$209.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.64
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
$664.44
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$498.33 |
| Rate for Payer: Cash Price |
$181.19
|
| Rate for Payer: Cash Price |
$181.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.35
|
| Rate for Payer: Healthfirst QHP |
$189.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$498.33
|
| Rate for Payer: SOMOS Essential |
$498.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.84
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
$260.05
|
|
|
Service Code
|
HCPCS 75625 TC
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$407.03 |
| Rate for Payer: Cash Price |
$70.96
|
| Rate for Payer: Cash Price |
$70.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.58
|
| Rate for Payer: Healthfirst QHP |
$74.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.04
|
| Rate for Payer: SOMOS Essential |
$195.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.30
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
$282.66
|
|
|
Service Code
|
HCPCS 75625 26
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$407.03 |
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Cash Price |
$76.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.72
|
| Rate for Payer: Healthfirst QHP |
$80.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.00
|
| Rate for Payer: SOMOS Essential |
$212.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.76
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
$542.71
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$407.03 |
| Rate for Payer: Cash Price |
$147.68
|
| Rate for Payer: Cash Price |
$147.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.31
|
| Rate for Payer: Healthfirst QHP |
$155.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$407.03
|
| Rate for Payer: SOMOS Essential |
$407.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.06
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
$218.89
|
|
|
Service Code
|
HCPCS 75605 26
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$386.03 |
| Rate for Payer: Cash Price |
$59.21
|
| Rate for Payer: Cash Price |
$59.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.41
|
| Rate for Payer: Healthfirst QHP |
$62.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.17
|
| Rate for Payer: SOMOS Essential |
$164.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.54
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
$514.71
|
|
|
Service Code
|
HCPCS 75605
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$386.03 |
| Rate for Payer: Cash Price |
$140.23
|
| Rate for Payer: Cash Price |
$140.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.71
|
| Rate for Payer: Healthfirst QHP |
$147.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$386.03
|
| Rate for Payer: SOMOS Essential |
$386.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.06
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
$295.86
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$386.03 |
| Rate for Payer: Cash Price |
$81.02
|
| Rate for Payer: Cash Price |
$81.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.30
|
| Rate for Payer: Healthfirst QHP |
$84.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.90
|
| Rate for Payer: SOMOS Essential |
$221.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.53
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
$800.31
|
|
|
Service Code
|
HCPCS 75600
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$600.23 |
| Rate for Payer: Cash Price |
$214.86
|
| Rate for Payer: Cash Price |
$214.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.23
|
| Rate for Payer: Healthfirst QHP |
$228.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$600.23
|
| Rate for Payer: SOMOS Essential |
$600.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.66
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
$101.96
|
|
|
Service Code
|
HCPCS 75600 26
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$600.23 |
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.67
|
| Rate for Payer: Healthfirst QHP |
$29.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.47
|
| Rate for Payer: SOMOS Essential |
$76.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.13
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
$698.36
|
|
|
Service Code
|
HCPCS 75600 TC
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$600.23 |
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.55
|
| Rate for Payer: Healthfirst QHP |
$199.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.77
|
| Rate for Payer: SOMOS Essential |
$523.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.53
|
|
|
CHG AQMBF PET REST AND PHARMACOLOGIC STRESS
|
Professional
|
$567.25
|
|
|
Service Code
|
HCPCS 78434
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$425.44 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$425.44
|
| Rate for Payer: SOMOS Essential |
$425.44
|
|
|
CHG AQMBF PET REST AND PHARMACOLOGIC STRESS
|
Professional
|
$452.69
|
|
|
Service Code
|
HCPCS 78434 TC
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$425.44 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.52
|
| Rate for Payer: SOMOS Essential |
$339.52
|
|
|
CHG AQMBF PET REST AND PHARMACOLOGIC STRESS
|
Professional
|
$114.56
|
|
|
Service Code
|
HCPCS 78434 26
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$425.44 |
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Cash Price |
$31.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.09
|
| Rate for Payer: Healthfirst QHP |
$32.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.92
|
| Rate for Payer: SOMOS Essential |
$85.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.73
|
|
|
CHG ASSAY OF THYROID STIMULATING HORMONE TSH
|
Professional
|
$42.00
|
|
|
Service Code
|
HCPCS 84443
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.96
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.50
|
| Rate for Payer: SOMOS Essential |
$31.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
|
|
CHG BASIC METABOLIC PANEL CALCIUM TOTAL
|
Professional
|
$21.15
|
|
|
Service Code
|
HCPCS 80048
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$15.86 |
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.04
|
| Rate for Payer: Healthfirst QHP |
$8.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.86
|
| Rate for Payer: SOMOS Essential |
$15.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.46
|
|
