|
CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ
|
Professional
|
$316.65
|
|
|
Service Code
|
HCPCS 88160
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$237.49 |
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.95
|
| Rate for Payer: Healthfirst QHP |
$90.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$237.49
|
| Rate for Payer: SOMOS Essential |
$237.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.47
|
|
|
CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I
|
Professional
|
$252.95
|
|
|
Service Code
|
HCPCS 70170
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$189.71 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.71
|
| Rate for Payer: SOMOS Essential |
$189.71
|
|
|
CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I
|
Professional
|
$194.08
|
|
|
Service Code
|
HCPCS 70170 TC
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$189.71 |
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.56
|
| Rate for Payer: SOMOS Essential |
$145.56
|
|
|
CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I
|
Professional
|
$58.87
|
|
|
Service Code
|
HCPCS 70170 26
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$189.71 |
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.98
|
| Rate for Payer: Healthfirst QHP |
$16.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.15
|
| Rate for Payer: SOMOS Essential |
$44.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.82
|
|
|
CHG DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION
|
Professional
|
$74.97
|
|
|
Service Code
|
HCPCS 87164 26
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$56.23 |
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.35
|
| Rate for Payer: Healthfirst QHP |
$21.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.23
|
| Rate for Payer: SOMOS Essential |
$56.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.42
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
$627.90
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$649.19 |
| Rate for Payer: Cash Price |
$169.03
|
| Rate for Payer: Cash Price |
$169.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.43
|
| Rate for Payer: Healthfirst QHP |
$179.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.92
|
| Rate for Payer: SOMOS Essential |
$470.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
$237.65
|
|
|
Service Code
|
HCPCS 71270 26
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$649.19 |
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.50
|
| Rate for Payer: Healthfirst QHP |
$67.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.24
|
| Rate for Payer: SOMOS Essential |
$178.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.90
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
$865.59
|
|
|
Service Code
|
HCPCS 71270
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$649.19 |
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Cash Price |
$233.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.94
|
| Rate for Payer: Healthfirst QHP |
$247.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$649.19
|
| Rate for Payer: SOMOS Essential |
$649.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.31
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
$223.51
|
|
|
Service Code
|
HCPCS 71260 26
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$550.18 |
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.67
|
| Rate for Payer: Healthfirst QHP |
$63.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.63
|
| Rate for Payer: SOMOS Essential |
$167.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.86
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
$510.02
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$550.18 |
| Rate for Payer: Cash Price |
$137.99
|
| Rate for Payer: Cash Price |
$137.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.43
|
| Rate for Payer: Healthfirst QHP |
$145.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$145.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$123.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$145.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$382.52
|
| Rate for Payer: SOMOS Essential |
$382.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.72
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
$733.57
|
|
|
Service Code
|
HCPCS 71260
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$550.18 |
| Rate for Payer: Cash Price |
$198.70
|
| Rate for Payer: Cash Price |
$198.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.11
|
| Rate for Payer: Healthfirst QHP |
$209.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$550.18
|
| Rate for Payer: SOMOS Essential |
$550.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.59
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
$582.79
|
|
|
Service Code
|
HCPCS 71250
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$437.09 |
| Rate for Payer: Cash Price |
$157.56
|
| Rate for Payer: Cash Price |
$157.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.18
|
| Rate for Payer: Healthfirst QHP |
$166.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$437.09
|
| Rate for Payer: SOMOS Essential |
$437.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.51
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
$207.76
|
|
|
Service Code
|
HCPCS 71250 26
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$437.09 |
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.39
|
| Rate for Payer: Healthfirst QHP |
$59.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.82
|
| Rate for Payer: SOMOS Essential |
$155.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.36
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
$375.06
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$437.09 |
| Rate for Payer: Cash Price |
$101.22
|
| Rate for Payer: Cash Price |
$101.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.80
|
| Rate for Payer: Healthfirst QHP |
$107.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.30
|
| Rate for Payer: SOMOS Essential |
$281.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.16
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Professional
|
$187.95
|
|
|
Service Code
|
HCPCS 77066 26
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$502.04 |
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.02
|
| Rate for Payer: Healthfirst QHP |
$53.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.96
|
| Rate for Payer: SOMOS Essential |
$140.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.70
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Professional
|
$669.38
|
|
|
Service Code
|
HCPCS 77066
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$502.04 |
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.69
|
| Rate for Payer: Healthfirst QHP |
$191.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$502.04
|
| Rate for Payer: SOMOS Essential |
$502.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.25
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI
|
Professional
|
$481.43
|
|
|
Service Code
|
HCPCS 77066 TC
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$502.04 |
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Cash Price |
$132.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.67
|
| Rate for Payer: Healthfirst QHP |
$137.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.07
|
| Rate for Payer: SOMOS Essential |
$361.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.55
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Professional
|
$532.00
|
|
|
Service Code
|
HCPCS 77065
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$145.33
|
| Rate for Payer: Cash Price |
$145.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.40
|
| Rate for Payer: Healthfirst QHP |
$152.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.00
|
| Rate for Payer: SOMOS Essential |
$399.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.00
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Professional
|
$377.93
|
|
|
Service Code
|
HCPCS 77065 TC
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Cash Price |
$103.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.58
|
| Rate for Payer: Healthfirst QHP |
$107.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.45
|
| Rate for Payer: SOMOS Essential |
$283.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.98
|
|
|
CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI
|
Professional
|
$154.07
|
|
|
Service Code
|
HCPCS 77065 26
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Cash Price |
$42.14
|
| Rate for Payer: Cash Price |
$42.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.82
|
| Rate for Payer: Healthfirst QHP |
$44.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.55
|
| Rate for Payer: SOMOS Essential |
$115.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.02
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
$156.59
|
|
|
Service Code
|
HCPCS 74485 26
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$379.31 |
| Rate for Payer: Cash Price |
$42.22
|
| Rate for Payer: Cash Price |
$42.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.50
|
| Rate for Payer: Healthfirst QHP |
$44.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.44
|
| Rate for Payer: SOMOS Essential |
$117.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.74
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
$505.75
|
|
|
Service Code
|
HCPCS 74485
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$379.31 |
| Rate for Payer: Cash Price |
$137.93
|
| Rate for Payer: Cash Price |
$137.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.28
|
| Rate for Payer: Healthfirst QHP |
$144.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.31
|
| Rate for Payer: SOMOS Essential |
$379.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.50
|
|
|
CHG DILATION URETERS/URETHRA RS&I
|
Professional
|
$349.16
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$379.31 |
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Cash Price |
$95.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.77
|
| Rate for Payer: Healthfirst QHP |
$99.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.87
|
| Rate for Payer: SOMOS Essential |
$261.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.76
|
|
|
CHG DISKOGRAPY CERVICAL/THORACIC RS&I
|
Professional
|
$318.99
|
|
|
Service Code
|
HCPCS 72285 TC
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$404.93 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.58
|
| Rate for Payer: Healthfirst QHP |
$91.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.24
|
| Rate for Payer: SOMOS Essential |
$239.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.14
|
|
|
CHG DISKOGRAPY CERVICAL/THORACIC RS&I
|
Professional
|
$539.91
|
|
|
Service Code
|
HCPCS 72285
|
| Min. Negotiated Rate |
$44.18 |
| Max. Negotiated Rate |
$404.93 |
| Rate for Payer: Cash Price |
$151.64
|
| Rate for Payer: Cash Price |
$151.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.55
|
| Rate for Payer: Healthfirst QHP |
$154.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$404.93
|
| Rate for Payer: SOMOS Essential |
$404.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.26
|
|
