|
FIELDER XT GUIDE WIRE
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66526603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
FIELDER XT GUIDE WIRE
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66526603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$162.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.25
|
| Rate for Payer: EmblemHealth Commercial |
$135.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.50
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.50
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41655018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$256.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$279.60
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$233.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41645018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$256.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$279.60
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$233.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41655018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41645018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
|
|
FILGRASTIM 300 MCG/ML IJ SOLN [10036]
|
Facility
|
OP
|
$377.80
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
55513053010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$283.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$256.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML IJ SOLN [10036]
|
Facility
|
OP
|
$377.80
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
55513053001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$283.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$256.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41641851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41641851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41651851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41651851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM 480 MCG/1.6ML IJ SOLN [108074]
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
55513054610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$282.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 480 MCG/1.6ML IJ SOLN [108074]
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
55513054601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$282.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Humana Medicare |
$1.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41643931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$1.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.57
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41653931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$1.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.57
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41643931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41653931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41640389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Humana Medicare |
$0.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.45
|
| Rate for Payer: SOMOS Essential |
$0.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41640389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41650389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Humana Medicare |
$0.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.45
|
| Rate for Payer: SOMOS Essential |
$0.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41650389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY [129453]
|
Facility
|
OP
|
$658.46
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
61314031801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$526.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$362.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$493.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$526.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$447.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Humana Medicare |
$0.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY [129453]
|
Facility
|
OP
|
$658.47
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
61314031805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$526.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$362.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$493.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$526.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$447.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Humana Medicare |
$0.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY [129454]
|
Facility
|
OP
|
$658.48
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
61314032601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$526.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$362.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$493.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$526.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$447.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Humana Medicare |
$0.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
