|
GUIDEWIRE ROSEN .035 260cm
|
Facility
|
OP
|
$147.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270624343N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare Advantage |
$44.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$37.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$37.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$29.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$37.61
|
| Rate for Payer: Cigna Commercial |
$73.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$35.70
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$32.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.91
|
|
|
GUIDEWIRE ROSEN .035 260cm
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270624343S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.27
|
|
|
GUIDEWIRE ROSEN .035 260cm
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270624343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$40.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.17
|
|
|
GUIDEWIRE ROSEN .035 260cm
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270624343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.27
|
|
|
GUIDEWIRE ROSEN .035 260cm
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270624343S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$16.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$40.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$19.80
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.17
|
|
|
GUIDEWIRE ROSEN .035 260cm J
|
Facility
|
OP
|
$86.13
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270623263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$32.73
|
| Rate for Payer: Aetna Medicare Advantage |
$25.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$21.96
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.92
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.28
|
|
|
GUIDEWIRE ROSEN .035 260cm J
|
Facility
|
IP
|
$86.13
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270623263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$17.23
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.84
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$18.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.92
|
|
|
GUIDEWIRE ROSEN THSCF 35-145-1
|
Facility
|
OP
|
$56.80
|
|
| Hospital Charge Code |
270658311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$28.40 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.48
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.04
|
| Rate for Payer: Oxford Commercial |
$11.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.51
|
|
|
GUIDEWIRE ROSEN THSCF 35-145-1
|
Facility
|
OP
|
$56.80
|
|
| Hospital Charge Code |
270658311S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$28.40 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.48
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.04
|
| Rate for Payer: Oxford Commercial |
$11.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.51
|
|
|
GUIDEWIRE ROSEN THSCF 35-145-1
|
Facility
|
IP
|
$56.80
|
|
| Hospital Charge Code |
270658311S
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.52
|
|
|
GUIDEWIRE ROSEN THSCF 35-145-1
|
Facility
|
IP
|
$56.80
|
|
| Hospital Charge Code |
270658311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.52
|
|
|
GUIDEWIRE ROSEN THSCF 35-145-1
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
270658311N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.50
|
|
|
GUIDEWIRE ROSEN THSCF 35-145-1
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
270658311N
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare Advantage |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$17.85
|
| Rate for Payer: Cigna Commercial |
$35.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$21.00
|
| Rate for Payer: Oxford Commercial |
$14.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$14.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.85
|
|
|
GUIDEWIRE ROSEN THSCF-35-180-1
|
Facility
|
IP
|
$56.80
|
|
| Hospital Charge Code |
2706000672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.52
|
|
|
GUIDEWIRE ROSEN THSCF-35-180-1
|
Facility
|
OP
|
$56.80
|
|
| Hospital Charge Code |
2706000672
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$28.40 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.48
|
| Rate for Payer: Cigna Commercial |
$28.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.04
|
| Rate for Payer: Oxford Commercial |
$11.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.52
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.37
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.51
|
|
|
GUIDEWIRE ROSEN THSCF35260***
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
270623529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare Advantage |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.75
|
| Rate for Payer: Cigna Commercial |
$25.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.00
|
| Rate for Payer: Oxford Commercial |
$10.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.32
|
|
|
GUIDEWIRE ROSEN THSCF35260***
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
270623529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.50
|
|
|
GUIDEWIRE ROSEN THSCF-35-260-1
|
Facility
|
IP
|
$81.80
|
|
| Hospital Charge Code |
2706000673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$12.27 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.27
|
|
|
GUIDEWIRE ROSEN THSCF-35-260-1
|
Facility
|
OP
|
$81.80
|
|
| Hospital Charge Code |
2706000673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$40.90 |
| Rate for Payer: Aetna Commercial |
$31.08
|
| Rate for Payer: Aetna Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$20.86
|
| Rate for Payer: Cigna Commercial |
$40.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24.54
|
| Rate for Payer: Oxford Commercial |
$16.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$12.27
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.17
|
|
|
GUIDEWIRE RUNTHR NS 180 251011
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Medicare Advantage |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$135.15
|
| Rate for Payer: Cigna Commercial |
$265.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$12.77
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.04
|
|
|
GUIDEWIRE RUNTHR NS 180 251011
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
270642945C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$128.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$106.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$128.26
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$116.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$79.50
|
|
|
GUIDEWIRE RUNTHROUGH NS .014
|
Facility
|
IP
|
$420.00
|
|
| Hospital Charge Code |
270642946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$101.64 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$92.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
|
|
GUIDEWIRE RUNTHROUGH NS .014
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
270642946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Medicare Advantage |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$107.10
|
| Rate for Payer: Cigna Commercial |
$210.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$101.64
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$92.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$63.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$11.13
|
|
|
GUIDEWIRE RUNTHROUGH NS 150cm
|
Facility
|
OP
|
$687.50
|
|
| Hospital Charge Code |
270642947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$343.75 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: Aetna Medicare Advantage |
$206.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$175.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$175.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$175.31
|
| Rate for Payer: Cigna Commercial |
$343.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.22
|
|
|
GUIDEWIRE RUNTHROUGH NS 150cm
|
Facility
|
IP
|
$687.50
|
|
| Hospital Charge Code |
270642947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$166.38 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$137.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$166.38
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$151.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$103.12
|
|
