|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
7411958
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$2,875.84
|
| Rate for Payer: Aetna Medicare Advantage |
$2,270.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,929.84
|
| Rate for Payer: Cigna Commercial |
$3,784.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,270.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$182.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$200.55
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
321050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
411050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
7411958
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$1,135.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
366850382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
366850382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
366850382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
366850382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-LT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382LT
|
| Hospital Charge Code |
321050382L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
IP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
7411959
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$1,135.20 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
OP
|
$7,568.00
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
7411959
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.39 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$2,875.84
|
| Rate for Payer: Aetna Medicare Advantage |
$2,270.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,929.84
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,929.84
|
| Rate for Payer: Cigna Commercial |
$3,784.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,270.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,135.20
|
| Rate for Payer: UnitedHealthcare Community & State |
$182.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$200.55
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
2691555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
321050382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
411050382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
OP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
411050382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$245.53 |
| Max. Negotiated Rate |
$5,093.90 |
| Rate for Payer: Aetna Commercial |
$3,871.36
|
| Rate for Payer: Aetna Medicare Advantage |
$3,056.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,597.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,626.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,597.89
|
| Rate for Payer: Cigna Commercial |
$5,093.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,056.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$245.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$269.98
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
2691555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR-REM/REPL URET STNT-RT
|
Facility
|
IP
|
$10,187.80
|
|
|
Service Code
|
HCPCS 50382RT
|
| Hospital Charge Code |
321050382R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,528.17 |
| Max. Negotiated Rate |
$1,528.17 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,528.17
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
IP
|
$3,062.65
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
366836589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$459.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.40
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
OP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
321036589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,089.21
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$87.50
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$96.21
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
OP
|
$3,062.65
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
411036589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$918.79
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$73.81
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$81.16
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
IP
|
$2,564.40
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
7411471
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.66 |
| Max. Negotiated Rate |
$384.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$384.66
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
OP
|
$2,564.40
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
7411471
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$3,593.00 |
| Rate for Payer: Aetna Commercial |
$2,027.08
|
| Rate for Payer: Aetna Medicare Advantage |
$2,414.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,690.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$745.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$862.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,690.13
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cigna Medicare Advantage |
$745.25
|
| Rate for Payer: Clover Medicare Advantage |
$707.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,235.75
|
| Rate for Payer: Humana Medicare Advantage |
$767.61
|
| Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage |
$745.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$769.32
|
| Rate for Payer: Oxford Commercial |
$2,269.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$384.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$3,593.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$61.80
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.96
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
IP
|
$3,062.65
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
411036589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$459.40 |
| Max. Negotiated Rate |
$459.40 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$459.40
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
321036589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
|
IR REM TUNN CV CATH W/O PO/PUM
|
Facility
|
IP
|
$3,630.70
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
2011279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.61 |
| Max. Negotiated Rate |
$544.61 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$544.61
|
|
