|
CH IGG CSF
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CH IGG CSF
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
|
|
CH IGG INDEX
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397072094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$54.30 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.30
|
|
|
CH IGG INDEX
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397072094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.06
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CH IGG SERUM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CH IGG SERUM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
|
|
CH IGM
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397071084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
|
|
CH IGM
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397071084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.93
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$24.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CH IGM CSF
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$20.54
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CH IGM CSF
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.70
|
|
|
CH IGM SERUM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
|
|
CH IGM SERUM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 82784
|
| Hospital Charge Code |
397073230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$21.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.08
|
| Rate for Payer: Cigna Commercial |
$9.30
|
| Rate for Payer: Cigna Medicare Advantage |
$4.65
|
| Rate for Payer: Clover Medicare Advantage |
$8.84
|
| Rate for Payer: EmblemHealth Commercial |
$27.90
|
| Rate for Payer: Humana Medicare Advantage |
$9.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16.77
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.35
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$9.30
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$9.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.30
|
|
|
CHIKUNGUNYA AB IGG IGM W REFLX
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38479744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
|
|
CHIKUNGUNYA AB IGG IGM W REFLX
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
38479744
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$443.55 |
| Rate for Payer: Aetna Commercial |
$41.73
|
| Rate for Payer: Aetna Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$47.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$47.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$443.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$47.19
|
| Rate for Payer: Cigna Commercial |
$12.88
|
| Rate for Payer: Cigna Medicare Advantage |
$6.44
|
| Rate for Payer: Clover Medicare Advantage |
$12.24
|
| Rate for Payer: EmblemHealth Commercial |
$38.64
|
| Rate for Payer: Humana Medicare Advantage |
$13.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.70
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$58.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$12.88
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$13.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.88
|
|
|
CHILDREN'S MOTRIN/100MG
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
CHILDREN'S MOTRIN/100MG
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
CHILDREN'S TYLENOL/80MG
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60632678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
CHILDREN'S TYLENOL/80MG
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60632678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$48,411.84
|
|
|
Service Code
|
APR-DRG 0111
|
| Min. Negotiated Rate |
$47,462.59 |
| Max. Negotiated Rate |
$48,411.84 |
| Rate for Payer: Aetna Better Health Medicaid |
$47,462.59
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$48,411.84
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$96,867.22
|
|
|
Service Code
|
APR-DRG 0112
|
| Min. Negotiated Rate |
$94,967.86 |
| Max. Negotiated Rate |
$96,867.22 |
| Rate for Payer: Aetna Better Health Medicaid |
$94,967.86
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$96,867.22
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$135,611.23
|
|
|
Service Code
|
APR-DRG 0113
|
| Min. Negotiated Rate |
$132,952.19 |
| Max. Negotiated Rate |
$135,611.23 |
| Rate for Payer: Aetna Better Health Medicaid |
$132,952.19
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$135,611.23
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$252,379.95
|
|
|
Service Code
|
APR-DRG 0114
|
| Min. Negotiated Rate |
$247,431.32 |
| Max. Negotiated Rate |
$252,379.95 |
| Rate for Payer: Aetna Better Health Medicaid |
$247,431.32
|
| Rate for Payer: Wellcare New Jersey Medicaid/Family Care |
$252,379.95
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$1,456,118.87
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$400,657.73 |
| Max. Negotiated Rate |
$1,456,118.87 |
| Rate for Payer: Aetna Commercial |
$1,456,118.87
|
| Rate for Payer: Aetna Medicare Advantage |
$471,235.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,015,568.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,015,568.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage |
$421,744.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,015,568.28
|
| Rate for Payer: Cigna Medicare Advantage |
$421,744.98
|
| Rate for Payer: Clover Medicare Advantage |
$400,657.73
|
| Rate for Payer: EmblemHealth Commercial |
$1,265,234.94
|
| Rate for Payer: Humana Medicare Advantage |
$434,397.33
|
| Rate for Payer: UnitedHealthcare Medicare Advantage |
$421,744.98
|
| Rate for Payer: Wellcare Ambetter Commercial-Exchange |
$447,049.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$421,744.98
|
|
|
CH IMIPRAMINE
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
397071167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
|
|
CH IMIPRAMINE
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
397071167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare Advantage |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$27.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$27.29
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$27.29
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$13.91
|
| Rate for Payer: Oxford Commercial |
$101.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$16.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$114.00
|
|
