|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
OP
|
$61,616.39
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
366837225R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.91 |
| Max. Negotiated Rate |
$30,808.19 |
| Rate for Payer: Aetna Commercial |
$23,414.23
|
| Rate for Payer: Aetna Medicare Advantage |
$18,484.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,712.18
|
| Rate for Payer: Cigna Commercial |
$30,808.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,020.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,242.46
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,947.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,749.91
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
OP
|
$61,616.39
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
321037225R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.91 |
| Max. Negotiated Rate |
$30,808.19 |
| Rate for Payer: Aetna Commercial |
$23,414.23
|
| Rate for Payer: Aetna Medicare Advantage |
$18,484.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,712.18
|
| Rate for Payer: Cigna Commercial |
$30,808.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,020.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,242.46
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,947.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,749.91
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
IP
|
$61,616.39
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
366837225R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,242.46 |
| Max. Negotiated Rate |
$9,242.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,242.46
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
OP
|
$47,711.75
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
7412044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,355.01 |
| Max. Negotiated Rate |
$23,855.88 |
| Rate for Payer: Aetna Commercial |
$18,130.47
|
| Rate for Payer: Aetna Medicare Advantage |
$14,313.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12,166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12,166.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12,166.50
|
| Rate for Payer: Cigna Commercial |
$23,855.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$12,405.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,156.76
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,507.69
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,355.01
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
IP
|
$47,711.75
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
7412044
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,156.76 |
| Max. Negotiated Rate |
$7,156.76 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7,156.76
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
OP
|
$61,616.39
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
7411928
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.91 |
| Max. Negotiated Rate |
$30,808.19 |
| Rate for Payer: Aetna Commercial |
$23,414.23
|
| Rate for Payer: Aetna Medicare Advantage |
$18,484.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,712.18
|
| Rate for Payer: Cigna Commercial |
$30,808.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,020.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,242.46
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,947.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,749.91
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
IP
|
$61,616.39
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
2691380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,242.46 |
| Max. Negotiated Rate |
$9,242.46 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,242.46
|
|
|
IR-ATHERECTOMY-FEM POP-RT
|
Facility
|
OP
|
$61,616.39
|
|
|
Service Code
|
HCPCS 37225RT
|
| Hospital Charge Code |
2691380
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,749.91 |
| Max. Negotiated Rate |
$30,808.19 |
| Rate for Payer: Aetna Commercial |
$23,414.23
|
| Rate for Payer: Aetna Medicare Advantage |
$18,484.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$15,712.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$15,712.18
|
| Rate for Payer: Cigna Commercial |
$30,808.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$16,020.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9,242.46
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,947.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,749.91
|
|
|
IR-ATHERECTOMY-TIBIOP-BIL
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 3722950
|
| Hospital Charge Code |
7411808
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-BIL
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 3722950
|
| Hospital Charge Code |
7411808
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
366837229L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
7411936
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
2691420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
7411936
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
2691420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
321037229L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
321037229L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-LT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229LT
|
| Hospital Charge Code |
366837229L
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
366837229R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
411037229R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
366837229R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
411037229R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
321037229R
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
IP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
2691425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14,087.68 |
| Max. Negotiated Rate |
$14,087.68 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
|
|
IR-ATHERECTOMY-TIBIOP-RT
|
Facility
|
OP
|
$93,917.89
|
|
|
Service Code
|
HCPCS 37229RT
|
| Hospital Charge Code |
2691425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,667.27 |
| Max. Negotiated Rate |
$46,958.94 |
| Rate for Payer: Aetna Commercial |
$35,688.80
|
| Rate for Payer: Aetna Medicare Advantage |
$28,175.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23,949.06
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,536.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23,949.06
|
| Rate for Payer: Cigna Commercial |
$46,958.94
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$24,418.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14,087.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$2,967.81
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2,667.27
|
|