|
MESH ELLIPSE 6 X 8 IN
|
Facility
|
IP
|
$6,431.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.73 |
| Max. Negotiated Rate |
$1,556.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,286.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,556.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$964.73
|
|
|
MESH ELLIPSE 6 X 8 IN
|
Facility
|
OP
|
$6,431.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.65 |
| Max. Negotiated Rate |
$3,215.75 |
| Rate for Payer: Aetna Commercial |
$2,443.97
|
| Rate for Payer: Aetna Medicare Advantage |
$1,929.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,640.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,640.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,286.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,640.03
|
| Rate for Payer: Cigna Commercial |
$3,215.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,556.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$964.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$203.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$182.65
|
|
|
MESH ELLIPSE 7 X9 IN VENTRALIG
|
Facility
|
OP
|
$8,593.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.06 |
| Max. Negotiated Rate |
$4,296.75 |
| Rate for Payer: Aetna Commercial |
$3,265.53
|
| Rate for Payer: Aetna Medicare Advantage |
$2,578.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,191.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,191.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,718.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,191.34
|
| Rate for Payer: Cigna Commercial |
$4,296.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,079.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,289.03
|
| Rate for Payer: UnitedHealthcare Community & State |
$271.55
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$244.06
|
|
|
MESH ELLIPSE 7 X9 IN VENTRALIG
|
Facility
|
IP
|
$8,593.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.03 |
| Max. Negotiated Rate |
$2,079.63 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,718.70
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,079.63
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,289.03
|
|
|
MESH ELLIPSE 8 X 10 IN
|
Facility
|
IP
|
$11,102.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,665.30 |
| Max. Negotiated Rate |
$2,686.68 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,220.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,686.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,665.30
|
|
|
MESH ELLIPSE 8 X 10 IN
|
Facility
|
OP
|
$11,102.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$315.30 |
| Max. Negotiated Rate |
$5,551.00 |
| Rate for Payer: Aetna Commercial |
$4,218.76
|
| Rate for Payer: Aetna Medicare Advantage |
$3,330.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,831.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,831.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,220.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,831.01
|
| Rate for Payer: Cigna Commercial |
$5,551.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,686.68
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,665.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$350.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$315.30
|
|
|
MESH,HERNIA, BARD COMP 48 INCH
|
Facility
|
IP
|
$257.00
|
|
| Hospital Charge Code |
270335383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
|
|
MESH,HERNIA, BARD COMP 48 INCH
|
Facility
|
OP
|
$257.00
|
|
| Hospital Charge Code |
270335383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$128.50 |
| Rate for Payer: Aetna Commercial |
$97.66
|
| Rate for Payer: Aetna Medicare Advantage |
$77.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.53
|
| Rate for Payer: Cigna Commercial |
$128.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.30
|
|
|
MESH,HERNIA,BARD COMPO 140 INC
|
Facility
|
OP
|
$257.00
|
|
| Hospital Charge Code |
270335385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$128.50 |
| Rate for Payer: Aetna Commercial |
$97.66
|
| Rate for Payer: Aetna Medicare Advantage |
$77.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.53
|
| Rate for Payer: Cigna Commercial |
$128.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.30
|
|
|
MESH,HERNIA,BARD COMPO 140 INC
|
Facility
|
IP
|
$257.00
|
|
| Hospital Charge Code |
270335385
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
|
|
MESH,HERNIA,BARD COMPO. 32 INC
|
Facility
|
OP
|
$257.00
|
|
| Hospital Charge Code |
270335382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$128.50 |
| Rate for Payer: Aetna Commercial |
$97.66
|
| Rate for Payer: Aetna Medicare Advantage |
$77.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.53
|
| Rate for Payer: Cigna Commercial |
$128.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.30
|
|
|
MESH,HERNIA,BARD COMPO. 32 INC
|
Facility
|
IP
|
$257.00
|
|
| Hospital Charge Code |
270335382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
|
|
MESH,HERNIA BARD COMPO 80 INCH
|
Facility
|
OP
|
$257.00
|
|
| Hospital Charge Code |
270335384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$128.50 |
| Rate for Payer: Aetna Commercial |
$97.66
|
| Rate for Payer: Aetna Medicare Advantage |
$77.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$65.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$65.53
|
| Rate for Payer: Cigna Commercial |
$128.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$8.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$7.30
|
|
|
MESH,HERNIA BARD COMPO 80 INCH
|
Facility
|
IP
|
$257.00
|
|
| Hospital Charge Code |
270335384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$62.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$51.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$62.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$38.55
|
|
|
MESH,HERNIA,BARD COMPO 8-18 IN
|
Facility
|
OP
|
$198.00
|
|
| Hospital Charge Code |
270335381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$75.24
|
| Rate for Payer: Aetna Medicare Advantage |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$50.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$50.49
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$50.49
|
| Rate for Payer: Cigna Commercial |
$99.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$6.26
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$5.62
|
|
|
MESH,HERNIA,BARD COMPO 8-18 IN
|
Facility
|
IP
|
$198.00
|
|
| Hospital Charge Code |
270335381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$47.92 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$39.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$47.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$29.70
|
|
|
MESH HERNIA L30xW15CM RECT
|
Facility
|
OP
|
$2,421.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270686569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$1,210.95 |
| Rate for Payer: Aetna Commercial |
$920.32
|
| Rate for Payer: Aetna Medicare Advantage |
$726.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$617.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$617.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$484.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$617.58
|
| Rate for Payer: Cigna Commercial |
$1,210.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$586.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.29
|
| Rate for Payer: UnitedHealthcare Community & State |
$76.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$68.78
|
|
|
MESH HERNIA L30xW15CM RECT
|
Facility
|
IP
|
$2,421.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270686569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.29 |
| Max. Negotiated Rate |
$586.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$484.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$586.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$363.29
|
|
|
MESH HERNIA MED RIGHT 3DMAX
|
Facility
|
IP
|
$1,442.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270685502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$216.30 |
| Max. Negotiated Rate |
$348.96 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.30
|
|
|
MESH HERNIA MED RIGHT 3DMAX
|
Facility
|
OP
|
$1,442.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270685502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna Commercial |
$547.96
|
| Rate for Payer: Aetna Medicare Advantage |
$432.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$367.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$367.71
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$288.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$367.71
|
| Rate for Payer: Cigna Commercial |
$721.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$348.96
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$216.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.95
|
|
|
MESH HERNIA SYMBOTEX 20X15CM
|
Facility
|
OP
|
$5,585.35
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270686534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$2,792.68 |
| Rate for Payer: Aetna Commercial |
$2,122.43
|
| Rate for Payer: Aetna Medicare Advantage |
$1,675.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,424.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,424.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,117.07
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,424.26
|
| Rate for Payer: Cigna Commercial |
$2,792.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,351.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$837.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$176.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$158.62
|
|
|
MESH HERNIA SYMBOTEX 20X15CM
|
Facility
|
IP
|
$5,585.35
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270686534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$837.80 |
| Max. Negotiated Rate |
$1,351.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,117.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,351.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$837.80
|
|
|
MESH HERNIA SYSTEM MED
|
Facility
|
OP
|
$1,448.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270650897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$724.38 |
| Rate for Payer: Aetna Commercial |
$550.52
|
| Rate for Payer: Aetna Medicare Advantage |
$434.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$369.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$369.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$289.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$369.43
|
| Rate for Payer: Cigna Commercial |
$724.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$350.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.31
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.14
|
|
|
MESH HERNIA SYSTEM MED
|
Facility
|
IP
|
$1,448.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270650897
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.31 |
| Max. Negotiated Rate |
$350.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$289.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$350.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$217.31
|
|
|
MESH INGUINAL 3DMAX LARGE 4X6
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270685691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Medicare Advantage |
$370.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$314.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$314.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$247.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$314.93
|
| Rate for Payer: Cigna Commercial |
$617.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$298.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$185.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.07
|
|