|
NAIL-LCKG. ANKLE 10X180MM
|
Facility
|
IP
|
$3,808.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.25 |
| Max. Negotiated Rate |
$921.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$761.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$921.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$571.25
|
|
|
NAIL-LCKG. ANKLE 10X180MM
|
Facility
|
OP
|
$3,808.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.16 |
| Max. Negotiated Rate |
$1,904.17 |
| Rate for Payer: Aetna Commercial |
$1,447.17
|
| Rate for Payer: Aetna Medicare Advantage |
$1,142.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$971.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$971.13
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$761.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$971.13
|
| Rate for Payer: Cigna Commercial |
$1,904.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$921.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$571.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$120.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$108.16
|
|
|
NAIL LEFT GAMA 3 10X380MM
|
Facility
|
IP
|
$17,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.00 |
| Max. Negotiated Rate |
$4,254.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
|
|
NAIL LEFT GAMA 3 10X380MM
|
Facility
|
OP
|
$17,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$8,790.00 |
| Rate for Payer: Aetna Commercial |
$6,680.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,274.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,482.90
|
| Rate for Payer: Cigna Commercial |
$8,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$555.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$499.27
|
|
|
NAIL LOCKING ANKLE
|
Facility
|
OP
|
$14,820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$7,410.00 |
| Rate for Payer: Aetna Commercial |
$5,631.60
|
| Rate for Payer: Aetna Medicare Advantage |
$4,446.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,779.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,779.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,964.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,779.10
|
| Rate for Payer: Cigna Commercial |
$7,410.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,586.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,223.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$468.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$420.89
|
|
|
NAIL LOCKING ANKLE
|
Facility
|
IP
|
$14,820.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270691270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,223.00 |
| Max. Negotiated Rate |
$3,586.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,964.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,586.44
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,223.00
|
|
|
NAIL LONG KIT 10X360X125 R1.5
|
Facility
|
OP
|
$17,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$8,790.00 |
| Rate for Payer: Aetna Commercial |
$6,680.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,274.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,482.90
|
| Rate for Payer: Cigna Commercial |
$8,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$555.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$499.27
|
|
|
NAIL LONG KIT 10X360X125 R1.5
|
Facility
|
IP
|
$17,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.00 |
| Max. Negotiated Rate |
$4,254.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
|
|
NAIL LONG LEFT 10 X 340 MM 125
|
Facility
|
OP
|
$2,370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$900.60
|
| Rate for Payer: Aetna Medicare Advantage |
$711.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$604.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$604.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$474.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$604.35
|
| Rate for Payer: Cigna Commercial |
$1,185.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$573.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$355.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$74.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$67.31
|
|
|
NAIL LONG LEFT 10 X 340 MM 125
|
Facility
|
IP
|
$2,370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270648627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$573.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$474.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$573.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$355.50
|
|
|
NAIL LONG LEFT 10 X 340 MM 125
|
Facility
|
IP
|
$17,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.00 |
| Max. Negotiated Rate |
$4,254.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
|
|
NAIL LONG LEFT 10 X 340 MM 125
|
Facility
|
OP
|
$17,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$8,790.00 |
| Rate for Payer: Aetna Commercial |
$6,680.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,274.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,482.90
|
| Rate for Payer: Cigna Commercial |
$8,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$555.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$499.27
|
|
|
Nail Long Proxi HumeralLEFT 8v
|
Facility
|
OP
|
$13,990.00
|
|
| Hospital Charge Code |
270665197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.32 |
| Max. Negotiated Rate |
$6,995.00 |
| Rate for Payer: Aetna Commercial |
$5,316.20
|
| Rate for Payer: Aetna Medicare Advantage |
$4,197.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,567.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,567.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,798.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,567.45
|
| Rate for Payer: Cigna Commercial |
$6,995.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,385.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,098.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$442.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$397.32
|
|
|
Nail Long Proxi HumeralLEFT 8v
|
Facility
|
IP
|
$13,990.00
|
|
| Hospital Charge Code |
270665197
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,098.50 |
| Max. Negotiated Rate |
$3,385.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,798.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,385.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,098.50
|
|
|
NAIL LONG PROXIMAL HUMERAL RT
|
Facility
|
IP
|
$1,340.00
|
|
| Hospital Charge Code |
270661244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$324.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.00
|
|
|
NAIL LONG PROXIMAL HUMERAL RT
|
Facility
|
OP
|
$1,340.00
|
|
| Hospital Charge Code |
270661244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna Commercial |
$509.20
|
| Rate for Payer: Aetna Medicare Advantage |
$402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$341.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$341.70
|
| Rate for Payer: Cigna Commercial |
$670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$324.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$201.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.06
|
|
|
NAIL LONG R1.5 TI RT 10X420MM
|
Facility
|
IP
|
$17,580.00
|
|
| Hospital Charge Code |
270667983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,637.00 |
| Max. Negotiated Rate |
$4,254.36 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
|
|
NAIL LONG R1.5 TI RT 10X420MM
|
Facility
|
OP
|
$17,580.00
|
|
| Hospital Charge Code |
270667983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.27 |
| Max. Negotiated Rate |
$8,790.00 |
| Rate for Payer: Aetna Commercial |
$6,680.40
|
| Rate for Payer: Aetna Medicare Advantage |
$5,274.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,482.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,516.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,482.90
|
| Rate for Payer: Cigna Commercial |
$8,790.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,254.36
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,637.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$555.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$499.27
|
|
|
NAIL LONG TI LEFT 10x360mm
|
Facility
|
IP
|
$18,460.00
|
|
| Hospital Charge Code |
270671131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,769.00 |
| Max. Negotiated Rate |
$4,467.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,692.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,467.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,769.00
|
|
|
NAIL LONG TI LEFT 10x360mm
|
Facility
|
OP
|
$18,460.00
|
|
| Hospital Charge Code |
270671131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.26 |
| Max. Negotiated Rate |
$9,230.00 |
| Rate for Payer: Aetna Commercial |
$7,014.80
|
| Rate for Payer: Aetna Medicare Advantage |
$5,538.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4,707.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4,707.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,692.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4,707.30
|
| Rate for Payer: Cigna Commercial |
$9,230.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,467.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,769.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$583.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$524.26
|
|
|
NAIL OST IKA KNEE 14/30 150MM
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.00
|
|
|
NAIL OST IKA KNEE 14/30 150MM
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
NAIL OST IKA KNEE 16/30 150MM
|
Facility
|
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
|
|
NAIL OST IKA KNEE 16/30 150MM
|
Facility
|
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$3,800.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,550.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,000.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,550.00
|
| Rate for Payer: Cigna Commercial |
$5,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,420.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,500.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$316.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$284.00
|
|
|
NAIL PANTA 11LGx180MM
|
Facility
|
IP
|
$16,651.80
|
|
| Hospital Charge Code |
270666222
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,497.77 |
| Max. Negotiated Rate |
$4,029.74 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$3,330.36
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4,029.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,497.77
|
|