|
NAIL TROCH FIX 12x170mm 130DEG
|
Facility
|
IP
|
$5,741.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$861.18 |
| Max. Negotiated Rate |
$1,389.37 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,148.24
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,389.37
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$861.18
|
|
|
NAIL TROCH FIX 340mm LEFT
|
Facility
|
IP
|
$7,555.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,133.26 |
| Max. Negotiated Rate |
$1,828.32 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,511.01
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,828.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,133.26
|
|
|
NAIL TROCH FIX 340mm LEFT
|
Facility
|
OP
|
$7,555.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270652815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.56 |
| Max. Negotiated Rate |
$3,777.53 |
| Rate for Payer: Aetna Commercial |
$2,870.92
|
| Rate for Payer: Aetna Medicare Advantage |
$2,266.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,926.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,926.54
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,511.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,926.54
|
| Rate for Payer: Cigna Commercial |
$3,777.53
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,828.32
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,133.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$238.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$214.56
|
|
|
NAIL TROCH FIX 380mm LEFT
|
Facility
|
OP
|
$7,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.31 |
| Max. Negotiated Rate |
$3,667.50 |
| Rate for Payer: Aetna Commercial |
$2,787.30
|
| Rate for Payer: Aetna Medicare Advantage |
$2,200.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,870.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,870.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,870.42
|
| Rate for Payer: Cigna Commercial |
$3,667.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,775.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,100.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$231.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$208.31
|
|
|
NAIL TROCH FIX 380mm LEFT
|
Facility
|
IP
|
$7,335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656649
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.25 |
| Max. Negotiated Rate |
$1,775.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,467.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,775.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,100.25
|
|
|
NAIL TROCH KIT 10x170MM 120 DE
|
Facility
|
IP
|
$9,742.20
|
|
| Hospital Charge Code |
270671167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.33 |
| Max. Negotiated Rate |
$2,357.61 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,948.44
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,357.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,461.33
|
|
|
NAIL TROCH KIT 10x170MM 120 DE
|
Facility
|
OP
|
$9,742.20
|
|
| Hospital Charge Code |
270671167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.68 |
| Max. Negotiated Rate |
$4,871.10 |
| Rate for Payer: Aetna Commercial |
$3,702.04
|
| Rate for Payer: Aetna Medicare Advantage |
$2,922.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,484.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,484.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,948.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,484.26
|
| Rate for Payer: Cigna Commercial |
$4,871.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,357.61
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,461.33
|
| Rate for Payer: UnitedHealthcare Community & State |
$307.85
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$276.68
|
|
|
NAIL TROCH LONG 11mm 36mm RT
|
Facility
|
IP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.00 |
| Max. Negotiated Rate |
$2,744.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
|
|
NAIL TROCH LONG 11mm 36mm RT
|
Facility
|
OP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270641254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.06 |
| Max. Negotiated Rate |
$5,670.00 |
| Rate for Payer: Aetna Commercial |
$4,309.20
|
| Rate for Payer: Aetna Medicare Advantage |
$3,402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,891.70
|
| Rate for Payer: Cigna Commercial |
$5,670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$358.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.06
|
|
|
NAIL TROCH LONG 11mmX38cm28238
|
Facility
|
IP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.00 |
| Max. Negotiated Rate |
$2,744.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
|
|
NAIL TROCH LONG 11mmX38cm28238
|
Facility
|
OP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637246
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.06 |
| Max. Negotiated Rate |
$5,670.00 |
| Rate for Payer: Aetna Commercial |
$4,309.20
|
| Rate for Payer: Aetna Medicare Advantage |
$3,402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,891.70
|
| Rate for Payer: Cigna Commercial |
$5,670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$358.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.06
|
|
|
NAIL TROCH LONG 11x36 LT 28236
|
Facility
|
OP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.06 |
| Max. Negotiated Rate |
$5,670.00 |
| Rate for Payer: Aetna Commercial |
$4,309.20
|
| Rate for Payer: Aetna Medicare Advantage |
$3,402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,891.70
|
| Rate for Payer: Cigna Commercial |
$5,670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$358.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.06
|
|
|
NAIL TROCH LONG 11x36 LT 28236
|
Facility
|
IP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.00 |
| Max. Negotiated Rate |
$2,744.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
|
|
NAIL TROCH LONG 38cm 28338
|
Facility
|
OP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.06 |
| Max. Negotiated Rate |
$5,670.00 |
| Rate for Payer: Aetna Commercial |
$4,309.20
|
| Rate for Payer: Aetna Medicare Advantage |
$3,402.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,891.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,891.70
|
| Rate for Payer: Cigna Commercial |
$5,670.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$358.34
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$322.06
|
|
|
NAIL TROCH LONG 38cm 28338
|
Facility
|
IP
|
$11,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.00 |
| Max. Negotiated Rate |
$2,744.28 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,268.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,744.28
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,701.00
|
|
|
NAIL TROCH X-SHORT 11mmDx17cmL
|
Facility
|
OP
|
$6,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$3,412.50 |
| Rate for Payer: Aetna Commercial |
$2,593.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,047.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,740.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,740.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,365.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,740.38
|
| Rate for Payer: Cigna Commercial |
$3,412.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,651.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,023.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$215.67
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$193.83
|
|
|
NAIL TROCH X-SHORT 11mmDx17cmL
|
Facility
|
IP
|
$6,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.75 |
| Max. Negotiated Rate |
$1,651.65 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,365.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,651.65
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,023.75
|
|
|
NAIL VAL 3.0 BEADED KWIRE
|
Facility
|
IP
|
$1,117.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$270.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.63
|
|
|
NAIL VAL 3.0 BEADED KWIRE
|
Facility
|
OP
|
$1,117.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$558.77 |
| Rate for Payer: Aetna Commercial |
$424.67
|
| Rate for Payer: Aetna Medicare Advantage |
$335.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$284.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$284.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$284.98
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.63
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.74
|
|
|
NAIL VAL 3.0 KWIRE
|
Facility
|
IP
|
$1,117.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$270.45 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.51
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.63
|
|
|
NAIL VAL 3.0 KWIRE
|
Facility
|
OP
|
$1,117.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$558.77 |
| Rate for Payer: Aetna Commercial |
$424.67
|
| Rate for Payer: Aetna Medicare Advantage |
$335.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$284.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$284.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$223.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$284.98
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$270.45
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$167.63
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.74
|
|
|
NAIL VAL 4.3MM DRILL SHORT
|
Facility
|
IP
|
$1,427.65
|
|
| Hospital Charge Code |
270699021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.15 |
| Max. Negotiated Rate |
$214.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.15
|
|
|
NAIL VAL 4.3MM DRILL SHORT
|
Facility
|
OP
|
$1,427.65
|
|
| Hospital Charge Code |
270699021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$713.83 |
| Rate for Payer: Aetna Commercial |
$542.51
|
| Rate for Payer: Aetna Medicare Advantage |
$428.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$364.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$364.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$364.05
|
| Rate for Payer: Cigna Commercial |
$713.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$371.19
|
| Rate for Payer: Oxford Commercial |
$285.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$285.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.11
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.55
|
|
|
NAIL VALOR 10MMX200MM
|
Facility
|
OP
|
$12,710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.96 |
| Max. Negotiated Rate |
$6,355.00 |
| Rate for Payer: Aetna Commercial |
$4,829.80
|
| Rate for Payer: Aetna Medicare Advantage |
$3,813.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,241.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,241.05
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,542.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,241.05
|
| Rate for Payer: Cigna Commercial |
$6,355.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,075.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,906.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$401.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$360.96
|
|
|
NAIL VALOR 10MMX200MM
|
Facility
|
IP
|
$12,710.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270678179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,906.50 |
| Max. Negotiated Rate |
$3,075.82 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,542.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,075.82
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,906.50
|
|