|
ONLAY TIB INSRT SZ4 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ4 8MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ4 9MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ4 9MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ5 10MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ5 10MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668833
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ5 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ5 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668834
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ5 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ5 8MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ5 9MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ5 9MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ6 10MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ6 10MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668837
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ6 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ6 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668838
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ6 8MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ6 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668835
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ6 9MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ6 9MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668836
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ7 10MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ7 10MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ7 12MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|
|
ONLAY TIB INSRT SZ7 12MM THICK
|
Facility
|
IP
|
$5,435.00
|
|
| Hospital Charge Code |
270668842
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$815.25 |
| Max. Negotiated Rate |
$1,315.27 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
|
|
ONLAY TIB INSRT SZ7 8MM THICK
|
Facility
|
OP
|
$5,435.00
|
|
| Hospital Charge Code |
270668839
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$2,717.50 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare Advantage |
$1,630.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,385.92
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,087.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,385.92
|
| Rate for Payer: Cigna Commercial |
$2,717.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,315.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$815.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$171.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$154.35
|
|