|
PLATE CONDYLAR 4.5MM 14H LT
|
Facility
|
OP
|
$8,241.05
|
|
| Hospital Charge Code |
270677615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.05 |
| Max. Negotiated Rate |
$4,120.52 |
| Rate for Payer: Aetna Commercial |
$3,131.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2,472.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,101.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,101.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,648.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,101.47
|
| Rate for Payer: Cigna Commercial |
$4,120.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,994.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,236.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.05
|
|
|
PLATE CONDYLAR 4.5MM 14H LT
|
Facility
|
IP
|
$8,241.05
|
|
| Hospital Charge Code |
270677615
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.16 |
| Max. Negotiated Rate |
$1,994.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,648.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,994.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,236.16
|
|
|
PLATE CONDYLAR 4.5MM 14H RT
|
Facility
|
OP
|
$8,241.05
|
|
| Hospital Charge Code |
270677614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.05 |
| Max. Negotiated Rate |
$4,120.52 |
| Rate for Payer: Aetna Commercial |
$3,131.60
|
| Rate for Payer: Aetna Medicare Advantage |
$2,472.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,101.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,101.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,648.21
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,101.47
|
| Rate for Payer: Cigna Commercial |
$4,120.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,994.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,236.16
|
| Rate for Payer: UnitedHealthcare Community & State |
$260.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$234.05
|
|
|
PLATE CONDYLAR 4.5MM 14H RT
|
Facility
|
IP
|
$8,241.05
|
|
| Hospital Charge Code |
270677614
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.16 |
| Max. Negotiated Rate |
$1,994.33 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,648.21
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,994.33
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,236.16
|
|
|
PLATE CONDYLAR 4.5MM 16H LT
|
Facility
|
IP
|
$8,401.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.26 |
| Max. Negotiated Rate |
$2,033.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,680.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,033.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,260.26
|
|
|
PLATE CONDYLAR 4.5MM 16H LT
|
Facility
|
OP
|
$8,401.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.61 |
| Max. Negotiated Rate |
$4,200.85 |
| Rate for Payer: Aetna Commercial |
$3,192.65
|
| Rate for Payer: Aetna Medicare Advantage |
$2,520.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,142.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,142.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,680.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,142.43
|
| Rate for Payer: Cigna Commercial |
$4,200.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,033.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,260.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.61
|
|
|
PLATE CONDYLAR 4.5MM 16H RT
|
Facility
|
OP
|
$8,401.70
|
|
| Hospital Charge Code |
270677616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.61 |
| Max. Negotiated Rate |
$4,200.85 |
| Rate for Payer: Aetna Commercial |
$3,192.65
|
| Rate for Payer: Aetna Medicare Advantage |
$2,520.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,142.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,142.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,680.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,142.43
|
| Rate for Payer: Cigna Commercial |
$4,200.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,033.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,260.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$265.49
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$238.61
|
|
|
PLATE CONDYLAR 4.5MM 16H RT
|
Facility
|
IP
|
$8,401.70
|
|
| Hospital Charge Code |
270677616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,260.26 |
| Max. Negotiated Rate |
$2,033.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,680.34
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,033.21
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,260.26
|
|
|
PLATE CONDYLAR 4.5MM 6H LT
|
Facility
|
IP
|
$7,088.45
|
|
| Hospital Charge Code |
270677608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,063.27 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,417.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,715.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,063.27
|
|
|
PLATE CONDYLAR 4.5MM 6H LT
|
Facility
|
OP
|
$7,088.45
|
|
| Hospital Charge Code |
270677608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$3,544.22 |
| Rate for Payer: Aetna Commercial |
$2,693.61
|
| Rate for Payer: Aetna Medicare Advantage |
$2,126.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,807.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,807.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,417.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,807.55
|
| Rate for Payer: Cigna Commercial |
$3,544.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,715.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,063.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$224.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$201.31
|
|
|
PLATE CONDYLAR 4.5MM 6H RT
|
Facility
|
OP
|
$7,088.45
|
|
| Hospital Charge Code |
270677607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$3,544.22 |
| Rate for Payer: Aetna Commercial |
$2,693.61
|
| Rate for Payer: Aetna Medicare Advantage |
$2,126.53
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,807.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,807.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,417.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,807.55
|
| Rate for Payer: Cigna Commercial |
$3,544.22
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,715.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,063.27
|
| Rate for Payer: UnitedHealthcare Community & State |
$224.00
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$201.31
|
|
|
PLATE CONDYLAR 4.5MM 6H RT
|
Facility
|
IP
|
$7,088.45
|
|
| Hospital Charge Code |
270677607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,063.27 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,417.69
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,715.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,063.27
|
|
|
PLATE CONDYLAR 4.5MM 6H RT ST
|
Facility
|
IP
|
$7,083.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,062.45 |
| Max. Negotiated Rate |
$1,714.09 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,416.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,714.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,062.45
|
|
|
PLATE CONDYLAR 4.5MM 6H RT ST
|
Facility
|
OP
|
$7,083.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.16 |
| Max. Negotiated Rate |
$3,541.50 |
| Rate for Payer: Aetna Commercial |
$2,691.54
|
| Rate for Payer: Aetna Medicare Advantage |
$2,124.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,806.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,806.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,416.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,806.16
|
| Rate for Payer: Cigna Commercial |
$3,541.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,714.09
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,062.45
|
| Rate for Payer: UnitedHealthcare Community & State |
$223.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$201.16
|
|
|
PLATE CONDYLAR 4.5MM 8H LT
|
Facility
|
OP
|
$7,227.50
|
|
| Hospital Charge Code |
270677610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.26 |
| Max. Negotiated Rate |
$3,613.75 |
| Rate for Payer: Aetna Commercial |
$2,746.45
|
| Rate for Payer: Aetna Medicare Advantage |
$2,168.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,843.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,843.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,843.01
|
| Rate for Payer: Cigna Commercial |
$3,613.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,749.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,084.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$205.26
|
|
|
PLATE CONDYLAR 4.5MM 8H LT
|
Facility
|
IP
|
$7,227.50
|
|
| Hospital Charge Code |
270677610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.12 |
| Max. Negotiated Rate |
$1,749.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,445.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,749.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,084.12
|
|
|
PLATE CONDYLAR 4.5MM 8H LT ST
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$3,772.50 |
| Rate for Payer: Aetna Commercial |
$2,867.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2,263.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,923.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,923.97
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,509.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,923.97
|
| Rate for Payer: Cigna Commercial |
$3,772.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,825.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,131.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$238.42
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$214.28
|
|
|
PLATE CONDYLAR 4.5MM 8H LT ST
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.75 |
| Max. Negotiated Rate |
$1,825.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,509.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,825.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,131.75
|
|
|
PLATE CONDYLAR 4.5MM 8H RT
|
Facility
|
IP
|
$7,227.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.12 |
| Max. Negotiated Rate |
$1,749.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,445.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,749.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,084.12
|
|
|
PLATE CONDYLAR 4.5MM 8H RT
|
Facility
|
OP
|
$7,227.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.26 |
| Max. Negotiated Rate |
$3,613.75 |
| Rate for Payer: Aetna Commercial |
$2,746.45
|
| Rate for Payer: Aetna Medicare Advantage |
$2,168.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,843.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,843.01
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,445.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,843.01
|
| Rate for Payer: Cigna Commercial |
$3,613.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,749.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,084.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$205.26
|
|
|
PLATE CONDYLAR 4.5MM 8H RT ST
|
Facility
|
IP
|
$7,218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.70 |
| Max. Negotiated Rate |
$1,746.76 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,443.60
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,746.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,082.70
|
|
|
PLATE CONDYLAR 4.5MM 8H RT ST
|
Facility
|
OP
|
$7,218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270677136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.99 |
| Max. Negotiated Rate |
$3,609.00 |
| Rate for Payer: Aetna Commercial |
$2,742.84
|
| Rate for Payer: Aetna Medicare Advantage |
$2,165.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,840.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,840.59
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,443.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,840.59
|
| Rate for Payer: Cigna Commercial |
$3,609.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,746.76
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,082.70
|
| Rate for Payer: UnitedHealthcare Community & State |
$228.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$204.99
|
|
|
PLATE CONDYLAR LCP 7H 2x54MM
|
Facility
|
OP
|
$3,373.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$1,686.83 |
| Rate for Payer: Aetna Commercial |
$1,281.99
|
| Rate for Payer: Aetna Medicare Advantage |
$1,012.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$860.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$860.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$674.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$860.28
|
| Rate for Payer: Cigna Commercial |
$1,686.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.05
|
| Rate for Payer: UnitedHealthcare Community & State |
$106.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$95.81
|
|
|
PLATE CONDYLAR LCP 7H 2x54MM
|
Facility
|
IP
|
$3,373.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.05 |
| Max. Negotiated Rate |
$816.42 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$674.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$816.42
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$506.05
|
|
|
PLATE CONDY LCP 10H 230MM LT
|
Facility
|
IP
|
$7,545.00
|
|
| Hospital Charge Code |
270676149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.75 |
| Max. Negotiated Rate |
$1,825.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,509.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,825.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,131.75
|
|