|
BALLOON CATH SDS 5FR 4x4 135cm
|
Facility
|
IP
|
$857.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270637377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$207.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
BALLOON CATH SDS 5FR 4x4 135cm
|
Facility
|
OP
|
$857.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270637377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$428.75 |
| Rate for Payer: Aetna Commercial |
$325.85
|
| Rate for Payer: Aetna Medicare Advantage |
$257.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.66
|
| Rate for Payer: Cigna Commercial |
$428.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.35
|
|
|
BALLOON CATH SDS 5FR 6x4 135cm
|
Facility
|
IP
|
$857.50
|
|
| Hospital Charge Code |
270635574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$128.62 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
BALLOON CATH SDS 5FR 6x4 135cm
|
Facility
|
OP
|
$857.50
|
|
| Hospital Charge Code |
270635574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$428.75 |
| Rate for Payer: Aetna Commercial |
$325.85
|
| Rate for Payer: Aetna Medicare Advantage |
$257.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.66
|
| Rate for Payer: Cigna Commercial |
$428.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$222.95
|
| Rate for Payer: Oxford Commercial |
$171.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
| Rate for Payer: UnitedHealthcare Commercial |
$171.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.35
|
|
|
BALLOON CATH SDS 5FR 7x4 135cm
|
Facility
|
IP
|
$857.50
|
|
| Hospital Charge Code |
270635773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$207.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
BALLOON CATH SDS 5FR 7x4 135cm
|
Facility
|
OP
|
$857.50
|
|
| Hospital Charge Code |
270635773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$428.75 |
| Rate for Payer: Aetna Commercial |
$325.85
|
| Rate for Payer: Aetna Medicare Advantage |
$257.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.66
|
| Rate for Payer: Cigna Commercial |
$428.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.35
|
|
|
BALLOON CATH SDS 7FR 8x6 75cm
|
Facility
|
OP
|
$857.50
|
|
| Hospital Charge Code |
270639322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$428.75 |
| Rate for Payer: Aetna Commercial |
$325.85
|
| Rate for Payer: Aetna Medicare Advantage |
$257.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.66
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.66
|
| Rate for Payer: Cigna Commercial |
$428.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.35
|
|
|
BALLOON CATH SDS 7FR 8x6 75cm
|
Facility
|
IP
|
$857.50
|
|
| Hospital Charge Code |
270639322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$207.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$207.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.62
|
|
|
BALLOON CATH SL OTW 4x150MM
|
Facility
|
OP
|
$1,642.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270670064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$821.42 |
| Rate for Payer: Aetna Commercial |
$624.28
|
| Rate for Payer: Aetna Medicare Advantage |
$492.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$418.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$418.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$328.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$418.93
|
| Rate for Payer: Cigna Commercial |
$821.42
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$246.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.66
|
|
|
BALLOON CATH SL OTW 4x150MM
|
Facility
|
IP
|
$1,642.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270670064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.43 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$328.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$397.57
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$246.43
|
|
|
BALLOON CATH XXL 12-4/5.8/75cm
|
Facility
|
OP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270623292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$716.38 |
| Rate for Payer: Aetna Commercial |
$544.45
|
| Rate for Payer: Aetna Medicare Advantage |
$429.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$365.35
|
| Rate for Payer: Cigna Commercial |
$716.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.69
|
|
|
BALLOON CATH XXL 12-4/5.8/75cm
|
Facility
|
IP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270623292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$346.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
|
|
BALLOON CATH XXL 12-4/5.8/75CM
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270623292N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$302.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
|
|
BALLOON CATH XXL 12-4/5.8/75CM
|
Facility
|
IP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270623292C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$346.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
|
|
BALLOON CATH XXL 12-4/5.8/75CM
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270623292N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$475.00
|
| Rate for Payer: Aetna Medicare Advantage |
$375.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$318.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$250.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$318.75
|
| Rate for Payer: Cigna Commercial |
$625.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$302.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$187.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.50
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.50
|
|
|
BALLOON CATH XXL 12-4/5.8/75CM
|
Facility
|
OP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270623292C
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$716.38 |
| Rate for Payer: Aetna Commercial |
$544.45
|
| Rate for Payer: Aetna Medicare Advantage |
$429.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$365.35
|
| Rate for Payer: Cigna Commercial |
$716.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.69
|
|
|
BALLOON CATH XXL 12-6/5.8/75cm
|
Facility
|
IP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270626885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$346.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
|
|
BALLOON CATH XXL 12-6/5.8/75cm
|
Facility
|
IP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270626885N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$346.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
|
|
BALLOON CATH XXL 12-6/5.8/75cm
|
Facility
|
IP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270626885S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$346.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
|
|
BALLOON CATH XXL 12-6/5.8/75cm
|
Facility
|
OP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270626885N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$716.38 |
| Rate for Payer: Aetna Commercial |
$544.45
|
| Rate for Payer: Aetna Medicare Advantage |
$429.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$365.35
|
| Rate for Payer: Cigna Commercial |
$716.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.69
|
|
|
BALLOON CATH XXL 12-6/5.8/75cm
|
Facility
|
OP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270626885S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$716.38 |
| Rate for Payer: Aetna Commercial |
$544.45
|
| Rate for Payer: Aetna Medicare Advantage |
$429.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$365.35
|
| Rate for Payer: Cigna Commercial |
$716.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.69
|
|
|
BALLOON CATH XXL 12-6/5.8/75cm
|
Facility
|
OP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270626885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$716.38 |
| Rate for Payer: Aetna Commercial |
$544.45
|
| Rate for Payer: Aetna Medicare Advantage |
$429.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$365.35
|
| Rate for Payer: Cigna Commercial |
$716.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.69
|
|
|
BALLOON CATH XXL 14-4/5.8/75cm
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624069S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$314.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$260.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
|
|
BALLOON CATH XXL 14-4/5.8/75cm
|
Facility
|
OP
|
$1,432.75
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624069N
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$716.38 |
| Rate for Payer: Aetna Commercial |
$544.45
|
| Rate for Payer: Aetna Medicare Advantage |
$429.82
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$365.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$286.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$365.35
|
| Rate for Payer: Cigna Commercial |
$716.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$346.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$214.91
|
| Rate for Payer: UnitedHealthcare Community & State |
$45.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.69
|
|
|
BALLOON CATH XXL 14-4/5.8/75cm
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
270624069S
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$494.00
|
| Rate for Payer: Aetna Medicare Advantage |
$390.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$331.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$260.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$331.50
|
| Rate for Payer: Cigna Commercial |
$650.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$314.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$195.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$41.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.92
|
|
