|
ROD CONTOURED 6.0MM 85MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 85MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$638.40
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.71
|
|
|
ROD CONTOURED 6.0MM 90MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$638.40
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.71
|
|
|
ROD CONTOURED 6.0MM 90MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670392
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 95MM
|
Facility
|
IP
|
$1,680.00
|
|
| Hospital Charge Code |
270670393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$406.56 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
|
|
ROD CONTOURED 6.0MM 95MM
|
Facility
|
OP
|
$1,680.00
|
|
| Hospital Charge Code |
270670393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$638.40
|
| Rate for Payer: Aetna Medicare Advantage |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$428.40
|
| Rate for Payer: Cigna Commercial |
$840.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$406.56
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$252.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$53.09
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$47.71
|
|
|
ROD CREO MIS CURVED 5.5X55MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVED 5.5X55MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.80
|
|
|
ROD CREO MIS CURVE TI 5.5X40MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.80
|
|
|
ROD CREO MIS CURVE TI 5.5X40MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270698397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVE TI 5.5X60MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS CURVE TI 5.5X60MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270697449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.80
|
|
|
ROD CREO MIS TI CURVE 5.5X45MM
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
|
|
ROD CREO MIS TI CURVE 5.5X45MM
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696206
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$510.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$510.00
|
| Rate for Payer: Cigna Commercial |
$1,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$484.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$300.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$56.80
|
|
|
ROD CURV BULLET NOSE 5.5X180MM
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: Aetna Medicare Advantage |
$675.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$573.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$573.75
|
| Rate for Payer: Cigna Commercial |
$1,125.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$71.10
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$63.90
|
|
|
ROD CURV BULLET NOSE 5.5X180MM
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$544.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$337.50
|
|
|
ROD CURVE 40MM
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Medicare Advantage |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$218.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$218.03
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$218.03
|
| Rate for Payer: Cigna Commercial |
$427.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$206.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.28
|
|
|
ROD CURVE 40MM
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$171.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$206.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$128.25
|
|
|
ROD CURVE 65MM
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
ROD CURVE 65MM
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688418
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
ROD CURVE 70MM
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$371.25 |
| Max. Negotiated Rate |
$598.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
|
|
ROD CURVE 70MM
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Aetna Commercial |
$940.50
|
| Rate for Payer: Aetna Medicare Advantage |
$742.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$631.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$631.12
|
| Rate for Payer: Cigna Commercial |
$1,237.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$598.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$371.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$78.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$70.29
|
|
|
ROD CURVED 20 MM
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Medicare Advantage |
$487.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$414.38
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$325.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$414.38
|
| Rate for Payer: Cigna Commercial |
$812.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$51.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.15
|
|
|
ROD CURVED 20 MM
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$325.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$393.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$243.75
|
|
|
ROD CURVED 40MM SAVANNAH-T
|
Facility
|
OP
|
$2,900.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270658046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$1,102.00
|
| Rate for Payer: Aetna Medicare Advantage |
$870.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$739.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$580.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$739.50
|
| Rate for Payer: Cigna Commercial |
$1,450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$701.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$435.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$91.64
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$82.36
|
|