|
SCREW CANNULATED 6.5x90MM
|
Facility
|
OP
|
$2,020.00
|
|
| Hospital Charge Code |
270672688
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.37 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: Aetna Commercial |
$767.60
|
| Rate for Payer: Aetna Medicare Advantage |
$606.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$515.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$515.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$404.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$515.10
|
| Rate for Payer: Cigna Commercial |
$1,010.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$488.84
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$303.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$63.83
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$57.37
|
|
|
SCREW CANNULATED 7.5X35MM
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
SCREW CANNULATED 7.5X35MM
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW CANNULATED AR-8730-24PT
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$353.40
|
| Rate for Payer: Aetna Medicare Advantage |
$279.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$237.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$237.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$237.15
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.41
|
|
|
SCREW CANNULATED AR-8730-24PT
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$225.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$186.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$225.06
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$139.50
|
|
|
SCREW CANNULATED ASNIS 4X12MM
|
Facility
|
IP
|
$1,360.00
|
|
| Hospital Charge Code |
270670579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANNULATED ASNIS 4X12MM
|
Facility
|
OP
|
$1,360.00
|
|
| Hospital Charge Code |
270670579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.62
|
|
|
SCREW CANNULATED ASNIS 4X14MM
|
Facility
|
IP
|
$1,360.00
|
|
| Hospital Charge Code |
270670578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANNULATED ASNIS 4X14MM
|
Facility
|
OP
|
$1,360.00
|
|
| Hospital Charge Code |
270670578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.62
|
|
|
SCREW CANNULATED ASNIS 4X40MM
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.62
|
|
|
SCREW CANNULATED ASNIS 4X40MM
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANNULATED ASNIS 4X55MM
|
Facility
|
IP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$329.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
|
|
SCREW CANNULATED ASNIS 4X55MM
|
Facility
|
OP
|
$1,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270670577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$516.80
|
| Rate for Payer: Aetna Medicare Advantage |
$408.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$346.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$346.80
|
| Rate for Payer: Cigna Commercial |
$680.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$329.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$204.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$42.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$38.62
|
|
|
SCREW CANNULATED LG 7.0D/16MMT
|
Facility
|
OP
|
$1,092.00
|
|
| Hospital Charge Code |
270654622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Medicare Advantage |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$278.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$278.46
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$278.46
|
| Rate for Payer: Cigna Commercial |
$546.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.51
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.01
|
|
|
SCREW CANNULATED LG 7.0D/16MMT
|
Facility
|
IP
|
$1,092.00
|
|
| Hospital Charge Code |
270654622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$264.26 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$218.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$264.26
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$163.80
|
|
|
SCREW CANNULATED MIS 6.5X35
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
SCREW CANNULATED MIS 6.5X35
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW CANNULATED MIS 6.5X45
|
Facility
|
IP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$2,601.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
|
|
SCREW CANNULATED MIS 6.5X45
|
Facility
|
OP
|
$10,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694770
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$305.30 |
| Max. Negotiated Rate |
$5,375.00 |
| Rate for Payer: Aetna Commercial |
$4,085.00
|
| Rate for Payer: Aetna Medicare Advantage |
$3,225.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,741.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,741.25
|
| Rate for Payer: Cigna Commercial |
$5,375.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,601.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,612.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$339.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$305.30
|
|
|
SCREW CANNULATED PT/THD 3x32MM
|
Facility
|
IP
|
$860.00
|
|
| Hospital Charge Code |
270672899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$172.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.00
|
|
|
SCREW CANNULATED PT/THD 3x32MM
|
Facility
|
OP
|
$860.00
|
|
| Hospital Charge Code |
270672899
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Medicare Advantage |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$172.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.30
|
| Rate for Payer: Cigna Commercial |
$430.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.42
|
|
|
SCREW CANNULATED PT/THD 3x36MM
|
Facility
|
OP
|
$860.00
|
|
| Hospital Charge Code |
270672898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Medicare Advantage |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$172.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$219.30
|
| Rate for Payer: Cigna Commercial |
$430.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.18
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.42
|
|
|
SCREW CANNULATED PT/THD 3x36MM
|
Facility
|
IP
|
$860.00
|
|
| Hospital Charge Code |
270672898
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$172.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$208.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$129.00
|
|
|
SCREW CANNULATED TI 4.0X36MM
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$360.58 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$360.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.50
|
|
|
SCREW CANNULATED TI 4.0X36MM
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.32 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Medicare Advantage |
$447.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$379.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$379.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$298.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$379.95
|
| Rate for Payer: Cigna Commercial |
$745.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$360.58
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$223.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.08
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.32
|
|