|
SCREW LOCKING LOW PRO 3x14MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Medicare Advantage |
$165.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.25
|
| Rate for Payer: Cigna Commercial |
$275.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.62
|
|
|
SCREW LOCKING LOW PRO 3x14MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270668717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$133.10 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.50
|
|
|
SCREW LOCKING LOW PRO 3x18MM
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270666081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$418.00
|
| Rate for Payer: Aetna Medicare Advantage |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$280.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$280.50
|
| Rate for Payer: Cigna Commercial |
$550.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$34.76
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.24
|
|
|
SCREW LOCKING LOW PRO 3x18MM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270666081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$266.20 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$220.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$266.20
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$165.00
|
|
|
SCREW LOCKING NL LP 2.7X16MMST
|
Facility
|
IP
|
$9,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.75 |
| Max. Negotiated Rate |
$2,193.73 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,813.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,193.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,359.75
|
|
|
SCREW LOCKING NL LP 2.7X16MMST
|
Facility
|
OP
|
$9,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270694569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$4,532.50 |
| Rate for Payer: Aetna Commercial |
$3,444.70
|
| Rate for Payer: Aetna Medicare Advantage |
$2,719.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,311.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,311.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,813.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,311.57
|
| Rate for Payer: Cigna Commercial |
$4,532.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,193.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,359.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$286.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$257.45
|
|
|
SCREW LOCKING NON 2.0X11 MM
|
Facility
|
IP
|
$925.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.82 |
| Max. Negotiated Rate |
$223.97 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.82
|
|
|
SCREW LOCKING NON 2.0X11 MM
|
Facility
|
OP
|
$925.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$462.75 |
| Rate for Payer: Aetna Commercial |
$351.69
|
| Rate for Payer: Aetna Medicare Advantage |
$277.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$236.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$185.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$236.00
|
| Rate for Payer: Cigna Commercial |
$462.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$223.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$138.82
|
| Rate for Payer: UnitedHealthcare Community & State |
$29.25
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.28
|
|
|
SCREW LOCKING PART THD 5x40MM
|
Facility
|
OP
|
$1,545.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$587.10
|
| Rate for Payer: Aetna Medicare Advantage |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$393.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$393.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$393.98
|
| Rate for Payer: Cigna Commercial |
$772.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$48.82
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$43.88
|
|
|
SCREW LOCKING PART THD 5x40MM
|
Facility
|
IP
|
$1,545.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$373.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$309.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$373.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$231.75
|
|
|
SCREW LOCKING SELFTAP 2.7x22mm
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.35
|
|
|
SCREW LOCKING SELFTAP 2.7x22mm
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270656632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$244.50 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Aetna Medicare Advantage |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.69
|
| Rate for Payer: Cigna Commercial |
$244.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.89
|
|
|
SCREW LOCKING SELFTAP 2.7x24mm
|
Facility
|
IP
|
$489.00
|
|
| Hospital Charge Code |
270656633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.35 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.35
|
|
|
SCREW LOCKING SELFTAP 2.7x24mm
|
Facility
|
OP
|
$489.00
|
|
| Hospital Charge Code |
270656633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$244.50 |
| Rate for Payer: Aetna Commercial |
$185.82
|
| Rate for Payer: Aetna Medicare Advantage |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$124.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$124.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$97.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$124.69
|
| Rate for Payer: Cigna Commercial |
$244.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$118.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$73.35
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.89
|
|
|
SCREW LOCKING SELF TAP 3.5x10m
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$211.75 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
|
|
SCREW LOCKING SELF TAP 3.5x10m
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667387
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Medicare Advantage |
$262.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$223.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$175.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$223.12
|
| Rate for Payer: Cigna Commercial |
$437.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$211.75
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$131.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$27.65
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$24.85
|
|
|
SCREW LOCKING SELF TAP 5x18MM
|
Facility
|
IP
|
$900.00
|
|
| Hospital Charge Code |
270674381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
|
|
SCREW LOCKING SELF TAP 5x18MM
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
270674381
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$342.00
|
| Rate for Payer: Aetna Medicare Advantage |
$270.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$229.50
|
| Rate for Payer: Cigna Commercial |
$450.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$217.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$135.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.56
|
|
|
SCREW LOCKING SLF TAP 2x12MM
|
Facility
|
OP
|
$502.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$251.43 |
| Rate for Payer: Aetna Commercial |
$191.08
|
| Rate for Payer: Aetna Medicare Advantage |
$150.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.23
|
| Rate for Payer: Cigna Commercial |
$251.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.89
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.28
|
|
|
SCREW LOCKING SLF TAP 2x12MM
|
Facility
|
IP
|
$502.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270674231
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.43 |
| Max. Negotiated Rate |
$121.69 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.57
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.69
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.43
|
|
|
SCREW LOCKING SLF TAP 2x7MM
|
Facility
|
OP
|
$474.00
|
|
| Hospital Charge Code |
270671993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$180.12
|
| Rate for Payer: Aetna Medicare Advantage |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$120.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$120.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$120.87
|
| Rate for Payer: Cigna Commercial |
$237.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.46
|
|
|
SCREW LOCKING SLF TAP 2x7MM
|
Facility
|
IP
|
$474.00
|
|
| Hospital Charge Code |
270671993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$114.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$94.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.10
|
|
|
SCREW LOCKING SLF TAP 2x8MM
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$180.12
|
| Rate for Payer: Aetna Medicare Advantage |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$120.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$120.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$120.87
|
| Rate for Payer: Cigna Commercial |
$237.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.10
|
| Rate for Payer: UnitedHealthcare Community & State |
$14.98
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$13.46
|
|
|
SCREW LOCKING SLF TAP 2x8MM
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$114.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$94.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$114.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$71.10
|
|
|
SCREW LOCKING SLF TAP 3.5x10MM
|
Facility
|
OP
|
$550.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270637258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$275.30 |
| Rate for Payer: Aetna Commercial |
$209.23
|
| Rate for Payer: Aetna Medicare Advantage |
$165.18
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$110.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$140.40
|
| Rate for Payer: Cigna Commercial |
$275.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$133.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$82.59
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.64
|
|