|
SCREW NON LOCKING LP 3.5x24MM
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667121
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Medicare Advantage |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$145.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$114.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$145.35
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.94
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$18.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.19
|
|
|
SCREW NON-LOCKING SCREW 3.5X48
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.74
|
|
|
SCREW NON-LOCKING SCREW 3.5X48
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW NON LOCKING T8 3.5x16MM
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$237.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.00
|
|
|
SCREW NON LOCKING T8 3.5x16MM
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna Commercial |
$372.40
|
| Rate for Payer: Aetna Medicare Advantage |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.90
|
| Rate for Payer: Cigna Commercial |
$490.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.83
|
|
|
SCREW NON LOCKING T8 3.5x18MM
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$490.00 |
| Rate for Payer: Aetna Commercial |
$372.40
|
| Rate for Payer: Aetna Medicare Advantage |
$294.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$249.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$249.90
|
| Rate for Payer: Cigna Commercial |
$490.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.97
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$27.83
|
|
|
SCREW NON LOCKING T8 3.5x18MM
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270667540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$237.16 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$196.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$237.16
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$147.00
|
|
|
SCREW NON LOCKING T8 3.5X22
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
270667539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
|
|
SCREW NON LOCKING T8 3.5X22
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
270667539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$361.00
|
| Rate for Payer: Aetna Medicare Advantage |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.25
|
| Rate for Payer: Cigna Commercial |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.98
|
|
|
SCREW NON-LOCKING T8 3.5X28
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
270668045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$361.00
|
| Rate for Payer: Aetna Medicare Advantage |
$285.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$242.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$242.25
|
| Rate for Payer: Cigna Commercial |
$475.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$30.02
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$26.98
|
|
|
SCREW NON-LOCKING T8 3.5X28
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
270668045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$190.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$229.90
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$142.50
|
|
|
SCREW NON LOCK L/PRO 2.7x10 MM
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
SCREW NON LOCK L/PRO 2.7x10 MM
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.42
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.51
|
|
|
SCREW NON LOCK L/PRO 2.7x13MM
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
SCREW NON LOCK L/PRO 2.7x13MM
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.42
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.51
|
|
|
SCREW NON LOCK L/PRO 2.7x14MM
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
SCREW NON LOCK L/PRO 2.7x14MM
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.42
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.51
|
|
|
SCREW NON LOCK L/PRO 2.7x24MM
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.42
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.51
|
|
|
SCREW NON LOCK L/PRO 2.7x24MM
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
SCREW NON LOCK L/PRO 2.7x26MM
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.25 |
| Max. Negotiated Rate |
$81.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
|
|
SCREW NON LOCK L/PRO 2.7x26MM
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Medicare Advantage |
$100.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$85.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$67.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$85.42
|
| Rate for Payer: Cigna Commercial |
$167.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$81.07
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$50.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$10.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$9.51
|
|
|
SCREW NONLOCK MINIBUN 2.7X16MM
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$297.66 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$297.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
|
|
SCREW NONLOCK MINIBUN 2.7X16MM
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270693664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$467.40
|
| Rate for Payer: Aetna Medicare Advantage |
$369.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$313.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$313.65
|
| Rate for Payer: Cigna Commercial |
$615.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$297.66
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$184.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$38.87
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$34.93
|
|
|
SCREW NONLOCK T6 2.3X10MM
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$240.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$199.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.25
|
|
|
SCREW NONLOCK T6 2.3X10MM
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695339
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$497.50 |
| Rate for Payer: Aetna Commercial |
$378.10
|
| Rate for Payer: Aetna Medicare Advantage |
$298.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$253.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$199.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$253.72
|
| Rate for Payer: Cigna Commercial |
$497.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$240.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$149.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.44
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.26
|
|