|
SCREW VAL TI 1.6X6MM
|
Facility
|
IP
|
$760.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$184.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$152.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
|
|
SCREW VAL TI 1.6X6MM
|
Facility
|
OP
|
$760.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$288.99
|
| Rate for Payer: Aetna Medicare Advantage |
$228.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.93
|
| Rate for Payer: Cigna Commercial |
$380.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.60
|
|
|
SCREW VAL TI 2.0 MMX 16 MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW VAL TI 2.0 MMX 16 MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SCREW VAL TI 2.0 X 10 MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SCREW VAL TI 2.0 X 10 MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689808
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW VAL TI 2.0 X 12 MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SCREW VAL TI 2.0 X 12 MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW VAL TI 2.0 X 14 MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW VAL TI 2.0 X 14 MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SCREW VAL TI 2.0X6MM
|
Facility
|
IP
|
$760.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$184.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$152.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
|
|
SCREW VAL TI 2.0X6MM
|
Facility
|
OP
|
$760.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$288.99
|
| Rate for Payer: Aetna Medicare Advantage |
$228.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.93
|
| Rate for Payer: Cigna Commercial |
$380.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.60
|
|
|
SCREW VAL TI 2.0X7MM
|
Facility
|
IP
|
$760.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$184.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$152.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
|
|
SCREW VAL TI 2.0X7MM
|
Facility
|
OP
|
$760.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270699866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$288.99
|
| Rate for Payer: Aetna Medicare Advantage |
$228.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$193.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$193.93
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$152.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$193.93
|
| Rate for Payer: Cigna Commercial |
$380.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$184.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$114.08
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.03
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.60
|
|
|
SCREW VAL TI 2.0 X 8 MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW VAL TI 2.0 X 8 MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270689806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SCREW VALTI 2.4 X 14MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|
|
SCREW VALTI 2.4 X 14MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
|
|
SCREW VAL TI 2.4X16MM
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690223
|
|
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 VAL TI 2.4X16MM
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690223
|
|
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 VAL TI 2X24MM
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.15 |
| Max. Negotiated Rate |
$174.48 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.15
|
|
|
SCREW VAL TI 2X24MM
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270702063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$360.50 |
| Rate for Payer: Aetna Commercial |
$273.98
|
| Rate for Payer: Aetna Medicare Advantage |
$216.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$183.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$183.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$144.20
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$183.85
|
| Rate for Payer: Cigna Commercial |
$360.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$174.48
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$108.15
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.78
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$20.48
|
|
|
SCREW VAR 6.5X35MM
|
Facility
|
OP
|
$1,834.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.09 |
| Max. Negotiated Rate |
$917.12 |
| Rate for Payer: Aetna Commercial |
$697.01
|
| Rate for Payer: Aetna Medicare Advantage |
$550.27
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$467.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$467.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$366.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$467.73
|
| Rate for Payer: Cigna Commercial |
$917.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$443.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$275.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$57.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.09
|
|
|
SCREW VAR 6.5X35MM
|
Facility
|
IP
|
$1,834.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270703617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.14 |
| Max. Negotiated Rate |
$443.89 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$366.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$443.89
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$275.14
|
|
|
SCREW VAR ANGLE 3x12MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270683541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Medicare Advantage |
$210.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$178.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$140.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$178.50
|
| Rate for Payer: Cigna Commercial |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$169.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$105.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$22.12
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.88
|
|