|
SCREW 2.7mm TITAN CORTEX 36mm
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 2.7mm TITAN CORTEX 36mm
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.83
|
|
|
SCREW 2.7mm TITAN CORTEX 38mm
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.83
|
|
|
SCREW 2.7mm TITAN CORTEX 38mm
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 2.7mm TITAN CORTEX 40mm
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 2.7mm TITAN CORTEX 40mm
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.83
|
|
|
SCREW 2.7mm TITAN CORTEX 6mm
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.83
|
|
|
SCREW 2.7mm TITAN CORTEX 6mm
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 2.7mm TITAN CORTEX 8mm
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$32.67 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
|
|
SCREW 2.7mm TITAN CORTEX 8mm
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270603046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare Advantage |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.42
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.42
|
| Rate for Payer: Cigna Commercial |
$67.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.83
|
|
|
SCREW 2.7mmx22mm
|
Facility
|
OP
|
$1,495.00
|
|
| Hospital Charge Code |
270647993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$747.50 |
| Rate for Payer: Aetna Commercial |
$568.10
|
| Rate for Payer: Aetna Medicare Advantage |
$448.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$381.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$381.23
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$381.23
|
| Rate for Payer: Cigna Commercial |
$747.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.46
|
|
|
SCREW 2.7mmx22mm
|
Facility
|
IP
|
$1,495.00
|
|
| Hospital Charge Code |
270647993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.25 |
| Max. Negotiated Rate |
$361.79 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$361.79
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.25
|
|
|
SCREW 2.7X12MM
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
270669675
|
|
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 2.7X12MM
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
270669675
|
|
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 2.7X14MM
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$447.70 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$370.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$447.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$277.50
|
|
|
SCREW 2.7X14MM
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270700107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.54 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Aetna Commercial |
$703.00
|
| Rate for Payer: Aetna Medicare Advantage |
$555.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$471.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$370.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$471.75
|
| Rate for Payer: Cigna Commercial |
$925.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$447.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$277.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$58.46
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$52.54
|
|
|
SCREW 2.7x14 NNLCK 8140-27-014
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.00
|
|
|
SCREW 2.7x14 NNLCK 8140-27-014
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270661576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Medicare Advantage |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$91.80
|
| Rate for Payer: Cigna Commercial |
$180.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$87.12
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$54.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$11.38
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$10.22
|
|
|
SCREW 2.7X16MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669679
|
|
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 2.7X16MM
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669679
|
|
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 2.7 X16 MM LOCKING
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$627.00
|
| Rate for Payer: Aetna Medicare Advantage |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$420.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$330.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$420.75
|
| Rate for Payer: Cigna Commercial |
$825.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$399.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$52.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$46.86
|
|
|
SCREW 2.7 X16 MM LOCKING
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$399.30 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$399.30
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$247.50
|
|
|
SCREW 2.7X18MM (L)
|
Facility
|
OP
|
$630.00
|
|
| Hospital Charge Code |
270703494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Medicare Advantage |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$160.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$160.65
|
| Rate for Payer: Cigna Commercial |
$315.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$19.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$17.89
|
|
|
SCREW 2.7X18MM (L)
|
Facility
|
IP
|
$630.00
|
|
| Hospital Charge Code |
270703494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$126.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$152.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$94.50
|
|
|
SCREW 2.7X20MM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669677
|
|
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
|
|