|
SCREW CANN 7.0x100mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x100mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654625
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x105mm
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.0x105mm
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.89
|
|
|
SCREW CANN 7.0x110mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x110mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x115mm
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.89
|
|
|
SCREW CANN 7.0x115mm
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.89
|
|
|
SCREW CANN 7.0x115mm
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.0x115mm
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.0x120mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x120mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654629
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x125mm
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Medicare Advantage |
$199.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$169.57
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.01
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.89
|
|
|
SCREW CANN 7.0x125mm
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$160.93 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$133.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$160.93
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.75
|
|
|
SCREW CANN 7.0x125mm
|
Facility
|
IP
|
$1,124.75
|
|
| Hospital Charge Code |
270604974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x125mm
|
Facility
|
OP
|
$1,124.75
|
|
| Hospital Charge Code |
270604974
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x30mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x30mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604933
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x32x110mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x32x110mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x32x120mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x32x120mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654666
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x32x130mm
|
Facility
|
IP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.71 |
| Max. Negotiated Rate |
$272.19 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
|
|
SCREW CANN 7.0x32x130mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654668
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|
|
SCREW CANN 7.0x32x45mm
|
Facility
|
OP
|
$1,124.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270654645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$562.38 |
| Rate for Payer: Aetna Commercial |
$427.40
|
| Rate for Payer: Aetna Medicare Advantage |
$337.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$286.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.95
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$286.81
|
| Rate for Payer: Cigna Commercial |
$562.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$272.19
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.71
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.54
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.94
|
|