|
SCREW CORTEX 2.7x14MM
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$48.73
|
| Rate for Payer: Aetna Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.70
|
| Rate for Payer: Cigna Commercial |
$64.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.64
|
|
|
SCREW CORTEX 2.7X14 MM
|
Facility
|
OP
|
$568.40
|
|
| Hospital Charge Code |
270703508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$284.20 |
| Rate for Payer: Aetna Commercial |
$215.99
|
| Rate for Payer: Aetna Medicare Advantage |
$170.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$144.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$144.94
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$113.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$144.94
|
| Rate for Payer: Cigna Commercial |
$284.20
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.26
|
| Rate for Payer: UnitedHealthcare Community & State |
$17.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$16.14
|
|
|
SCREW CORTEX 2.7X14 MM
|
Facility
|
IP
|
$568.40
|
|
| Hospital Charge Code |
270703508
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.26 |
| Max. Negotiated Rate |
$137.55 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$113.68
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$137.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$85.26
|
|
|
SCREW CORTEX 2.7x18MM
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
|
|
SCREW CORTEX 2.7x18MM
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$48.73
|
| Rate for Payer: Aetna Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.70
|
| Rate for Payer: Cigna Commercial |
$64.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.64
|
|
|
SCREW CORTEX 2.7x20MM
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$48.73
|
| Rate for Payer: Aetna Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.70
|
| Rate for Payer: Cigna Commercial |
$64.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.64
|
|
|
SCREW CORTEX 2.7x20MM
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
|
|
SCREW CORTEX 2.7X 24
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$127.05 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
|
|
SCREW CORTEX 2.7X 24
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270687190
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Medicare Advantage |
$157.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$133.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$133.88
|
| Rate for Payer: Cigna Commercial |
$262.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$127.05
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$78.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.59
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.91
|
|
|
SCREW CORTEX 2.7x24mm
|
Facility
|
IP
|
$124.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$30.13 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.68
|
|
|
SCREW CORTEX 2.7x24mm
|
Facility
|
OP
|
$124.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$62.25 |
| Rate for Payer: Aetna Commercial |
$47.31
|
| Rate for Payer: Aetna Medicare Advantage |
$37.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$31.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$31.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$24.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$31.75
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$30.13
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.68
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.93
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.54
|
|
|
SCREW CORTEX 2.7X38MM SLF TAP
|
Facility
|
OP
|
$135.75
|
|
| Hospital Charge Code |
270670541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$67.88 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Aetna Medicare Advantage |
$40.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.62
|
| Rate for Payer: Cigna Commercial |
$67.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.86
|
|
|
SCREW CORTEX 2.7X38MM SLF TAP
|
Facility
|
IP
|
$135.75
|
|
| Hospital Charge Code |
270670541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.36
|
|
|
SCREW CORTEX 2.7x55MM
|
Facility
|
IP
|
$135.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$32.85 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.15
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.36
|
|
|
SCREW CORTEX 2.7x55MM
|
Facility
|
OP
|
$135.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270660329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$67.88 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Aetna Medicare Advantage |
$40.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$34.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$34.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$27.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$34.62
|
| Rate for Payer: Cigna Commercial |
$67.88
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$32.85
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$20.36
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.86
|
|
|
SCREW CORTEX 2.7x6MM
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
|
|
SCREW CORTEX 2.7x6MM
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604184
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$48.73
|
| Rate for Payer: Aetna Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$32.70
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$25.65
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$32.70
|
| Rate for Payer: Cigna Commercial |
$64.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$31.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$19.24
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.64
|
|
|
SCREW CORTEX 3.5 MM
|
Facility
|
IP
|
$93.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.00
|
|
|
SCREW CORTEX 3.5 MM
|
Facility
|
OP
|
$93.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270690440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$46.67 |
| Rate for Payer: Aetna Commercial |
$35.47
|
| Rate for Payer: Aetna Medicare Advantage |
$28.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$18.67
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$23.80
|
| Rate for Payer: Cigna Commercial |
$46.67
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$22.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$14.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.95
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$2.65
|
|
|
SCREW CORTEX 3.5MM x 42MM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$72.60 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
|
|
SCREW CORTEX 3.5MM x 42MM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681335
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Medicare Advantage |
$90.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$76.50
|
| Rate for Payer: Cigna Commercial |
$150.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$72.60
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$45.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$9.48
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$8.52
|
|
|
SCREW CORTEX 3.5x10mm
|
Facility
|
OP
|
$64.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$32.45 |
| Rate for Payer: Aetna Commercial |
$24.66
|
| Rate for Payer: Aetna Medicare Advantage |
$19.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.55
|
| Rate for Payer: Cigna Commercial |
$32.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.84
|
|
|
SCREW CORTEX 3.5x10mm
|
Facility
|
IP
|
$64.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.73
|
|
|
SCREW CORTEX 3.5x12mm
|
Facility
|
IP
|
$64.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$15.71 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.98
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.73
|
|
|
SCREW CORTEX 3.5x12mm
|
Facility
|
OP
|
$64.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270604203
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$32.45 |
| Rate for Payer: Aetna Commercial |
$24.66
|
| Rate for Payer: Aetna Medicare Advantage |
$19.47
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$16.55
|
| Rate for Payer: Cigna Commercial |
$32.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.71
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.73
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.84
|
|