|
SCREW HEADLESS 2.4 X 24MM
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$535.80
|
| Rate for Payer: Aetna Medicare Advantage |
$423.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$359.55
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$359.55
|
| Rate for Payer: Cigna Commercial |
$705.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.56
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$40.04
|
|
|
SCREW HEADLESS 2.4 X 24MM
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$341.22 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$282.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$341.22
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$211.50
|
|
|
SCREW HEADLESS 2.4X25MM
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Medicare Advantage |
$525.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$446.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$446.25
|
| Rate for Payer: Cigna Commercial |
$875.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$55.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$49.70
|
|
|
SCREW HEADLESS 2.4X25MM
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270696523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$423.50 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$350.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$423.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$262.50
|
|
|
SCREW HEADLESS 2.4X 26
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$338.80 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
|
|
SCREW HEADLESS 2.4X 26
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686492
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Medicare Advantage |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$357.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$280.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$357.00
|
| Rate for Payer: Cigna Commercial |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$338.80
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$210.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$44.24
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$39.76
|
|
|
SCREW HEADLESS 2.4 x28mm
|
Facility
|
OP
|
$1,495.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$747.92 |
| Rate for Payer: Aetna Commercial |
$568.42
|
| Rate for Payer: Aetna Medicare Advantage |
$448.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$381.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$381.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$381.44
|
| Rate for Payer: Cigna Commercial |
$747.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.48
|
|
|
SCREW HEADLESS 2.4 x28mm
|
Facility
|
IP
|
$1,495.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.38 |
| Max. Negotiated Rate |
$362.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.38
|
|
|
SCREW HEADLESS 2.4 x 32mm
|
Facility
|
OP
|
$1,495.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$747.92 |
| Rate for Payer: Aetna Commercial |
$568.42
|
| Rate for Payer: Aetna Medicare Advantage |
$448.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$381.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$381.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$381.44
|
| Rate for Payer: Cigna Commercial |
$747.92
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.38
|
| Rate for Payer: UnitedHealthcare Community & State |
$47.27
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$42.48
|
|
|
SCREW HEADLESS 2.4 x 32mm
|
Facility
|
IP
|
$1,495.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.38 |
| Max. Negotiated Rate |
$362.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$299.17
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$362.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$224.38
|
|
|
SCREW HEADLESS 2.5 X 12
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.89
|
|
|
SCREW HEADLESS 2.5 X 12
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270688091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREW HEADLESS 2.5 X16MM
|
Facility
|
OP
|
$1,000.00
|
|
| Hospital Charge Code |
270690578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$380.00
|
| Rate for Payer: Aetna Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$255.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$255.00
|
| Rate for Payer: Cigna Commercial |
$500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$260.00
|
| Rate for Payer: Oxford Commercial |
$200.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
| Rate for Payer: UnitedHealthcare Commercial |
$200.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$31.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$28.40
|
|
|
SCREW HEADLESS 2.5 X16MM
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
270690578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$150.00
|
|
|
SCREW HEADLESS 2.5X16MM
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$377.52 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$312.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$377.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$234.00
|
|
|
SCREW HEADLESS 2.5X16MM
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270692679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$592.80
|
| Rate for Payer: Aetna Medicare Advantage |
$468.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$397.80
|
| Rate for Payer: Cigna Commercial |
$780.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$377.52
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$234.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$49.30
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$44.30
|
|
|
SCREW HEADLESS 2.5x18mm
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREW HEADLESS 2.5x18mm
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270681075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.89
|
|
|
SCREW HEADLESS 2.5 X 20
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.89
|
|
|
SCREW HEADLESS 2.5 X 20
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270679768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREW HEADLESS 2.5 X 20
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.89
|
|
|
SCREW HEADLESS 2.5 X 20
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREW HEADLESS 2.5 X 30 MM
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$737.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Medicare Advantage |
$442.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$376.12
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$376.12
|
| Rate for Payer: Cigna Commercial |
$737.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.89
|
|
|
SCREW HEADLESS 2.5 X 30 MM
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270684641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.25 |
| Max. Negotiated Rate |
$356.95 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$295.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$356.95
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$221.25
|
|
|
SCREW HEADLESS 3.0 38
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270686747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$565.00 |
| Rate for Payer: Aetna Commercial |
$429.40
|
| Rate for Payer: Aetna Medicare Advantage |
$339.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$288.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$288.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$226.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$288.15
|
| Rate for Payer: Cigna Commercial |
$565.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$273.46
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$169.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$32.09
|
|