|
SCREW LOCKING 2.7x16MM
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
270673695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Medicare Advantage |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.85
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.03
|
|
|
SCREW LOCKING 2.7x16MM
|
Facility
|
IP
|
$670.00
|
|
| Hospital Charge Code |
270673695
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$162.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
|
|
SCREW LOCKING 2.7x16MM
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270676416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$642.50 |
| Rate for Payer: Aetna Commercial |
$488.30
|
| Rate for Payer: Aetna Medicare Advantage |
$385.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$327.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$327.68
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$257.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$327.68
|
| Rate for Payer: Cigna Commercial |
$642.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$310.97
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$192.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$40.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$36.49
|
|
|
SCREW LOCKING 2.7 X 18 MM
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$250.80
|
| Rate for Payer: Aetna Medicare Advantage |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$168.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$168.30
|
| Rate for Payer: Cigna Commercial |
$330.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$20.86
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$18.74
|
|
|
SCREW LOCKING 2.7 X 18 MM
|
Facility
|
IP
|
$907.50
|
|
| Hospital Charge Code |
270701526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LOCKING 2.7 X 18 MM
|
Facility
|
OP
|
$907.50
|
|
| Hospital Charge Code |
270701526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LOCKING 2.7 X 18 MM
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$159.72 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$132.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$159.72
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$99.00
|
|
|
SCREW LOCKING 2.7 X 18MM
|
Facility
|
IP
|
$840.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.14 |
| Max. Negotiated Rate |
$203.51 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$168.19
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$203.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.14
|
|
|
SCREW LOCKING 2.7 X 18MM
|
Facility
|
OP
|
$840.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270664326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare Advantage |
$252.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$214.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$214.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$168.19
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$214.44
|
| Rate for Payer: Cigna Commercial |
$420.48
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$203.51
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$126.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$26.57
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$23.88
|
|
|
SCREW LOCKING 2.7x18mm
|
Facility
|
OP
|
$518.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$259.38 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Aetna Medicare Advantage |
$155.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$132.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$132.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$132.28
|
| Rate for Payer: Cigna Commercial |
$259.38
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.81
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.73
|
|
|
SCREW LOCKING 2.7x18mm
|
Facility
|
IP
|
$518.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270642555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.81 |
| Max. Negotiated Rate |
$125.54 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$103.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$125.54
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$77.81
|
|
|
SCREW LOCKING 2.7x18MM
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$267.50 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Aetna Medicare Advantage |
$160.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$136.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$136.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$107.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$136.43
|
| Rate for Payer: Cigna Commercial |
$267.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$16.91
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$15.19
|
|
|
SCREW LOCKING 2.7x18MM
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270673616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.25 |
| Max. Negotiated Rate |
$129.47 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$107.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$129.47
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$80.25
|
|
|
SCREW LOCKING 2.7X18MM
|
Facility
|
IP
|
$1,256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.44 |
| Max. Negotiated Rate |
$304.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.44
|
|
|
SCREW LOCKING 2.7X18MM
|
Facility
|
OP
|
$1,256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270669673
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.68 |
| Max. Negotiated Rate |
$628.12 |
| Rate for Payer: Aetna Commercial |
$477.38
|
| Rate for Payer: Aetna Medicare Advantage |
$376.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$320.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$320.34
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$251.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$320.34
|
| Rate for Payer: Cigna Commercial |
$628.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$304.01
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$188.44
|
| Rate for Payer: UnitedHealthcare Community & State |
$39.70
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$35.68
|
|
|
SCREW LOCKING 2.7 X 19 MM
|
Facility
|
IP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.12 |
| Max. Negotiated Rate |
$219.62 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
|
|
SCREW LOCKING 2.7 X 19 MM
|
Facility
|
OP
|
$907.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270701528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$453.75 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Medicare Advantage |
$272.25
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$231.41
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$181.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$231.41
|
| Rate for Payer: Cigna Commercial |
$453.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$219.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$136.12
|
| Rate for Payer: UnitedHealthcare Community & State |
$28.68
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$25.77
|
|
|
SCREW LOCKING 2.7x20mm
|
Facility
|
IP
|
$503.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270644880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$121.88 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.55
|
|
|
SCREW LOCKING 2.7x20mm
|
Facility
|
OP
|
$503.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270644880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$251.82 |
| Rate for Payer: Aetna Commercial |
$191.39
|
| Rate for Payer: Aetna Medicare Advantage |
$151.09
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$128.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$128.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$128.43
|
| Rate for Payer: Cigna Commercial |
$251.82
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.88
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.30
|
|
|
SCREW LOCKING 2.7x20MM
|
Facility
|
IP
|
$670.00
|
|
| Hospital Charge Code |
270673694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$162.14 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
|
|
SCREW LOCKING 2.7x20MM
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
270673694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Medicare Advantage |
$201.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$170.85
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$134.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$170.85
|
| Rate for Payer: Cigna Commercial |
$335.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$162.14
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$100.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$21.17
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$19.03
|
|
|
SCREW LOCKING 2.7X20MM
|
Facility
|
OP
|
$1,465.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.61 |
| Max. Negotiated Rate |
$732.50 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Medicare Advantage |
$439.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$373.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$373.57
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$373.57
|
| Rate for Payer: Cigna Commercial |
$732.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$354.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$46.29
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$41.61
|
|
|
SCREW LOCKING 2.7X20MM
|
Facility
|
IP
|
$1,465.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270705008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.75 |
| Max. Negotiated Rate |
$354.53 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$293.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$354.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$219.75
|
|
|
SCREW LOCKING 2.7x22 53-27622E
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
|
|
SCREW LOCKING 2.7x22 53-27622E
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270643447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,280.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,530.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,530.00
|
| Rate for Payer: Cigna Commercial |
$3,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,452.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$900.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$189.60
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$170.40
|
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