|
SCREW LOCKING CAP KIT 38MM GRN
|
Facility
|
OP
|
$1,175.00
|
|
| Hospital Charge Code |
270670956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$587.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare Advantage |
$352.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$299.62
|
| Rate for Payer: Cigna Commercial |
$587.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$37.13
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$33.37
|
|
|
SCREW LOCKING CAP KIT 38MM GRN
|
Facility
|
IP
|
$1,175.00
|
|
| Hospital Charge Code |
270670956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$235.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$284.35
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$176.25
|
|
|
SCREW LOCKING CAP T30
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$186.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.50
|
|
|
SCREW LOCKING CAP T30
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270695295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Medicare Advantage |
$231.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$196.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$196.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$154.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$196.35
|
| Rate for Payer: Cigna Commercial |
$385.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$186.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$115.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.33
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$21.87
|
|
|
SCREW LOCKING CORT 3.5x12MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x12MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x16MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x16MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x18MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x18MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270672100
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x20MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x20MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x22MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x22MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671026
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x24MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x24MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x26MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x26MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270671027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x28MM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x28MM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
270665920
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CORT 3.5x30MM
|
Facility
|
OP
|
$1,120.00
|
|
| Hospital Charge Code |
270671025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Medicare Advantage |
$336.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$285.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$285.60
|
| Rate for Payer: Cigna Commercial |
$560.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$35.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$31.81
|
|
|
SCREW LOCKING CORT 3.5x30MM
|
Facility
|
IP
|
$1,120.00
|
|
| Hospital Charge Code |
270671025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$271.04 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$224.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$271.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$168.00
|
|
|
SCREW LOCKING CRO PIN 2.3X20MM
|
Facility
|
OP
|
$790.00
|
|
| Hospital Charge Code |
270669930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Medicare Advantage |
$237.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$201.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$158.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$201.45
|
| Rate for Payer: Cigna Commercial |
$395.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$191.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
| Rate for Payer: UnitedHealthcare Community & State |
$24.96
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$22.44
|
|
|
SCREW LOCKING CRO PIN 2.3X20MM
|
Facility
|
IP
|
$790.00
|
|
| Hospital Charge Code |
270669930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$191.18 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$158.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$191.18
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$118.50
|
|
|
SCREW LOCKING FIXED 36x4.75x26
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
270674700
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare Advantage |
$150.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$127.50
|
| Rate for Payer: Cigna Commercial |
$250.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$121.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$75.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$15.80
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$14.20
|
|