|
ACETABULAR INSERT APEX 36x58MM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270672530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
ACETABULAR INSERT APEX 36x60MM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270672531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
ACETABULAR INSERT APEX 36x60MM
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270672531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
ACETABULAR INSERT APEX 36x62MM
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270672532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
ACETABULAR INSERT APEX 36x62MM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270672532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
ACETABULAR INSERT APEX 36x64MM
|
Facility
|
IP
|
$4,000.00
|
|
| Hospital Charge Code |
270672533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$968.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
|
|
ACETABULAR INSERT APEX 36x64MM
|
Facility
|
OP
|
$4,000.00
|
|
| Hospital Charge Code |
270672533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,520.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,200.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$800.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$2,000.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$968.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$600.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$126.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$113.60
|
|
|
ACETABULAR INSERT LINK 32x48MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 32x48MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 32x50MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 32x50MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672535
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x52MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x52MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x54MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x54MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x56MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x56MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672538
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x58MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x58MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672539
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x60MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x60MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672540
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x62MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x62MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|
|
ACETABULAR INSERT LINK 36x64MM
|
Facility
|
IP
|
$7,000.00
|
|
| Hospital Charge Code |
270672542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$1,694.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
|
|
ACETABULAR INSERT LINK 36x64MM
|
Facility
|
OP
|
$7,000.00
|
|
| Hospital Charge Code |
270672542
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,660.00
|
| Rate for Payer: Aetna Medicare Advantage |
$2,100.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,785.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,400.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,785.00
|
| Rate for Payer: Cigna Commercial |
$3,500.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,694.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,050.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$221.20
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$198.80
|
|