|
HC AR ROTATION LASSO 90
|
Facility
IP
|
$962.50
|
|
| Hospital Charge Code |
41608047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR ROTATION LASSO 90
|
Facility
OP
|
$962.50
|
|
| Hospital Charge Code |
41608047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC AR SCORPION NEEDLE HD
|
Facility
OP
|
$1,072.50
|
|
| Hospital Charge Code |
41608322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$353.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$407.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$389.32
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Centivo All Commercial |
$546.98
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Humana Medicare |
$546.98
|
| Rate for Payer: Lucent All Commercial |
$546.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$418.28
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$911.62
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
| Rate for Payer: United Healthcare Medicare |
$353.92
|
|
|
HC AR SCORPION NEEDLE HD
|
Facility
IP
|
$1,072.50
|
|
| Hospital Charge Code |
41608322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$804.38 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$926.64
|
| Rate for Payer: Cash Price |
$664.95
|
| Rate for Payer: Cigna All Commercial |
$925.57
|
| Rate for Payer: CORVEL All Commercial |
$997.42
|
| Rate for Payer: Coventry All Commercial |
$943.80
|
| Rate for Payer: Encore All Commercial |
$987.24
|
| Rate for Payer: Frontpath All Commercial |
$986.70
|
| Rate for Payer: Humana ChoiceCare |
$926.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: PHCS All Commercial |
$804.38
|
| Rate for Payer: PHP All Commercial |
$813.38
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.18
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC AR SCREW 10X20 INT
|
Facility
OP
|
$1,622.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$1,369.39
|
| Rate for Payer: Aetna Medicare |
$535.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$535.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$931.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,014.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$615.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$588.97
|
| Rate for Payer: Cash Price |
$1,005.95
|
| Rate for Payer: Cash Price |
$1,005.95
|
| Rate for Payer: Centivo All Commercial |
$827.48
|
| Rate for Payer: Cigna All Commercial |
$1,400.22
|
| Rate for Payer: CORVEL All Commercial |
$1,508.92
|
| Rate for Payer: Coventry All Commercial |
$1,427.80
|
| Rate for Payer: Encore All Commercial |
$1,493.51
|
| Rate for Payer: Frontpath All Commercial |
$1,492.70
|
| Rate for Payer: Humana ChoiceCare |
$1,401.35
|
| Rate for Payer: Humana Medicare |
$827.48
|
| Rate for Payer: Lucent All Commercial |
$827.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,460.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,216.88
|
| Rate for Payer: PHP All Commercial |
$1,230.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$632.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,252.57
|
| Rate for Payer: Signature Care EPO |
$1,346.68
|
| Rate for Payer: Signature Care PPO |
$1,427.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,379.12
|
| Rate for Payer: United Healthcare Commercial |
$1,278.53
|
| Rate for Payer: United Healthcare Medicare |
$535.42
|
|
|
HC AR SCREW 10X20 INT
|
Facility
IP
|
$1,622.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$1,401.84
|
| Rate for Payer: Cash Price |
$1,005.95
|
| Rate for Payer: Cigna All Commercial |
$1,400.22
|
| Rate for Payer: CORVEL All Commercial |
$1,508.92
|
| Rate for Payer: Coventry All Commercial |
$1,427.80
|
| Rate for Payer: Encore All Commercial |
$1,493.51
|
| Rate for Payer: Frontpath All Commercial |
$1,492.70
|
| Rate for Payer: Humana ChoiceCare |
$1,401.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,460.25
|
| Rate for Payer: PHCS All Commercial |
$1,216.88
|
| Rate for Payer: PHP All Commercial |
$1,230.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,252.57
|
| Rate for Payer: Signature Care EPO |
$1,346.68
|
| Rate for Payer: Signature Care PPO |
$1,427.80
|
| Rate for Payer: United Healthcare Commercial |
$1,278.53
|
|
|
HC AR SCREW 10X30 INT
|
Facility
OP
|
$1,622.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$1,369.39
|
| Rate for Payer: Aetna Medicare |
$535.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$535.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$931.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,014.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$615.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$588.97
|
| Rate for Payer: Cash Price |
$1,005.95
|
| Rate for Payer: Cash Price |
$1,005.95
|
| Rate for Payer: Centivo All Commercial |
$827.48
|
| Rate for Payer: Cigna All Commercial |
$1,400.22
|
| Rate for Payer: CORVEL All Commercial |
$1,508.92
|
| Rate for Payer: Coventry All Commercial |
$1,427.80
|
| Rate for Payer: Encore All Commercial |
$1,493.51
|
| Rate for Payer: Frontpath All Commercial |
$1,492.70
|
| Rate for Payer: Humana ChoiceCare |
$1,401.35
|
| Rate for Payer: Humana Medicare |
$827.48
|
| Rate for Payer: Lucent All Commercial |
$827.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,460.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,216.88
|
| Rate for Payer: PHP All Commercial |
$1,230.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$632.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,252.57
|
| Rate for Payer: Signature Care EPO |
$1,346.68
|
| Rate for Payer: Signature Care PPO |
$1,427.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,379.12
|
| Rate for Payer: United Healthcare Commercial |
$1,278.53
|
| Rate for Payer: United Healthcare Medicare |
$535.42
|
|
|
HC AR SCREW 10X30 INT
|
Facility
IP
|
$1,622.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.88 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$1,401.84
|
| Rate for Payer: Cash Price |
$1,005.95
|
| Rate for Payer: Cigna All Commercial |
$1,400.22
|
| Rate for Payer: CORVEL All Commercial |
$1,508.92
|
| Rate for Payer: Coventry All Commercial |
$1,427.80
|
| Rate for Payer: Encore All Commercial |
$1,493.51
|
| Rate for Payer: Frontpath All Commercial |
$1,492.70
|
| Rate for Payer: Humana ChoiceCare |
$1,401.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,460.25
|
| Rate for Payer: PHCS All Commercial |
$1,216.88
|
| Rate for Payer: PHP All Commercial |
$1,230.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,252.57
|
| Rate for Payer: Signature Care EPO |
$1,346.68
|
| Rate for Payer: Signature Care PPO |
$1,427.80
|
| Rate for Payer: United Healthcare Commercial |
$1,278.53
|
|
|
HC AR SCREW 20 CANN TAP
|
Facility
OP
|
$990.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$835.56
|
| Rate for Payer: Aetna Medicare |
$326.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.37
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Centivo All Commercial |
$504.90
|
| Rate for Payer: Cigna All Commercial |
$854.37
|
| Rate for Payer: CORVEL All Commercial |
$920.70
|
| Rate for Payer: Coventry All Commercial |
$871.20
|
| Rate for Payer: Encore All Commercial |
$911.30
|
| Rate for Payer: Frontpath All Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$855.06
|
| Rate for Payer: Humana Medicare |
$504.90
|
| Rate for Payer: Lucent All Commercial |
$504.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$742.50
|
| Rate for Payer: PHP All Commercial |
$750.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$386.10
|
| Rate for Payer: Sagamore Health Network All Products |
$764.28
|
| Rate for Payer: Signature Care EPO |
$821.70
|
| Rate for Payer: Signature Care PPO |
$871.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.50
|
| Rate for Payer: United Healthcare Commercial |
$780.12
|
| Rate for Payer: United Healthcare Medicare |
$326.70
|
|
|
HC AR SCREW 20 CANN TAP
|
Facility
IP
|
$990.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41605891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$855.36
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna All Commercial |
$854.37
|
| Rate for Payer: CORVEL All Commercial |
$920.70
|
| Rate for Payer: Coventry All Commercial |
$871.20
|
| Rate for Payer: Encore All Commercial |
$911.30
|
| Rate for Payer: Frontpath All Commercial |
$910.80
|
| Rate for Payer: Humana ChoiceCare |
$855.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$891.00
|
| Rate for Payer: PHCS All Commercial |
$742.50
|
| Rate for Payer: PHP All Commercial |
$750.82
|
| Rate for Payer: Sagamore Health Network All Products |
$764.28
|
| Rate for Payer: Signature Care EPO |
$821.70
|
| Rate for Payer: Signature Care PPO |
$871.20
|
| Rate for Payer: United Healthcare Commercial |
$780.12
|
|
|
HC AR SCREW 2.5X38 MICRO FT
|
Facility
OP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,624.70
|
| Rate for Payer: Aetna Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$635.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,105.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,203.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$730.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$698.78
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Centivo All Commercial |
$981.75
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Humana Medicare |
$981.75
|
| Rate for Payer: Lucent All Commercial |
$981.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$750.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,636.25
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
| Rate for Payer: United Healthcare Medicare |
$635.25
|
|
|
HC AR SCREW 2.5X38 MICRO FT
|
Facility
IP
|
$1,925.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608178
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Cash Price |
$1,193.50
|
| Rate for Payer: Cigna All Commercial |
$1,661.28
|
| Rate for Payer: CORVEL All Commercial |
$1,790.25
|
| Rate for Payer: Coventry All Commercial |
$1,694.00
|
| Rate for Payer: Encore All Commercial |
$1,771.96
|
| Rate for Payer: Frontpath All Commercial |
$1,771.00
|
| Rate for Payer: Humana ChoiceCare |
$1,662.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,732.50
|
| Rate for Payer: PHCS All Commercial |
$1,443.75
|
| Rate for Payer: PHP All Commercial |
$1,459.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,486.10
|
| Rate for Payer: Signature Care EPO |
$1,597.75
|
| Rate for Payer: Signature Care PPO |
$1,694.00
|
| Rate for Payer: United Healthcare Commercial |
$1,516.90
|
|
|
HC AR SCREW 3.0X18 VAL
|
Facility
IP
|
$875.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$756.00
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
|
|
HC AR SCREW 3.0X18 VAL
|
Facility
OP
|
$875.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604395
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$813.75 |
| Rate for Payer: Aetna Commercial |
$738.50
|
| Rate for Payer: Aetna Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$288.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$502.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$546.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$332.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$317.62
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Centivo All Commercial |
$446.25
|
| Rate for Payer: Cigna All Commercial |
$755.12
|
| Rate for Payer: CORVEL All Commercial |
$813.75
|
| Rate for Payer: Coventry All Commercial |
$770.00
|
| Rate for Payer: Encore All Commercial |
$805.44
|
| Rate for Payer: Frontpath All Commercial |
$805.00
|
| Rate for Payer: Humana ChoiceCare |
$755.74
|
| Rate for Payer: Humana Medicare |
$446.25
|
| Rate for Payer: Lucent All Commercial |
$446.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$787.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$656.25
|
| Rate for Payer: PHP All Commercial |
$663.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$341.25
|
| Rate for Payer: Sagamore Health Network All Products |
$675.50
|
| Rate for Payer: Signature Care EPO |
$726.25
|
| Rate for Payer: Signature Care PPO |
$770.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$743.75
|
| Rate for Payer: United Healthcare Commercial |
$689.50
|
| Rate for Payer: United Healthcare Medicare |
$288.75
|
|
|
HC AR SCREW 3.5X40
|
Facility
IP
|
$4,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,577.50 |
| Max. Negotiated Rate |
$4,436.10 |
| Rate for Payer: Aetna Commercial |
$4,121.28
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cigna All Commercial |
$4,116.51
|
| Rate for Payer: CORVEL All Commercial |
$4,436.10
|
| Rate for Payer: Coventry All Commercial |
$4,197.60
|
| Rate for Payer: Encore All Commercial |
$4,390.78
|
| Rate for Payer: Frontpath All Commercial |
$4,388.40
|
| Rate for Payer: Humana ChoiceCare |
$4,119.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,293.00
|
| Rate for Payer: PHCS All Commercial |
$3,577.50
|
| Rate for Payer: PHP All Commercial |
$3,617.57
|
| Rate for Payer: Sagamore Health Network All Products |
$3,682.44
|
| Rate for Payer: Signature Care EPO |
$3,959.10
|
| Rate for Payer: Signature Care PPO |
$4,197.60
|
| Rate for Payer: United Healthcare Commercial |
$3,758.76
|
|
|
HC AR SCREW 3.5X40
|
Facility
OP
|
$4,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608333
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,436.10 |
| Rate for Payer: Aetna Commercial |
$4,025.88
|
| Rate for Payer: Aetna Medicare |
$1,574.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,574.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,739.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,981.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,810.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,731.51
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Centivo All Commercial |
$2,432.70
|
| Rate for Payer: Cigna All Commercial |
$4,116.51
|
| Rate for Payer: CORVEL All Commercial |
$4,436.10
|
| Rate for Payer: Coventry All Commercial |
$4,197.60
|
| Rate for Payer: Encore All Commercial |
$4,390.78
|
| Rate for Payer: Frontpath All Commercial |
$4,388.40
|
| Rate for Payer: Humana ChoiceCare |
$4,119.85
|
| Rate for Payer: Humana Medicare |
$2,432.70
|
| Rate for Payer: Lucent All Commercial |
$2,432.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,293.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,577.50
|
| Rate for Payer: PHP All Commercial |
$3,617.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,860.30
|
| Rate for Payer: Sagamore Health Network All Products |
$3,682.44
|
| Rate for Payer: Signature Care EPO |
$3,959.10
|
| Rate for Payer: Signature Care PPO |
$4,197.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,054.50
|
| Rate for Payer: United Healthcare Commercial |
$3,758.76
|
| Rate for Payer: United Healthcare Medicare |
$1,574.10
|
|
|
HC AR SCREW 3.5X44 BV FT
|
Facility
OP
|
$4,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,436.10 |
| Rate for Payer: Aetna Commercial |
$4,025.88
|
| Rate for Payer: Aetna Medicare |
$1,574.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,574.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,739.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,981.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,810.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,731.51
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Centivo All Commercial |
$2,432.70
|
| Rate for Payer: Cigna All Commercial |
$4,116.51
|
| Rate for Payer: CORVEL All Commercial |
$4,436.10
|
| Rate for Payer: Coventry All Commercial |
$4,197.60
|
| Rate for Payer: Encore All Commercial |
$4,390.78
|
| Rate for Payer: Frontpath All Commercial |
$4,388.40
|
| Rate for Payer: Humana ChoiceCare |
$4,119.85
|
| Rate for Payer: Humana Medicare |
$2,432.70
|
| Rate for Payer: Lucent All Commercial |
$2,432.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,293.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,577.50
|
| Rate for Payer: PHP All Commercial |
$3,617.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,860.30
|
| Rate for Payer: Sagamore Health Network All Products |
$3,682.44
|
| Rate for Payer: Signature Care EPO |
$3,959.10
|
| Rate for Payer: Signature Care PPO |
$4,197.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,054.50
|
| Rate for Payer: United Healthcare Commercial |
$3,758.76
|
| Rate for Payer: United Healthcare Medicare |
$1,574.10
|
|
|
HC AR SCREW 3.5X44 BV FT
|
Facility
IP
|
$4,770.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,577.50 |
| Max. Negotiated Rate |
$4,436.10 |
| Rate for Payer: Aetna Commercial |
$4,121.28
|
| Rate for Payer: Cash Price |
$2,957.40
|
| Rate for Payer: Cigna All Commercial |
$4,116.51
|
| Rate for Payer: CORVEL All Commercial |
$4,436.10
|
| Rate for Payer: Coventry All Commercial |
$4,197.60
|
| Rate for Payer: Encore All Commercial |
$4,390.78
|
| Rate for Payer: Frontpath All Commercial |
$4,388.40
|
| Rate for Payer: Humana ChoiceCare |
$4,119.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,293.00
|
| Rate for Payer: PHCS All Commercial |
$3,577.50
|
| Rate for Payer: PHP All Commercial |
$3,617.57
|
| Rate for Payer: Sagamore Health Network All Products |
$3,682.44
|
| Rate for Payer: Signature Care EPO |
$3,959.10
|
| Rate for Payer: Signature Care PPO |
$4,197.60
|
| Rate for Payer: United Healthcare Commercial |
$3,758.76
|
|
|
HC AR SCREW 4.5X40 LP
|
Facility
OP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.62 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC AR SCREW 4.5X40 LP
|
Facility
IP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607709
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR SCREW 4.5X45 LP
|
Facility
IP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR SCREW 4.5X45 LP
|
Facility
OP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.62 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC AR SCREW 4.5X50 LP
|
Facility
OP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$317.62 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Aetna Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$317.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$552.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$601.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$349.39
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Centivo All Commercial |
$490.88
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Humana Medicare |
$490.88
|
| Rate for Payer: Lucent All Commercial |
$490.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$375.38
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$818.12
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
| Rate for Payer: United Healthcare Medicare |
$317.62
|
|
|
HC AR SCREW 4.5X50 LP
|
Facility
IP
|
$962.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.88 |
| Max. Negotiated Rate |
$895.12 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna All Commercial |
$830.64
|
| Rate for Payer: CORVEL All Commercial |
$895.12
|
| Rate for Payer: Coventry All Commercial |
$847.00
|
| Rate for Payer: Encore All Commercial |
$885.98
|
| Rate for Payer: Frontpath All Commercial |
$885.50
|
| Rate for Payer: Humana ChoiceCare |
$831.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$866.25
|
| Rate for Payer: PHCS All Commercial |
$721.88
|
| Rate for Payer: PHP All Commercial |
$729.96
|
| Rate for Payer: Sagamore Health Network All Products |
$743.05
|
| Rate for Payer: Signature Care EPO |
$798.88
|
| Rate for Payer: Signature Care PPO |
$847.00
|
| Rate for Payer: United Healthcare Commercial |
$758.45
|
|
|
HC AR SCREW 4X44 CANN
|
Facility
OP
|
$1,375.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.75 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,160.50
|
| Rate for Payer: Aetna Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$453.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$789.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$859.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$521.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$499.12
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Centivo All Commercial |
$701.25
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Humana Medicare |
$701.25
|
| Rate for Payer: Lucent All Commercial |
$701.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$536.25
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,168.75
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
| Rate for Payer: United Healthcare Medicare |
$453.75
|
|
