|
HC AQUATIC THERAPY/15 MIN-PT
|
Facility
|
OP
|
$137.53
|
|
|
Service Code
|
CPT 97113 GP
|
| Hospital Charge Code |
1728002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$116.08
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$47.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$78.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$47.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.41
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Centivo All Commercial |
$74.82
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Humana Medicare |
$44.01
|
| Rate for Payer: Lucent All Commercial |
$74.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: Managed Health Services Medicaid |
$47.81
|
| Rate for Payer: MDWise Medicaid |
$47.81
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.64
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
| Rate for Payer: United Healthcare Medicare |
$44.01
|
|
|
HC AQUATIC THERAPY/15 MIN-PT
|
Facility
|
IP
|
$137.53
|
|
|
Service Code
|
CPT 97113 GP
|
| Hospital Charge Code |
1728002
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$127.90 |
| Rate for Payer: Aetna Commercial |
$118.83
|
| Rate for Payer: Cash Price |
$82.52
|
| Rate for Payer: Cigna All Commercial |
$118.69
|
| Rate for Payer: CORVEL All Commercial |
$127.90
|
| Rate for Payer: Coventry All Commercial |
$121.03
|
| Rate for Payer: Encore All Commercial |
$126.60
|
| Rate for Payer: Frontpath All Commercial |
$126.53
|
| Rate for Payer: Humana ChoiceCare |
$118.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.78
|
| Rate for Payer: PHCS All Commercial |
$103.15
|
| Rate for Payer: PHP All Commercial |
$104.30
|
| Rate for Payer: Sagamore Health Network All Products |
$106.17
|
| Rate for Payer: Signature Care EPO |
$114.15
|
| Rate for Payer: Signature Care PPO |
$121.03
|
| Rate for Payer: United Healthcare Commercial |
$108.37
|
|
|
HC AR .045" GUIDE WIRE TROC TIP
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41602602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.63
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Centivo All Commercial |
$92.15
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$54.21
|
| Rate for Payer: Lucent All Commercial |
$92.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
|
|
HC AR .045" GUIDE WIRE TROC TIP
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41602602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC AR 0.62 GUIDEWIRE TROC TIP
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$86.62 |
| Max. Negotiated Rate |
$107.42 |
| Rate for Payer: Aetna Commercial |
$99.79
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna All Commercial |
$99.68
|
| Rate for Payer: CORVEL All Commercial |
$107.42
|
| Rate for Payer: Coventry All Commercial |
$101.64
|
| Rate for Payer: Encore All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$106.26
|
| Rate for Payer: Humana ChoiceCare |
$99.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.95
|
| Rate for Payer: PHCS All Commercial |
$86.62
|
| Rate for Payer: PHP All Commercial |
$87.60
|
| Rate for Payer: Sagamore Health Network All Products |
$89.17
|
| Rate for Payer: Signature Care EPO |
$95.86
|
| Rate for Payer: Signature Care PPO |
$101.64
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
|
|
HC AR 0.62 GUIDEWIRE TROC TIP
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$97.48
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$66.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Centivo All Commercial |
$62.83
|
| Rate for Payer: Cigna All Commercial |
$99.68
|
| Rate for Payer: CORVEL All Commercial |
$107.42
|
| Rate for Payer: Coventry All Commercial |
$101.64
|
| Rate for Payer: Encore All Commercial |
$106.32
|
| Rate for Payer: Frontpath All Commercial |
$106.26
|
| Rate for Payer: Humana ChoiceCare |
$99.76
|
| Rate for Payer: Humana Medicare |
$36.96
|
| Rate for Payer: Lucent All Commercial |
$62.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$103.95
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$86.62
|
| Rate for Payer: PHP All Commercial |
$87.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.05
|
| Rate for Payer: Sagamore Health Network All Products |
$89.17
|
| Rate for Payer: Signature Care EPO |
$95.86
|
| Rate for Payer: Signature Care PPO |
$101.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.17
|
| Rate for Payer: United Healthcare Commercial |
$91.01
|
| Rate for Payer: United Healthcare Medicare |
$36.96
|
|
|
HC AR 0.86 GUIDE WIRE TROC TIP
|
Facility
|
OP
|
$169.40
|
|
| Hospital Charge Code |
41602600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$142.97
|
| Rate for Payer: Aetna Medicare |
$54.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$97.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$105.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.63
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Centivo All Commercial |
$92.15
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Humana Medicare |
$54.21
|
| Rate for Payer: Lucent All Commercial |
$92.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.07
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$143.99
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
| Rate for Payer: United Healthcare Medicare |
$54.21
|
|
|
HC AR 0.86 GUIDE WIRE TROC TIP
|
Facility
|
IP
|
$169.40
|
|
| Hospital Charge Code |
41602600
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.05 |
| Max. Negotiated Rate |
$157.54 |
| Rate for Payer: Aetna Commercial |
$146.36
|
| Rate for Payer: Cash Price |
$101.64
|
| Rate for Payer: Cigna All Commercial |
$146.19
|
| Rate for Payer: CORVEL All Commercial |
$157.54
|
| Rate for Payer: Coventry All Commercial |
$149.07
|
| Rate for Payer: Encore All Commercial |
$155.93
|
| Rate for Payer: Frontpath All Commercial |
$155.85
|
| Rate for Payer: Humana ChoiceCare |
$146.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$152.46
|
| Rate for Payer: PHCS All Commercial |
$127.05
|
| Rate for Payer: PHP All Commercial |
$128.47
|
| Rate for Payer: Sagamore Health Network All Products |
$130.78
|
| Rate for Payer: Signature Care EPO |
$140.60
|
| Rate for Payer: Signature Care PPO |
$149.07
|
| Rate for Payer: United Healthcare Commercial |
$133.49
|
|
|
HC AR 1.35 GUIDEWIRE
|
Facility
|
IP
|
$479.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.62 |
| Max. Negotiated Rate |
$445.94 |
| Rate for Payer: Aetna Commercial |
$414.29
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna All Commercial |
$413.81
|
| Rate for Payer: CORVEL All Commercial |
$445.94
|
| Rate for Payer: Coventry All Commercial |
$421.96
|
| Rate for Payer: Encore All Commercial |
$441.38
|
| Rate for Payer: Frontpath All Commercial |
$441.14
|
| Rate for Payer: Humana ChoiceCare |
$414.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.55
|
| Rate for Payer: PHCS All Commercial |
$359.62
|
| Rate for Payer: PHP All Commercial |
$363.65
|
| Rate for Payer: Sagamore Health Network All Products |
$370.17
|
| Rate for Payer: Signature Care EPO |
$397.99
|
| Rate for Payer: Signature Care PPO |
$421.96
|
| Rate for Payer: United Healthcare Commercial |
$377.85
|
|
|
HC AR 1.35 GUIDEWIRE
|
Facility
|
OP
|
$479.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$445.94 |
| Rate for Payer: Aetna Commercial |
$404.70
|
| Rate for Payer: Aetna Medicare |
$153.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.78
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Centivo All Commercial |
$260.85
|
| Rate for Payer: Cigna All Commercial |
$413.81
|
| Rate for Payer: CORVEL All Commercial |
$445.94
|
| Rate for Payer: Coventry All Commercial |
$421.96
|
| Rate for Payer: Encore All Commercial |
$441.38
|
| Rate for Payer: Frontpath All Commercial |
$441.14
|
| Rate for Payer: Humana ChoiceCare |
$414.14
|
| Rate for Payer: Humana Medicare |
$153.44
|
| Rate for Payer: Lucent All Commercial |
$260.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.55
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$359.62
|
| Rate for Payer: PHP All Commercial |
$363.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.00
|
| Rate for Payer: Sagamore Health Network All Products |
$370.17
|
| Rate for Payer: Signature Care EPO |
$397.99
|
| Rate for Payer: Signature Care PPO |
$421.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.57
|
| Rate for Payer: United Healthcare Commercial |
$377.85
|
| Rate for Payer: United Healthcare Medicare |
$153.44
|
|
|
HC AR 1.35 GUIDEWIRE TROC TIP
|
Facility
|
IP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$218.09 |
| Rate for Payer: Aetna Commercial |
$202.61
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.09
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.63
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
|
|
HC AR 1.35 GUIDEWIRE TROC TIP
|
Facility
|
OP
|
$234.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$218.09 |
| Rate for Payer: Aetna Commercial |
$197.92
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$72.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$146.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$82.54
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: Centivo All Commercial |
$127.57
|
| Rate for Payer: Cigna All Commercial |
$202.37
|
| Rate for Payer: CORVEL All Commercial |
$218.09
|
| Rate for Payer: Coventry All Commercial |
$206.36
|
| Rate for Payer: Encore All Commercial |
$215.86
|
| Rate for Payer: Frontpath All Commercial |
$215.74
|
| Rate for Payer: Humana ChoiceCare |
$202.54
|
| Rate for Payer: Humana Medicare |
$75.04
|
| Rate for Payer: Lucent All Commercial |
$127.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$211.05
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$175.88
|
| Rate for Payer: PHP All Commercial |
$177.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$91.45
|
| Rate for Payer: Sagamore Health Network All Products |
$181.03
|
| Rate for Payer: Signature Care EPO |
$194.63
|
| Rate for Payer: Signature Care PPO |
$206.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$199.32
|
| Rate for Payer: United Healthcare Commercial |
$184.79
|
| Rate for Payer: United Healthcare Medicare |
$75.04
|
|
|
HC AR 1.4X3.5 GUIDEWIRE BV FT
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$533.82 |
| Rate for Payer: Aetna Commercial |
$484.46
|
| Rate for Payer: Aetna Medicare |
$183.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$329.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$358.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$211.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$202.05
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Centivo All Commercial |
$312.26
|
| Rate for Payer: Cigna All Commercial |
$495.36
|
| Rate for Payer: CORVEL All Commercial |
$533.82
|
| Rate for Payer: Coventry All Commercial |
$505.12
|
| Rate for Payer: Encore All Commercial |
$528.37
|
| Rate for Payer: Frontpath All Commercial |
$528.08
|
| Rate for Payer: Humana ChoiceCare |
$495.76
|
| Rate for Payer: Humana Medicare |
$183.68
|
| Rate for Payer: Lucent All Commercial |
$312.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.60
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$430.50
|
| Rate for Payer: PHP All Commercial |
$435.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$223.86
|
| Rate for Payer: Sagamore Health Network All Products |
$443.13
|
| Rate for Payer: Signature Care EPO |
$476.42
|
| Rate for Payer: Signature Care PPO |
$505.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$487.90
|
| Rate for Payer: United Healthcare Commercial |
$452.31
|
| Rate for Payer: United Healthcare Medicare |
$183.68
|
|
|
HC AR 1.4X3.5 GUIDEWIRE BV FT
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.50 |
| Max. Negotiated Rate |
$533.82 |
| Rate for Payer: Aetna Commercial |
$495.94
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna All Commercial |
$495.36
|
| Rate for Payer: CORVEL All Commercial |
$533.82
|
| Rate for Payer: Coventry All Commercial |
$505.12
|
| Rate for Payer: Encore All Commercial |
$528.37
|
| Rate for Payer: Frontpath All Commercial |
$528.08
|
| Rate for Payer: Humana ChoiceCare |
$495.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$516.60
|
| Rate for Payer: PHCS All Commercial |
$430.50
|
| Rate for Payer: PHP All Commercial |
$435.32
|
| Rate for Payer: Sagamore Health Network All Products |
$443.13
|
| Rate for Payer: Signature Care EPO |
$476.42
|
| Rate for Payer: Signature Care PPO |
$505.12
|
| Rate for Payer: United Healthcare Commercial |
$452.31
|
|
|
HC AR 2.4 DRILL/WIRE CANN
|
Facility
|
OP
|
$2,460.00
|
|
| Hospital Charge Code |
41608240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,076.24
|
| Rate for Payer: Aetna Medicare |
$787.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$762.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,412.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,537.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$905.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$865.92
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Centivo All Commercial |
$1,338.24
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Humana Medicare |
$787.20
|
| Rate for Payer: Lucent All Commercial |
$1,338.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$959.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,091.00
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
| Rate for Payer: United Healthcare Medicare |
$787.20
|
|
|
HC AR 2.4 DRILL/WIRE CANN
|
Facility
|
IP
|
$2,460.00
|
|
| Hospital Charge Code |
41608240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$2,287.80 |
| Rate for Payer: Aetna Commercial |
$2,125.44
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna All Commercial |
$2,122.98
|
| Rate for Payer: CORVEL All Commercial |
$2,287.80
|
| Rate for Payer: Coventry All Commercial |
$2,164.80
|
| Rate for Payer: Encore All Commercial |
$2,264.43
|
| Rate for Payer: Frontpath All Commercial |
$2,263.20
|
| Rate for Payer: Humana ChoiceCare |
$2,124.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,214.00
|
| Rate for Payer: PHCS All Commercial |
$1,845.00
|
| Rate for Payer: PHP All Commercial |
$1,865.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,899.12
|
| Rate for Payer: Signature Care EPO |
$2,041.80
|
| Rate for Payer: Signature Care PPO |
$2,164.80
|
| Rate for Payer: United Healthcare Commercial |
$1,938.48
|
|
|
HC AR 2.7MM DRILL BIT CMP FT CAL
|
Facility
|
IP
|
$1,072.50
|
|
| Hospital Charge Code |
41602614
|
|
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 |
$643.50
|
| 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 |
$890.17
|
| Rate for Payer: Signature Care PPO |
$943.80
|
| Rate for Payer: United Healthcare Commercial |
$845.13
|
|
|
HC AR 2.7MM DRILL BIT CMP FT CAL
|
Facility
|
OP
|
$1,072.50
|
|
| Hospital Charge Code |
41602614
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$997.42 |
| Rate for Payer: Aetna Commercial |
$905.19
|
| Rate for Payer: Aetna Medicare |
$343.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$332.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$615.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$670.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$394.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$377.52
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Centivo All Commercial |
$583.44
|
| 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 |
$343.20
|
| Rate for Payer: Lucent All Commercial |
$583.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$965.25
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| 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 |
$418.27
|
| Rate for Payer: Sagamore Health Network All Products |
$827.97
|
| Rate for Payer: Signature Care EPO |
$890.17
|
| 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 |
$343.20
|
|
|
HC AR 3.9 LOOP TACK TENODESIS
|
Facility
|
IP
|
$3,168.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.00 |
| Max. Negotiated Rate |
$2,946.24 |
| Rate for Payer: Aetna Commercial |
$2,737.15
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cigna All Commercial |
$2,733.98
|
| Rate for Payer: CORVEL All Commercial |
$2,946.24
|
| Rate for Payer: Coventry All Commercial |
$2,787.84
|
| Rate for Payer: Encore All Commercial |
$2,916.14
|
| Rate for Payer: Frontpath All Commercial |
$2,914.56
|
| Rate for Payer: Humana ChoiceCare |
$2,736.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,851.20
|
| Rate for Payer: PHCS All Commercial |
$2,376.00
|
| Rate for Payer: PHP All Commercial |
$2,402.61
|
| Rate for Payer: Sagamore Health Network All Products |
$2,445.70
|
| Rate for Payer: Signature Care EPO |
$2,629.44
|
| Rate for Payer: Signature Care PPO |
$2,787.84
|
| Rate for Payer: United Healthcare Commercial |
$2,496.38
|
|
|
HC AR 3.9 LOOP TACK TENODESIS
|
Facility
|
OP
|
$3,168.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,946.24 |
| Rate for Payer: Aetna Commercial |
$2,673.79
|
| Rate for Payer: Aetna Medicare |
$1,013.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$982.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,819.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,980.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,165.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,115.14
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Centivo All Commercial |
$1,723.39
|
| Rate for Payer: Cigna All Commercial |
$2,733.98
|
| Rate for Payer: CORVEL All Commercial |
$2,946.24
|
| Rate for Payer: Coventry All Commercial |
$2,787.84
|
| Rate for Payer: Encore All Commercial |
$2,916.14
|
| Rate for Payer: Frontpath All Commercial |
$2,914.56
|
| Rate for Payer: Humana ChoiceCare |
$2,736.20
|
| Rate for Payer: Humana Medicare |
$1,013.76
|
| Rate for Payer: Lucent All Commercial |
$1,723.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,851.20
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$2,376.00
|
| Rate for Payer: PHP All Commercial |
$2,402.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,235.52
|
| Rate for Payer: Sagamore Health Network All Products |
$2,445.70
|
| Rate for Payer: Signature Care EPO |
$2,629.44
|
| Rate for Payer: Signature Care PPO |
$2,787.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare Commercial |
$2,496.38
|
| Rate for Payer: United Healthcare Medicare |
$1,013.76
|
|
|
HC AR ACL/PCL REPAIR
|
Facility
|
IP
|
$2,376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,782.00 |
| Max. Negotiated Rate |
$2,209.68 |
| Rate for Payer: Aetna Commercial |
$2,052.86
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cigna All Commercial |
$2,050.49
|
| Rate for Payer: CORVEL All Commercial |
$2,209.68
|
| Rate for Payer: Coventry All Commercial |
$2,090.88
|
| Rate for Payer: Encore All Commercial |
$2,187.11
|
| Rate for Payer: Frontpath All Commercial |
$2,185.92
|
| Rate for Payer: Humana ChoiceCare |
$2,052.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,138.40
|
| Rate for Payer: PHCS All Commercial |
$1,782.00
|
| Rate for Payer: PHP All Commercial |
$1,801.96
|
| Rate for Payer: Sagamore Health Network All Products |
$1,834.27
|
| Rate for Payer: Signature Care EPO |
$1,972.08
|
| Rate for Payer: Signature Care PPO |
$2,090.88
|
| Rate for Payer: United Healthcare Commercial |
$1,872.29
|
|
|
HC AR ACL/PCL REPAIR
|
Facility
|
OP
|
$2,376.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606191
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,209.68 |
| Rate for Payer: Aetna Commercial |
$2,005.34
|
| Rate for Payer: Aetna Medicare |
$760.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$736.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,364.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,485.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$874.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$836.35
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Centivo All Commercial |
$1,292.54
|
| Rate for Payer: Cigna All Commercial |
$2,050.49
|
| Rate for Payer: CORVEL All Commercial |
$2,209.68
|
| Rate for Payer: Coventry All Commercial |
$2,090.88
|
| Rate for Payer: Encore All Commercial |
$2,187.11
|
| Rate for Payer: Frontpath All Commercial |
$2,185.92
|
| Rate for Payer: Humana ChoiceCare |
$2,052.15
|
| Rate for Payer: Humana Medicare |
$760.32
|
| Rate for Payer: Lucent All Commercial |
$1,292.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,138.40
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,782.00
|
| Rate for Payer: PHP All Commercial |
$1,801.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$926.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1,834.27
|
| Rate for Payer: Signature Care EPO |
$1,972.08
|
| Rate for Payer: Signature Care PPO |
$2,090.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,019.60
|
| Rate for Payer: United Healthcare Commercial |
$1,872.29
|
| Rate for Payer: United Healthcare Medicare |
$760.32
|
|
|
HC AR AC REPAIR KIT
|
Facility
|
OP
|
$4,455.00
|
|
| Hospital Charge Code |
41606545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$4,143.15 |
| Rate for Payer: Aetna Commercial |
$3,760.02
|
| Rate for Payer: Aetna Medicare |
$1,425.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,381.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,558.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,784.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,639.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,568.16
|
| Rate for Payer: Cash Price |
$2,673.00
|
| Rate for Payer: Cash Price |
$2,673.00
|
| Rate for Payer: Centivo All Commercial |
$2,423.52
|
| Rate for Payer: Cigna All Commercial |
$3,844.66
|
| Rate for Payer: CORVEL All Commercial |
$4,143.15
|
| Rate for Payer: Coventry All Commercial |
$3,920.40
|
| Rate for Payer: Encore All Commercial |
$4,100.83
|
| Rate for Payer: Frontpath All Commercial |
$4,098.60
|
| Rate for Payer: Humana ChoiceCare |
$3,847.78
|
| Rate for Payer: Humana Medicare |
$1,425.60
|
| Rate for Payer: Lucent All Commercial |
$2,423.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,009.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$3,341.25
|
| Rate for Payer: PHP All Commercial |
$3,378.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,737.45
|
| Rate for Payer: Sagamore Health Network All Products |
$3,439.26
|
| Rate for Payer: Signature Care EPO |
$3,697.65
|
| Rate for Payer: Signature Care PPO |
$3,920.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,786.75
|
| Rate for Payer: United Healthcare Commercial |
$3,510.54
|
| Rate for Payer: United Healthcare Medicare |
$1,425.60
|
|
|
HC AR AC REPAIR KIT
|
Facility
|
IP
|
$4,455.00
|
|
| Hospital Charge Code |
41606545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,341.25 |
| Max. Negotiated Rate |
$4,143.15 |
| Rate for Payer: Aetna Commercial |
$3,849.12
|
| Rate for Payer: Cash Price |
$2,673.00
|
| Rate for Payer: Cigna All Commercial |
$3,844.66
|
| Rate for Payer: CORVEL All Commercial |
$4,143.15
|
| Rate for Payer: Coventry All Commercial |
$3,920.40
|
| Rate for Payer: Encore All Commercial |
$4,100.83
|
| Rate for Payer: Frontpath All Commercial |
$4,098.60
|
| Rate for Payer: Humana ChoiceCare |
$3,847.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,009.50
|
| Rate for Payer: PHCS All Commercial |
$3,341.25
|
| Rate for Payer: PHP All Commercial |
$3,378.67
|
| Rate for Payer: Sagamore Health Network All Products |
$3,439.26
|
| Rate for Payer: Signature Care EPO |
$3,697.65
|
| Rate for Payer: Signature Care PPO |
$3,920.40
|
| Rate for Payer: United Healthcare Commercial |
$3,510.54
|
|
|
HC AR ALLOGRAFT IMPLANT SYSTEM
|
Facility
|
IP
|
$11,732.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,799.30 |
| Max. Negotiated Rate |
$10,911.13 |
| Rate for Payer: Aetna Commercial |
$10,136.79
|
| Rate for Payer: Cash Price |
$7,039.44
|
| Rate for Payer: Cigna All Commercial |
$10,125.06
|
| Rate for Payer: CORVEL All Commercial |
$10,911.13
|
| Rate for Payer: Coventry All Commercial |
$10,324.51
|
| Rate for Payer: Encore All Commercial |
$10,799.67
|
| Rate for Payer: Frontpath All Commercial |
$10,793.81
|
| Rate for Payer: Humana ChoiceCare |
$10,133.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,559.16
|
| Rate for Payer: PHCS All Commercial |
$8,799.30
|
| Rate for Payer: PHP All Commercial |
$8,897.85
|
| Rate for Payer: Sagamore Health Network All Products |
$9,057.41
|
| Rate for Payer: Signature Care EPO |
$9,737.89
|
| Rate for Payer: Signature Care PPO |
$10,324.51
|
| Rate for Payer: United Healthcare Commercial |
$9,245.13
|
|
