|
HC AR SUTURETAK KIT
|
Facility
|
IP
|
$797.50
|
|
| Hospital Charge Code |
41607030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.12 |
| Max. Negotiated Rate |
$741.67 |
| Rate for Payer: Aetna Commercial |
$689.04
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna All Commercial |
$688.24
|
| Rate for Payer: CORVEL All Commercial |
$741.67
|
| Rate for Payer: Coventry All Commercial |
$701.80
|
| Rate for Payer: Encore All Commercial |
$734.10
|
| Rate for Payer: Frontpath All Commercial |
$733.70
|
| Rate for Payer: Humana ChoiceCare |
$688.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$717.75
|
| Rate for Payer: PHCS All Commercial |
$598.12
|
| Rate for Payer: PHP All Commercial |
$604.82
|
| Rate for Payer: Sagamore Health Network All Products |
$615.67
|
| Rate for Payer: Signature Care EPO |
$661.92
|
| Rate for Payer: Signature Care PPO |
$701.80
|
| Rate for Payer: United Healthcare Commercial |
$628.43
|
|
|
HC AR SUTURETAK KIT
|
Facility
|
OP
|
$797.50
|
|
| Hospital Charge Code |
41607030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$741.67 |
| Rate for Payer: Aetna Commercial |
$673.09
|
| Rate for Payer: Aetna Medicare |
$255.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$247.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$458.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$498.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$293.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$280.72
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Centivo All Commercial |
$433.84
|
| Rate for Payer: Cigna All Commercial |
$688.24
|
| Rate for Payer: CORVEL All Commercial |
$741.67
|
| Rate for Payer: Coventry All Commercial |
$701.80
|
| Rate for Payer: Encore All Commercial |
$734.10
|
| Rate for Payer: Frontpath All Commercial |
$733.70
|
| Rate for Payer: Humana ChoiceCare |
$688.80
|
| Rate for Payer: Humana Medicare |
$255.20
|
| Rate for Payer: Lucent All Commercial |
$433.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$717.75
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$598.12
|
| Rate for Payer: PHP All Commercial |
$604.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$311.02
|
| Rate for Payer: Sagamore Health Network All Products |
$615.67
|
| Rate for Payer: Signature Care EPO |
$661.92
|
| Rate for Payer: Signature Care PPO |
$701.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$677.88
|
| Rate for Payer: United Healthcare Commercial |
$628.43
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
|
|
HC AR SUTURE TAPE
|
Facility
|
IP
|
$269.50
|
|
| Hospital Charge Code |
41606190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.12 |
| Max. Negotiated Rate |
$250.63 |
| Rate for Payer: Aetna Commercial |
$232.85
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.63
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.69
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
|
|
HC AR SUTURE TAPE
|
Facility
|
OP
|
$269.50
|
|
| Hospital Charge Code |
41606190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$250.63 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$86.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$154.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$168.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$99.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.86
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Centivo All Commercial |
$146.61
|
| Rate for Payer: Cigna All Commercial |
$232.58
|
| Rate for Payer: CORVEL All Commercial |
$250.63
|
| Rate for Payer: Coventry All Commercial |
$237.16
|
| Rate for Payer: Encore All Commercial |
$248.07
|
| Rate for Payer: Frontpath All Commercial |
$247.94
|
| Rate for Payer: Humana ChoiceCare |
$232.77
|
| Rate for Payer: Humana Medicare |
$86.24
|
| Rate for Payer: Lucent All Commercial |
$146.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$242.55
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$202.12
|
| Rate for Payer: PHP All Commercial |
$204.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$105.11
|
| Rate for Payer: Sagamore Health Network All Products |
$208.05
|
| Rate for Payer: Signature Care EPO |
$223.69
|
| Rate for Payer: Signature Care PPO |
$237.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$229.07
|
| Rate for Payer: United Healthcare Commercial |
$212.37
|
| Rate for Payer: United Healthcare Medicare |
$86.24
|
|
|
HC AR SUTURE TIGERLINK
|
Facility
|
IP
|
$731.50
|
|
| Hospital Charge Code |
41606313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$680.29 |
| Rate for Payer: Aetna Commercial |
$632.02
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.29
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
|
|
HC AR SUTURE TIGERLINK
|
Facility
|
OP
|
$731.50
|
|
| Hospital Charge Code |
41606313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$680.29 |
| Rate for Payer: Aetna Commercial |
$617.39
|
| Rate for Payer: Aetna Medicare |
$234.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$226.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$420.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$457.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$269.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$257.49
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Cash Price |
$438.90
|
| Rate for Payer: Centivo All Commercial |
$397.94
|
| Rate for Payer: Cigna All Commercial |
$631.28
|
| Rate for Payer: CORVEL All Commercial |
$680.29
|
| Rate for Payer: Coventry All Commercial |
$643.72
|
| Rate for Payer: Encore All Commercial |
$673.35
|
| Rate for Payer: Frontpath All Commercial |
$672.98
|
| Rate for Payer: Humana ChoiceCare |
$631.80
|
| Rate for Payer: Humana Medicare |
$234.08
|
| Rate for Payer: Lucent All Commercial |
$397.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$658.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$548.62
|
| Rate for Payer: PHP All Commercial |
$554.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$285.29
|
| Rate for Payer: Sagamore Health Network All Products |
$564.72
|
| Rate for Payer: Signature Care EPO |
$607.14
|
| Rate for Payer: Signature Care PPO |
$643.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$621.77
|
| Rate for Payer: United Healthcare Commercial |
$576.42
|
| Rate for Payer: United Healthcare Medicare |
$234.08
|
|
|
HC AR SUTURE TIGERLINK 1.3
|
Facility
|
OP
|
$654.50
|
|
| Hospital Charge Code |
41606541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$552.40
|
| Rate for Payer: Aetna Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$375.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$240.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.38
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Centivo All Commercial |
$356.05
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Humana Medicare |
$209.44
|
| Rate for Payer: Lucent All Commercial |
$356.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.25
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.33
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
| Rate for Payer: United Healthcare Medicare |
$209.44
|
|
|
HC AR SUTURE TIGERLINK 1.3
|
Facility
|
IP
|
$654.50
|
|
| Hospital Charge Code |
41606541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.88 |
| Max. Negotiated Rate |
$608.68 |
| Rate for Payer: Aetna Commercial |
$565.49
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna All Commercial |
$564.83
|
| Rate for Payer: CORVEL All Commercial |
$608.68
|
| Rate for Payer: Coventry All Commercial |
$575.96
|
| Rate for Payer: Encore All Commercial |
$602.47
|
| Rate for Payer: Frontpath All Commercial |
$602.14
|
| Rate for Payer: Humana ChoiceCare |
$565.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.05
|
| Rate for Payer: PHCS All Commercial |
$490.88
|
| Rate for Payer: PHP All Commercial |
$496.37
|
| Rate for Payer: Sagamore Health Network All Products |
$505.27
|
| Rate for Payer: Signature Care EPO |
$543.24
|
| Rate for Payer: Signature Care PPO |
$575.96
|
| Rate for Payer: United Healthcare Commercial |
$515.75
|
|
|
HC AR SUTURE TIGERTAPE 1.7
|
Facility
|
IP
|
$584.50
|
|
| Hospital Charge Code |
41608164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.38 |
| Max. Negotiated Rate |
$543.59 |
| Rate for Payer: Aetna Commercial |
$505.01
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.59
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.13
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
|
|
HC AR SUTURE TIGERTAPE 1.7
|
Facility
|
OP
|
$584.50
|
|
| Hospital Charge Code |
41608164
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$543.59 |
| Rate for Payer: Aetna Commercial |
$493.32
|
| Rate for Payer: Aetna Medicare |
$187.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$181.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$335.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$205.74
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Cash Price |
$350.70
|
| Rate for Payer: Centivo All Commercial |
$317.97
|
| Rate for Payer: Cigna All Commercial |
$504.42
|
| Rate for Payer: CORVEL All Commercial |
$543.59
|
| Rate for Payer: Coventry All Commercial |
$514.36
|
| Rate for Payer: Encore All Commercial |
$538.03
|
| Rate for Payer: Frontpath All Commercial |
$537.74
|
| Rate for Payer: Humana ChoiceCare |
$504.83
|
| Rate for Payer: Humana Medicare |
$187.04
|
| Rate for Payer: Lucent All Commercial |
$317.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.05
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$438.38
|
| Rate for Payer: PHP All Commercial |
$443.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.96
|
| Rate for Payer: Sagamore Health Network All Products |
$451.23
|
| Rate for Payer: Signature Care EPO |
$485.13
|
| Rate for Payer: Signature Care PPO |
$514.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$496.82
|
| Rate for Payer: United Healthcare Commercial |
$460.59
|
| Rate for Payer: United Healthcare Medicare |
$187.04
|
|
|
HC AR SUTURE TIGERTAPE #2
|
Facility
|
OP
|
$385.00
|
|
| Hospital Charge Code |
41606207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Aetna Medicare |
$123.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$119.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$221.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$141.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$135.52
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Centivo All Commercial |
$209.44
|
| Rate for Payer: Cigna All Commercial |
$332.25
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Humana Medicare |
$123.20
|
| Rate for Payer: Lucent All Commercial |
$209.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.15
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.25
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
| Rate for Payer: United Healthcare Medicare |
$123.20
|
|
|
HC AR SUTURE TIGERTAPE #2
|
Facility
|
IP
|
$385.00
|
|
| Hospital Charge Code |
41606207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$358.05 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna All Commercial |
$332.25
|
| Rate for Payer: CORVEL All Commercial |
$358.05
|
| Rate for Payer: Coventry All Commercial |
$338.80
|
| Rate for Payer: Encore All Commercial |
$354.39
|
| Rate for Payer: Frontpath All Commercial |
$354.20
|
| Rate for Payer: Humana ChoiceCare |
$332.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.50
|
| Rate for Payer: PHCS All Commercial |
$288.75
|
| Rate for Payer: PHP All Commercial |
$291.98
|
| Rate for Payer: Sagamore Health Network All Products |
$297.22
|
| Rate for Payer: Signature Care EPO |
$319.55
|
| Rate for Payer: Signature Care PPO |
$338.80
|
| Rate for Payer: United Healthcare Commercial |
$303.38
|
|
|
HC AR SWIVELLOCK 3.5X13.5
|
Facility
|
OP
|
$2,552.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,373.73 |
| Rate for Payer: Aetna Commercial |
$2,154.23
|
| Rate for Payer: Aetna Medicare |
$816.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$791.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,465.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,595.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$939.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$898.44
|
| Rate for Payer: Cash Price |
$1,531.44
|
| Rate for Payer: Cash Price |
$1,531.44
|
| Rate for Payer: Centivo All Commercial |
$1,388.51
|
| Rate for Payer: Cigna All Commercial |
$2,202.72
|
| Rate for Payer: CORVEL All Commercial |
$2,373.73
|
| Rate for Payer: Coventry All Commercial |
$2,246.11
|
| Rate for Payer: Encore All Commercial |
$2,349.48
|
| Rate for Payer: Frontpath All Commercial |
$2,348.21
|
| Rate for Payer: Humana ChoiceCare |
$2,204.51
|
| Rate for Payer: Humana Medicare |
$816.77
|
| Rate for Payer: Lucent All Commercial |
$1,388.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,297.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,914.30
|
| Rate for Payer: PHP All Commercial |
$1,935.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$995.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,970.45
|
| Rate for Payer: Signature Care EPO |
$2,118.49
|
| Rate for Payer: Signature Care PPO |
$2,246.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,169.54
|
| Rate for Payer: United Healthcare Commercial |
$2,011.29
|
| Rate for Payer: United Healthcare Medicare |
$816.77
|
|
|
HC AR SWIVELLOCK 3.5X13.5
|
Facility
|
IP
|
$2,552.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.30 |
| Max. Negotiated Rate |
$2,373.73 |
| Rate for Payer: Aetna Commercial |
$2,205.27
|
| Rate for Payer: Cash Price |
$1,531.44
|
| Rate for Payer: Cigna All Commercial |
$2,202.72
|
| Rate for Payer: CORVEL All Commercial |
$2,373.73
|
| Rate for Payer: Coventry All Commercial |
$2,246.11
|
| Rate for Payer: Encore All Commercial |
$2,349.48
|
| Rate for Payer: Frontpath All Commercial |
$2,348.21
|
| Rate for Payer: Humana ChoiceCare |
$2,204.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,297.16
|
| Rate for Payer: PHCS All Commercial |
$1,914.30
|
| Rate for Payer: PHP All Commercial |
$1,935.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,970.45
|
| Rate for Payer: Signature Care EPO |
$2,118.49
|
| Rate for Payer: Signature Care PPO |
$2,246.11
|
| Rate for Payer: United Healthcare Commercial |
$2,011.29
|
|
|
HC AR SWIVELOCK 3.9X17.9
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
|
|
HC AR SWIVELOCK 3.9X17.9
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607777
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,046.00 |
| Rate for Payer: Aetna Commercial |
$1,856.80
|
| Rate for Payer: Aetna Medicare |
$704.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$682.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,263.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,375.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$809.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$774.40
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Centivo All Commercial |
$1,196.80
|
| Rate for Payer: Cigna All Commercial |
$1,898.60
|
| Rate for Payer: CORVEL All Commercial |
$2,046.00
|
| Rate for Payer: Coventry All Commercial |
$1,936.00
|
| Rate for Payer: Encore All Commercial |
$2,025.10
|
| Rate for Payer: Frontpath All Commercial |
$2,024.00
|
| Rate for Payer: Humana ChoiceCare |
$1,900.14
|
| Rate for Payer: Humana Medicare |
$704.00
|
| Rate for Payer: Lucent All Commercial |
$1,196.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,980.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,650.00
|
| Rate for Payer: PHP All Commercial |
$1,668.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$858.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,698.40
|
| Rate for Payer: Signature Care EPO |
$1,826.00
|
| Rate for Payer: Signature Care PPO |
$1,936.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,870.00
|
| Rate for Payer: United Healthcare Commercial |
$1,733.60
|
| Rate for Payer: United Healthcare Medicare |
$704.00
|
|
|
HC AR SWVLCK MENISCAL REPAIR KIT
|
Facility
|
IP
|
$8,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,277.50 |
| Max. Negotiated Rate |
$7,784.10 |
| Rate for Payer: Aetna Commercial |
$7,231.68
|
| Rate for Payer: Cash Price |
$5,022.00
|
| Rate for Payer: Cigna All Commercial |
$7,223.31
|
| Rate for Payer: CORVEL All Commercial |
$7,784.10
|
| Rate for Payer: Coventry All Commercial |
$7,365.60
|
| Rate for Payer: Encore All Commercial |
$7,704.59
|
| Rate for Payer: Frontpath All Commercial |
$7,700.40
|
| Rate for Payer: Humana ChoiceCare |
$7,229.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,533.00
|
| Rate for Payer: PHCS All Commercial |
$6,277.50
|
| Rate for Payer: PHP All Commercial |
$6,347.81
|
| Rate for Payer: Sagamore Health Network All Products |
$6,461.64
|
| Rate for Payer: Signature Care EPO |
$6,947.10
|
| Rate for Payer: Signature Care PPO |
$7,365.60
|
| Rate for Payer: United Healthcare Commercial |
$6,595.56
|
|
|
HC AR SWVLCK MENISCAL REPAIR KIT
|
Facility
|
OP
|
$8,370.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$7,784.10 |
| Rate for Payer: Aetna Commercial |
$7,064.28
|
| Rate for Payer: Aetna Medicare |
$2,678.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,594.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,806.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,232.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,080.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,946.24
|
| Rate for Payer: Cash Price |
$5,022.00
|
| Rate for Payer: Cash Price |
$5,022.00
|
| Rate for Payer: Centivo All Commercial |
$4,553.28
|
| Rate for Payer: Cigna All Commercial |
$7,223.31
|
| Rate for Payer: CORVEL All Commercial |
$7,784.10
|
| Rate for Payer: Coventry All Commercial |
$7,365.60
|
| Rate for Payer: Encore All Commercial |
$7,704.59
|
| Rate for Payer: Frontpath All Commercial |
$7,700.40
|
| Rate for Payer: Humana ChoiceCare |
$7,229.17
|
| Rate for Payer: Humana Medicare |
$2,678.40
|
| Rate for Payer: Lucent All Commercial |
$4,553.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,533.00
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$6,277.50
|
| Rate for Payer: PHP All Commercial |
$6,347.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,264.30
|
| Rate for Payer: Sagamore Health Network All Products |
$6,461.64
|
| Rate for Payer: Signature Care EPO |
$6,947.10
|
| Rate for Payer: Signature Care PPO |
$7,365.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,114.50
|
| Rate for Payer: United Healthcare Commercial |
$6,595.56
|
| Rate for Payer: United Healthcare Medicare |
$2,678.40
|
|
|
HC AR SWVLK 4.75 DBL
|
Facility
|
IP
|
$2,552.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,914.30 |
| Max. Negotiated Rate |
$2,373.73 |
| Rate for Payer: Aetna Commercial |
$2,205.27
|
| Rate for Payer: Cash Price |
$1,531.44
|
| Rate for Payer: Cigna All Commercial |
$2,202.72
|
| Rate for Payer: CORVEL All Commercial |
$2,373.73
|
| Rate for Payer: Coventry All Commercial |
$2,246.11
|
| Rate for Payer: Encore All Commercial |
$2,349.48
|
| Rate for Payer: Frontpath All Commercial |
$2,348.21
|
| Rate for Payer: Humana ChoiceCare |
$2,204.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,297.16
|
| Rate for Payer: PHCS All Commercial |
$1,914.30
|
| Rate for Payer: PHP All Commercial |
$1,935.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,970.45
|
| Rate for Payer: Signature Care EPO |
$2,118.49
|
| Rate for Payer: Signature Care PPO |
$2,246.11
|
| Rate for Payer: United Healthcare Commercial |
$2,011.29
|
|
|
HC AR SWVLK 4.75 DBL
|
Facility
|
OP
|
$2,552.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$2,373.73 |
| Rate for Payer: Aetna Commercial |
$2,154.23
|
| Rate for Payer: Aetna Medicare |
$816.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$791.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,465.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,595.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$134.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$939.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$898.44
|
| Rate for Payer: Cash Price |
$1,531.44
|
| Rate for Payer: Cash Price |
$1,531.44
|
| Rate for Payer: Centivo All Commercial |
$1,388.51
|
| Rate for Payer: Cigna All Commercial |
$2,202.72
|
| Rate for Payer: CORVEL All Commercial |
$2,373.73
|
| Rate for Payer: Coventry All Commercial |
$2,246.11
|
| Rate for Payer: Encore All Commercial |
$2,349.48
|
| Rate for Payer: Frontpath All Commercial |
$2,348.21
|
| Rate for Payer: Humana ChoiceCare |
$2,204.51
|
| Rate for Payer: Humana Medicare |
$816.77
|
| Rate for Payer: Lucent All Commercial |
$1,388.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,297.16
|
| Rate for Payer: Managed Health Services Medicaid |
$134.40
|
| Rate for Payer: MDWise Medicaid |
$134.40
|
| Rate for Payer: PHCS All Commercial |
$1,914.30
|
| Rate for Payer: PHP All Commercial |
$1,935.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$995.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,970.45
|
| Rate for Payer: Signature Care EPO |
$2,118.49
|
| Rate for Payer: Signature Care PPO |
$2,246.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,169.54
|
| Rate for Payer: United Healthcare Commercial |
$2,011.29
|
| Rate for Payer: United Healthcare Medicare |
$816.77
|
|
|
HC ARTERIAL BLOOD GASES
|
Facility
|
IP
|
$339.63
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
63001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$254.72 |
| Max. Negotiated Rate |
$315.86 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Cash Price |
$203.78
|
| Rate for Payer: Cigna All Commercial |
$293.10
|
| Rate for Payer: CORVEL All Commercial |
$315.86
|
| Rate for Payer: Coventry All Commercial |
$298.87
|
| Rate for Payer: Encore All Commercial |
$312.63
|
| Rate for Payer: Frontpath All Commercial |
$312.46
|
| Rate for Payer: Humana ChoiceCare |
$293.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$305.67
|
| Rate for Payer: PHCS All Commercial |
$254.72
|
| Rate for Payer: PHP All Commercial |
$257.58
|
| Rate for Payer: Sagamore Health Network All Products |
$262.19
|
| Rate for Payer: Signature Care EPO |
$281.89
|
| Rate for Payer: Signature Care PPO |
$298.87
|
| Rate for Payer: United Healthcare Commercial |
$267.63
|
|
|
HC ARTERIAL BLOOD GASES
|
Facility
|
OP
|
$339.63
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
63001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$315.86 |
| Rate for Payer: Aetna Commercial |
$286.65
|
| Rate for Payer: Aetna Medicare |
$108.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$26.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$156.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.55
|
| Rate for Payer: Cash Price |
$203.78
|
| Rate for Payer: Cash Price |
$203.78
|
| Rate for Payer: Centivo All Commercial |
$184.76
|
| Rate for Payer: Cigna All Commercial |
$293.10
|
| Rate for Payer: CORVEL All Commercial |
$315.86
|
| Rate for Payer: Coventry All Commercial |
$298.87
|
| Rate for Payer: Encore All Commercial |
$312.63
|
| Rate for Payer: Frontpath All Commercial |
$312.46
|
| Rate for Payer: Humana ChoiceCare |
$293.34
|
| Rate for Payer: Humana Medicare |
$108.68
|
| Rate for Payer: Lucent All Commercial |
$184.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$305.67
|
| Rate for Payer: Managed Health Services Medicaid |
$26.07
|
| Rate for Payer: MDWise Medicaid |
$26.07
|
| Rate for Payer: PHCS All Commercial |
$254.72
|
| Rate for Payer: PHP All Commercial |
$257.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.46
|
| Rate for Payer: Sagamore Health Network All Products |
$262.19
|
| Rate for Payer: Signature Care EPO |
$281.89
|
| Rate for Payer: Signature Care PPO |
$298.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$288.69
|
| Rate for Payer: United Healthcare Commercial |
$267.63
|
| Rate for Payer: United Healthcare Medicare |
$108.68
|
|
|
HC ARTERIAL DRAW
|
Facility
|
IP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1260762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.85 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
|
|
HC ARTERIAL DRAW
|
Facility
|
OP
|
$98.47
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
1260762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$83.11
|
| Rate for Payer: Aetna Medicare |
$31.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.66
|
| Rate for Payer: Cash Price |
$59.08
|
| Rate for Payer: Centivo All Commercial |
$53.57
|
| Rate for Payer: Cigna All Commercial |
$84.98
|
| Rate for Payer: CORVEL All Commercial |
$91.58
|
| Rate for Payer: Coventry All Commercial |
$86.65
|
| Rate for Payer: Encore All Commercial |
$90.64
|
| Rate for Payer: Frontpath All Commercial |
$90.59
|
| Rate for Payer: Humana ChoiceCare |
$85.05
|
| Rate for Payer: Humana Medicare |
$31.51
|
| Rate for Payer: Lucent All Commercial |
$53.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.62
|
| Rate for Payer: PHCS All Commercial |
$73.85
|
| Rate for Payer: PHP All Commercial |
$74.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.40
|
| Rate for Payer: Sagamore Health Network All Products |
$76.02
|
| Rate for Payer: Signature Care EPO |
$81.73
|
| Rate for Payer: Signature Care PPO |
$86.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$77.59
|
| Rate for Payer: United Healthcare Medicare |
$31.51
|
|
|
HC ARTERIAL LINE INSERTION
|
Facility
|
OP
|
$415.21
|
|
| Hospital Charge Code |
1682004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.72 |
| Max. Negotiated Rate |
$386.15 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Aetna Medicare |
$132.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$238.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.15
|
| Rate for Payer: Cash Price |
$249.13
|
| Rate for Payer: Centivo All Commercial |
$225.87
|
| Rate for Payer: Cigna All Commercial |
$358.33
|
| Rate for Payer: CORVEL All Commercial |
$386.15
|
| Rate for Payer: Coventry All Commercial |
$365.38
|
| Rate for Payer: Encore All Commercial |
$382.20
|
| Rate for Payer: Frontpath All Commercial |
$381.99
|
| Rate for Payer: Humana ChoiceCare |
$358.62
|
| Rate for Payer: Humana Medicare |
$132.87
|
| Rate for Payer: Lucent All Commercial |
$225.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$373.69
|
| Rate for Payer: PHCS All Commercial |
$311.41
|
| Rate for Payer: PHP All Commercial |
$314.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.93
|
| Rate for Payer: Sagamore Health Network All Products |
$320.54
|
| Rate for Payer: Signature Care EPO |
$344.62
|
| Rate for Payer: Signature Care PPO |
$365.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.93
|
| Rate for Payer: United Healthcare Commercial |
$327.19
|
| Rate for Payer: United Healthcare Medicare |
$132.87
|
|
