|
HC I2B SCREW 2.4X10 NON LOCK
|
Facility
IP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.50 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,149.12
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
|
|
HC I2B SCREW 2.4X11 NON LOCK
|
Facility
IP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.50 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,149.12
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
|
|
HC I2B SCREW 2.4X11 NON LOCK
|
Facility
OP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,122.52
|
| Rate for Payer: Aetna Medicare |
$438.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$763.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$831.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$504.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$482.79
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Centivo All Commercial |
$678.30
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Humana Medicare |
$678.30
|
| Rate for Payer: Lucent All Commercial |
$678.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,130.50
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
|
|
HC I2B SCREW 2.4X12 LOCK
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,055.00
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$453.75
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Centivo All Commercial |
$637.50
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Humana Medicare |
$637.50
|
| Rate for Payer: Lucent All Commercial |
$637.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicare |
$412.50
|
|
|
HC I2B SCREW 2.4X12 LOCK
|
Facility
IP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
|
|
HC I2B SCREW 2.4X12 NON LOCK
|
Facility
IP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.50 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,149.12
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
|
|
HC I2B SCREW 2.4X12 NON LOCK
|
Facility
OP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,122.52
|
| Rate for Payer: Aetna Medicare |
$438.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$763.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$831.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$504.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$482.79
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Centivo All Commercial |
$678.30
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Humana Medicare |
$678.30
|
| Rate for Payer: Lucent All Commercial |
$678.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,130.50
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
|
|
HC I2B SCREW 2.4X13 NON LOCK
|
Facility
OP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,122.52
|
| Rate for Payer: Aetna Medicare |
$438.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$438.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$763.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$831.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$504.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$482.79
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Centivo All Commercial |
$678.30
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Humana Medicare |
$678.30
|
| Rate for Payer: Lucent All Commercial |
$678.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$518.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,130.50
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
|
|
HC I2B SCREW 2.4X13 NON LOCK
|
Facility
IP
|
$1,330.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.50 |
| Max. Negotiated Rate |
$1,236.90 |
| Rate for Payer: Aetna Commercial |
$1,149.12
|
| Rate for Payer: Cash Price |
$824.60
|
| Rate for Payer: Cigna All Commercial |
$1,147.79
|
| Rate for Payer: CORVEL All Commercial |
$1,236.90
|
| Rate for Payer: Coventry All Commercial |
$1,170.40
|
| Rate for Payer: Encore All Commercial |
$1,224.26
|
| Rate for Payer: Frontpath All Commercial |
$1,223.60
|
| Rate for Payer: Humana ChoiceCare |
$1,148.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,197.00
|
| Rate for Payer: PHCS All Commercial |
$997.50
|
| Rate for Payer: PHP All Commercial |
$1,008.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,026.76
|
| Rate for Payer: Signature Care EPO |
$1,103.90
|
| Rate for Payer: Signature Care PPO |
$1,170.40
|
| Rate for Payer: United Healthcare Commercial |
$1,048.04
|
|
|
HC I2B SCREW 2.4X16 NON LOCK
|
Facility
OP
|
$1,590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,341.96
|
| Rate for Payer: Aetna Medicare |
$524.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$524.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$913.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$993.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$577.17
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Centivo All Commercial |
$810.90
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Humana Medicare |
$810.90
|
| Rate for Payer: Lucent All Commercial |
$810.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$620.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,351.50
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
| Rate for Payer: United Healthcare Medicare |
$524.70
|
|
|
HC I2B SCREW 2.4X16 NON LOCK
|
Facility
IP
|
$1,590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,373.76
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
|
|
HC I2B SCREW 2.4X9 LOCK
|
Facility
OP
|
$1,690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,571.70 |
| Rate for Payer: Aetna Commercial |
$1,426.36
|
| Rate for Payer: Aetna Medicare |
$557.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$557.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$970.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,056.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$641.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$613.47
|
| Rate for Payer: Cash Price |
$1,047.80
|
| Rate for Payer: Cash Price |
$1,047.80
|
| Rate for Payer: Centivo All Commercial |
$861.90
|
| Rate for Payer: Cigna All Commercial |
$1,458.47
|
| Rate for Payer: CORVEL All Commercial |
$1,571.70
|
| Rate for Payer: Coventry All Commercial |
$1,487.20
|
| Rate for Payer: Encore All Commercial |
$1,555.64
|
| Rate for Payer: Frontpath All Commercial |
$1,554.80
|
| Rate for Payer: Humana ChoiceCare |
$1,459.65
|
| Rate for Payer: Humana Medicare |
$861.90
|
| Rate for Payer: Lucent All Commercial |
$861.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,521.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,267.50
|
| Rate for Payer: PHP All Commercial |
$1,281.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$659.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,304.68
|
| Rate for Payer: Signature Care EPO |
$1,402.70
|
| Rate for Payer: Signature Care PPO |
$1,487.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,436.50
|
| Rate for Payer: United Healthcare Commercial |
$1,331.72
|
| Rate for Payer: United Healthcare Medicare |
$557.70
|
|
|
HC I2B SCREW 2.4X9 LOCK
|
Facility
IP
|
$1,690.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.50 |
| Max. Negotiated Rate |
$1,571.70 |
| Rate for Payer: Aetna Commercial |
$1,460.16
|
| Rate for Payer: Cash Price |
$1,047.80
|
| Rate for Payer: Cigna All Commercial |
$1,458.47
|
| Rate for Payer: CORVEL All Commercial |
$1,571.70
|
| Rate for Payer: Coventry All Commercial |
$1,487.20
|
| Rate for Payer: Encore All Commercial |
$1,555.64
|
| Rate for Payer: Frontpath All Commercial |
$1,554.80
|
| Rate for Payer: Humana ChoiceCare |
$1,459.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,521.00
|
| Rate for Payer: PHCS All Commercial |
$1,267.50
|
| Rate for Payer: PHP All Commercial |
$1,281.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1,304.68
|
| Rate for Payer: Signature Care EPO |
$1,402.70
|
| Rate for Payer: Signature Care PPO |
$1,487.20
|
| Rate for Payer: United Healthcare Commercial |
$1,331.72
|
|
|
HC I2B SCREW 2.5X12 COLAG
|
Facility
IP
|
$2,217.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,663.20 |
| Max. Negotiated Rate |
$2,062.37 |
| Rate for Payer: Aetna Commercial |
$1,916.01
|
| Rate for Payer: Cash Price |
$1,374.91
|
| Rate for Payer: Cigna All Commercial |
$1,913.79
|
| Rate for Payer: CORVEL All Commercial |
$2,062.37
|
| Rate for Payer: Coventry All Commercial |
$1,951.49
|
| Rate for Payer: Encore All Commercial |
$2,041.30
|
| Rate for Payer: Frontpath All Commercial |
$2,040.19
|
| Rate for Payer: Humana ChoiceCare |
$1,915.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,995.84
|
| Rate for Payer: PHCS All Commercial |
$1,663.20
|
| Rate for Payer: PHP All Commercial |
$1,681.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,711.99
|
| Rate for Payer: Signature Care EPO |
$1,840.61
|
| Rate for Payer: Signature Care PPO |
$1,951.49
|
| Rate for Payer: United Healthcare Commercial |
$1,747.47
|
|
|
HC I2B SCREW 2.5X12 COLAG
|
Facility
OP
|
$2,217.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,062.37 |
| Rate for Payer: Aetna Commercial |
$1,871.65
|
| Rate for Payer: Aetna Medicare |
$731.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$731.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,273.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,386.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$841.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$804.99
|
| Rate for Payer: Cash Price |
$1,374.91
|
| Rate for Payer: Cash Price |
$1,374.91
|
| Rate for Payer: Centivo All Commercial |
$1,130.98
|
| Rate for Payer: Cigna All Commercial |
$1,913.79
|
| Rate for Payer: CORVEL All Commercial |
$2,062.37
|
| Rate for Payer: Coventry All Commercial |
$1,951.49
|
| Rate for Payer: Encore All Commercial |
$2,041.30
|
| Rate for Payer: Frontpath All Commercial |
$2,040.19
|
| Rate for Payer: Humana ChoiceCare |
$1,915.34
|
| Rate for Payer: Humana Medicare |
$1,130.98
|
| Rate for Payer: Lucent All Commercial |
$1,130.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,995.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,663.20
|
| Rate for Payer: PHP All Commercial |
$1,681.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$864.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,711.99
|
| Rate for Payer: Signature Care EPO |
$1,840.61
|
| Rate for Payer: Signature Care PPO |
$1,951.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,884.96
|
| Rate for Payer: United Healthcare Commercial |
$1,747.47
|
| Rate for Payer: United Healthcare Medicare |
$731.81
|
|
|
HC I2B SCREW 2.5X14 COLAG
|
Facility
OP
|
$2,217.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,062.37 |
| Rate for Payer: Aetna Commercial |
$1,871.65
|
| Rate for Payer: Aetna Medicare |
$731.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$731.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,273.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,386.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$841.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$804.99
|
| Rate for Payer: Cash Price |
$1,374.91
|
| Rate for Payer: Cash Price |
$1,374.91
|
| Rate for Payer: Centivo All Commercial |
$1,130.98
|
| Rate for Payer: Cigna All Commercial |
$1,913.79
|
| Rate for Payer: CORVEL All Commercial |
$2,062.37
|
| Rate for Payer: Coventry All Commercial |
$1,951.49
|
| Rate for Payer: Encore All Commercial |
$2,041.30
|
| Rate for Payer: Frontpath All Commercial |
$2,040.19
|
| Rate for Payer: Humana ChoiceCare |
$1,915.34
|
| Rate for Payer: Humana Medicare |
$1,130.98
|
| Rate for Payer: Lucent All Commercial |
$1,130.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,995.84
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,663.20
|
| Rate for Payer: PHP All Commercial |
$1,681.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$864.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,711.99
|
| Rate for Payer: Signature Care EPO |
$1,840.61
|
| Rate for Payer: Signature Care PPO |
$1,951.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,884.96
|
| Rate for Payer: United Healthcare Commercial |
$1,747.47
|
| Rate for Payer: United Healthcare Medicare |
$731.81
|
|
|
HC I2B SCREW 2.5X14 COLAG
|
Facility
IP
|
$2,217.60
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,663.20 |
| Max. Negotiated Rate |
$2,062.37 |
| Rate for Payer: Aetna Commercial |
$1,916.01
|
| Rate for Payer: Cash Price |
$1,374.91
|
| Rate for Payer: Cigna All Commercial |
$1,913.79
|
| Rate for Payer: CORVEL All Commercial |
$2,062.37
|
| Rate for Payer: Coventry All Commercial |
$1,951.49
|
| Rate for Payer: Encore All Commercial |
$2,041.30
|
| Rate for Payer: Frontpath All Commercial |
$2,040.19
|
| Rate for Payer: Humana ChoiceCare |
$1,915.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,995.84
|
| Rate for Payer: PHCS All Commercial |
$1,663.20
|
| Rate for Payer: PHP All Commercial |
$1,681.83
|
| Rate for Payer: Sagamore Health Network All Products |
$1,711.99
|
| Rate for Payer: Signature Care EPO |
$1,840.61
|
| Rate for Payer: Signature Care PPO |
$1,951.49
|
| Rate for Payer: United Healthcare Commercial |
$1,747.47
|
|
|
HC I2B SCREW 2.7X 14 LOCK
|
Facility
OP
|
$1,590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,341.96
|
| Rate for Payer: Aetna Medicare |
$524.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$524.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$913.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$993.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$603.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$577.17
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Centivo All Commercial |
$810.90
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Humana Medicare |
$810.90
|
| Rate for Payer: Lucent All Commercial |
$810.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$620.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,351.50
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
| Rate for Payer: United Healthcare Medicare |
$524.70
|
|
|
HC I2B SCREW 2.7X 14 LOCK
|
Facility
IP
|
$1,590.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,192.50 |
| Max. Negotiated Rate |
$1,478.70 |
| Rate for Payer: Aetna Commercial |
$1,373.76
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna All Commercial |
$1,372.17
|
| Rate for Payer: CORVEL All Commercial |
$1,478.70
|
| Rate for Payer: Coventry All Commercial |
$1,399.20
|
| Rate for Payer: Encore All Commercial |
$1,463.60
|
| Rate for Payer: Frontpath All Commercial |
$1,462.80
|
| Rate for Payer: Humana ChoiceCare |
$1,373.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,431.00
|
| Rate for Payer: PHCS All Commercial |
$1,192.50
|
| Rate for Payer: PHP All Commercial |
$1,205.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1,227.48
|
| Rate for Payer: Signature Care EPO |
$1,319.70
|
| Rate for Payer: Signature Care PPO |
$1,399.20
|
| Rate for Payer: United Healthcare Commercial |
$1,252.92
|
|
|
HC I2B SCREW 2.7X 14 NONLOCK
|
Facility
IP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
|
|
HC I2B SCREW 2.7X 14 NONLOCK
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,055.00
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$453.75
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Centivo All Commercial |
$637.50
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Humana Medicare |
$637.50
|
| Rate for Payer: Lucent All Commercial |
$637.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicare |
$412.50
|
|
|
HC I2B SCREW 2.7X 16LOCK
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,055.00
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$412.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$717.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$781.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$474.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$453.75
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Centivo All Commercial |
$637.50
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Humana Medicare |
$637.50
|
| Rate for Payer: Lucent All Commercial |
$637.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$487.50
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
| Rate for Payer: United Healthcare Medicare |
$412.50
|
|
|
HC I2B SCREW 2.7X 16LOCK
|
Facility
IP
|
$1,250.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$1,162.50 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna All Commercial |
$1,078.75
|
| Rate for Payer: CORVEL All Commercial |
$1,162.50
|
| Rate for Payer: Coventry All Commercial |
$1,100.00
|
| Rate for Payer: Encore All Commercial |
$1,150.62
|
| Rate for Payer: Frontpath All Commercial |
$1,150.00
|
| Rate for Payer: Humana ChoiceCare |
$1,079.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,125.00
|
| Rate for Payer: PHCS All Commercial |
$937.50
|
| Rate for Payer: PHP All Commercial |
$948.00
|
| Rate for Payer: Sagamore Health Network All Products |
$965.00
|
| Rate for Payer: Signature Care EPO |
$1,037.50
|
| Rate for Payer: Signature Care PPO |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$985.00
|
|
|
HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE
|
Facility
OP
|
$247.86
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
63087634
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$230.51 |
| Rate for Payer: Aetna Commercial |
$209.19
|
| Rate for Payer: Aetna Medicare |
$81.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$142.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$70.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$94.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.97
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Centivo All Commercial |
$126.41
|
| Rate for Payer: Cigna All Commercial |
$213.90
|
| Rate for Payer: CORVEL All Commercial |
$230.51
|
| Rate for Payer: Coventry All Commercial |
$218.12
|
| Rate for Payer: Encore All Commercial |
$228.16
|
| Rate for Payer: Frontpath All Commercial |
$228.03
|
| Rate for Payer: Humana ChoiceCare |
$214.08
|
| Rate for Payer: Humana Medicare |
$126.41
|
| Rate for Payer: Lucent All Commercial |
$126.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.07
|
| Rate for Payer: Managed Health Services Medicaid |
$70.20
|
| Rate for Payer: MDWise Medicaid |
$70.20
|
| Rate for Payer: PHCS All Commercial |
$185.90
|
| Rate for Payer: PHP All Commercial |
$187.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.67
|
| Rate for Payer: Sagamore Health Network All Products |
$191.35
|
| Rate for Payer: Signature Care EPO |
$205.72
|
| Rate for Payer: Signature Care PPO |
$218.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$210.68
|
| Rate for Payer: United Healthcare Commercial |
$195.31
|
| Rate for Payer: United Healthcare Medicare |
$81.79
|
|
|
HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE
|
Facility
IP
|
$247.86
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
63087634
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$185.90 |
| Max. Negotiated Rate |
$230.51 |
| Rate for Payer: Aetna Commercial |
$214.15
|
| Rate for Payer: Cash Price |
$153.67
|
| Rate for Payer: Cigna All Commercial |
$213.90
|
| Rate for Payer: CORVEL All Commercial |
$230.51
|
| Rate for Payer: Coventry All Commercial |
$218.12
|
| Rate for Payer: Encore All Commercial |
$228.16
|
| Rate for Payer: Frontpath All Commercial |
$228.03
|
| Rate for Payer: Humana ChoiceCare |
$214.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$223.07
|
| Rate for Payer: PHCS All Commercial |
$185.90
|
| Rate for Payer: PHP All Commercial |
$187.98
|
| Rate for Payer: Sagamore Health Network All Products |
$191.35
|
| Rate for Payer: Signature Care EPO |
$205.72
|
| Rate for Payer: Signature Care PPO |
$218.12
|
| Rate for Payer: United Healthcare Commercial |
$195.31
|
|
