|
HC SN PL SCREW 4.0X55 CANC FT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X55 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601657
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X55 CANC PT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X55 CANC PT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X56 CANN PT
|
Facility
IP
|
$1,019.27
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$764.45 |
| Max. Negotiated Rate |
$947.92 |
| Rate for Payer: Aetna Commercial |
$880.65
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Cigna All Commercial |
$879.63
|
| Rate for Payer: CORVEL All Commercial |
$947.92
|
| Rate for Payer: Coventry All Commercial |
$896.96
|
| Rate for Payer: Encore All Commercial |
$938.24
|
| Rate for Payer: Frontpath All Commercial |
$937.73
|
| Rate for Payer: Humana ChoiceCare |
$880.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$917.34
|
| Rate for Payer: PHCS All Commercial |
$764.45
|
| Rate for Payer: PHP All Commercial |
$773.01
|
| Rate for Payer: Sagamore Health Network All Products |
$786.88
|
| Rate for Payer: Signature Care EPO |
$845.99
|
| Rate for Payer: Signature Care PPO |
$896.96
|
| Rate for Payer: United Healthcare Commercial |
$803.18
|
|
|
HC SN PL SCREW 4.0X56 CANN PT
|
Facility
OP
|
$1,019.27
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.36 |
| Max. Negotiated Rate |
$947.92 |
| Rate for Payer: Aetna Commercial |
$860.26
|
| Rate for Payer: Aetna Medicare |
$336.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$336.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$585.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$637.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$386.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$370.00
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Cash Price |
$631.95
|
| Rate for Payer: Centivo All Commercial |
$519.83
|
| Rate for Payer: Cigna All Commercial |
$879.63
|
| Rate for Payer: CORVEL All Commercial |
$947.92
|
| Rate for Payer: Coventry All Commercial |
$896.96
|
| Rate for Payer: Encore All Commercial |
$938.24
|
| Rate for Payer: Frontpath All Commercial |
$937.73
|
| Rate for Payer: Humana ChoiceCare |
$880.34
|
| Rate for Payer: Humana Medicare |
$519.83
|
| Rate for Payer: Lucent All Commercial |
$519.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$917.34
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$764.45
|
| Rate for Payer: PHP All Commercial |
$773.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$397.52
|
| Rate for Payer: Sagamore Health Network All Products |
$786.88
|
| Rate for Payer: Signature Care EPO |
$845.99
|
| Rate for Payer: Signature Care PPO |
$896.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$866.38
|
| Rate for Payer: United Healthcare Commercial |
$803.18
|
| Rate for Payer: United Healthcare Medicare |
$336.36
|
|
|
HC SN PL SCREW 4.0X58 CANN PT
|
Facility
OP
|
$1,496.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.68 |
| Max. Negotiated Rate |
$1,391.28 |
| Rate for Payer: Aetna Commercial |
$1,262.62
|
| Rate for Payer: Aetna Medicare |
$493.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$493.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$859.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$935.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$567.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.05
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Centivo All Commercial |
$762.96
|
| Rate for Payer: Cigna All Commercial |
$1,291.05
|
| Rate for Payer: CORVEL All Commercial |
$1,391.28
|
| Rate for Payer: Coventry All Commercial |
$1,316.48
|
| Rate for Payer: Encore All Commercial |
$1,377.07
|
| Rate for Payer: Frontpath All Commercial |
$1,376.32
|
| Rate for Payer: Humana ChoiceCare |
$1,292.10
|
| Rate for Payer: Humana Medicare |
$762.96
|
| Rate for Payer: Lucent All Commercial |
$762.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,346.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,122.00
|
| Rate for Payer: PHP All Commercial |
$1,134.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,154.91
|
| Rate for Payer: Signature Care EPO |
$1,241.68
|
| Rate for Payer: Signature Care PPO |
$1,316.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,271.60
|
| Rate for Payer: United Healthcare Commercial |
$1,178.85
|
| Rate for Payer: United Healthcare Medicare |
$493.68
|
|
|
HC SN PL SCREW 4.0X58 CANN PT
|
Facility
IP
|
$1,496.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$1,391.28 |
| Rate for Payer: Aetna Commercial |
$1,292.54
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Cigna All Commercial |
$1,291.05
|
| Rate for Payer: CORVEL All Commercial |
$1,391.28
|
| Rate for Payer: Coventry All Commercial |
$1,316.48
|
| Rate for Payer: Encore All Commercial |
$1,377.07
|
| Rate for Payer: Frontpath All Commercial |
$1,376.32
|
| Rate for Payer: Humana ChoiceCare |
$1,292.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,346.40
|
| Rate for Payer: PHCS All Commercial |
$1,122.00
|
| Rate for Payer: PHP All Commercial |
$1,134.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,154.91
|
| Rate for Payer: Signature Care EPO |
$1,241.68
|
| Rate for Payer: Signature Care PPO |
$1,316.48
|
| Rate for Payer: United Healthcare Commercial |
$1,178.85
|
|
|
HC SN PL SCREW 4.0X60 CANC FT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X60 CANC FT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X60 CANC PT
|
Facility
OP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$524.16 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$82.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$89.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.07
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Centivo All Commercial |
$73.15
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Humana Medicare |
$73.15
|
| Rate for Payer: Lucent All Commercial |
$73.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.94
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$121.92
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
| Rate for Payer: United Healthcare Medicare |
$47.33
|
|
|
HC SN PL SCREW 4.0X60 CANC PT
|
Facility
IP
|
$143.43
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$133.39 |
| Rate for Payer: Aetna Commercial |
$123.92
|
| Rate for Payer: Cash Price |
$88.93
|
| Rate for Payer: Cigna All Commercial |
$123.78
|
| Rate for Payer: CORVEL All Commercial |
$133.39
|
| Rate for Payer: Coventry All Commercial |
$126.22
|
| Rate for Payer: Encore All Commercial |
$132.03
|
| Rate for Payer: Frontpath All Commercial |
$131.96
|
| Rate for Payer: Humana ChoiceCare |
$123.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.09
|
| Rate for Payer: PHCS All Commercial |
$107.57
|
| Rate for Payer: PHP All Commercial |
$108.78
|
| Rate for Payer: Sagamore Health Network All Products |
$110.73
|
| Rate for Payer: Signature Care EPO |
$119.05
|
| Rate for Payer: Signature Care PPO |
$126.22
|
| Rate for Payer: United Healthcare Commercial |
$113.02
|
|
|
HC SN PL SCREW 4.0X60 CANN PT
|
Facility
IP
|
$1,496.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$1,391.28 |
| Rate for Payer: Aetna Commercial |
$1,292.54
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Cigna All Commercial |
$1,291.05
|
| Rate for Payer: CORVEL All Commercial |
$1,391.28
|
| Rate for Payer: Coventry All Commercial |
$1,316.48
|
| Rate for Payer: Encore All Commercial |
$1,377.07
|
| Rate for Payer: Frontpath All Commercial |
$1,376.32
|
| Rate for Payer: Humana ChoiceCare |
$1,292.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,346.40
|
| Rate for Payer: PHCS All Commercial |
$1,122.00
|
| Rate for Payer: PHP All Commercial |
$1,134.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,154.91
|
| Rate for Payer: Signature Care EPO |
$1,241.68
|
| Rate for Payer: Signature Care PPO |
$1,316.48
|
| Rate for Payer: United Healthcare Commercial |
$1,178.85
|
|
|
HC SN PL SCREW 4.0X60 CANN PT
|
Facility
OP
|
$1,496.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.68 |
| Max. Negotiated Rate |
$1,391.28 |
| Rate for Payer: Aetna Commercial |
$1,262.62
|
| Rate for Payer: Aetna Medicare |
$493.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$493.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$859.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$935.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$567.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$543.05
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Centivo All Commercial |
$762.96
|
| Rate for Payer: Cigna All Commercial |
$1,291.05
|
| Rate for Payer: CORVEL All Commercial |
$1,391.28
|
| Rate for Payer: Coventry All Commercial |
$1,316.48
|
| Rate for Payer: Encore All Commercial |
$1,377.07
|
| Rate for Payer: Frontpath All Commercial |
$1,376.32
|
| Rate for Payer: Humana ChoiceCare |
$1,292.10
|
| Rate for Payer: Humana Medicare |
$762.96
|
| Rate for Payer: Lucent All Commercial |
$762.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,346.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,122.00
|
| Rate for Payer: PHP All Commercial |
$1,134.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$583.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,154.91
|
| Rate for Payer: Signature Care EPO |
$1,241.68
|
| Rate for Payer: Signature Care PPO |
$1,316.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,271.60
|
| Rate for Payer: United Healthcare Commercial |
$1,178.85
|
| Rate for Payer: United Healthcare Medicare |
$493.68
|
|
|
HC SN PL SCREW 5.0X12 OSTEO VLP
|
Facility
OP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.77 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$510.92
|
| Rate for Payer: Aetna Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.75
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Centivo All Commercial |
$308.73
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Humana Medicare |
$308.73
|
| Rate for Payer: Lucent All Commercial |
$308.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.09
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$514.56
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare |
$199.77
|
|
|
HC SN PL SCREW 5.0X12 OSTEO VLP
|
Facility
IP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.02 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$523.03
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
|
|
HC SN PL SCREW 5.0X14 OSTEO VLP
|
Facility
IP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.02 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$523.03
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
|
|
HC SN PL SCREW 5.0X14 OSTEO VLP
|
Facility
OP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.77 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$510.92
|
| Rate for Payer: Aetna Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.75
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Centivo All Commercial |
$308.73
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Humana Medicare |
$308.73
|
| Rate for Payer: Lucent All Commercial |
$308.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.09
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$514.56
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare |
$199.77
|
|
|
HC SN PL SCREW 5.0X18 OSTEO VLP
|
Facility
IP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.02 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$523.03
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
|
|
HC SN PL SCREW 5.0X18 OSTEO VLP
|
Facility
OP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.77 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$510.92
|
| Rate for Payer: Aetna Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.75
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Centivo All Commercial |
$308.73
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Humana Medicare |
$308.73
|
| Rate for Payer: Lucent All Commercial |
$308.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.09
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$514.56
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare |
$199.77
|
|
|
HC SN PL SCREW 5.0X22 OSTEO VLP
|
Facility
IP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.02 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$523.03
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
|
|
HC SN PL SCREW 5.0X22 OSTEO VLP
|
Facility
OP
|
$605.36
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41602518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.77 |
| Max. Negotiated Rate |
$562.98 |
| Rate for Payer: Aetna Commercial |
$510.92
|
| Rate for Payer: Aetna Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$199.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$347.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$378.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.75
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Cash Price |
$375.32
|
| Rate for Payer: Centivo All Commercial |
$308.73
|
| Rate for Payer: Cigna All Commercial |
$522.43
|
| Rate for Payer: CORVEL All Commercial |
$562.98
|
| Rate for Payer: Coventry All Commercial |
$532.72
|
| Rate for Payer: Encore All Commercial |
$557.23
|
| Rate for Payer: Frontpath All Commercial |
$556.93
|
| Rate for Payer: Humana ChoiceCare |
$522.85
|
| Rate for Payer: Humana Medicare |
$308.73
|
| Rate for Payer: Lucent All Commercial |
$308.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$544.82
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$454.02
|
| Rate for Payer: PHP All Commercial |
$459.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$236.09
|
| Rate for Payer: Sagamore Health Network All Products |
$467.34
|
| Rate for Payer: Signature Care EPO |
$502.45
|
| Rate for Payer: Signature Care PPO |
$532.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$514.56
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: United Healthcare Medicare |
$199.77
|
|
|
HC SN PL TAP 4.0 CANN
|
Facility
IP
|
$2,398.50
|
|
| Hospital Charge Code |
41602521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,798.88 |
| Max. Negotiated Rate |
$2,230.60 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Cash Price |
$1,487.07
|
| Rate for Payer: Cigna All Commercial |
$2,069.91
|
| Rate for Payer: CORVEL All Commercial |
$2,230.60
|
| Rate for Payer: Coventry All Commercial |
$2,110.68
|
| Rate for Payer: Encore All Commercial |
$2,207.82
|
| Rate for Payer: Frontpath All Commercial |
$2,206.62
|
| Rate for Payer: Humana ChoiceCare |
$2,071.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,158.65
|
| Rate for Payer: PHCS All Commercial |
$1,798.88
|
| Rate for Payer: PHP All Commercial |
$1,819.02
|
| Rate for Payer: Sagamore Health Network All Products |
$1,851.64
|
| Rate for Payer: Signature Care EPO |
$1,990.76
|
| Rate for Payer: Signature Care PPO |
$2,110.68
|
| Rate for Payer: United Healthcare Commercial |
$1,890.02
|
|
|
HC SN PL TAP 4.0 CANN
|
Facility
OP
|
$2,398.50
|
|
| Hospital Charge Code |
41602521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,230.60 |
| Rate for Payer: Aetna Commercial |
$2,024.33
|
| Rate for Payer: Aetna Medicare |
$791.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$791.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,377.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,499.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$910.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$870.66
|
| Rate for Payer: Cash Price |
$1,487.07
|
| Rate for Payer: Cash Price |
$1,487.07
|
| Rate for Payer: Centivo All Commercial |
$1,223.24
|
| Rate for Payer: Cigna All Commercial |
$2,069.91
|
| Rate for Payer: CORVEL All Commercial |
$2,230.60
|
| Rate for Payer: Coventry All Commercial |
$2,110.68
|
| Rate for Payer: Encore All Commercial |
$2,207.82
|
| Rate for Payer: Frontpath All Commercial |
$2,206.62
|
| Rate for Payer: Humana ChoiceCare |
$2,071.58
|
| Rate for Payer: Humana Medicare |
$1,223.24
|
| Rate for Payer: Lucent All Commercial |
$1,223.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,158.65
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,798.88
|
| Rate for Payer: PHP All Commercial |
$1,819.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$935.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,851.64
|
| Rate for Payer: Signature Care EPO |
$1,990.76
|
| Rate for Payer: Signature Care PPO |
$2,110.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,038.72
|
| Rate for Payer: United Healthcare Commercial |
$1,890.02
|
| Rate for Payer: United Healthcare Medicare |
$791.50
|
|
|
HC SN SCREW 7.0X100 16 SS CANN PT
|
Facility
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,925.10 |
| Rate for Payer: Aetna Commercial |
$1,747.08
|
| Rate for Payer: Aetna Medicare |
$683.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$683.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,188.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,293.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$785.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$751.41
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Cash Price |
$1,283.40
|
| Rate for Payer: Centivo All Commercial |
$1,055.70
|
| Rate for Payer: Cigna All Commercial |
$1,786.41
|
| Rate for Payer: CORVEL All Commercial |
$1,925.10
|
| Rate for Payer: Coventry All Commercial |
$1,821.60
|
| Rate for Payer: Encore All Commercial |
$1,905.44
|
| Rate for Payer: Frontpath All Commercial |
$1,904.40
|
| Rate for Payer: Humana ChoiceCare |
$1,787.86
|
| Rate for Payer: Humana Medicare |
$1,055.70
|
| Rate for Payer: Lucent All Commercial |
$1,055.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,863.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,552.50
|
| Rate for Payer: PHP All Commercial |
$1,569.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$807.30
|
| Rate for Payer: Sagamore Health Network All Products |
$1,598.04
|
| Rate for Payer: Signature Care EPO |
$1,718.10
|
| Rate for Payer: Signature Care PPO |
$1,821.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,759.50
|
| Rate for Payer: United Healthcare Commercial |
$1,631.16
|
| Rate for Payer: United Healthcare Medicare |
$683.10
|
|
