|
HC TISSUE CULT-NON-NEOP
|
Facility
|
IP
|
$324.18
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
63002075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.13 |
| Max. Negotiated Rate |
$301.48 |
| Rate for Payer: Aetna Commercial |
$280.09
|
| Rate for Payer: Cash Price |
$200.99
|
| Rate for Payer: Cigna All Commercial |
$279.76
|
| Rate for Payer: CORVEL All Commercial |
$301.48
|
| Rate for Payer: Coventry All Commercial |
$285.28
|
| Rate for Payer: Encore All Commercial |
$298.40
|
| Rate for Payer: Frontpath All Commercial |
$298.24
|
| Rate for Payer: Humana ChoiceCare |
$279.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.76
|
| Rate for Payer: PHCS All Commercial |
$243.13
|
| Rate for Payer: PHP All Commercial |
$245.86
|
| Rate for Payer: Sagamore Health Network All Products |
$250.26
|
| Rate for Payer: Signature Care EPO |
$269.07
|
| Rate for Payer: Signature Care PPO |
$285.28
|
| Rate for Payer: United Healthcare Commercial |
$255.45
|
|
|
HC TISSUE CULT-NON-NEOP
|
Facility
|
OP
|
$324.18
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
63002075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$301.48 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Medicare |
$106.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$186.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$202.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$75.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.68
|
| Rate for Payer: Cash Price |
$200.99
|
| Rate for Payer: Cash Price |
$200.99
|
| Rate for Payer: Centivo All Commercial |
$165.33
|
| Rate for Payer: Cigna All Commercial |
$279.76
|
| Rate for Payer: CORVEL All Commercial |
$301.48
|
| Rate for Payer: Coventry All Commercial |
$285.28
|
| Rate for Payer: Encore All Commercial |
$298.40
|
| Rate for Payer: Frontpath All Commercial |
$298.24
|
| Rate for Payer: Humana ChoiceCare |
$279.99
|
| Rate for Payer: Humana Medicare |
$165.33
|
| Rate for Payer: Lucent All Commercial |
$165.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$291.76
|
| Rate for Payer: Managed Health Services Medicaid |
$75.71
|
| Rate for Payer: MDWise Medicaid |
$75.71
|
| Rate for Payer: PHCS All Commercial |
$243.13
|
| Rate for Payer: PHP All Commercial |
$245.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.43
|
| Rate for Payer: Sagamore Health Network All Products |
$250.26
|
| Rate for Payer: Signature Care EPO |
$269.07
|
| Rate for Payer: Signature Care PPO |
$285.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$275.55
|
| Rate for Payer: United Healthcare Commercial |
$255.45
|
| Rate for Payer: United Healthcare Medicare |
$106.98
|
|
|
HC TISSUE CULTURE-NEOPLAST
|
Facility
|
OP
|
$61.06
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
63002077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$86.50 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare |
$20.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$86.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.16
|
| Rate for Payer: Cash Price |
$37.86
|
| Rate for Payer: Cash Price |
$37.86
|
| Rate for Payer: Centivo All Commercial |
$31.14
|
| Rate for Payer: Cigna All Commercial |
$52.69
|
| Rate for Payer: CORVEL All Commercial |
$56.78
|
| Rate for Payer: Coventry All Commercial |
$53.73
|
| Rate for Payer: Encore All Commercial |
$56.20
|
| Rate for Payer: Frontpath All Commercial |
$56.17
|
| Rate for Payer: Humana ChoiceCare |
$52.74
|
| Rate for Payer: Humana Medicare |
$31.14
|
| Rate for Payer: Lucent All Commercial |
$31.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.95
|
| Rate for Payer: Managed Health Services Medicaid |
$86.50
|
| Rate for Payer: MDWise Medicaid |
$86.50
|
| Rate for Payer: PHCS All Commercial |
$45.79
|
| Rate for Payer: PHP All Commercial |
$46.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.81
|
| Rate for Payer: Sagamore Health Network All Products |
$47.14
|
| Rate for Payer: Signature Care EPO |
$50.68
|
| Rate for Payer: Signature Care PPO |
$53.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.90
|
| Rate for Payer: United Healthcare Commercial |
$48.11
|
| Rate for Payer: United Healthcare Medicare |
$20.15
|
|
|
HC TISSUE CULTURE-NEOPLAST
|
Facility
|
IP
|
$61.06
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
63002077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.79 |
| Max. Negotiated Rate |
$56.78 |
| Rate for Payer: Aetna Commercial |
$52.75
|
| Rate for Payer: Cash Price |
$37.86
|
| Rate for Payer: Cigna All Commercial |
$52.69
|
| Rate for Payer: CORVEL All Commercial |
$56.78
|
| Rate for Payer: Coventry All Commercial |
$53.73
|
| Rate for Payer: Encore All Commercial |
$56.20
|
| Rate for Payer: Frontpath All Commercial |
$56.17
|
| Rate for Payer: Humana ChoiceCare |
$52.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.95
|
| Rate for Payer: PHCS All Commercial |
$45.79
|
| Rate for Payer: PHP All Commercial |
$46.31
|
| Rate for Payer: Sagamore Health Network All Products |
$47.14
|
| Rate for Payer: Signature Care EPO |
$50.68
|
| Rate for Payer: Signature Care PPO |
$53.73
|
| Rate for Payer: United Healthcare Commercial |
$48.11
|
|
|
HC TISSUE PLACENTAL VIAFLOW
|
Facility
|
OP
|
$11,581.20
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41605116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$10,770.52 |
| Rate for Payer: Aetna Commercial |
$9,774.53
|
| Rate for Payer: Aetna Medicare |
$3,821.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,821.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,651.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,239.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,395.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,203.98
|
| Rate for Payer: Cash Price |
$7,180.34
|
| Rate for Payer: Cash Price |
$7,180.34
|
| Rate for Payer: Centivo All Commercial |
$5,906.41
|
| Rate for Payer: Cigna All Commercial |
$9,994.58
|
| Rate for Payer: CORVEL All Commercial |
$10,770.52
|
| Rate for Payer: Coventry All Commercial |
$10,191.46
|
| Rate for Payer: Encore All Commercial |
$10,660.49
|
| Rate for Payer: Frontpath All Commercial |
$10,654.70
|
| Rate for Payer: Humana ChoiceCare |
$10,002.68
|
| Rate for Payer: Humana Medicare |
$5,906.41
|
| Rate for Payer: Lucent All Commercial |
$5,906.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,423.08
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$8,685.90
|
| Rate for Payer: PHP All Commercial |
$8,783.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,516.67
|
| Rate for Payer: Sagamore Health Network All Products |
$8,940.69
|
| Rate for Payer: Signature Care EPO |
$9,612.40
|
| Rate for Payer: Signature Care PPO |
$10,191.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,844.02
|
| Rate for Payer: United Healthcare Commercial |
$9,125.99
|
| Rate for Payer: United Healthcare Medicare |
$3,821.80
|
|
|
HC TISSUE PLACENTAL VIAFLOW
|
Facility
|
IP
|
$11,581.20
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41605116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,685.90 |
| Max. Negotiated Rate |
$10,770.52 |
| Rate for Payer: Aetna Commercial |
$10,006.16
|
| Rate for Payer: Cash Price |
$7,180.34
|
| Rate for Payer: Cigna All Commercial |
$9,994.58
|
| Rate for Payer: CORVEL All Commercial |
$10,770.52
|
| Rate for Payer: Coventry All Commercial |
$10,191.46
|
| Rate for Payer: Encore All Commercial |
$10,660.49
|
| Rate for Payer: Frontpath All Commercial |
$10,654.70
|
| Rate for Payer: Humana ChoiceCare |
$10,002.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,423.08
|
| Rate for Payer: PHCS All Commercial |
$8,685.90
|
| Rate for Payer: PHP All Commercial |
$8,783.18
|
| Rate for Payer: Sagamore Health Network All Products |
$8,940.69
|
| Rate for Payer: Signature Care EPO |
$9,612.40
|
| Rate for Payer: Signature Care PPO |
$10,191.46
|
| Rate for Payer: United Healthcare Commercial |
$9,125.99
|
|
|
HC TISSUE POST TIB TENDON
|
Facility
|
IP
|
$6,480.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41602616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,860.00 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,598.72
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
|
|
HC TISSUE POST TIB TENDON
|
Facility
|
OP
|
$6,480.00
|
|
|
Service Code
|
CPT C1762
|
| Hospital Charge Code |
41602616
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,026.40 |
| Rate for Payer: Aetna Commercial |
$5,469.12
|
| Rate for Payer: Aetna Medicare |
$2,138.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,138.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,721.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,050.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,459.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,352.24
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Cash Price |
$4,017.60
|
| Rate for Payer: Centivo All Commercial |
$3,304.80
|
| Rate for Payer: Cigna All Commercial |
$5,592.24
|
| Rate for Payer: CORVEL All Commercial |
$6,026.40
|
| Rate for Payer: Coventry All Commercial |
$5,702.40
|
| Rate for Payer: Encore All Commercial |
$5,964.84
|
| Rate for Payer: Frontpath All Commercial |
$5,961.60
|
| Rate for Payer: Humana ChoiceCare |
$5,596.78
|
| Rate for Payer: Humana Medicare |
$3,304.80
|
| Rate for Payer: Lucent All Commercial |
$3,304.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,832.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,860.00
|
| Rate for Payer: PHP All Commercial |
$4,914.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,527.20
|
| Rate for Payer: Sagamore Health Network All Products |
$5,002.56
|
| Rate for Payer: Signature Care EPO |
$5,378.40
|
| Rate for Payer: Signature Care PPO |
$5,702.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,508.00
|
| Rate for Payer: United Healthcare Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare Medicare |
$2,138.40
|
|
|
HC TISSUE TRANSGLUT IGA
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC TISSUE TRANSGLUT IGA
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC TISSUE TRANSGLUT IGG
|
Facility
|
OP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$110.44
|
| Rate for Payer: Aetna Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$75.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.50
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Centivo All Commercial |
$66.74
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Humana Medicare |
$66.74
|
| Rate for Payer: Lucent All Commercial |
$66.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.53
|
| Rate for Payer: MDWise Medicaid |
$11.53
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.03
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.23
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
| Rate for Payer: United Healthcare Medicare |
$43.18
|
|
|
HC TISSUE TRANSGLUT IGG
|
Facility
|
IP
|
$130.86
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
63001599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.14 |
| Max. Negotiated Rate |
$121.70 |
| Rate for Payer: Aetna Commercial |
$113.06
|
| Rate for Payer: Cash Price |
$81.13
|
| Rate for Payer: Cigna All Commercial |
$112.93
|
| Rate for Payer: CORVEL All Commercial |
$121.70
|
| Rate for Payer: Coventry All Commercial |
$115.15
|
| Rate for Payer: Encore All Commercial |
$120.45
|
| Rate for Payer: Frontpath All Commercial |
$120.39
|
| Rate for Payer: Humana ChoiceCare |
$113.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.77
|
| Rate for Payer: PHCS All Commercial |
$98.14
|
| Rate for Payer: PHP All Commercial |
$99.24
|
| Rate for Payer: Sagamore Health Network All Products |
$101.02
|
| Rate for Payer: Signature Care EPO |
$108.61
|
| Rate for Payer: Signature Care PPO |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$103.11
|
|
|
HC T'LIFT RETRACTION SYSTEM
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
41601262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$472.64
|
| Rate for Payer: Aetna Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$184.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$321.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$350.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.28
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Centivo All Commercial |
$285.60
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Humana Medicare |
$285.60
|
| Rate for Payer: Lucent All Commercial |
$285.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.40
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$476.00
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
| Rate for Payer: United Healthcare Medicare |
$184.80
|
|
|
HC T'LIFT RETRACTION SYSTEM
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
41601262
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$483.84
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cigna All Commercial |
$483.28
|
| Rate for Payer: CORVEL All Commercial |
$520.80
|
| Rate for Payer: Coventry All Commercial |
$492.80
|
| Rate for Payer: Encore All Commercial |
$515.48
|
| Rate for Payer: Frontpath All Commercial |
$515.20
|
| Rate for Payer: Humana ChoiceCare |
$483.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.00
|
| Rate for Payer: PHCS All Commercial |
$420.00
|
| Rate for Payer: PHP All Commercial |
$424.70
|
| Rate for Payer: Sagamore Health Network All Products |
$432.32
|
| Rate for Payer: Signature Care EPO |
$464.80
|
| Rate for Payer: Signature Care PPO |
$492.80
|
| Rate for Payer: United Healthcare Commercial |
$441.28
|
|
|
HC TOBRAMYCIN-PEAK
|
Facility
|
OP
|
$201.26
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$187.17 |
| Rate for Payer: Aetna Commercial |
$169.86
|
| Rate for Payer: Aetna Medicare |
$66.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.06
|
| Rate for Payer: Cash Price |
$124.78
|
| Rate for Payer: Cash Price |
$124.78
|
| Rate for Payer: Centivo All Commercial |
$102.64
|
| Rate for Payer: Cigna All Commercial |
$173.68
|
| Rate for Payer: CORVEL All Commercial |
$187.17
|
| Rate for Payer: Coventry All Commercial |
$177.11
|
| Rate for Payer: Encore All Commercial |
$185.26
|
| Rate for Payer: Frontpath All Commercial |
$185.16
|
| Rate for Payer: Humana ChoiceCare |
$173.82
|
| Rate for Payer: Humana Medicare |
$102.64
|
| Rate for Payer: Lucent All Commercial |
$102.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.13
|
| Rate for Payer: Managed Health Services Medicaid |
$16.13
|
| Rate for Payer: MDWise Medicaid |
$16.13
|
| Rate for Payer: PHCS All Commercial |
$150.94
|
| Rate for Payer: PHP All Commercial |
$152.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.49
|
| Rate for Payer: Sagamore Health Network All Products |
$155.37
|
| Rate for Payer: Signature Care EPO |
$167.04
|
| Rate for Payer: Signature Care PPO |
$177.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171.07
|
| Rate for Payer: United Healthcare Commercial |
$158.59
|
| Rate for Payer: United Healthcare Medicare |
$66.41
|
|
|
HC TOBRAMYCIN-PEAK
|
Facility
|
IP
|
$201.26
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001329
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.94 |
| Max. Negotiated Rate |
$187.17 |
| Rate for Payer: Aetna Commercial |
$173.89
|
| Rate for Payer: Cash Price |
$124.78
|
| Rate for Payer: Cigna All Commercial |
$173.68
|
| Rate for Payer: CORVEL All Commercial |
$187.17
|
| Rate for Payer: Coventry All Commercial |
$177.11
|
| Rate for Payer: Encore All Commercial |
$185.26
|
| Rate for Payer: Frontpath All Commercial |
$185.16
|
| Rate for Payer: Humana ChoiceCare |
$173.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.13
|
| Rate for Payer: PHCS All Commercial |
$150.94
|
| Rate for Payer: PHP All Commercial |
$152.63
|
| Rate for Payer: Sagamore Health Network All Products |
$155.37
|
| Rate for Payer: Signature Care EPO |
$167.04
|
| Rate for Payer: Signature Care PPO |
$177.11
|
| Rate for Payer: United Healthcare Commercial |
$158.59
|
|
|
HC TOBRAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
|
OP
|
$107.37
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$99.85 |
| Rate for Payer: Aetna Commercial |
$90.62
|
| Rate for Payer: Aetna Medicare |
$35.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$61.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.97
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: Centivo All Commercial |
$54.76
|
| Rate for Payer: Cigna All Commercial |
$92.66
|
| Rate for Payer: CORVEL All Commercial |
$99.85
|
| Rate for Payer: Coventry All Commercial |
$94.48
|
| Rate for Payer: Encore All Commercial |
$98.83
|
| Rate for Payer: Frontpath All Commercial |
$98.78
|
| Rate for Payer: Humana ChoiceCare |
$92.73
|
| Rate for Payer: Humana Medicare |
$54.76
|
| Rate for Payer: Lucent All Commercial |
$54.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.63
|
| Rate for Payer: Managed Health Services Medicaid |
$16.13
|
| Rate for Payer: MDWise Medicaid |
$16.13
|
| Rate for Payer: PHCS All Commercial |
$80.52
|
| Rate for Payer: PHP All Commercial |
$81.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.87
|
| Rate for Payer: Sagamore Health Network All Products |
$82.89
|
| Rate for Payer: Signature Care EPO |
$89.11
|
| Rate for Payer: Signature Care PPO |
$94.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91.26
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
| Rate for Payer: United Healthcare Medicare |
$35.43
|
|
|
HC TOBRAMYCIN - RANDOM OR NON-SPECIFIC
|
Facility
|
IP
|
$107.37
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$99.85 |
| Rate for Payer: Aetna Commercial |
$92.76
|
| Rate for Payer: Cash Price |
$66.57
|
| Rate for Payer: Cigna All Commercial |
$92.66
|
| Rate for Payer: CORVEL All Commercial |
$99.85
|
| Rate for Payer: Coventry All Commercial |
$94.48
|
| Rate for Payer: Encore All Commercial |
$98.83
|
| Rate for Payer: Frontpath All Commercial |
$98.78
|
| Rate for Payer: Humana ChoiceCare |
$92.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$96.63
|
| Rate for Payer: PHCS All Commercial |
$80.52
|
| Rate for Payer: PHP All Commercial |
$81.43
|
| Rate for Payer: Sagamore Health Network All Products |
$82.89
|
| Rate for Payer: Signature Care EPO |
$89.11
|
| Rate for Payer: Signature Care PPO |
$94.48
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
|
HC TOBRAMYCIN-TROUGH
|
Facility
|
OP
|
$201.26
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001330
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$187.17 |
| Rate for Payer: Aetna Commercial |
$169.86
|
| Rate for Payer: Aetna Medicare |
$66.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$115.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$125.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$76.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.06
|
| Rate for Payer: Cash Price |
$124.78
|
| Rate for Payer: Cash Price |
$124.78
|
| Rate for Payer: Centivo All Commercial |
$102.64
|
| Rate for Payer: Cigna All Commercial |
$173.68
|
| Rate for Payer: CORVEL All Commercial |
$187.17
|
| Rate for Payer: Coventry All Commercial |
$177.11
|
| Rate for Payer: Encore All Commercial |
$185.26
|
| Rate for Payer: Frontpath All Commercial |
$185.16
|
| Rate for Payer: Humana ChoiceCare |
$173.82
|
| Rate for Payer: Humana Medicare |
$102.64
|
| Rate for Payer: Lucent All Commercial |
$102.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.13
|
| Rate for Payer: Managed Health Services Medicaid |
$16.13
|
| Rate for Payer: MDWise Medicaid |
$16.13
|
| Rate for Payer: PHCS All Commercial |
$150.94
|
| Rate for Payer: PHP All Commercial |
$152.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$78.49
|
| Rate for Payer: Sagamore Health Network All Products |
$155.37
|
| Rate for Payer: Signature Care EPO |
$167.04
|
| Rate for Payer: Signature Care PPO |
$177.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$171.07
|
| Rate for Payer: United Healthcare Commercial |
$158.59
|
| Rate for Payer: United Healthcare Medicare |
$66.41
|
|
|
HC TOBRAMYCIN-TROUGH
|
Facility
|
IP
|
$201.26
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
63001330
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.94 |
| Max. Negotiated Rate |
$187.17 |
| Rate for Payer: Aetna Commercial |
$173.89
|
| Rate for Payer: Cash Price |
$124.78
|
| Rate for Payer: Cigna All Commercial |
$173.68
|
| Rate for Payer: CORVEL All Commercial |
$187.17
|
| Rate for Payer: Coventry All Commercial |
$177.11
|
| Rate for Payer: Encore All Commercial |
$185.26
|
| Rate for Payer: Frontpath All Commercial |
$185.16
|
| Rate for Payer: Humana ChoiceCare |
$173.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$181.13
|
| Rate for Payer: PHCS All Commercial |
$150.94
|
| Rate for Payer: PHP All Commercial |
$152.63
|
| Rate for Payer: Sagamore Health Network All Products |
$155.37
|
| Rate for Payer: Signature Care EPO |
$167.04
|
| Rate for Payer: Signature Care PPO |
$177.11
|
| Rate for Payer: United Healthcare Commercial |
$158.59
|
|
|
HC TOPAZ MICRODEBRIDER
|
Facility
|
OP
|
$2,000.00
|
|
| Hospital Charge Code |
41602824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,688.00
|
| Rate for Payer: Aetna Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$660.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,148.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,250.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$759.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$726.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Centivo All Commercial |
$1,020.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Humana Medicare |
$1,020.00
|
| Rate for Payer: Lucent All Commercial |
$1,020.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$780.00
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
| Rate for Payer: United Healthcare Medicare |
$660.00
|
|
|
HC TOPAZ MICRODEBRIDER
|
Facility
|
IP
|
$2,000.00
|
|
| Hospital Charge Code |
41602824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,240.00
|
| Rate for Payer: Cigna All Commercial |
$1,726.00
|
| Rate for Payer: CORVEL All Commercial |
$1,860.00
|
| Rate for Payer: Coventry All Commercial |
$1,760.00
|
| Rate for Payer: Encore All Commercial |
$1,841.00
|
| Rate for Payer: Frontpath All Commercial |
$1,840.00
|
| Rate for Payer: Humana ChoiceCare |
$1,727.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,800.00
|
| Rate for Payer: PHCS All Commercial |
$1,500.00
|
| Rate for Payer: PHP All Commercial |
$1,516.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,544.00
|
| Rate for Payer: Signature Care EPO |
$1,660.00
|
| Rate for Payer: Signature Care PPO |
$1,760.00
|
| Rate for Payer: United Healthcare Commercial |
$1,576.00
|
|
|
HC TOPIRAMATE
|
Facility
|
IP
|
$229.45
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
63001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.09 |
| Max. Negotiated Rate |
$213.39 |
| Rate for Payer: Aetna Commercial |
$198.24
|
| Rate for Payer: Cash Price |
$142.26
|
| Rate for Payer: Cigna All Commercial |
$198.01
|
| Rate for Payer: CORVEL All Commercial |
$213.39
|
| Rate for Payer: Coventry All Commercial |
$201.92
|
| Rate for Payer: Encore All Commercial |
$211.21
|
| Rate for Payer: Frontpath All Commercial |
$211.09
|
| Rate for Payer: Humana ChoiceCare |
$198.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.50
|
| Rate for Payer: PHCS All Commercial |
$172.09
|
| Rate for Payer: PHP All Commercial |
$174.01
|
| Rate for Payer: Sagamore Health Network All Products |
$177.13
|
| Rate for Payer: Signature Care EPO |
$190.44
|
| Rate for Payer: Signature Care PPO |
$201.92
|
| Rate for Payer: United Healthcare Commercial |
$180.81
|
|
|
HC TOPIRAMATE
|
Facility
|
OP
|
$229.45
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
63001380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$213.39 |
| Rate for Payer: Aetna Commercial |
$193.65
|
| Rate for Payer: Aetna Medicare |
$75.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.29
|
| Rate for Payer: Cash Price |
$142.26
|
| Rate for Payer: Cash Price |
$142.26
|
| Rate for Payer: Centivo All Commercial |
$117.02
|
| Rate for Payer: Cigna All Commercial |
$198.01
|
| Rate for Payer: CORVEL All Commercial |
$213.39
|
| Rate for Payer: Coventry All Commercial |
$201.92
|
| Rate for Payer: Encore All Commercial |
$211.21
|
| Rate for Payer: Frontpath All Commercial |
$211.09
|
| Rate for Payer: Humana ChoiceCare |
$198.18
|
| Rate for Payer: Humana Medicare |
$117.02
|
| Rate for Payer: Lucent All Commercial |
$117.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.50
|
| Rate for Payer: Managed Health Services Medicaid |
$11.92
|
| Rate for Payer: MDWise Medicaid |
$11.92
|
| Rate for Payer: PHCS All Commercial |
$172.09
|
| Rate for Payer: PHP All Commercial |
$174.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.49
|
| Rate for Payer: Sagamore Health Network All Products |
$177.13
|
| Rate for Payer: Signature Care EPO |
$190.44
|
| Rate for Payer: Signature Care PPO |
$201.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.03
|
| Rate for Payer: United Healthcare Commercial |
$180.81
|
| Rate for Payer: United Healthcare Medicare |
$75.72
|
|
|
HC TORNIER GREAT TOE JOINT SZ 20
|
Facility
|
OP
|
$6,955.20
|
|
|
Service Code
|
CPT L8642
|
| Hospital Charge Code |
41603272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$6,468.34 |
| Rate for Payer: Aetna Commercial |
$5,870.19
|
| Rate for Payer: Aetna Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,295.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,994.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,347.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,639.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,524.74
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Cash Price |
$4,312.22
|
| Rate for Payer: Centivo All Commercial |
$3,547.15
|
| Rate for Payer: Cigna All Commercial |
$6,002.34
|
| Rate for Payer: CORVEL All Commercial |
$6,468.34
|
| Rate for Payer: Coventry All Commercial |
$6,120.58
|
| Rate for Payer: Encore All Commercial |
$6,402.26
|
| Rate for Payer: Frontpath All Commercial |
$6,398.78
|
| Rate for Payer: Humana ChoiceCare |
$6,007.21
|
| Rate for Payer: Humana Medicare |
$3,547.15
|
| Rate for Payer: Lucent All Commercial |
$3,547.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,259.68
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$5,216.40
|
| Rate for Payer: PHP All Commercial |
$5,274.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,712.53
|
| Rate for Payer: Sagamore Health Network All Products |
$5,369.41
|
| Rate for Payer: Signature Care EPO |
$5,772.82
|
| Rate for Payer: Signature Care PPO |
$6,120.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,911.92
|
| Rate for Payer: United Healthcare Commercial |
$5,480.70
|
| Rate for Payer: United Healthcare Medicare |
$2,295.22
|
|
