|
HC Z SCREW 7.0X35 CANN FT
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X35 CANN FT
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X40 16 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X40 16 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X40 CANN FT
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X40 CANN FT
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X45 16 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X45 16 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X45 32 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X45 32 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X45 CANN FT
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X45 CANN FT
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X50 16 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X50 16 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X50 32 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X50 32 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X50 CANN FT
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X50 CANN FT
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X55 16 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X55 16 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X55 32 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X55 32 CANN
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X55 CANN FT
|
Facility
IP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.29 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$963.40
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
|
|
HC Z SCREW 7.0X55 CANN FT
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
|
HC Z SCREW 7.0X60 16 CANN
|
Facility
OP
|
$1,115.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Aetna Commercial |
$941.10
|
| Rate for Payer: Aetna Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$367.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$640.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$697.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.76
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Cash Price |
$691.33
|
| Rate for Payer: Centivo All Commercial |
$568.68
|
| Rate for Payer: Cigna All Commercial |
$962.29
|
| Rate for Payer: CORVEL All Commercial |
$1,037.00
|
| Rate for Payer: Coventry All Commercial |
$981.24
|
| Rate for Payer: Encore All Commercial |
$1,026.40
|
| Rate for Payer: Frontpath All Commercial |
$1,025.85
|
| Rate for Payer: Humana ChoiceCare |
$963.07
|
| Rate for Payer: Humana Medicare |
$568.68
|
| Rate for Payer: Lucent All Commercial |
$568.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,003.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$836.29
|
| Rate for Payer: PHP All Commercial |
$845.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$434.87
|
| Rate for Payer: Sagamore Health Network All Products |
$860.82
|
| Rate for Payer: Signature Care EPO |
$925.49
|
| Rate for Payer: Signature Care PPO |
$981.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$947.79
|
| Rate for Payer: United Healthcare Commercial |
$878.66
|
| Rate for Payer: United Healthcare Medicare |
$367.97
|
|
