|
HC Z SCREW ULS 3.5X50 LOCK
|
Facility
IP
|
$675.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.89 |
| Max. Negotiated Rate |
$628.54 |
| Rate for Payer: Aetna Commercial |
$583.93
|
| Rate for Payer: Cash Price |
$419.03
|
| Rate for Payer: Cigna All Commercial |
$583.26
|
| Rate for Payer: CORVEL All Commercial |
$628.54
|
| Rate for Payer: Coventry All Commercial |
$594.75
|
| Rate for Payer: Encore All Commercial |
$622.12
|
| Rate for Payer: Frontpath All Commercial |
$621.78
|
| Rate for Payer: Humana ChoiceCare |
$583.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$608.26
|
| Rate for Payer: PHCS All Commercial |
$506.89
|
| Rate for Payer: PHP All Commercial |
$512.56
|
| Rate for Payer: Sagamore Health Network All Products |
$521.76
|
| Rate for Payer: Signature Care EPO |
$560.96
|
| Rate for Payer: Signature Care PPO |
$594.75
|
| Rate for Payer: United Healthcare Commercial |
$532.57
|
|
|
HC Z SCREW ULS 3.5X50 LOCK
|
Facility
OP
|
$675.85
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41607455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.03 |
| Max. Negotiated Rate |
$628.54 |
| Rate for Payer: Aetna Commercial |
$570.42
|
| Rate for Payer: Aetna Medicare |
$223.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$223.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$388.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$422.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$256.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.33
|
| Rate for Payer: Cash Price |
$419.03
|
| Rate for Payer: Cash Price |
$419.03
|
| Rate for Payer: Centivo All Commercial |
$344.68
|
| Rate for Payer: Cigna All Commercial |
$583.26
|
| Rate for Payer: CORVEL All Commercial |
$628.54
|
| Rate for Payer: Coventry All Commercial |
$594.75
|
| Rate for Payer: Encore All Commercial |
$622.12
|
| Rate for Payer: Frontpath All Commercial |
$621.78
|
| Rate for Payer: Humana ChoiceCare |
$583.73
|
| Rate for Payer: Humana Medicare |
$344.68
|
| Rate for Payer: Lucent All Commercial |
$344.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$608.26
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$506.89
|
| Rate for Payer: PHP All Commercial |
$512.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$263.58
|
| Rate for Payer: Sagamore Health Network All Products |
$521.76
|
| Rate for Payer: Signature Care EPO |
$560.96
|
| Rate for Payer: Signature Care PPO |
$594.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$574.47
|
| Rate for Payer: United Healthcare Commercial |
$532.57
|
| Rate for Payer: United Healthcare Medicare |
$223.03
|
|
|
HC Z SCREW VPC 2.5X10
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X10
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X11
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X11
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604552
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X12
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X12
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X13
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X13
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604554
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X14
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X14
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X16
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X16
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X18
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X18
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X20
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X20
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604558
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X22
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X22
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X24
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X24
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604560
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X26
|
Facility
OP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,430.50
|
| Rate for Payer: Aetna Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$559.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$973.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,059.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$643.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$615.25
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Centivo All Commercial |
$864.40
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Humana Medicare |
$864.40
|
| Rate for Payer: Lucent All Commercial |
$864.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$661.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,440.66
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
| Rate for Payer: United Healthcare Medicare |
$559.32
|
|
|
HC Z SCREW VPC 2.5X26
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
|
HC Z SCREW VPC 2.5X28
|
Facility
IP
|
$1,694.90
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604562
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.18 |
| Max. Negotiated Rate |
$1,576.26 |
| Rate for Payer: Aetna Commercial |
$1,464.39
|
| Rate for Payer: Cash Price |
$1,050.84
|
| Rate for Payer: Cigna All Commercial |
$1,462.70
|
| Rate for Payer: CORVEL All Commercial |
$1,576.26
|
| Rate for Payer: Coventry All Commercial |
$1,491.51
|
| Rate for Payer: Encore All Commercial |
$1,560.16
|
| Rate for Payer: Frontpath All Commercial |
$1,559.31
|
| Rate for Payer: Humana ChoiceCare |
$1,463.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,525.41
|
| Rate for Payer: PHCS All Commercial |
$1,271.18
|
| Rate for Payer: PHP All Commercial |
$1,285.41
|
| Rate for Payer: Sagamore Health Network All Products |
$1,308.46
|
| Rate for Payer: Signature Care EPO |
$1,406.77
|
| Rate for Payer: Signature Care PPO |
$1,491.51
|
| Rate for Payer: United Healthcare Commercial |
$1,335.58
|
|
