|
HC Z SF PLATE RECN 3.5 6-
|
Facility
OP
|
$2,230.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604236
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,074.32 |
| Rate for Payer: Aetna Commercial |
$1,882.50
|
| Rate for Payer: Aetna Medicare |
$736.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$736.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,280.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,394.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$846.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$809.65
|
| Rate for Payer: Cash Price |
$1,382.88
|
| Rate for Payer: Cash Price |
$1,382.88
|
| Rate for Payer: Centivo All Commercial |
$1,137.53
|
| Rate for Payer: Cigna All Commercial |
$1,924.88
|
| Rate for Payer: CORVEL All Commercial |
$2,074.32
|
| Rate for Payer: Coventry All Commercial |
$1,962.80
|
| Rate for Payer: Encore All Commercial |
$2,053.13
|
| Rate for Payer: Frontpath All Commercial |
$2,052.01
|
| Rate for Payer: Humana ChoiceCare |
$1,926.44
|
| Rate for Payer: Humana Medicare |
$1,137.53
|
| Rate for Payer: Lucent All Commercial |
$1,137.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,007.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,672.84
|
| Rate for Payer: PHP All Commercial |
$1,691.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$869.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,721.91
|
| Rate for Payer: Signature Care EPO |
$1,851.27
|
| Rate for Payer: Signature Care PPO |
$1,962.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,895.88
|
| Rate for Payer: United Healthcare Commercial |
$1,757.59
|
| Rate for Payer: United Healthcare Medicare |
$736.05
|
|
|
HC Z SF PLATE RECN 3.5 7-
|
Facility
IP
|
$2,330.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,747.69 |
| Max. Negotiated Rate |
$2,167.13 |
| Rate for Payer: Aetna Commercial |
$2,013.34
|
| Rate for Payer: Cash Price |
$1,444.76
|
| Rate for Payer: Cigna All Commercial |
$2,011.01
|
| Rate for Payer: CORVEL All Commercial |
$2,167.13
|
| Rate for Payer: Coventry All Commercial |
$2,050.62
|
| Rate for Payer: Encore All Commercial |
$2,145.00
|
| Rate for Payer: Frontpath All Commercial |
$2,143.83
|
| Rate for Payer: Humana ChoiceCare |
$2,012.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,097.22
|
| Rate for Payer: PHCS All Commercial |
$1,747.69
|
| Rate for Payer: PHP All Commercial |
$1,767.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,798.95
|
| Rate for Payer: Signature Care EPO |
$1,934.11
|
| Rate for Payer: Signature Care PPO |
$2,050.62
|
| Rate for Payer: United Healthcare Commercial |
$1,836.24
|
|
|
HC Z SF PLATE RECN 3.5 7-
|
Facility
OP
|
$2,330.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604239
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,167.13 |
| Rate for Payer: Aetna Commercial |
$1,966.73
|
| Rate for Payer: Aetna Medicare |
$768.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$768.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,338.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,456.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$884.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$845.88
|
| Rate for Payer: Cash Price |
$1,444.76
|
| Rate for Payer: Cash Price |
$1,444.76
|
| Rate for Payer: Centivo All Commercial |
$1,188.43
|
| Rate for Payer: Cigna All Commercial |
$2,011.01
|
| Rate for Payer: CORVEL All Commercial |
$2,167.13
|
| Rate for Payer: Coventry All Commercial |
$2,050.62
|
| Rate for Payer: Encore All Commercial |
$2,145.00
|
| Rate for Payer: Frontpath All Commercial |
$2,143.83
|
| Rate for Payer: Humana ChoiceCare |
$2,012.64
|
| Rate for Payer: Humana Medicare |
$1,188.43
|
| Rate for Payer: Lucent All Commercial |
$1,188.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,097.22
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,747.69
|
| Rate for Payer: PHP All Commercial |
$1,767.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$908.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,798.95
|
| Rate for Payer: Signature Care EPO |
$1,934.11
|
| Rate for Payer: Signature Care PPO |
$2,050.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,980.71
|
| Rate for Payer: United Healthcare Commercial |
$1,836.24
|
| Rate for Payer: United Healthcare Medicare |
$768.98
|
|
|
HC Z SF PLATE RECN 3.5 8-
|
Facility
IP
|
$2,413.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,810.12 |
| Max. Negotiated Rate |
$2,244.56 |
| Rate for Payer: Aetna Commercial |
$2,085.26
|
| Rate for Payer: Cash Price |
$1,496.37
|
| Rate for Payer: Cigna All Commercial |
$2,082.85
|
| Rate for Payer: CORVEL All Commercial |
$2,244.56
|
| Rate for Payer: Coventry All Commercial |
$2,123.88
|
| Rate for Payer: Encore All Commercial |
$2,221.63
|
| Rate for Payer: Frontpath All Commercial |
$2,220.42
|
| Rate for Payer: Humana ChoiceCare |
$2,084.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,172.15
|
| Rate for Payer: PHCS All Commercial |
$1,810.12
|
| Rate for Payer: PHP All Commercial |
$1,830.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,863.22
|
| Rate for Payer: Signature Care EPO |
$2,003.20
|
| Rate for Payer: Signature Care PPO |
$2,123.88
|
| Rate for Payer: United Healthcare Commercial |
$1,901.84
|
|
|
HC Z SF PLATE RECN 3.5 8-
|
Facility
OP
|
$2,413.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,244.56 |
| Rate for Payer: Aetna Commercial |
$2,036.99
|
| Rate for Payer: Aetna Medicare |
$796.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$796.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,386.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,508.68
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$915.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$876.10
|
| Rate for Payer: Cash Price |
$1,496.37
|
| Rate for Payer: Cash Price |
$1,496.37
|
| Rate for Payer: Centivo All Commercial |
$1,230.88
|
| Rate for Payer: Cigna All Commercial |
$2,082.85
|
| Rate for Payer: CORVEL All Commercial |
$2,244.56
|
| Rate for Payer: Coventry All Commercial |
$2,123.88
|
| Rate for Payer: Encore All Commercial |
$2,221.63
|
| Rate for Payer: Frontpath All Commercial |
$2,220.42
|
| Rate for Payer: Humana ChoiceCare |
$2,084.54
|
| Rate for Payer: Humana Medicare |
$1,230.88
|
| Rate for Payer: Lucent All Commercial |
$1,230.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,172.15
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,810.12
|
| Rate for Payer: PHP All Commercial |
$1,830.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$941.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,863.22
|
| Rate for Payer: Signature Care EPO |
$2,003.20
|
| Rate for Payer: Signature Care PPO |
$2,123.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,051.48
|
| Rate for Payer: United Healthcare Commercial |
$1,901.84
|
| Rate for Payer: United Healthcare Medicare |
$796.46
|
|
|
HC Z SF PLATE RECN 3.5 9-
|
Facility
IP
|
$2,480.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,860.08 |
| Max. Negotiated Rate |
$2,306.49 |
| Rate for Payer: Aetna Commercial |
$2,142.81
|
| Rate for Payer: Cash Price |
$1,537.66
|
| Rate for Payer: Cigna All Commercial |
$2,140.33
|
| Rate for Payer: CORVEL All Commercial |
$2,306.49
|
| Rate for Payer: Coventry All Commercial |
$2,182.49
|
| Rate for Payer: Encore All Commercial |
$2,282.93
|
| Rate for Payer: Frontpath All Commercial |
$2,281.69
|
| Rate for Payer: Humana ChoiceCare |
$2,142.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,232.09
|
| Rate for Payer: PHCS All Commercial |
$1,860.08
|
| Rate for Payer: PHP All Commercial |
$1,880.91
|
| Rate for Payer: Sagamore Health Network All Products |
$1,914.64
|
| Rate for Payer: Signature Care EPO |
$2,058.48
|
| Rate for Payer: Signature Care PPO |
$2,182.49
|
| Rate for Payer: United Healthcare Commercial |
$1,954.32
|
|
|
HC Z SF PLATE RECN 3.5 9-
|
Facility
OP
|
$2,480.10
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,306.49 |
| Rate for Payer: Aetna Commercial |
$2,093.20
|
| Rate for Payer: Aetna Medicare |
$818.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$818.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,424.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,550.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$941.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$900.28
|
| Rate for Payer: Cash Price |
$1,537.66
|
| Rate for Payer: Cash Price |
$1,537.66
|
| Rate for Payer: Centivo All Commercial |
$1,264.85
|
| Rate for Payer: Cigna All Commercial |
$2,140.33
|
| Rate for Payer: CORVEL All Commercial |
$2,306.49
|
| Rate for Payer: Coventry All Commercial |
$2,182.49
|
| Rate for Payer: Encore All Commercial |
$2,282.93
|
| Rate for Payer: Frontpath All Commercial |
$2,281.69
|
| Rate for Payer: Humana ChoiceCare |
$2,142.06
|
| Rate for Payer: Humana Medicare |
$1,264.85
|
| Rate for Payer: Lucent All Commercial |
$1,264.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,232.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,860.08
|
| Rate for Payer: PHP All Commercial |
$1,880.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$967.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1,914.64
|
| Rate for Payer: Signature Care EPO |
$2,058.48
|
| Rate for Payer: Signature Care PPO |
$2,182.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,108.08
|
| Rate for Payer: United Healthcare Commercial |
$1,954.32
|
| Rate for Payer: United Healthcare Medicare |
$818.43
|
|
|
HC Z SF SCREW 3.5X12 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X12 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X14 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X14 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604139
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X16 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X16 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604140
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X18 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X18 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X20 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X20 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604142
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X22 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X22 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604143
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X24 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X24 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X26 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
|
HC Z SF SCREW 3.5X26 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X28 LOCK
|
Facility
IP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.32 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$604.01
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
|
|
HC Z SF SCREW 3.5X28 LOCK
|
Facility
OP
|
$699.09
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41604146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.70 |
| Max. Negotiated Rate |
$650.15 |
| Rate for Payer: Aetna Commercial |
$590.03
|
| Rate for Payer: Aetna Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$437.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.77
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Cash Price |
$433.44
|
| Rate for Payer: Centivo All Commercial |
$356.54
|
| Rate for Payer: Cigna All Commercial |
$603.31
|
| Rate for Payer: CORVEL All Commercial |
$650.15
|
| Rate for Payer: Coventry All Commercial |
$615.20
|
| Rate for Payer: Encore All Commercial |
$643.51
|
| Rate for Payer: Frontpath All Commercial |
$643.16
|
| Rate for Payer: Humana ChoiceCare |
$603.80
|
| Rate for Payer: Humana Medicare |
$356.54
|
| Rate for Payer: Lucent All Commercial |
$356.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$629.18
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$524.32
|
| Rate for Payer: PHP All Commercial |
$530.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.65
|
| Rate for Payer: Sagamore Health Network All Products |
$539.70
|
| Rate for Payer: Signature Care EPO |
$580.24
|
| Rate for Payer: Signature Care PPO |
$615.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$594.23
|
| Rate for Payer: United Healthcare Commercial |
$550.88
|
| Rate for Payer: United Healthcare Medicare |
$230.70
|
|
