STAPLE RELOAD 60MM
|
Facility
OP
|
$2,704.00
|
|
Hospital Charge Code |
64906292
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$946.40 |
Max. Negotiated Rate |
$2,163.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,487.20
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,352.00
|
Rate for Payer: Aetna Government |
$1,352.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,163.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,838.72
|
Rate for Payer: Group Health Inc Commercial |
$1,352.00
|
Rate for Payer: Group Health Inc Medicare |
$946.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,352.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,352.00
|
|
STAPLER ENDO ARTICUL 60MM ECHELON
|
Facility
OP
|
$844.87
|
|
Hospital Charge Code |
64904758
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$295.70 |
Max. Negotiated Rate |
$675.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$464.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$422.44
|
Rate for Payer: Aetna Government |
$422.44
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$675.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$574.51
|
Rate for Payer: Group Health Inc Commercial |
$422.44
|
Rate for Payer: Group Health Inc Medicare |
$295.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.44
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.44
|
|
STAPLER ENDO GIA C
|
Facility
OP
|
$426.73
|
|
Hospital Charge Code |
64907072
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$149.36 |
Max. Negotiated Rate |
$341.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$234.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$213.36
|
Rate for Payer: Aetna Government |
$213.36
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$341.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$290.18
|
Rate for Payer: Group Health Inc Commercial |
$213.36
|
Rate for Payer: Group Health Inc Medicare |
$149.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$213.36
|
|
STAPLER ENDO GIA UNIV 030449
|
Facility
OP
|
$195.00
|
|
Hospital Charge Code |
40206014
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$68.25 |
Max. Negotiated Rate |
$156.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.50
|
Rate for Payer: Aetna Government |
$97.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.60
|
Rate for Payer: Group Health Inc Commercial |
$97.50
|
Rate for Payer: Group Health Inc Medicare |
$68.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$97.50
|
|
STAPLER ENDO GIA UNIV 12MM 030449
|
Facility
OP
|
$216.42
|
|
Hospital Charge Code |
40206015
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$75.75 |
Max. Negotiated Rate |
$173.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.21
|
Rate for Payer: Aetna Government |
$108.21
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.17
|
Rate for Payer: Group Health Inc Commercial |
$108.21
|
Rate for Payer: Group Health Inc Medicare |
$75.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.21
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$108.21
|
|
STAPLER,ENDOSCOPIC,CRVD,INTRALU
|
Facility
OP
|
$802.03
|
|
Hospital Charge Code |
64905151
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$280.71 |
Max. Negotiated Rate |
$641.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$441.12
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$401.02
|
Rate for Payer: Aetna Government |
$401.02
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.62
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$545.38
|
Rate for Payer: Group Health Inc Commercial |
$401.02
|
Rate for Payer: Group Health Inc Medicare |
$280.71
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.02
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$401.02
|
|
STAPLER,HEAD,FIXED,35 WIDE,STRL
|
Facility
OP
|
$17.50
|
|
Hospital Charge Code |
64905623
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$6.12 |
Max. Negotiated Rate |
$14.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.75
|
Rate for Payer: Aetna Government |
$8.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.90
|
Rate for Payer: Group Health Inc Commercial |
$8.75
|
Rate for Payer: Group Health Inc Medicare |
$6.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8.75
|
|
STAPLER,INTERNAL,LINEAR,PROXIMAT
|
Facility
OP
|
$230.38
|
|
Hospital Charge Code |
64902930
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$80.63 |
Max. Negotiated Rate |
$184.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.71
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$115.19
|
Rate for Payer: Aetna Government |
$115.19
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$184.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.66
|
Rate for Payer: Group Health Inc Commercial |
$115.19
|
Rate for Payer: Group Health Inc Medicare |
$80.63
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$115.19
|
|
STAPLER INTERNAL RELOADBL 60MML
|
Facility
OP
|
$995.25
|
|
Hospital Charge Code |
64905173
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$348.34 |
Max. Negotiated Rate |
$796.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$547.39
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$497.62
|
Rate for Payer: Aetna Government |
$497.62
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$796.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$676.77
|
Rate for Payer: Group Health Inc Commercial |
$497.62
|
Rate for Payer: Group Health Inc Medicare |
$348.34
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$497.62
|
|
STAPLER LINEAR A
|
Facility
OP
|
$227.10
|
|
Hospital Charge Code |
64902925
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$79.48 |
Max. Negotiated Rate |
$181.68 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.55
|
Rate for Payer: Aetna Government |
$113.55
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$181.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$154.43
|
Rate for Payer: Group Health Inc Commercial |
$113.55
|
Rate for Payer: Group Health Inc Medicare |
$79.48
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.55
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$113.55
|
|
STAPLER LINEAR C
|
Facility
OP
|
$106.94
|
|
Hospital Charge Code |
64902927
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$37.43 |
Max. Negotiated Rate |
$85.55 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.82
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.47
|
Rate for Payer: Aetna Government |
$53.47
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.55
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.72
|
Rate for Payer: Group Health Inc Commercial |
$53.47
|
Rate for Payer: Group Health Inc Medicare |
$37.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.47
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.47
|
|
STAPLER LINEAR D
|
Facility
OP
|
$106.94
|
|
Hospital Charge Code |
64902928
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$37.43 |
Max. Negotiated Rate |
$85.55 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.82
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.47
|
Rate for Payer: Aetna Government |
$53.47
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.55
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.72
|
Rate for Payer: Group Health Inc Commercial |
$53.47
|
Rate for Payer: Group Health Inc Medicare |
$37.43
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.47
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$53.47
|
|
STAPLER,LINEAR,PROXIMATE,90MM
|
Facility
OP
|
$253.63
|
|
Hospital Charge Code |
64905141
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$88.77 |
Max. Negotiated Rate |
$202.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.82
|
Rate for Payer: Aetna Government |
$126.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$202.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$172.47
|
Rate for Payer: Group Health Inc Commercial |
$126.82
|
Rate for Payer: Group Health Inc Medicare |
$88.77
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.82
|
|
STAPLER LINEAR TX60G
|
Facility
OP
|
$230.38
|
|
Hospital Charge Code |
64902712
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$80.63 |
Max. Negotiated Rate |
$184.30 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.71
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$115.19
|
Rate for Payer: Aetna Government |
$115.19
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$184.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.66
|
Rate for Payer: Group Health Inc Commercial |
$115.19
|
Rate for Payer: Group Health Inc Medicare |
$80.63
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.19
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$115.19
|
|
STAPLER SKIN APPOSE
|
Facility
OP
|
$13.83
|
|
Hospital Charge Code |
64907098
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.84 |
Max. Negotiated Rate |
$11.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.61
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.92
|
Rate for Payer: Aetna Government |
$6.92
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.06
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.40
|
Rate for Payer: Group Health Inc Commercial |
$6.92
|
Rate for Payer: Group Health Inc Medicare |
$4.84
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.92
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.92
|
|
STAPLER SKIN FX HD SIGNET 35W
|
Facility
OP
|
$28.13
|
|
Hospital Charge Code |
64901533
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$9.85 |
Max. Negotiated Rate |
$22.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.47
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.06
|
Rate for Payer: Aetna Government |
$14.06
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.13
|
Rate for Payer: Group Health Inc Commercial |
$14.06
|
Rate for Payer: Group Health Inc Medicare |
$9.85
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14.06
|
|
STAPLER SKIN MULTIFIRE PREM
|
Facility
OP
|
$21.58
|
|
Hospital Charge Code |
64907099
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$7.55 |
Max. Negotiated Rate |
$17.26 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.87
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.79
|
Rate for Payer: Aetna Government |
$10.79
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.67
|
Rate for Payer: Group Health Inc Commercial |
$10.79
|
Rate for Payer: Group Health Inc Medicare |
$7.55
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$10.79
|
|
STAPLER SKIN MULTIFIRE VERSATACK
|
Facility
OP
|
$1,596.96
|
|
Hospital Charge Code |
40205116
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$558.94 |
Max. Negotiated Rate |
$1,277.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$878.33
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$798.48
|
Rate for Payer: Aetna Government |
$798.48
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,277.57
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,085.93
|
Rate for Payer: Group Health Inc Commercial |
$798.48
|
Rate for Payer: Group Health Inc Medicare |
$558.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$798.48
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$798.48
|
|
STAPLER,SKIN,PROXI PLUS MD,WIDE
|
Facility
OP
|
$12.50
|
|
Hospital Charge Code |
64902923
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$4.38 |
Max. Negotiated Rate |
$10.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
Rate for Payer: Aetna Government |
$6.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.50
|
Rate for Payer: Group Health Inc Commercial |
$6.25
|
Rate for Payer: Group Health Inc Medicare |
$4.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
|
STAPLER TA60-4.8 SU RELOADABLE
|
Facility
OP
|
$190.00
|
|
Hospital Charge Code |
40206042
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$66.50 |
Max. Negotiated Rate |
$152.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
Rate for Payer: Aetna Government |
$95.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
Rate for Payer: Group Health Inc Commercial |
$95.00
|
Rate for Payer: Group Health Inc Medicare |
$66.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
STAPLE SMALL 11 X 8MM
|
Facility
OP
|
$812.50
|
|
Hospital Charge Code |
64901840
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
STAPLE SMALL 13 X 10MM
|
Facility
OP
|
$812.50
|
|
Hospital Charge Code |
64901841
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
STAPLE SMALL 15 X 12MM 1.5MM WIRE
|
Facility
OP
|
$775.00
|
|
Hospital Charge Code |
64904706
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$271.25 |
Max. Negotiated Rate |
$620.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$426.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$387.50
|
Rate for Payer: Aetna Government |
$387.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$620.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$527.00
|
Rate for Payer: Group Health Inc Commercial |
$387.50
|
Rate for Payer: Group Health Inc Medicare |
$271.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$387.50
|
|
STAPLE SMALL 7 X 5MM
|
Facility
OP
|
$812.50
|
|
Hospital Charge Code |
64901836
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
STAPLE SMALL 9 X 7MM
|
Facility
OP
|
$812.50
|
|
Hospital Charge Code |
64901838
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|