[ { "hospital_name": "ASEM/Hospital de Trauma", "last_updated_on": "2024-20-05", "version": "1.0.0", "hospital_location": [ "Centro Médico de PR" ], "hospital_address": [ "Centro Médico, Paseo Dr. Jose Celso Balbosa, Bo. Monacillos", "San Juan, PR 00935-0001" ], "license_information": { "license_number": "59", "state": "PR" }, "affirmation": { "affirmation": "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.", "confirm_affirmation": true }, "notes": " N/A = Service not provided by hospital or not covered by health plan, ER and Amb fee = Service included in ER or ambulatory fee, Perdiem = Service included in Perdiem" }, { "Description Of Service ": "INTENSIVE CARE TRAUMA", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 2102.97, " Gross Charge In-Patient ": 2102.97, " Discounted Cash Price Out Patient ": 2102.97, " Discounted Cash Price In Patient ": 2102.97, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 1049, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1061, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1231, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1105, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1764, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1100, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1500, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1500, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 1599, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 880, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 1070, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 843.41, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1492, " Cigna In Patient ": "N/A", " Cigna Out Patient ": 960, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1700, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1300, " Max. Price ": 2102.97, " Min. Price ": 843.41 }, { "Description Of Service ": "STABILIZER UNIT", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 2102.97, " Gross Charge In-Patient ": 2102.97, " Discounted Cash Price Out Patient ": 2102.97, " Discounted Cash Price In Patient ": 2102.97, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 1049, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1061, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1231, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1130.06, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1105, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1764, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1500, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1500, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 1599, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 880, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 1070, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 843.41, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 840, " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1700, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1300, " Max. Price ": 2102.97, " Min. Price ": 840 }, { "Description Of Service ": "INTERMEDIATE", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1323, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1000, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 987, " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA CORDON ESPINAL", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1323, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": 850, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA ENDOVASCULAR", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA INTERMEDIATE PT=K", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA INTERMEDIO III", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA ISOLATION PT=J", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA NEUROCIRUGIA", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "TRAUMA STROKE", "CPT/HCPCS/DRG/NDC/REV. CODE": 206, " Gross Charge Out-Patient ": 1627, " Gross Charge In-Patient ": 1627, " Discounted Cash Price Out Patient ": 1627, " Discounted Cash Price In Patient ": 1627, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 990, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 920, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1119, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1122.35, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1037, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 990, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 990, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 946, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 705, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 711, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 882, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 931, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1020, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": 1450, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1100, " Max. Price ": 1627, " Min. Price ": 705 }, { "Description Of Service ": "INTENSIVE CARE", "CPT/HCPCS/DRG/NDC/REV. CODE": 200, " Gross Charge Out-Patient ": 2102.97, " Gross Charge In-Patient ": 2102.97, " Discounted Cash Price Out Patient ": 2102.97, " Discounted Cash Price In Patient ": 2102.97, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 1049, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 940, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1231, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1130.06, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1105, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1544, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1100, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1154, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1154, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 1207, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 1056, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 1070, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 1069.43, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 1066, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1175, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1135, " Cigna In Patient ": "N/A", " Cigna Out Patient ": 960, " Acaa Out Patient ": 500, " Acaa In Patient ": 1700, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1200, " Max. Price ": 2102.97, " Min. Price ": 500 }, { "Description Of Service ": "TRAUMA TICU II", "CPT/HCPCS/DRG/NDC/REV. CODE": 200, " Gross Charge Out-Patient ": 2102.97, " Gross Charge In-Patient ": 2102.97, " Discounted Cash Price Out Patient ": 2102.97, " Discounted Cash Price In Patient ": 2102.97, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 1049, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 940, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1231, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 1130.06, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1105, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1544, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1154, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1154, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": 1207, " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 1056, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 1070, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 1069.43, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 1066, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1175, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": 500, " Acaa In Patient ": 1700, " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": 1200, " Max. Price ": 2102.97, " Min. Price ": 500 }, { "Description Of Service ": "TRAUMA TICU PT=I", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 99288, " Gross Charge Out-Patient ": 251.43, " Gross Charge In-Patient ": 251.43, " Discounted Cash Price Out Patient ": 251.43, " Discounted Cash Price In Patient ": 251.43, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. Price ": 251.43, " Min. Price ": 251.43 }, { "Description Of Service ": "ER-LEVEL V", "CPT/HCPCS/DRG/NDC/REV. CODE": 99285, " Gross Charge Out-Patient ": 951, " Gross Charge In-Patient ": 951, " Discounted Cash Price Out Patient ": 951, " Discounted Cash Price In Patient ": 951, " Triple S Vital Out Patient ": 248, " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": 234, " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": 260, " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": 242.55, " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": 400, " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": 341, " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": 370, " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": 500, " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": 500, " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": 525, " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": 230, " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": 204, " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": 370, " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": 250, " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": 25, " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. Price ": 951, " Min. Price ": 25 }, { "Description Of Service ": "ER-LEVEL IV", "CPT/HCPCS/DRG/NDC/REV. CODE": 99284, " Gross Charge Out-Patient ": 851, " Gross Charge In-Patient ": 851, " Discounted Cash Price Out Patient ": 851, " Discounted Cash Price In Patient ": 851, " Triple S Vital Out Patient ": 219, " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": 208, " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": 234, " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": 220.5, " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": 325, " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": 221, " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": 340, " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": 400, " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": 400, " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": 420, " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": 230, " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": 204, " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": 340, " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": 200, " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. Price ": 851, " Min. Price ": 200 }, { "Description Of Service ": "ER VISIT LEVEL III", "CPT/HCPCS/DRG/NDC/REV. CODE": 99283, " Gross Charge Out-Patient ": 751, " Gross Charge In-Patient ": 751, " Discounted Cash Price Out Patient ": 751, " Discounted Cash Price In Patient ": 751, " Triple S Vital Out Patient ": 199, " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": 185, " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": 208, " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": 192.94, " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": 275, " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": 192, " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": 310, " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": 300, " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": 300, " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": 315, " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": 197, " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": 204, " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": 310, " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": 185, " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. Price ": 751, " Min. Price ": 185 }, { "Description Of Service ": "ER-LEVEL II", "CPT/HCPCS/DRG/NDC/REV. CODE": 99282, " Gross Charge Out-Patient ": 651, " Gross Charge In-Patient ": 651, " Discounted Cash Price Out Patient ": 651, " Discounted Cash Price In Patient ": 651, " Triple S Vital Out Patient ": 199, " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": 185, " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": 204, " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": 165.38, " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": 225, " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": 143, " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": 280, " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": 300, " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": 300, " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": 315, " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": 197, " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": 204, " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": 280, " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": 175, " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. Price ": 651, " Min. Price ": 143 }, { "Description Of Service ": "ER-LEVEL 1", "CPT/HCPCS/DRG/NDC/REV. CODE": 99281, " Gross Charge Out-Patient ": 551, " Gross Charge In-Patient ": 551, " Discounted Cash Price Out Patient ": 551, " Discounted Cash Price In Patient ": 551, " Triple S Vital Out Patient ": 199, " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": 185, " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": 204, " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": 137.81, " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": 175, " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": 88, " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": 250, " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": 200, " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": 200, " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": 210, " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": 197, " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": 204, " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": 250, " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": 150, " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. Price ": 551, " Min. Price ": 88 }, { "Description Of Service ": "ROOM ER", "CPT/HCPCS/DRG/NDC/REV. CODE": 99281, " Gross Charge Out-Patient ": 551, " Gross Charge In-Patient ": 551, " Discounted Cash Price Out Patient ": 551, " Discounted Cash Price In Patient ": 551, " Triple S Vital Out Patient ": 199, " Triple S Vital In Patient ": "N/A", " Triple S Comercial Out Patient ": 185, " Triple S Comercial In Patient ": "N/A", " Triple S Advantage Out Patient ": 204, " Triple S Advantage In Patient ": "N/A", " Mmm Vital Out Patient ": 137.81, " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": 175, " Mmm Advantage In Patient ": "N/A", " Menonita Vital Out Patient ": 88, " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": 250, " Menonita Comercial In Patient ": "N/A", " Humana Comercial Ppo ": 200, " Humana Comercial Ppo In Patient ": "N/A", " Humana Comercial Hmo ": 200, " Humana Comercial Hmo In Patient ": "N/A", " Humana Advantage Out Patient ": 210, " Humana Advantage In Patient ": "N/A", " Mcs Advantage Out Patient ": 197, " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": 204, " Mcs Comercial In Patient ": "N/A", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": 250, " Imc Comercial In Patient ": "N/A", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": 150, " Mapfre Comercial In Patient ": "N/A", " Cigna In Patient ": "N/A", " Cigna Out Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Physician Correctional Out Patient ": "N/A", " Physician Correctional In Patient ": "N/A", " Max. 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CODE": 43, " Gross Charge Out-Patient ": 1871.32, " Gross Charge In-Patient ": 1871.32, " Discounted Cash Price Out Patient ": 1871.32, " Discounted Cash Price In Patient ": 1871.32, " Triple S Vital Out Patient ": 129, " Triple S Vital In Patient ": 129, " Triple S Comercial Out Patient ": 129, " Triple S Comercial In Patient ": 129, " Triple S Advantage Out Patient ": 129, " Triple S Advantage In Patient ": 129, " Mmm Vital Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mmm Vital In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mmm Advantage Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mmm Advantage In Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Vital Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Vital In Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Ppo ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Ppo In Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Hmo ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Hmo In Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Advantage Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Advantage In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Advantage Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Advantage In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " First Medical Vital Out Patient ": "NEUROVASCULAR FACILITY FEE ", " First Medical Vital In Patient ": "NEUROVASCULAR FACILITY FEE ", " Imc Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Imc Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " Prossam Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Prossam In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mapfre Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mapfre Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " Cigna In Patient ": "NEUROVASCULAR FACILITY FEE ", " Cigna Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa In Patient ": "NEUROVASCULAR FACILITY FEE ", " Physician Correctional Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Physician Correctional In Patient ": "NEUROVASCULAR FACILITY FEE ", " Max. Price ": 1871.32, " Min. Price ": 129 }, { "Description Of Service ": "ENTERPRICE INTRACRANEAL STENT", "CPT/HCPCS/DRG/NDC/REV. CODE": 45, " Gross Charge Out-Patient ": 482.08, " Gross Charge In-Patient ": 482.08, " Discounted Cash Price Out Patient ": 482.08, " Discounted Cash Price In Patient ": 482.08, " Triple S Vital Out Patient ": 3799, " Triple S Vital In Patient ": 3799, " Triple S Comercial Out Patient ": 3799, " Triple S Comercial In Patient ": 3799, " Triple S Advantage Out Patient ": 3799, " Triple S Advantage In Patient ": 3799, " Mmm Vital Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mmm Vital In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mmm Advantage Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mmm Advantage In Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Vital Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Vital In Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Menonita Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Ppo ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Ppo In Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Hmo ": "NEUROVASCULAR FACILITY FEE ", " Humana Comercial Hmo In Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Advantage Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Humana Advantage In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Advantage Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Advantage In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mcs Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " First Medical Vital Out Patient ": "NEUROVASCULAR FACILITY FEE ", " First Medical Vital In Patient ": "NEUROVASCULAR FACILITY FEE ", " Imc Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Imc Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " Prossam Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Prossam In Patient ": "NEUROVASCULAR FACILITY FEE ", " Mapfre Comercial Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Mapfre Comercial In Patient ": "NEUROVASCULAR FACILITY FEE ", " Cigna In Patient ": "NEUROVASCULAR FACILITY FEE ", " Cigna Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa In Patient ": "NEUROVASCULAR FACILITY FEE ", " Physician Correctional Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Physician Correctional In Patient ": "NEUROVASCULAR FACILITY FEE ", " Max. 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CODE": 46.91, " Gross Charge Out-Patient ": 30.41, " Gross Charge In-Patient ": 30.41, " Discounted Cash Price Out Patient ": 30.41, " Discounted Cash Price In Patient ": 30.41, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "ER OR AMB FEE", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "ER OR AMB FEE", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "ER OR AMB FEE", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "ER OR AMB FEE", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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Price ": 133, " Min. Price ": 133 }, { "Description Of Service ": "BUNDLE ARTERIAL LINE (RADIAL)", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 73.17, " Gross Charge In-Patient ": 73.17, " Discounted Cash Price Out Patient ": 73.17, " Discounted Cash Price In Patient ": 73.17, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 208, " Gross Charge Out-Patient ": 80, " Gross Charge In-Patient ": 80, " Discounted Cash Price Out Patient ": 80, " Discounted Cash Price In Patient ": 80, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 80, " Min. Price ": 80 }, { "Description Of Service ": "BUNDLE CHEST TUBE", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 188.72, " Gross Charge In-Patient ": 188.72, " Discounted Cash Price Out Patient ": 188.72, " Discounted Cash Price In Patient ": 188.72, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 208, " Gross Charge Out-Patient ": 2252, " Gross Charge In-Patient ": 2252, " Discounted Cash Price Out Patient ": 2252, " Discounted Cash Price In Patient ": 2252, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 2252, " Min. Price ": 2252 }, { "Description Of Service ": "BUNDLE ER-REBOA", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 83.48, " Gross Charge In-Patient ": 83.48, " Discounted Cash Price Out Patient ": 83.48, " Discounted Cash Price In Patient ": 83.48, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 83.48, " Min. Price ": 83.48 }, { "Description Of Service ": "BUNDLE INTUBATION", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 109, " Gross Charge In-Patient ": 109, " Discounted Cash Price Out Patient ": 109, " Discounted Cash Price In Patient ": 109, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 109, " Min. Price ": 109 }, { "Description Of Service ": "BUNDLE MASSIVE TRANSFUSION LIN", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 157, " Gross Charge In-Patient ": 157, " Discounted Cash Price Out Patient ": 157, " Discounted Cash Price In Patient ": 157, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 157, " Min. Price ": 157 }, { "Description Of Service ": "BUNDLE VENTRICULOSTOMY", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 1026, " Gross Charge In-Patient ": 1026, " Discounted Cash Price Out Patient ": 1026, " Discounted Cash Price In Patient ": 1026, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 1026, " Min. Price ": 1026 }, { "Description Of Service ": "HORA USO UNIDAD ESTABILIZADOR", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 209, " Gross Charge Out-Patient ": 207.11, " Gross Charge In-Patient ": 207.11, " Discounted Cash Price Out Patient ": 207.11, " Discounted Cash Price In Patient ": 207.11, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 209, " Gross Charge Out-Patient ": 12.15, " Gross Charge In-Patient ": 12.15, " Discounted Cash Price Out Patient ": 12.15, " Discounted Cash Price In Patient ": 12.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 209, " Gross Charge Out-Patient ": 98.65, " Gross Charge In-Patient ": 98.65, " Discounted Cash Price Out Patient ": 98.65, " Discounted Cash Price In Patient ": 98.65, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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Price ": 21.87, " Min. Price ": 21.87 }, { "Description Of Service ": "TRACHEOTOMY TUBE CHARGE", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 209, " Gross Charge Out-Patient ": 18.24, " Gross Charge In-Patient ": 18.24, " Discounted Cash Price Out Patient ": 18.24, " Discounted Cash Price In Patient ": 18.24, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 18.24, " Min. Price ": 18.24 }, { "Description Of Service ": "Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complication or comorbidities", "CPT/HCPCS/DRG/NDC/REV. CODE": 216, " Gross Charge Out-Patient ": "N/A", " Gross Charge In-Patient ": "N/A", " Discounted Cash Price Out Patient ": "N/A", " Discounted Cash Price In Patient ": "N/A", " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 0, " Min. Price ": 0 }, { "Description Of Service ": "ACLS HANDBOOK", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 229, " Gross Charge Out-Patient ": 236.25, " Gross Charge In-Patient ": 236.25, " Discounted Cash Price Out Patient ": 236.25, " Discounted Cash Price In Patient ": 236.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 720.67, " Gross Charge In-Patient ": 720.67, " Discounted Cash Price Out Patient ": 720.67, " Discounted Cash Price In Patient ": 720.67, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 765.62, " Gross Charge In-Patient ": 765.62, " Discounted Cash Price Out Patient ": 765.62, " Discounted Cash Price In Patient ": 765.62, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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Price ": 86.25, " Min. Price ": 86.25 }, { "Description Of Service ": "13-G MATCH-GROUND FOUR FACE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 94.35, " Gross Charge In-Patient ": 94.35, " Discounted Cash Price Out Patient ": 94.35, " Discounted Cash Price In Patient ": 94.35, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 86.25, " Gross Charge In-Patient ": 86.25, " Discounted Cash Price Out Patient ": 86.25, " Discounted Cash Price In Patient ": 86.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 86.25, " Min. Price ": 86.25 }, { "Description Of Service ": "150 ML SYRINGE WITH HANDFIL", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 8.31, " Gross Charge In-Patient ": 8.31, " Discounted Cash Price Out Patient ": 8.31, " Discounted Cash Price In Patient ": 8.31, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 11.1, " Gross Charge In-Patient ": 11.1, " Discounted Cash Price Out Patient ": 11.1, " Discounted Cash Price In Patient ": 11.1, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 86.25, " Gross Charge In-Patient ": 86.25, " Discounted Cash Price Out Patient ": 86.25, " Discounted Cash Price In Patient ": 86.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 33.3, " Gross Charge In-Patient ": 33.3, " Discounted Cash Price Out Patient ": 33.3, " Discounted Cash Price In Patient ": 33.3, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 26.25, " Gross Charge In-Patient ": 26.25, " Discounted Cash Price Out Patient ": 26.25, " Discounted Cash Price In Patient ": 26.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1034.52, " Gross Charge In-Patient ": 1034.52, " Discounted Cash Price Out Patient ": 1034.52, " Discounted Cash Price In Patient ": 1034.52, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 6.85, " Gross Charge In-Patient ": 6.85, " Discounted Cash Price Out Patient ": 6.85, " Discounted Cash Price In Patient ": 6.85, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 86.25, " Gross Charge In-Patient ": 86.25, " Discounted Cash Price Out Patient ": 86.25, " Discounted Cash Price In Patient ": 86.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 80.5, " Gross Charge In-Patient ": 80.5, " Discounted Cash Price Out Patient ": 80.5, " Discounted Cash Price In Patient ": 80.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 80.5, " Min. Price ": 80.5 }, { "Description Of Service ": "20MHZ DOPPLER 2MM TIP 115MM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 375.8, " Gross Charge In-Patient ": 375.8, " Discounted Cash Price Out Patient ": 375.8, " Discounted Cash Price In Patient ": 375.8, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 486.06, " Gross Charge In-Patient ": 486.06, " Discounted Cash Price Out Patient ": 486.06, " Discounted Cash Price In Patient ": 486.06, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 186.86, " Gross Charge In-Patient ": 186.86, " Discounted Cash Price Out Patient ": 186.86, " Discounted Cash Price In Patient ": 186.86, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 456.32, " Gross Charge In-Patient ": 456.32, " Discounted Cash Price Out Patient ": 456.32, " Discounted Cash Price In Patient ": 456.32, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 982.35, " Gross Charge In-Patient ": 982.35, " Discounted Cash Price Out Patient ": 982.35, " Discounted Cash Price In Patient ": 982.35, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 26.25, " Gross Charge In-Patient ": 26.25, " Discounted Cash Price Out Patient ": 26.25, " Discounted Cash Price In Patient ": 26.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 6093.9, " Gross Charge In-Patient ": 6093.9, " Discounted Cash Price Out Patient ": 6093.9, " Discounted Cash Price In Patient ": 6093.9, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 41.53, " Gross Charge In-Patient ": 41.53, " Discounted Cash Price Out Patient ": 41.53, " Discounted Cash Price In Patient ": 41.53, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 260.85, " Gross Charge In-Patient ": 260.85, " Discounted Cash Price Out Patient ": 260.85, " Discounted Cash Price In Patient ": 260.85, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 24.13, " Gross Charge In-Patient ": 24.13, " Discounted Cash Price Out Patient ": 24.13, " Discounted Cash Price In Patient ": 24.13, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 56.42, " Gross Charge In-Patient ": 56.42, " Discounted Cash Price Out Patient ": 56.42, " Discounted Cash Price In Patient ": 56.42, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 56.42, " Min. Price ": 56.42 }, { "Description Of Service ": "ACTICOAT 4 X 4", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.88, " Gross Charge In-Patient ": 11.88, " Discounted Cash Price Out Patient ": 11.88, " Discounted Cash Price In Patient ": 11.88, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 11.88, " Min. Price ": 11.88 }, { "Description Of Service ": "ACTICOAT DRESSING 8X16 #20301", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 63.78, " Gross Charge In-Patient ": 63.78, " Discounted Cash Price Out Patient ": 63.78, " Discounted Cash Price In Patient ": 63.78, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 63.78, " Min. Price ": 63.78 }, { "Description Of Service ": "ACTIVE LIFE COLOSTOMY BAG", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.04, " Gross Charge In-Patient ": 2.04, " Discounted Cash Price Out Patient ": 2.04, " Discounted Cash Price In Patient ": 2.04, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 2.04, " Min. Price ": 2.04 }, { "Description Of Service ": "ADAPTER TEE 22MM X 2MM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.3, " Gross Charge In-Patient ": 2.3, " Discounted Cash Price Out Patient ": 2.3, " Discounted Cash Price In Patient ": 2.3, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 2.3, " Min. Price ": 2.3 }, { "Description Of Service ": "Adapter tee valve 22mm x 22mm", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.3, " Gross Charge In-Patient ": 2.3, " Discounted Cash Price Out Patient ": 2.3, " Discounted Cash Price In Patient ": 2.3, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 2.3, " Min. Price ": 2.3 }, { "Description Of Service ": "ADHESIVE PADS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 7.77, " Gross Charge In-Patient ": 7.77, " Discounted Cash Price Out Patient ": 7.77, " Discounted Cash Price In Patient ": 7.77, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 7.77, " Min. Price ": 7.77 }, { "Description Of Service ": "ADHESIVE TAPE PRE-CUT ASSORTE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 7.35, " Gross Charge In-Patient ": 7.35, " Discounted Cash Price Out Patient ": 7.35, " Discounted Cash Price In Patient ": 7.35, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 7.35, " Min. Price ": 7.35 }, { "Description Of Service ": "ADM. INTRAVENOUS BLOOD", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 549.45, " Gross Charge In-Patient ": 549.45, " Discounted Cash Price Out Patient ": 549.45, " Discounted Cash Price In Patient ": 549.45, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 61.05, " Gross Charge In-Patient ": 61.05, " Discounted Cash Price Out Patient ": 61.05, " Discounted Cash Price In Patient ": 61.05, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 593.85, " Gross Charge In-Patient ": 593.85, " Discounted Cash Price Out Patient ": 593.85, " Discounted Cash Price In Patient ": 593.85, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 167.58, " Gross Charge In-Patient ": 167.58, " Discounted Cash Price Out Patient ": 167.58, " Discounted Cash Price In Patient ": 167.58, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1.76, " Gross Charge In-Patient ": 1.76, " Discounted Cash Price Out Patient ": 1.76, " Discounted Cash Price In Patient ": 1.76, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 10.96, " Gross Charge In-Patient ": 10.96, " Discounted Cash Price Out Patient ": 10.96, " Discounted Cash Price In Patient ": 10.96, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 159.84, " Gross Charge In-Patient ": 159.84, " Discounted Cash Price Out Patient ": 159.84, " Discounted Cash Price In Patient ": 159.84, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.78, " Gross Charge In-Patient ": 2.78, " Discounted Cash Price Out Patient ": 2.78, " Discounted Cash Price In Patient ": 2.78, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 9.99, " Gross Charge In-Patient ": 9.99, " Discounted Cash Price Out Patient ": 9.99, " Discounted Cash Price In Patient ": 9.99, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 10.7, " Gross Charge In-Patient ": 10.7, " Discounted Cash Price Out Patient ": 10.7, " Discounted Cash Price In Patient ": 10.7, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 3.49, " Gross Charge In-Patient ": 3.49, " Discounted Cash Price Out Patient ": 3.49, " Discounted Cash Price In Patient ": 3.49, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 387.06, " Gross Charge In-Patient ": 387.06, " Discounted Cash Price Out Patient ": 387.06, " Discounted Cash Price In Patient ": 387.06, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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Price ": 1665, " Min. Price ": 1665 }, { "Description Of Service ": "BIOPSY NEEDLE KIT PASSIVE", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 93.24, " Gross Charge In-Patient ": 93.24, " Discounted Cash Price Out Patient ": 93.24, " Discounted Cash Price In Patient ": 93.24, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 93.24, " Gross Charge In-Patient ": 93.24, " Discounted Cash Price Out Patient ": 93.24, " Discounted Cash Price In Patient ": 93.24, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 93.24, " Min. Price ": 93.24 }, { "Description Of Service ": "COAXIAL NEEDLE 17G X 9.5CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 13.88, " Gross Charge In-Patient ": 13.88, " Discounted Cash Price Out Patient ": 13.88, " Discounted Cash Price In Patient ": 13.88, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 13.88, " Min. Price ": 13.88 }, { "Description Of Service ": "COAXIAL NEEDLE 18 X 20", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 14.23, " Gross Charge In-Patient ": 14.23, " Discounted Cash Price Out Patient ": 14.23, " Discounted Cash Price In Patient ": 14.23, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 75.48, " Gross Charge In-Patient ": 75.48, " Discounted Cash Price Out Patient ": 75.48, " Discounted Cash Price In Patient ": 75.48, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 75.48, " Min. Price ": 75.48 }, { "Description Of Service ": "COBRA 2 5F-65CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 73.26, " Gross Charge In-Patient ": 73.26, " Discounted Cash Price Out Patient ": 73.26, " Discounted Cash Price In Patient ": 73.26, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2164.5, " Gross Charge In-Patient ": 2164.5, " Discounted Cash Price Out Patient ": 2164.5, " Discounted Cash Price In Patient ": 2164.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 3.89, " Gross Charge In-Patient ": 3.89, " Discounted Cash Price Out Patient ": 3.89, " Discounted Cash Price In Patient ": 3.89, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 47.18, " Gross Charge In-Patient ": 47.18, " Discounted Cash Price Out Patient ": 47.18, " Discounted Cash Price In Patient ": 47.18, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 83.25, " Gross Charge In-Patient ": 83.25, " Discounted Cash Price Out Patient ": 83.25, " Discounted Cash Price In Patient ": 83.25, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 684.84, " Gross Charge In-Patient ": 684.84, " Discounted Cash Price Out Patient ": 684.84, " Discounted Cash Price In Patient ": 684.84, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 12.21, " Gross Charge In-Patient ": 12.21, " Discounted Cash Price Out Patient ": 12.21, " Discounted Cash Price In Patient ": 12.21, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.4, " Gross Charge In-Patient ": 0.4, " Discounted Cash Price Out Patient ": 0.4, " Discounted Cash Price In Patient ": 0.4, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 0.4, " Min. Price ": 0.4 }, { "Description Of Service ": "CORTRACK FEEDIN TUBE 10FR 36\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 122.1, " Gross Charge In-Patient ": 122.1, " Discounted Cash Price Out Patient ": 122.1, " Discounted Cash Price In Patient ": 122.1, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 122.1, " Min. Price ": 122.1 }, { "Description Of Service ": "CORTRACK FEEDING TUBE 10FR 43\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 128.21, " Gross Charge In-Patient ": 128.21, " Discounted Cash Price Out Patient ": 128.21, " Discounted Cash Price In Patient ": 128.21, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 128.21, " Min. Price ": 128.21 }, { "Description Of Service ": "CORTRACK FEEDING TUBE 10FR 55\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 185.37, " Gross Charge In-Patient ": 185.37, " Discounted Cash Price Out Patient ": 185.37, " Discounted Cash Price In Patient ": 185.37, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 122.1, " Gross Charge In-Patient ": 122.1, " Discounted Cash Price Out Patient ": 122.1, " Discounted Cash Price In Patient ": 122.1, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 122.1, " Gross Charge In-Patient ": 122.1, " Discounted Cash Price Out Patient ": 122.1, " Discounted Cash Price In Patient ": 122.1, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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Price ": 185.37, " Min. Price ": 185.37 }, { "Description Of Service ": "COTONOIDES 1\"\" X 6\"\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.61, " Gross Charge In-Patient ": 0.61, " Discounted Cash Price Out Patient ": 0.61, " Discounted Cash Price In Patient ": 0.61, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 0.61, " Min. Price ": 0.61 }, { "Description Of Service ": "COTONOIDES 1/2\"\" X 6\"\"", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 1.89, " Gross Charge In-Patient ": 1.89, " Discounted Cash Price Out Patient ": 1.89, " Discounted Cash Price In Patient ": 1.89, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 61.05, " Gross Charge In-Patient ": 61.05, " Discounted Cash Price Out Patient ": 61.05, " Discounted Cash Price In Patient ": 61.05, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 19.15, " Gross Charge In-Patient ": 19.15, " Discounted Cash Price Out Patient ": 19.15, " Discounted Cash Price In Patient ": 19.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 132.09, " Gross Charge In-Patient ": 132.09, " Discounted Cash Price Out Patient ": 132.09, " Discounted Cash Price In Patient ": 132.09, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 143.19, " Gross Charge In-Patient ": 143.19, " Discounted Cash Price Out Patient ": 143.19, " Discounted Cash Price In Patient ": 143.19, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.13, " Gross Charge In-Patient ": 2.13, " Discounted Cash Price Out Patient ": 2.13, " Discounted Cash Price In Patient ": 2.13, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 177.6, " Gross Charge In-Patient ": 177.6, " Discounted Cash Price Out Patient ": 177.6, " Discounted Cash Price In Patient ": 177.6, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 32.76, " Gross Charge In-Patient ": 32.76, " Discounted Cash Price Out Patient ": 32.76, " Discounted Cash Price In Patient ": 32.76, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 61.05, " Gross Charge In-Patient ": 61.05, " Discounted Cash Price Out Patient ": 61.05, " Discounted Cash Price In Patient ": 61.05, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 61.05, " Min. Price ": 61.05 }, { "Description Of Service ": "DUAL NASAL CANNULA CO2/O2", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 6.66, " Gross Charge In-Patient ": 6.66, " Discounted Cash Price Out Patient ": 6.66, " Discounted Cash Price In Patient ": 6.66, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 72.15, " Gross Charge In-Patient ": 72.15, " Discounted Cash Price Out Patient ": 72.15, " Discounted Cash Price In Patient ": 72.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 4.44, " Gross Charge In-Patient ": 4.44, " Discounted Cash Price Out Patient ": 4.44, " Discounted Cash Price In Patient ": 4.44, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 30.71, " Gross Charge In-Patient ": 30.71, " Discounted Cash Price Out Patient ": 30.71, " Discounted Cash Price In Patient ": 30.71, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 8.82, " Gross Charge In-Patient ": 8.82, " Discounted Cash Price Out Patient ": 8.82, " Discounted Cash Price In Patient ": 8.82, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.43, " Gross Charge In-Patient ": 0.43, " Discounted Cash Price Out Patient ": 0.43, " Discounted Cash Price In Patient ": 0.43, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.81, " Gross Charge In-Patient ": 0.81, " Discounted Cash Price Out Patient ": 0.81, " Discounted Cash Price In Patient ": 0.81, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 41.92, " Gross Charge In-Patient ": 41.92, " Discounted Cash Price Out Patient ": 41.92, " Discounted Cash Price In Patient ": 41.92, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 41.92, " Min. Price ": 41.92 }, { "Description Of Service ": "EXAMINING PAPER 21 ROLL", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.37, " Gross Charge In-Patient ": 2.37, " Discounted Cash Price Out Patient ": 2.37, " Discounted Cash Price In Patient ": 2.37, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 2.37, " Min. Price ": 2.37 }, { "Description Of Service ": "EXAMINING PATIENT GOWN", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.31, " Gross Charge In-Patient ": 0.31, " Discounted Cash Price Out Patient ": 0.31, " Discounted Cash Price In Patient ": 0.31, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 0.31, " Min. Price ": 0.31 }, { "Description Of Service ": "EXCELSIOR SL-10 MICROCATH STR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 455.1, " Gross Charge In-Patient ": 455.1, " Discounted Cash Price Out Patient ": 455.1, " Discounted Cash Price In Patient ": 455.1, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 455.1, " Min. Price ": 455.1 }, { "Description Of Service ": "EXCHANGE MEMORY PCB 512K", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 335.35, " Gross Charge In-Patient ": 335.35, " Discounted Cash Price Out Patient ": 335.35, " Discounted Cash Price In Patient ": 335.35, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 335.35, " Min. Price ": 335.35 }, { "Description Of Service ": "EXHALATION FILTER", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 22.52, " Gross Charge In-Patient ": 22.52, " Discounted Cash Price Out Patient ": 22.52, " Discounted Cash Price In Patient ": 22.52, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 22.52, " Min. Price ": 22.52 }, { "Description Of Service ": "EXPANDABLE LEMAITRE VALVULOTOM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 864.69, " Gross Charge In-Patient ": 864.69, " Discounted Cash Price Out Patient ": 864.69, " Discounted Cash Price In Patient ": 864.69, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 864.69, " Min. Price ": 864.69 }, { "Description Of Service ": "EXPANDABLE TUBING 120\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.12, " Gross Charge In-Patient ": 11.12, " Discounted Cash Price Out Patient ": 11.12, " Discounted Cash Price In Patient ": 11.12, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 11.12, " Min. Price ": 11.12 }, { "Description Of Service ": "EXPIRATORY VALVE SET FOR C3", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 32.75, " Gross Charge In-Patient ": 32.75, " Discounted Cash Price Out Patient ": 32.75, " Discounted Cash Price In Patient ": 32.75, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 32.75, " Min. Price ": 32.75 }, { "Description Of Service ": "EXPIRATORY VALVE SET FOR T-1", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 33.86, " Gross Charge In-Patient ": 33.86, " Discounted Cash Price Out Patient ": 33.86, " Discounted Cash Price In Patient ": 33.86, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 33.86, " Min. Price ": 33.86 }, { "Description Of Service ": "EXPRESS BONE BIOPSY DEVICE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 310.8, " Gross Charge In-Patient ": 310.8, " Discounted Cash Price Out Patient ": 310.8, " Discounted Cash Price In Patient ": 310.8, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1243.2, " Gross Charge In-Patient ": 1243.2, " Discounted Cash Price Out Patient ": 1243.2, " Discounted Cash Price In Patient ": 1243.2, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 1243.2, " Min. Price ": 1243.2 }, { "Description Of Service ": "EXPRESS LD 6X27X75 #63075", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1243.2, " Gross Charge In-Patient ": 1243.2, " Discounted Cash Price Out Patient ": 1243.2, " Discounted Cash Price In Patient ": 1243.2, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 1243.2, " Min. Price ": 1243.2 }, { "Description Of Service ": "EXPRESS OSTEOINTRO.TROCAR TIP", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 349.65, " Gross Charge In-Patient ": 349.65, " Discounted Cash Price Out Patient ": 349.65, " Discounted Cash Price In Patient ": 349.65, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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Price ": 198.69, " Min. Price ": 198.69 }, { "Description Of Service ": "EXT. HEPARIN LOCK 6\"\" APROX.", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.87, " Gross Charge In-Patient ": 0.87, " Discounted Cash Price Out Patient ": 0.87, " Discounted Cash Price In Patient ": 0.87, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 177.6, " Gross Charge In-Patient ": 177.6, " Discounted Cash Price Out Patient ": 177.6, " Discounted Cash Price In Patient ": 177.6, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 4.44, " Gross Charge In-Patient ": 4.44, " Discounted Cash Price Out Patient ": 4.44, " Discounted Cash Price In Patient ": 4.44, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 404.8, " Gross Charge In-Patient ": 404.8, " Discounted Cash Price Out Patient ": 404.8, " Discounted Cash Price In Patient ": 404.8, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.81, " Gross Charge In-Patient ": 0.81, " Discounted Cash Price Out Patient ": 0.81, " Discounted Cash Price In Patient ": 0.81, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 31.17, " Gross Charge In-Patient ": 31.17, " Discounted Cash Price Out Patient ": 31.17, " Discounted Cash Price In Patient ": 31.17, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 31.17, " Min. Price ": 31.17 }, { "Description Of Service ": "FLOW SENSOR GALILEO", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 0.61, " Gross Charge In-Patient ": 0.61, " Discounted Cash Price Out Patient ": 0.61, " Discounted Cash Price In Patient ": 0.61, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 799.2, " Gross Charge In-Patient ": 799.2, " Discounted Cash Price Out Patient ": 799.2, " Discounted Cash Price In Patient ": 799.2, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1098.9, " Gross Charge In-Patient ": 1098.9, " Discounted Cash Price Out Patient ": 1098.9, " Discounted Cash Price In Patient ": 1098.9, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1087.8, " Gross Charge In-Patient ": 1087.8, " Discounted Cash Price Out Patient ": 1087.8, " Discounted Cash Price In Patient ": 1087.8, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1087.8, " Gross Charge In-Patient ": 1087.8, " Discounted Cash Price Out Patient ": 1087.8, " Discounted Cash Price In Patient ": 1087.8, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 568.05, " Gross Charge In-Patient ": 568.05, " Discounted Cash Price Out Patient ": 568.05, " Discounted Cash Price In Patient ": 568.05, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 568.05, " Min. Price ": 568.05 }, { "Description Of Service ": "GELFOAM (ABSORD GELATIN) 1\"\"*1", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 22.13, " Gross Charge In-Patient ": 22.13, " Discounted Cash Price Out Patient ": 22.13, " Discounted Cash Price In Patient ": 22.13, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 22.13, " Min. Price ": 22.13 }, { "Description Of Service ": "GEMINI 4WR BASKET 3.0FR/120CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 198.69, " Gross Charge In-Patient ": 198.69, " Discounted Cash Price Out Patient ": 198.69, " Discounted Cash Price In Patient ": 198.69, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 10.36, " Gross Charge In-Patient ": 10.36, " Discounted Cash Price Out Patient ": 10.36, " Discounted Cash Price In Patient ": 10.36, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 70.49, " Gross Charge In-Patient ": 70.49, " Discounted Cash Price Out Patient ": 70.49, " Discounted Cash Price In Patient ": 70.49, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 59.66, " Gross Charge In-Patient ": 59.66, " Discounted Cash Price Out Patient ": 59.66, " Discounted Cash Price In Patient ": 59.66, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 48.23, " Gross Charge In-Patient ": 48.23, " Discounted Cash Price Out Patient ": 48.23, " Discounted Cash Price In Patient ": 48.23, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 108.04, " Gross Charge In-Patient ": 108.04, " Discounted Cash Price Out Patient ": 108.04, " Discounted Cash Price In Patient ": 108.04, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 3.77, " Gross Charge In-Patient ": 3.77, " Discounted Cash Price Out Patient ": 3.77, " Discounted Cash Price In Patient ": 3.77, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 5.55, " Gross Charge In-Patient ": 5.55, " Discounted Cash Price Out Patient ": 5.55, " Discounted Cash Price In Patient ": 5.55, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 76.59, " Gross Charge In-Patient ": 76.59, " Discounted Cash Price Out Patient ": 76.59, " Discounted Cash Price In Patient ": 76.59, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 368.15, " Gross Charge In-Patient ": 368.15, " Discounted Cash Price Out Patient ": 368.15, " Discounted Cash Price In Patient ": 368.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1054.5, " Gross Charge In-Patient ": 1054.5, " Discounted Cash Price Out Patient ": 1054.5, " Discounted Cash Price In Patient ": 1054.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1054.5, " Gross Charge In-Patient ": 1054.5, " Discounted Cash Price Out Patient ": 1054.5, " Discounted Cash Price In Patient ": 1054.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 106.56, " Gross Charge In-Patient ": 106.56, " Discounted Cash Price Out Patient ": 106.56, " Discounted Cash Price In Patient ": 106.56, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 20.08, " Gross Charge In-Patient ": 20.08, " Discounted Cash Price Out Patient ": 20.08, " Discounted Cash Price In Patient ": 20.08, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1159.95, " Gross Charge In-Patient ": 1159.95, " Discounted Cash Price Out Patient ": 1159.95, " Discounted Cash Price In Patient ": 1159.95, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 141.53, " Gross Charge In-Patient ": 141.53, " Discounted Cash Price Out Patient ": 141.53, " Discounted Cash Price In Patient ": 141.53, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 832.5, " Gross Charge In-Patient ": 832.5, " Discounted Cash Price Out Patient ": 832.5, " Discounted Cash Price In Patient ": 832.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 32.36, " Gross Charge In-Patient ": 32.36, " Discounted Cash Price Out Patient ": 32.36, " Discounted Cash Price In Patient ": 32.36, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 85.47, " Gross Charge In-Patient ": 85.47, " Discounted Cash Price Out Patient ": 85.47, " Discounted Cash Price In Patient ": 85.47, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 17.76, " Gross Charge In-Patient ": 17.76, " Discounted Cash Price Out Patient ": 17.76, " Discounted Cash Price In Patient ": 17.76, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 366.3, " Gross Charge In-Patient ": 366.3, " Discounted Cash Price Out Patient ": 366.3, " Discounted Cash Price In Patient ": 366.3, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 42.18, " Gross Charge In-Patient ": 42.18, " Discounted Cash Price Out Patient ": 42.18, " Discounted Cash Price In Patient ": 42.18, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 9.26, " Gross Charge In-Patient ": 9.26, " Discounted Cash Price Out Patient ": 9.26, " Discounted Cash Price In Patient ": 9.26, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 337.44, " Gross Charge In-Patient ": 337.44, " Discounted Cash Price Out Patient ": 337.44, " Discounted Cash Price In Patient ": 337.44, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 337.44, " Min. Price ": 337.44 }, { "Description Of Service ": "LAP SYSTEM W/DISSECTING HOOK 5", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 219.69, " Gross Charge In-Patient ": 219.69, " Discounted Cash Price Out Patient ": 219.69, " Discounted Cash Price In Patient ": 219.69, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 219.69, " Min. Price ": 219.69 }, { "Description Of Service ": "LAPARATOMY PACK II (10/BOX)", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 44.37, " Gross Charge In-Patient ": 44.37, " Discounted Cash Price Out Patient ": 44.37, " Discounted Cash Price In Patient ": 44.37, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 44.37, " Min. Price ": 44.37 }, { "Description Of Service ": "LAPAROSCOPIC ELECTRODE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 37.19, " Gross Charge In-Patient ": 37.19, " Discounted Cash Price Out Patient ": 37.19, " Discounted Cash Price In Patient ": 37.19, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 37.19, " Min. Price ": 37.19 }, { "Description Of Service ": "LAPAROSCOPIC HANDSET PENCIL", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 66.6, " Gross Charge In-Patient ": 66.6, " Discounted Cash Price Out Patient ": 66.6, " Discounted Cash Price In Patient ": 66.6, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 66.6, " Min. Price ": 66.6 }, { "Description Of Service ": "LAPAROSTOMIA DE ARTROSCOPIA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 47.15, " Gross Charge In-Patient ": 47.15, " Discounted Cash Price Out Patient ": 47.15, " Discounted Cash Price In Patient ": 47.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 47.15, " Min. Price ": 47.15 }, { "Description Of Service ": "LAPAROSTOMIA DE NEUROCIRUGIA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 108.31, " Gross Charge In-Patient ": 108.31, " Discounted Cash Price Out Patient ": 108.31, " Discounted Cash Price In Patient ": 108.31, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 108.31, " Min. Price ": 108.31 }, { "Description Of Service ": "LAPAROSTOMIA DE OFTALMOLOGIA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 52.82, " Gross Charge In-Patient ": 52.82, " Discounted Cash Price Out Patient ": 52.82, " Discounted Cash Price In Patient ": 52.82, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 52.82, " Min. Price ": 52.82 }, { "Description Of Service ": "LARGE BONE BLADE", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 37.3, " Min. Price ": 37.3 }, { "Description Of Service ": "LARGE BONE BLADE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 27.75, " Gross Charge In-Patient ": 27.75, " Discounted Cash Price Out Patient ": 27.75, " Discounted Cash Price In Patient ": 27.75, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 23.31, " Gross Charge In-Patient ": 23.31, " Discounted Cash Price Out Patient ": 23.31, " Discounted Cash Price In Patient ": 23.31, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.78, " Gross Charge In-Patient ": 2.78, " Discounted Cash Price Out Patient ": 2.78, " Discounted Cash Price In Patient ": 2.78, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 6.79, " Gross Charge In-Patient ": 6.79, " Discounted Cash Price Out Patient ": 6.79, " Discounted Cash Price In Patient ": 6.79, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 360.75, " Gross Charge In-Patient ": 360.75, " Discounted Cash Price Out Patient ": 360.75, " Discounted Cash Price In Patient ": 360.75, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 399.6, " Gross Charge In-Patient ": 399.6, " Discounted Cash Price Out Patient ": 399.6, " Discounted Cash Price In Patient ": 399.6, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 469.9, " Gross Charge In-Patient ": 469.9, " Discounted Cash Price Out Patient ": 469.9, " Discounted Cash Price In Patient ": 469.9, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 428.38, " Gross Charge In-Patient ": 428.38, " Discounted Cash Price Out Patient ": 428.38, " Discounted Cash Price In Patient ": 428.38, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 505.05, " Gross Charge In-Patient ": 505.05, " Discounted Cash Price Out Patient ": 505.05, " Discounted Cash Price In Patient ": 505.05, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 462.5, " Gross Charge In-Patient ": 462.5, " Discounted Cash Price Out Patient ": 462.5, " Discounted Cash Price In Patient ": 462.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 477.3, " Gross Charge In-Patient ": 477.3, " Discounted Cash Price Out Patient ": 477.3, " Discounted Cash Price In Patient ": 477.3, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 405.15, " Gross Charge In-Patient ": 405.15, " Discounted Cash Price Out Patient ": 405.15, " Discounted Cash Price In Patient ": 405.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 471.75, " Gross Charge In-Patient ": 471.75, " Discounted Cash Price Out Patient ": 471.75, " Discounted Cash Price In Patient ": 471.75, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 508.75, " Gross Charge In-Patient ": 508.75, " Discounted Cash Price Out Patient ": 508.75, " Discounted Cash Price In Patient ": 508.75, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 38.63, " Gross Charge In-Patient ": 38.63, " Discounted Cash Price Out Patient ": 38.63, " Discounted Cash Price In Patient ": 38.63, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 266.4, " Gross Charge In-Patient ": 266.4, " Discounted Cash Price Out Patient ": 266.4, " Discounted Cash Price In Patient ": 266.4, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 223.85, " Gross Charge In-Patient ": 223.85, " Discounted Cash Price Out Patient ": 223.85, " Discounted Cash Price In Patient ": 223.85, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 223.85, " Min. Price ": 223.85 }, { "Description Of Service ": "LINEAR CUTTER 100MM RELOAD", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 79.55, " Gross Charge In-Patient ": 79.55, " Discounted Cash Price Out Patient ": 79.55, " Discounted Cash Price In Patient ": 79.55, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 61.83, " Gross Charge In-Patient ": 61.83, " Discounted Cash Price Out Patient ": 61.83, " Discounted Cash Price In Patient ": 61.83, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 32.19, " Gross Charge In-Patient ": 32.19, " Discounted Cash Price Out Patient ": 32.19, " Discounted Cash Price In Patient ": 32.19, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 13.99, " Gross Charge In-Patient ": 13.99, " Discounted Cash Price Out Patient ": 13.99, " Discounted Cash Price In Patient ": 13.99, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 13.99, " Min. Price ": 13.99 }, { "Description Of Service ": "LUCAS 2 DISPOSABLE SUCTION CUP", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 35.15, " Gross Charge In-Patient ": 35.15, " Discounted Cash Price Out Patient ": 35.15, " Discounted Cash Price In Patient ": 35.15, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 8.49, " Gross Charge In-Patient ": 8.49, " Discounted Cash Price Out Patient ": 8.49, " Discounted Cash Price In Patient ": 8.49, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 8.49, " Min. Price ": 8.49 }, { "Description Of Service ": "NEONATAL REM POLYHESIVE II", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 19.68, " Gross Charge In-Patient ": 19.68, " Discounted Cash Price Out Patient ": 19.68, " Discounted Cash Price In Patient ": 19.68, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 19.68, " Min. Price ": 19.68 }, { "Description Of Service ": "NEONATAL TRACHEAL TUBE 3.0", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 38.85, " Gross Charge In-Patient ": 38.85, " Discounted Cash Price Out Patient ": 38.85, " Discounted Cash Price In Patient ": 38.85, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 94.35, " Gross Charge In-Patient ": 94.35, " Discounted Cash Price Out Patient ": 94.35, " Discounted Cash Price In Patient ": 94.35, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 94.35, " Min. Price ": 94.35 }, { "Description Of Service ": "NEOSOFT DRAIN CATH 14FR*30CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 61.05, " Gross Charge In-Patient ": 61.05, " Discounted Cash Price Out Patient ": 61.05, " Discounted Cash Price In Patient ": 61.05, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. Price ": 61.05, " Min. Price ": 61.05 }, { "Description Of Service ": "NEPH PERCUTAN PIGTAIL NO 8", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 116.55, " Gross Charge In-Patient ": 116.55, " Discounted Cash Price Out Patient ": 116.55, " Discounted Cash Price In Patient ": 116.55, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 190.13, " Gross Charge In-Patient ": 190.13, " Discounted Cash Price Out Patient ": 190.13, " Discounted Cash Price In Patient ": 190.13, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 277.5, " Gross Charge In-Patient ": 277.5, " Discounted Cash Price Out Patient ": 277.5, " Discounted Cash Price In Patient ": 277.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 44.4, " Gross Charge In-Patient ": 44.4, " Discounted Cash Price Out Patient ": 44.4, " Discounted Cash Price In Patient ": 44.4, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 99.9, " Gross Charge In-Patient ": 99.9, " Discounted Cash Price Out Patient ": 99.9, " Discounted Cash Price In Patient ": 99.9, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 17.34, " Gross Charge In-Patient ": 17.34, " Discounted Cash Price Out Patient ": 17.34, " Discounted Cash Price In Patient ": 17.34, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 17.35, " Gross Charge In-Patient ": 17.35, " Discounted Cash Price Out Patient ": 17.35, " Discounted Cash Price In Patient ": 17.35, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 166.5, " Gross Charge In-Patient ": 166.5, " Discounted Cash Price Out Patient ": 166.5, " Discounted Cash Price In Patient ": 166.5, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 45.43, " Gross Charge In-Patient ": 45.43, " Discounted Cash Price Out Patient ": 45.43, " Discounted Cash Price In Patient ": 45.43, " Triple S Vital Out Patient ": "ER OR AMB FEE", " Triple S Vital In Patient ": "PERDIEM", " Triple S Comercial Out Patient ": "ER OR AMB FEE", " Triple S Comercial In Patient ": "PERDIEM", " Triple S Advantage Out Patient ": "ER OR AMB FEE", " Triple S Advantage In Patient ": "PERDIEM", " Mmm Vital Out Patient ": "ER OR AMB FEE", " Mmm Vital In Patient ": "PERDIEM", " Mmm Advantage Out Patient ": "ER OR AMB FEE", " Mmm Advantage In Patient ": "PERDIEM", " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "PERDIEM", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": "PERDIEM", " Humana Comercial Ppo ": "ER OR AMB FEE", " Humana Comercial Ppo In Patient ": "PERDIEM", " Humana Comercial Hmo ": "ER OR AMB FEE", " Humana Comercial Hmo In Patient ": "PERDIEM", " Humana Advantage Out Patient ": "ER OR AMB FEE", " Humana Advantage In Patient ": "PERDIEM", " Mcs Advantage Out Patient ": "ER OR AMB FEE", " Mcs Advantage In Patient ": "PERDIEM", " Mcs Comercial Out Patient ": "ER OR AMB FEE", " Mcs Comercial In Patient ": "PERDIEM", " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "PERDIEM", " Imc Comercial Out Patient ": "ER OR AMB FEE", " Imc Comercial In Patient ": "PERDIEM", " Prossam Out Patient ": "N/A", " Prossam In Patient ": "PERDIEM", " Mapfre Comercial Out Patient ": "ER OR AMB FEE", " Mapfre Comercial In Patient ": "PERDIEM", " Cigna In Patient ": "ER OR AMB FEE", " Cigna Out Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Physician Correctional Out Patient ": "ER OR AMB FEE", " Physician Correctional In Patient ": "PERDIEM", " Max. 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