{ [ { "hospital_name": "Hospital Universitario de Adultos", "last_updated_on": "2024-15-08", "version": "1.0.0", "hospital_location": [ "Centro Médico de PR" ], "hospital_address": [ "Centro Médico, Bo. Monacillos, Carr. Num 2", "Rio Piedras, PR 00922-2116" ], "license_information": { "license_number": "03", "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 ": "NEUROSURGERY INTENSIVE CARE UNIT", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " 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 ": 984, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1133, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 1101, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 961, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1110, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 1140, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1073, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1188, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1188, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 924, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 833, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": "N/A", " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 928, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1295, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1206, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 1508, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 880, " Max. Price ": 2102.97, " Min. Price ": 833 }, { "Description Of Service ": "NEUROSURGERY INTENSIVE CARE UNIT", "CPT/HCPCS/DRG/NDC/REV. CODE": 204, " 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 ": "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 ": 990.05, " 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", "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. Price ": 2102.97, " Min. Price ": 990.05 }, { "Description Of Service ": "INTENSIVE CARE ", "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 ": 869, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1008, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 998, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": "N/A", " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1040, " 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 ": 1009, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1009, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": "N/A", " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 838, " 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 ": 1105, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 904, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 806, " Max. Price ": 2102.97, " Min. Price ": 806 }, { "Description Of Service ": "INTERMEDIATE CARE NEUROSURGERY", "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 ": 984, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1012, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 998, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 961, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1089, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": "N/A", " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 961, " 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 ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 867, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 780, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 990.05, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 882, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1295, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1166, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 1508, " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. Price ": 1627, " Min. Price ": 780 }, { "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 ": 984, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1012, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 998, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 961, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1089, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 992, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 961, " 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 ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 867, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 780, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 990.05, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 882, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1295, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1166, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 1508, " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. Price ": 1627, " Min. Price ": 780 }, { "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 ": 869, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1008, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 998, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 742, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1040, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 992, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1013, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1099, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1099, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 924, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 833, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 990.05, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 844, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 904, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1105, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 904, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 806, " Max. Price ": 2102.97, " Min. Price ": 742 }, { "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 ": 869, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1008, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 998, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 742, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1040, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 992, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1013, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1099, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1099, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 924, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 833, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 990.05, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 844, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 904, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1105, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 904, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 806, " Max. Price ": 2102.97, " Min. Price ": 742 }, { "Description Of Service ": "TRAUMA TICU PT=I", "CPT/HCPCS/DRG/NDC/REV. CODE": 200, " Gross Charge Out-Patient ": 1247.93, " Gross Charge In-Patient ": 1247.93, " Discounted Cash Price Out Patient ": 1247.93, " Discounted Cash Price In Patient ": 1247.93, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 869, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 1008, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 998, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 742, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1040, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 992, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 1013, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 1099, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 1099, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 924, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 833, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 990.05, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 844, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 904, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 1105, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 904, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 806, " Max. 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CODE": 169, " Gross Charge Out-Patient ": 1247.93, " Gross Charge In-Patient ": 1247.93, " Discounted Cash Price Out Patient ": 1247.93, " Discounted Cash Price In Patient ": 1247.93, " 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 ": 655, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 655, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 559, " 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 ": 1013, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. Price ": 1247.93, " Min. Price ": 559 }, { "Description Of Service ": "ISOLATION", "CPT/HCPCS/DRG/NDC/REV. CODE": 164, " Gross Charge Out-Patient ": 1617.85, " Gross Charge In-Patient ": 1617.85, " Discounted Cash Price Out Patient ": 1617.85, " Discounted Cash Price In Patient ": 1617.85, " Triple S Vital Out Patient ": "N/A", " Triple S Vital In Patient ": 788, " Triple S Comercial Out Patient ": "N/A", " Triple S Comercial In Patient ": 870, " Triple S Advantage Out Patient ": "N/A", " Triple S Advantage In Patient ": 913, " Mmm Vital Out Patient ": "N/A", " Mmm Vital In Patient ": 798, " Mmm Advantage Out Patient ": "N/A", " Mmm Advantage In Patient ": 1002, " Menonita Vital Out Patient ": "N/A", " Menonita Vital In Patient ": 750, " Menonita Comercial Out Patient ": "N/A", " Menonita Comercial In Patient ": 950, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 982, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 982, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " Mcs Advantage Out Patient ": "N/A", " Mcs Advantage In Patient ": 867, " Mcs Comercial Out Patient ": "N/A", " Mcs Comercial In Patient ": 780, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 829.08, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 812, " Prossam Out Patient ": "N/A", " Prossam In Patient ": 1195, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 1204, " Acaa Out Patient ": "N/A", " Acaa In Patient ": 725, " Max. Price ": 1617.85, " Min. Price ": 725 }, { "Description Of Service ": "NURSERY TREATMENT- ADMISSION", "CPT/HCPCS/DRG/NDC/REV. CODE": 173, " Gross Charge Out-Patient ": 800, " Gross Charge In-Patient ": 800, " Discounted Cash Price Out Patient ": 800, " Discounted Cash Price In Patient ": 800, " 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 ": 816, " Humana Comercial Ppo ": "N/A", " Humana Comercial Ppo In Patient ": 800, " Humana Comercial Hmo ": "N/A", " Humana Comercial Hmo In Patient ": 800, " Humana Advantage Out Patient ": "N/A", " Humana Advantage In Patient ": "DRG", " 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 ": 800, " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": 992, "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": 1245, " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. Price ": 1245, " Min. Price ": 800 }, { "Description Of Service ": "NEW BORN CARE- NURSERY", "CPT/HCPCS/DRG/NDC/REV. CODE": 170, " Gross Charge Out-Patient ": 800, " Gross Charge In-Patient ": 800, " Discounted Cash Price Out Patient ": 800, " Discounted Cash Price In Patient ": 800, " 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 ": 721, " First Medical Vital Out Patient ": "N/A", " First Medical Vital In Patient ": 754.11, " Imc Comercial Out Patient ": "N/A", " Imc Comercial In Patient ": 716, " Prossam Out Patient ": "N/A", " Prossam In Patient ": "N/A", " Mapfre Comercial Out Patient ": "N/A", " Mapfre Comercial In Patient ": "N/A", "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. Price ": 800, " Min. Price ": 716 }, { "Description Of Service ": "ONCOLOGY UNIT", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 800, " Min. Price ": 103.86 }, { "Description Of Service ": "DELIVERY ROOM", "CPT/HCPCS/DRG/NDC/REV. CODE": 721, " Gross Charge Out-Patient ": 103.86, " Gross Charge In-Patient ": 103.86, " Discounted Cash Price Out Patient ": 103.86, " Discounted Cash Price In Patient ": 103.86, " 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 ": 798, " 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", "Auxilio Salud Out Patient ": "N/A", "Auxilio Salud In Patient ": "N/A", " Acaa Out Patient ": "N/A", " Acaa In Patient ": "N/A", " Max. 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Price ": 1247.93, " Min. Price ": 950 }, { "Description Of Service ": "STROKE SERVICE ROOM/ADMISSION ORDER", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 364.67, " Min. Price ": 105 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { " Mcs Comercial Out Patient ": 125, " Max. Price ": 125, " Min. Price ": 125 }, { "Description Of Service ": "NBCA TRUFIL", "CPT/HCPCS/DRG/NDC/REV. 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 ": 142, " Triple S Vital In Patient ": 142, " 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 ", "Auxilio Salud Out Patient ": "NEUROVASCULAR FACILITY FEE ", "Auxilio Salud In Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa 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 ": 4188, " Triple S Vital In Patient ": 4188, " 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 ", "Auxilio Salud Out Patient ": "NEUROVASCULAR FACILITY FEE ", "Auxilio Salud In Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa Out Patient ": "NEUROVASCULAR FACILITY FEE ", " Acaa In Patient ": "NEUROVASCULAR FACILITY FEE ", " Max. Price ": 4188, " Min. Price ": 482.08 }, { "Description Of Service ": "BUNDLE ARTERIAL LINE (FEMORAL)", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 133, " Gross Charge In-Patient ": 133, " Discounted Cash Price Out Patient ": 133, " Discounted Cash Price In Patient ": 133, " 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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 73.17, " Min. Price ": 73.17 }, { "Description Of Service ": "BUNDLE CENTRAL LINE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 188.72, " Min. Price ": 188.72 }, { "Description Of Service ": "BUNDLE COBRA-OS", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 1026, " Min. Price ": 1026 }, { "Description Of Service ": "HORA USO UNIDAD ESTABILIZADOR", "CPT/HCPCS/DRG/NDC/REV. CODE": 208, " Gross Charge Out-Patient ": 285.66, " Gross Charge In-Patient ": 285.66, " Discounted Cash Price Out Patient ": 285.66, " Discounted Cash Price In Patient ": 285.66, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 285.66, " Min. Price ": 285.66 }, { "Description Of Service ": "ARTERIAL LINE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 207.11, " Min. Price ": 207.11 }, { "Description Of Service ": "TUBE THORACOTOMY", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 314.21, " Gross Charge In-Patient ": 314.21, " Discounted Cash Price Out Patient ": 314.21, " Discounted Cash Price In Patient ": 314.21, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 314.21, " Min. Price ": 314.21 }, { "Description Of Service ": "TUBE THORACOTOMY", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 24.32, " Gross Charge In-Patient ": 24.32, " Discounted Cash Price Out Patient ": 24.32, " Discounted Cash Price In Patient ": 24.32, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 24.32, " Min. Price ": 24.32 }, { "Description Of Service ": "VELPEAU", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 79.82, " Gross Charge In-Patient ": 79.82, " Discounted Cash Price Out Patient ": 79.82, " Discounted Cash Price In Patient ": 79.82, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 79.82, " Min. Price ": 79.82 }, { "Description Of Service ": "VENOPUNCTION CATHETER", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 158.24, " Gross Charge In-Patient ": 158.24, " Discounted Cash Price Out Patient ": 158.24, " Discounted Cash Price In Patient ": 158.24, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 158.24, " Min. Price ": 158.24 }, { "Description Of Service ": "VENOUS CUTDOWN", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 65.77, " Gross Charge In-Patient ": 65.77, " Discounted Cash Price Out Patient ": 65.77, " Discounted Cash Price In Patient ": 65.77, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 65.77, " Min. Price ": 65.77 }, { "Description Of Service ": "VENOUS CUTDOWN", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 65.77, " Gross Charge In-Patient ": 65.77, " Discounted Cash Price Out Patient ": 65.77, " Discounted Cash Price In Patient ": 65.77, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 65.77, " Min. Price ": 65.77 }, { "Description Of Service ": "WINDOWING OF CAST", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 41.45, " Gross Charge In-Patient ": 41.45, " Discounted Cash Price Out Patient ": 41.45, " Discounted Cash Price In Patient ": 41.45, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 41.45, " Min. Price ": 41.45 }, { "Description Of Service ": "A) FIRST DEGREE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 189.97, " Gross Charge In-Patient ": 189.97, " Discounted Cash Price Out Patient ": 189.97, " Discounted Cash Price In Patient ": 189.97, " 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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 189.97, " Min. Price ": 189.97 }, { "Description Of Service ": "A) FIRST DEGREE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 46.39, " Gross Charge In-Patient ": 46.39, " Discounted Cash Price Out Patient ": 46.39, " Discounted Cash Price In Patient ": 46.39, " 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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 46.39, " Min. Price ": 46.39 }, { "Description Of Service ": "ABDOMINAL LAVAGE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 46.95, " Gross Charge In-Patient ": 46.95, " Discounted Cash Price Out Patient ": 46.95, " Discounted Cash Price In Patient ": 46.95, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 46.95, " Min. Price ": 46.95 }, { "Description Of Service ": "ADM. MEDICAMENTOS", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 12.15, " Min. Price ": 12.15 }, { "Description Of Service ": "ADM. SANGRE Y SUS DERIVADOS", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 38.7, " Gross Charge In-Patient ": 38.7, " Discounted Cash Price Out Patient ": 38.7, " Discounted Cash Price In Patient ": 38.7, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 38.7, " Min. Price ": 38.7 }, { "Description Of Service ": "ADULT LONG ARM CAST", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 67.94, " Gross Charge In-Patient ": 67.94, " Discounted Cash Price Out Patient ": 67.94, " Discounted Cash Price In Patient ": 67.94, " 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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 67.94, " Min. Price ": 67.94 }, { "Description Of Service ": "ADULT LONG ARM SPLINT", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 308.24, " Gross Charge In-Patient ": 308.24, " Discounted Cash Price Out Patient ": 308.24, " Discounted Cash Price In Patient ": 308.24, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 308.24, " Min. Price ": 308.24 }, { "Description Of Service ": "ADULT LONG LEG CAST", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 98.65, " Min. Price ": 98.65 }, { "Description Of Service ": "ADULT LONG LEG SPLINT", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 86.04, " Gross Charge In-Patient ": 86.04, " Discounted Cash Price Out Patient ": 86.04, " Discounted Cash Price In Patient ": 86.04, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 86.04, " Min. Price ": 86.04 }, { "Description Of Service ": "ADULT SHORT ARM CAST", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 71, " Gross Charge In-Patient ": 71, " Discounted Cash Price Out Patient ": 71, " Discounted Cash Price In Patient ": 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 71, " Min. Price ": 71 }, { "Description Of Service ": "ADULT SHORT ARM SPLINT", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 92.95, " Gross Charge In-Patient ": 92.95, " Discounted Cash Price Out Patient ": 92.95, " Discounted Cash Price In Patient ": 92.95, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 92.95, " Min. Price ": 92.95 }, { "Description Of Service ": "ADULT SHORT LEG CAST", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 66.95, " Gross Charge In-Patient ": 66.95, " Discounted Cash Price Out Patient ": 66.95, " Discounted Cash Price In Patient ": 66.95, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 66.95, " Min. Price ": 66.95 }, { "Description Of Service ": "ADULT SHORT LEG SPLINT", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 37.62, " Gross Charge In-Patient ": 37.62, " Discounted Cash Price Out Patient ": 37.62, " Discounted Cash Price In Patient ": 37.62, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 37.62, " Min. Price ": 37.62 }, { "Description Of Service ": "ANK.DI.TRE.W/OR OUT PE.CU.FIX", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 907.69, " Gross Charge In-Patient ": 907.69, " Discounted Cash Price Out Patient ": 907.69, " Discounted Cash Price In Patient ": 907.69, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 907.69, " Min. Price ": 907.69 }, { "Description Of Service ": "ANTHROCENTE.ASPIRAT.&/OR INJE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 36.45, " Gross Charge In-Patient ": 36.45, " Discounted Cash Price Out Patient ": 36.45, " Discounted Cash Price In Patient ": 36.45, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 36.45, " Min. Price ": 36.45 }, { "Description Of Service ": "ANTHROCENTE.ASPIRAT.&/OR INJE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 36.45, " Gross Charge In-Patient ": 36.45, " Discounted Cash Price Out Patient ": 36.45, " Discounted Cash Price In Patient ": 36.45, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 36.45, " Min. Price ": 36.45 }, { "Description Of Service ": "TRACHEOSTOMY & VENTILATOR VALV", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 141.02, " Gross Charge In-Patient ": 141.02, " Discounted Cash Price Out Patient ": 141.02, " Discounted Cash Price In Patient ": 141.02, " 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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 141.02, " Min. Price ": 141.02 }, { "Description Of Service ": "TRACHEOSTOMY TUBE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 21.87, " Gross Charge In-Patient ": 21.87, " Discounted Cash Price Out Patient ": 21.87, " Discounted Cash Price In Patient ": 21.87, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 21.87, " Min. Price ": 21.87 }, { "Description Of Service ": "TRACHEOTOMY TUBE CHARGE", "CPT/HCPCS/DRG/NDC/REV. CODE": 209, " Gross Charge Out-Patient ": 87.4, " Gross Charge In-Patient ": 87.4, " Discounted Cash Price Out Patient ": 87.4, " Discounted Cash Price In Patient ": 87.4, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 87.4, " Min. Price ": 87.4 }, { "Description Of Service ": "TRACHEOTOMY TUBE CHARGE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 0, " Min. Price ": 0 }, { "Description Of Service ": "ACLS HANDBOOK", "CPT/HCPCS/DRG/NDC/REV. CODE": 229, " Gross Charge Out-Patient ": 21, " Gross Charge In-Patient ": 21, " Discounted Cash Price Out Patient ": 21, " Discounted Cash Price In Patient ": 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 21, " Min. Price ": 21 }, { "Description Of Service ": "ACLS MD - INSTITUTION", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 236.25, " Min. Price ": 236.25 }, { "Description Of Service ": "ACLS MD RESIDENCE TRAINING-RCM", "CPT/HCPCS/DRG/NDC/REV. CODE": 229, " Gross Charge Out-Patient ": 199.5, " Gross Charge In-Patient ": 199.5, " Discounted Cash Price Out Patient ": 199.5, " Discounted Cash Price In Patient ": 199.5, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 199.5, " Min. Price ": 199.5 }, { "Description Of Service ": "ACLS MD STAFF TRAINING - ASEM", "CPT/HCPCS/DRG/NDC/REV. CODE": 229, " Gross Charge Out-Patient ": 157.5, " Gross Charge In-Patient ": 157.5, " Discounted Cash Price Out Patient ": 157.5, " Discounted Cash Price In Patient ": 157.5, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 157.5, " Min. Price ": 157.5 }, { "Description Of Service ": "ACLS MD TRAINING - TRAUMA", "CPT/HCPCS/DRG/NDC/REV. CODE": 229, " Gross Charge Out-Patient ": 199.5, " Gross Charge In-Patient ": 199.5, " Discounted Cash Price Out Patient ": 199.5, " Discounted Cash Price In Patient ": 199.5, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. 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Price ": 105, " Min. Price ": 105 }, { "Description Of Service ": "ACLS NURSE TRAINING BOOK-ASEM", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 36.75, " Min. Price ": 36.75 }, { "Description Of Service ": "ACLS NURSE TRAINING-EXTERNAL", "CPT/HCPCS/DRG/NDC/REV. CODE": 229, " Gross Charge Out-Patient ": 183.75, " Gross Charge In-Patient ": 183.75, " Discounted Cash Price Out Patient ": 183.75, " Discounted Cash Price In Patient ": 183.75, " 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 ": "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", "Auxilio Salud Out Patient ": "ER OR AMB FEE", "Auxilio Salud In Patient ": "PERDIEM", " Acaa Out Patient ": "ER OR AMB FEE", " Acaa In Patient ": "PERDIEM", " Max. Price ": 183.75, " Min. Price ": 183.75 }, { "Description Of Service ": "ACLS NURSE TRAINING-INSTITUTIO", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 157.5, " Min. Price ": 157.5 }, { "Description Of Service ": " 7.5MM TRACH DISPOSABLE INNER", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 5, " Gross Charge In-Patient ": 5, " Discounted Cash Price Out Patient ": 5, " Discounted Cash Price In Patient ": 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 5, " Min. Price ": 5 }, { "Description Of Service ": "0.9MM ULTRA SLEEVE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 33.3, " Min. Price ": 33.3 }, { "Description Of Service ": "1 LITER BAG LATEX FREE #5431", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 6.85, " Min. Price ": 6.85 }, { "Description Of Service ": "10FR DILATOR 35.5CM W/OUT SIDE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 86.25, " Min. Price ": 86.25 }, { "Description Of Service ": "11CM IQ KNIFE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 702.08, " Gross Charge In-Patient ": 702.08, " Discounted Cash Price Out Patient ": 702.08, " Discounted Cash Price In Patient ": 702.08, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 701.52, " Gross Charge In-Patient ": 701.52, " Discounted Cash Price Out Patient ": 701.52, " Discounted Cash Price In Patient ": 701.52, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 375.8, " Min. Price ": 375.8 }, { "Description Of Service ": "23KHZ CURVED EXT STAND TIP", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 486.06, " Min. Price ": 486.06 }, { "Description Of Service ": "23KHZ MANIFOLD TUBING", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 186.86, " Min. Price ": 186.86 }, { "Description Of Service ": "23KHZ MICRO TIP 4", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 456.32, " Min. Price ": 456.32 }, { "Description Of Service ": "23KHZ STERILE TORQUE WRENCH", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 351.87, " Gross Charge In-Patient ": 351.87, " Discounted Cash Price Out Patient ": 351.87, " Discounted Cash Price In Patient ": 351.87, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 260.85, " Min. Price ": 260.85 }, { "Description Of Service ": "ACROMIONIZER 4.0 BLADE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 24.13, " Min. Price ": 24.13 }, { "Description Of Service ": "ACSTKII RM.018X60 CM6 FLP20711", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 7.35, " Min. Price ": 7.35 }, { "Description Of Service ": "ADM. INTRAVENOUS BLOOD", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.97, " Gross Charge In-Patient ": 2.97, " Discounted Cash Price Out Patient ": 2.97, " Discounted Cash Price In Patient ": 2.97, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 2.97, " Min. Price ": 2.97 }, { "Description Of Service ": "ADMINISTRATION SET NO 2C-0133", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 22.2, " Gross Charge In-Patient ": 22.2, " Discounted Cash Price Out Patient ": 22.2, " Discounted Cash Price In Patient ": 22.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.27, " Gross Charge In-Patient ": 0.27, " Discounted Cash Price Out Patient ": 0.27, " Discounted Cash Price In Patient ": 0.27, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 56.61, " Gross Charge In-Patient ": 56.61, " Discounted Cash Price Out Patient ": 56.61, " Discounted Cash Price In Patient ": 56.61, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 0.78, " Min. Price ": 0.78 }, { "Description Of Service ": "ANASEPT ANTIMICROBIAL CLEANSER", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 16.59, " Gross Charge In-Patient ": 16.59, " Discounted Cash Price Out Patient ": 16.59, " Discounted Cash Price In Patient ": 16.59, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 27.2, " Gross Charge In-Patient ": 27.2, " Discounted Cash Price Out Patient ": 27.2, " Discounted Cash Price In Patient ": 27.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 27.2, " Min. Price ": 27.2 }, { "Description Of Service ": "ANGIOCATH I.V. #24G", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 1.62, " Min. Price ": 1.62 }, { "Description Of Service ": "ANGIOCATH IV #16G", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1.62, " Gross Charge In-Patient ": 1.62, " Discounted Cash Price Out Patient ": 1.62, " Discounted Cash Price In Patient ": 1.62, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.62, " Min. Price ": 1.62 }, { "Description Of Service ": "ANGIOCATH IV #18G", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 83.29, " Gross Charge In-Patient ": 83.29, " Discounted Cash Price Out Patient ": 83.29, " Discounted Cash Price In Patient ": 83.29, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 32.22, " Gross Charge In-Patient ": 32.22, " Discounted Cash Price Out Patient ": 32.22, " Discounted Cash Price In Patient ": 32.22, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 305.25, " Gross Charge In-Patient ": 305.25, " Discounted Cash Price Out Patient ": 305.25, " Discounted Cash Price In Patient ": 305.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 244.2, " Gross Charge In-Patient ": 244.2, " Discounted Cash Price Out Patient ": 244.2, " Discounted Cash Price In Patient ": 244.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 244.2, " Min. Price ": 244.2 }, { "Description Of Service ": "AVIGO GUIDEWIRE 200CM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 549.45, " Min. Price ": 549.45 }, { "Description Of Service ": "AWPLUS ENDOZYME", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 61.05, " Min. Price ": 61.05 }, { "Description Of Service ": "AXIEM POINTER TRACER", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 593.85, " Min. Price ": 593.85 }, { "Description Of Service ": "AXIEM SHUNT KIT NON-INVASIVE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 760.35, " Gross Charge In-Patient ": 760.35, " Discounted Cash Price Out Patient ": 760.35, " Discounted Cash Price In Patient ": 760.35, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 760.35, " Min. Price ": 760.35 }, { "Description Of Service ": "AXIEM TUMOR RESEC KIT NON-INVA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 760.35, " Gross Charge In-Patient ": 760.35, " Discounted Cash Price Out Patient ": 760.35, " Discounted Cash Price In Patient ": 760.35, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 760.35, " Min. Price ": 760.35 }, { "Description Of Service ": "AXIS SCOPE SINGLE USE URETEROS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1215.45, " Gross Charge In-Patient ": 1215.45, " Discounted Cash Price Out Patient ": 1215.45, " Discounted Cash Price In Patient ": 1215.45, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1215.45, " Min. Price ": 1215.45 }, { "Description Of Service ": "BABCOCK GRASPING FORCEPS 10MM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 721.5, " Gross Charge In-Patient ": 721.5, " Discounted Cash Price Out Patient ": 721.5, " Discounted Cash Price In Patient ": 721.5, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 721.5, " Min. Price ": 721.5 }, { "Description Of Service ": "BABCOCKS 5MM W/RTHT HDLE 5BB", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 167.58, " Min. Price ": 167.58 }, { "Description Of Service ": "BAGS, COLOSTOMY, FOR ADULTS", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.76, " Min. Price ": 1.76 }, { "Description Of Service ": "BALANCE SALT SOL 500CC", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 10.96, " Min. Price ": 10.96 }, { "Description Of Service ": "BALANCE SALT SOL. 0.9% 18CC/B", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 7.54, " Gross Charge In-Patient ": 7.54, " Discounted Cash Price Out Patient ": 7.54, " Discounted Cash Price In Patient ": 7.54, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 7.54, " Min. Price ": 7.54 }, { "Description Of Service ": "BALANCE SALT SOLUTION 15ML", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4.43, " Gross Charge In-Patient ": 4.43, " Discounted Cash Price Out Patient ": 4.43, " Discounted Cash Price In Patient ": 4.43, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 4.43, " Min. Price ": 4.43 }, { "Description Of Service ": "BALANCE SALT SOLUTION 0.9 250", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.79, " Gross Charge In-Patient ": 11.79, " Discounted Cash Price Out Patient ": 11.79, " Discounted Cash Price In Patient ": 11.79, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 11.79, " Min. Price ": 11.79 }, { "Description Of Service ": "BALANCE SALT SOLUTION 0.9 500", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 6.11, " Gross Charge In-Patient ": 6.11, " Discounted Cash Price Out Patient ": 6.11, " Discounted Cash Price In Patient ": 6.11, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 6.11, " Min. Price ": 6.11 }, { "Description Of Service ": "BALKIN UP & OVER CONTRALATERAL", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 108.23, " Gross Charge In-Patient ": 108.23, " Discounted Cash Price Out Patient ": 108.23, " Discounted Cash Price In Patient ": 108.23, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 108.23, " Min. Price ": 108.23 }, { "Description Of Service ": "BALLON URET CATH. 7 FR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 159.84, " Min. Price ": 159.84 }, { "Description Of Service ": "BANANA STRAIGHT 3MM KNIFE", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 89.89, " Gross Charge In-Patient ": 89.89, " Discounted Cash Price Out Patient ": 89.89, " Discounted Cash Price In Patient ": 89.89, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 37.8, " Gross Charge In-Patient ": 37.8, " Discounted Cash Price Out Patient ": 37.8, " Discounted Cash Price In Patient ": 37.8, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 11.47, " Gross Charge In-Patient ": 11.47, " Discounted Cash Price Out Patient ": 11.47, " Discounted Cash Price In Patient ": 11.47, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 11.47, " Min. Price ": 11.47 }, { "Description Of Service ": "BIOFLO PICC 5FR DOUBLE LUMEN", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 198.69, " Min. Price ": 198.69 }, { "Description Of Service ": "BIOFLO PIIC NON-VALVE 5FR DUAL", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 310.13, " Gross Charge In-Patient ": 310.13, " Discounted Cash Price Out Patient ": 310.13, " Discounted Cash Price In Patient ": 310.13, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 310.13, " Min. Price ": 310.13 }, { "Description Of Service ": "BIOFLO PIIC NON-VALVE 6FR TRIP", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 387.06, " Min. Price ": 387.06 }, { "Description Of Service ": "BIOPSY COAXIAL NEEDLE 18X20", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 14.43, " Gross Charge In-Patient ": 14.43, " Discounted Cash Price Out Patient ": 14.43, " Discounted Cash Price In Patient ": 14.43, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1665, " Gross Charge In-Patient ": 1665, " Discounted Cash Price Out Patient ": 1665, " Discounted Cash Price In Patient ": 1665, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1665, " Min. Price ": 1665 }, { "Description Of Service ": "BIOPSY NEEDLE KIT PASSIVE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 682.65, " Gross Charge In-Patient ": 682.65, " Discounted Cash Price Out Patient ": 682.65, " Discounted Cash Price In Patient ": 682.65, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 682.65, " Min. Price ": 682.65 }, { "Description Of Service ": "BIOSYN 2-0 V-20/GU", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 5.24, " Gross Charge In-Patient ": 5.24, " Discounted Cash Price Out Patient ": 5.24, " Discounted Cash Price In Patient ": 5.24, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 5.24, " Min. Price ": 5.24 }, { "Description Of Service ": "BIS QUATRO PEDIATRIC SENSOR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 39.96, " Gross Charge In-Patient ": 39.96, " Discounted Cash Price Out Patient ": 39.96, " Discounted Cash Price In Patient ": 39.96, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 39.96, " Min. Price ": 39.96 }, { "Description Of Service ": "BIS QUATRO XP ADULT SENSOR", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 71.04, " Gross Charge In-Patient ": 71.04, " Discounted Cash Price Out Patient ": 71.04, " Discounted Cash Price In Patient ": 71.04, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 234.43, " Gross Charge In-Patient ": 234.43, " Discounted Cash Price Out Patient ": 234.43, " Discounted Cash Price In Patient ": 234.43, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 208.68, " Gross Charge In-Patient ": 208.68, " Discounted Cash Price Out Patient ": 208.68, " Discounted Cash Price In Patient ": 208.68, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 4.14, " Min. Price ": 4.14 }, { "Description Of Service ": "C-FLEX MULTI LENGTH STENT 22CM", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 3.33, " Gross Charge In-Patient ": 3.33, " Discounted Cash Price Out Patient ": 3.33, " Discounted Cash Price In Patient ": 3.33, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.25, " Gross Charge In-Patient ": 0.25, " Discounted Cash Price Out Patient ": 0.25, " Discounted Cash Price In Patient ": 0.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 8.92, " Min. Price ": 8.92 }, { "Description Of Service ": "CARE DRAPE UPPER BODY BLANKET", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 8.31, " Min. Price ": 8.31 }, { "Description Of Service ": "CARE QUILT BLANKET", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 7.19, " Gross Charge In-Patient ": 7.19, " Discounted Cash Price Out Patient ": 7.19, " Discounted Cash Price In Patient ": 7.19, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 7.19, " Min. Price ": 7.19 }, { "Description Of Service ": "CASSETTE 20500MV", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 83.95, " Gross Charge In-Patient ": 83.95, " Discounted Cash Price Out Patient ": 83.95, " Discounted Cash Price In Patient ": 83.95, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 83.95, " Min. Price ": 83.95 }, { "Description Of Service ": "CAST CUTTER BLADE STAINLESS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 19.98, " Gross Charge In-Patient ": 19.98, " Discounted Cash Price Out Patient ": 19.98, " Discounted Cash Price In Patient ": 19.98, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 71.31, " Gross Charge In-Patient ": 71.31, " Discounted Cash Price Out Patient ": 71.31, " Discounted Cash Price In Patient ": 71.31, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 16.93, " Min. Price ": 16.93 }, { "Description Of Service ": "CATH PIG TAIL UNF FR 5 65 CM", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 19.43, " Gross Charge In-Patient ": 19.43, " Discounted Cash Price Out Patient ": 19.43, " Discounted Cash Price In Patient ": 19.43, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 43.29, " Gross Charge In-Patient ": 43.29, " Discounted Cash Price Out Patient ": 43.29, " Discounted Cash Price In Patient ": 43.29, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 43.29, " Min. Price ": 43.29 }, { "Description Of Service ": "CATHETER THORACIC 12FR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4.6, " Gross Charge In-Patient ": 4.6, " Discounted Cash Price Out Patient ": 4.6, " Discounted Cash Price In Patient ": 4.6, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 4.6, " Min. Price ": 4.6 }, { "Description Of Service ": "CATHETER THORACIC 16FR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 9.55, " Gross Charge In-Patient ": 9.55, " Discounted Cash Price Out Patient ": 9.55, " Discounted Cash Price In Patient ": 9.55, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 9.55, " Min. Price ": 9.55 }, { "Description Of Service ": "CATHETER THORACIC 20FR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4.6, " Gross Charge In-Patient ": 4.6, " Discounted Cash Price Out Patient ": 4.6, " Discounted Cash Price In Patient ": 4.6, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 4.6, " Min. Price ": 4.6 }, { "Description Of Service ": "CATHETER THORACIC 24FR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4.03, " Gross Charge In-Patient ": 4.03, " Discounted Cash Price Out Patient ": 4.03, " Discounted Cash Price In Patient ": 4.03, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 4.6, " Gross Charge In-Patient ": 4.6, " Discounted Cash Price Out Patient ": 4.6, " Discounted Cash Price In Patient ": 4.6, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 172.05, " Gross Charge In-Patient ": 172.05, " Discounted Cash Price Out Patient ": 172.05, " Discounted Cash Price In Patient ": 172.05, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 5.58, " Gross Charge In-Patient ": 5.58, " Discounted Cash Price Out Patient ": 5.58, " Discounted Cash Price In Patient ": 5.58, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.76, " Gross Charge In-Patient ": 0.76, " Discounted Cash Price Out Patient ": 0.76, " Discounted Cash Price In Patient ": 0.76, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 0.85, " Min. Price ": 0.85 }, { "Description Of Service ": "CATHETER FOLEY 5CC #16", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.85, " Gross Charge In-Patient ": 0.85, " Discounted Cash Price Out Patient ": 0.85, " Discounted Cash Price In Patient ": 0.85, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.85, " Min. Price ": 0.85 }, { "Description Of Service ": "CATHETER FOLEY 5CC #18", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.83, " Gross Charge In-Patient ": 0.83, " Discounted Cash Price Out Patient ": 0.83, " Discounted Cash Price In Patient ": 0.83, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.83, " Min. Price ": 0.83 }, { "Description Of Service ": "CATHETER FOLEY 5CC #20", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.86, " Gross Charge In-Patient ": 0.86, " Discounted Cash Price Out Patient ": 0.86, " Discounted Cash Price In Patient ": 0.86, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 19.98, " Gross Charge In-Patient ": 19.98, " Discounted Cash Price Out Patient ": 19.98, " Discounted Cash Price In Patient ": 19.98, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 2.22, " Min. Price ": 2.22 }, { "Description Of Service ": "CLEAR RENAL SHEALTH", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 64.38, " Gross Charge In-Patient ": 64.38, " Discounted Cash Price Out Patient ": 64.38, " Discounted Cash Price In Patient ": 64.38, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 13.88, " Min. Price ": 13.88 }, { "Description Of Service ": "COAGULATING SHEARS 5MM 14CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 421.99, " Gross Charge In-Patient ": 421.99, " Discounted Cash Price Out Patient ": 421.99, " Discounted Cash Price In Patient ": 421.99, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 59.94, " Gross Charge In-Patient ": 59.94, " Discounted Cash Price Out Patient ": 59.94, " Discounted Cash Price In Patient ": 59.94, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 59.94, " Min. Price ": 59.94 }, { "Description Of Service ": "COAXIAL BONE BIOPSY NEEDLE SET", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 71.04, " Gross Charge In-Patient ": 71.04, " Discounted Cash Price Out Patient ": 71.04, " Discounted Cash Price In Patient ": 71.04, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 71.04, " Min. Price ": 71.04 }, { "Description Of Service ": "COAXIAL BONE BIOPSY PENETRATOR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 14.23, " Min. Price ": 14.23 }, { "Description Of Service ": "COBRA 2 4FR 65CM 451-443VO", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 73.26, " Min. Price ": 73.26 }, { "Description Of Service ": "COBRA-OS KIT", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 2164.5, " Min. Price ": 2164.5 }, { "Description Of Service ": "CODMAN DISP. VEIN STRIPPER", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 25.62, " Gross Charge In-Patient ": 25.62, " Discounted Cash Price Out Patient ": 25.62, " Discounted Cash Price In Patient ": 25.62, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 25.62, " Min. Price ": 25.62 }, { "Description Of Service ": "CODMAN EXTERNAL DRAIN SYS II", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 725.94, " Gross Charge In-Patient ": 725.94, " Discounted Cash Price Out Patient ": 725.94, " Discounted Cash Price In Patient ": 725.94, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 725.94, " Min. Price ": 725.94 }, { "Description Of Service ": "COIL TUBING 60\"", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 5.66, " Gross Charge In-Patient ": 5.66, " Discounted Cash Price Out Patient ": 5.66, " Discounted Cash Price In Patient ": 5.66, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.14, " Gross Charge In-Patient ": 2.14, " Discounted Cash Price Out Patient ": 2.14, " Discounted Cash Price In Patient ": 2.14, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.53, " Gross Charge In-Patient ": 2.53, " Discounted Cash Price Out Patient ": 2.53, " Discounted Cash Price In Patient ": 2.53, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 216.45, " Gross Charge In-Patient ": 216.45, " Discounted Cash Price Out Patient ": 216.45, " Discounted Cash Price In Patient ": 216.45, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 216.45, " Min. Price ": 216.45 }, { "Description Of Service ": "CONSTELLATION FRAGMENTATION TI", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 83.25, " Min. Price ": 83.25 }, { "Description Of Service ": "CONSTELLATION PHACO PACK", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 133.2, " Gross Charge In-Patient ": 133.2, " Discounted Cash Price Out Patient ": 133.2, " Discounted Cash Price In Patient ": 133.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 133.2, " Min. Price ": 133.2 }, { "Description Of Service ": "CONSTELLATION TOTAL PLUS VITRE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 527.25, " Gross Charge In-Patient ": 527.25, " Discounted Cash Price Out Patient ": 527.25, " Discounted Cash Price In Patient ": 527.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 527.25, " Min. Price ": 527.25 }, { "Description Of Service ": "CONTOUR FLEX VALVE SMALL MED.", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 449.55, " Gross Charge In-Patient ": 449.55, " Discounted Cash Price Out Patient ": 449.55, " Discounted Cash Price In Patient ": 449.55, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 449.55, " Min. Price ": 449.55 }, { "Description Of Service ": "CONTOUR SE/300-500-2ML SYRINGE", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 0.61, " Min. Price ": 0.61 }, { "Description Of Service ": "COTONOIDES 1/2\"\" X 6\"\"", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.43, " Min. Price ": 0.43 }, { "Description Of Service ": "COTONOIDES 3/4\"\" X 6\"\"", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 3.43, " Min. Price ": 3.43 }, { "Description Of Service ": "CROMICO 3-0G 122-H", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 138.75, " Gross Charge In-Patient ": 138.75, " Discounted Cash Price Out Patient ": 138.75, " Discounted Cash Price In Patient ": 138.75, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 164.28, " Gross Charge In-Patient ": 164.28, " Discounted Cash Price Out Patient ": 164.28, " Discounted Cash Price In Patient ": 164.28, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 164.28, " Min. Price ": 164.28 }, { "Description Of Service ": "DISSECTING TOOL AM-52", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 165.39, " Gross Charge In-Patient ": 165.39, " Discounted Cash Price Out Patient ": 165.39, " Discounted Cash Price In Patient ": 165.39, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 165.39, " Min. Price ": 165.39 }, { "Description Of Service ": "DISSECTING TOOL B-1", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 98.79, " Gross Charge In-Patient ": 98.79, " Discounted Cash Price Out Patient ": 98.79, " Discounted Cash Price In Patient ": 98.79, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 98.79, " Min. Price ": 98.79 }, { "Description Of Service ": "DISSECTING TOOL M-1", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 138.75, " Gross Charge In-Patient ": 138.75, " Discounted Cash Price Out Patient ": 138.75, " Discounted Cash Price In Patient ": 138.75, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 138.75, " Min. Price ": 138.75 }, { "Description Of Service ": "DISSECTING TOOL M-10", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 142.08, " Gross Charge In-Patient ": 142.08, " Discounted Cash Price Out Patient ": 142.08, " Discounted Cash Price In Patient ": 142.08, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 142.08, " Min. Price ": 142.08 }, { "Description Of Service ": "DISSECTING TOOL M-1716", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 172.05, " Gross Charge In-Patient ": 172.05, " Discounted Cash Price Out Patient ": 172.05, " Discounted Cash Price In Patient ": 172.05, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 135.42, " Min. Price ": 135.42 }, { "Description Of Service ": "DOUBLE PIGTAIL 5FR 24CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 134.31, " Gross Charge In-Patient ": 134.31, " Discounted Cash Price Out Patient ": 134.31, " Discounted Cash Price In Patient ": 134.31, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 3.83, " Gross Charge In-Patient ": 3.83, " Discounted Cash Price Out Patient ": 3.83, " Discounted Cash Price In Patient ": 3.83, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 164.28, " Gross Charge In-Patient ": 164.28, " Discounted Cash Price Out Patient ": 164.28, " Discounted Cash Price In Patient ": 164.28, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 100.12, " Gross Charge In-Patient ": 100.12, " Discounted Cash Price Out Patient ": 100.12, " Discounted Cash Price In Patient ": 100.12, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 8.88, " Gross Charge In-Patient ": 8.88, " Discounted Cash Price Out Patient ": 8.88, " Discounted Cash Price In Patient ": 8.88, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 8.88, " Min. Price ": 8.88 }, { "Description Of Service ": "DRAPE PENTERO MICROSCOPE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 21.09, " Gross Charge In-Patient ": 21.09, " Discounted Cash Price Out Patient ": 21.09, " Discounted Cash Price In Patient ": 21.09, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1.94, " Gross Charge In-Patient ": 1.94, " Discounted Cash Price Out Patient ": 1.94, " Discounted Cash Price In Patient ": 1.94, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.94, " Min. Price ": 1.94 }, { "Description Of Service ": "DRESSING SOF-FOAM 4 X 5", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 3.71, " Gross Charge In-Patient ": 3.71, " Discounted Cash Price Out Patient ": 3.71, " Discounted Cash Price In Patient ": 3.71, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 143.19, " Min. Price ": 143.19 }, { "Description Of Service ": "DRY JET NEBULIZER 200-400 ML", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 2.13, " Min. Price ": 2.13 }, { "Description Of Service ": "DSP ILM FORCEP +/23GA", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 177.6, " Min. Price ": 177.6 }, { "Description Of Service ": "DUAL GASTROSTOMY TUBE 24FR VI", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 32.76, " Min. Price ": 32.76 }, { "Description Of Service ": "DUAL LUMEN URETERAL CATH", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 6.66, " Min. Price ": 6.66 }, { "Description Of Service ": "DUAL WAVW OUTFLOW CASSETTE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 72.15, " Min. Price ": 72.15 }, { "Description Of Service ": "DUODERM - ESTERILE 4X5", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 4.44, " Min. Price ": 4.44 }, { "Description Of Service ": "DUODERM - ESTERILE 6 X 7", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.13, " Gross Charge In-Patient ": 11.13, " Discounted Cash Price Out Patient ": 11.13, " Discounted Cash Price In Patient ": 11.13, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 11.13, " Min. Price ": 11.13 }, { "Description Of Service ": "DUODERM 8 X 12 H7644", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 1.76, " Min. Price ": 1.76 }, { "Description Of Service ": "ELASTOPLAST ELASTIC BAND 4X5.", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 9.33, " Min. Price ": 9.33 }, { "Description Of Service ": "ELASTOPLAST ELASTIC BAND 6X5.", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 28.86, " Gross Charge In-Patient ": 28.86, " Discounted Cash Price Out Patient ": 28.86, " Discounted Cash Price In Patient ": 28.86, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 28.86, " Min. Price ": 28.86 }, { "Description Of Service ": "ENDO DISSERT 5MM CURVED", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 56.78, " Gross Charge In-Patient ": 56.78, " Discounted Cash Price Out Patient ": 56.78, " Discounted Cash Price In Patient ": 56.78, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 294.35, " Gross Charge In-Patient ": 294.35, " Discounted Cash Price Out Patient ": 294.35, " Discounted Cash Price In Patient ": 294.35, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 294.35, " Min. Price ": 294.35 }, { "Description Of Service ": "ENDO GIA 30 2 5 STAPLE DLU", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 108.13, " Gross Charge In-Patient ": 108.13, " Discounted Cash Price Out Patient ": 108.13, " Discounted Cash Price In Patient ": 108.13, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 108.13, " Min. Price ": 108.13 }, { "Description Of Service ": "ENDO GIA 30 3.5 DLU", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 204.8, " Gross Charge In-Patient ": 204.8, " Discounted Cash Price Out Patient ": 204.8, " Discounted Cash Price In Patient ": 204.8, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 327.64, " Gross Charge In-Patient ": 327.64, " Discounted Cash Price Out Patient ": 327.64, " Discounted Cash Price In Patient ": 327.64, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 367.22, " Min. Price ": 367.22 }, { "Description Of Service ": "ENDO GRASPER", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 65.7, " Gross Charge In-Patient ": 65.7, " Discounted Cash Price Out Patient ": 65.7, " Discounted Cash Price In Patient ": 65.7, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 65.7, " Min. Price ": 65.7 }, { "Description Of Service ": "ENDO STITCH DLU", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 30.71, " Min. Price ": 30.71 }, { "Description Of Service ": "ENDOBROQUIAL BLOCKER SET", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 216.45, " Gross Charge In-Patient ": 216.45, " Discounted Cash Price Out Patient ": 216.45, " Discounted Cash Price In Patient ": 216.45, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 216.45, " Min. Price ": 216.45 }, { "Description Of Service ": "ENDOCERVICAL CURETTES CAJA DE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 8.82, " Min. Price ": 8.82 }, { "Description Of Service ": "ENDOCERVICAL LATEX PROBE COVE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.43, " Min. Price ": 0.43 }, { "Description Of Service ": "ENDOFLATOR 50 TUBING SET", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 120.44, " Gross Charge In-Patient ": 120.44, " Discounted Cash Price Out Patient ": 120.44, " Discounted Cash Price In Patient ": 120.44, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 120.44, " Min. Price ": 120.44 }, { "Description Of Service ": "ENDOGIA UNIVERSAL SHORT", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 188.7, " Gross Charge In-Patient ": 188.7, " Discounted Cash Price Out Patient ": 188.7, " Discounted Cash Price In Patient ": 188.7, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 188.7, " Min. Price ": 188.7 }, { "Description Of Service ": "ENDOPATH EXCEL 12MM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 59.77, " Gross Charge In-Patient ": 59.77, " Discounted Cash Price Out Patient ": 59.77, " Discounted Cash Price In Patient ": 59.77, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 59.77, " Min. Price ": 59.77 }, { "Description Of Service ": "ENDOPATH EXCEL 5MM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 45.97, " Gross Charge In-Patient ": 45.97, " Discounted Cash Price Out Patient ": 45.97, " Discounted Cash Price In Patient ": 45.97, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 45.97, " Min. Price ": 45.97 }, { "Description Of Service ": "ENDOPYELOTOMY STENT SET 24FR", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 122.1, " Min. Price ": 122.1 }, { "Description Of Service ": "ENDOTRACH.TUBE UNCUFF 4.0 PED", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 2.11, " Min. Price ": 2.11 }, { "Description Of Service ": "ENDOTRACH.TUBE UNCUFF 4.5 PED", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 13.6, " Gross Charge In-Patient ": 13.6, " Discounted Cash Price Out Patient ": 13.6, " Discounted Cash Price In Patient ": 13.6, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 13.6, " Min. Price ": 13.6 }, { "Description Of Service ": "ENDOTRACHEAL TUBE STYLET INFA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4.77, " Gross Charge In-Patient ": 4.77, " Discounted Cash Price Out Patient ": 4.77, " Discounted Cash Price In Patient ": 4.77, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 4.77, " Min. Price ": 4.77 }, { "Description Of Service ": "ENDOVIVE STANDARD PEG KIT 24FR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 72.15, " Min. Price ": 72.15 }, { "Description Of Service ": "ENEMA READY TO USE 4 1/2", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.81, " Min. Price ": 0.81 }, { "Description Of Service ": "ENGINE CANISTER", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 405.15, " Min. Price ": 405.15 }, { "Description Of Service ": "ENTERAL FEEDING TUBE 12FR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 17.14, " Gross Charge In-Patient ": 17.14, " Discounted Cash Price Out Patient ": 17.14, " Discounted Cash Price In Patient ": 17.14, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 17.14, " Min. Price ": 17.14 }, { "Description Of Service ": "ENTERP INTRACRAN STENT 4.5 X28", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4218, " Gross Charge In-Patient ": 4218, " Discounted Cash Price Out Patient ": 4218, " Discounted Cash Price In Patient ": 4218, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 4218, " Min. Price ": 4218 }, { "Description Of Service ": "ENVASE PLASTICO DISP MAT CONT", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 3.16, " Min. Price ": 3.16 }, { "Description Of Service ": "ENVASE PLASTICO DISP MAT CONT", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 2.76, " Min. Price ": 2.76 }, { "Description Of Service ": "ETHILON 5 0 P 3 BLK MONOF", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 310.8, " Min. Price ": 310.8 }, { "Description Of Service ": "EXPRESS FOOT CUFFS LARGE", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 0.25, " Gross Charge In-Patient ": 0.25, " Discounted Cash Price Out Patient ": 0.25, " Discounted Cash Price In Patient ": 0.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1942.5, " Gross Charge In-Patient ": 1942.5, " Discounted Cash Price Out Patient ": 1942.5, " Discounted Cash Price In Patient ": 1942.5, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 71.6, " Gross Charge In-Patient ": 71.6, " Discounted Cash Price Out Patient ": 71.6, " Discounted Cash Price In Patient ": 71.6, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 51.75, " Gross Charge In-Patient ": 51.75, " Discounted Cash Price Out Patient ": 51.75, " Discounted Cash Price In Patient ": 51.75, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 577.2, " Gross Charge In-Patient ": 577.2, " Discounted Cash Price Out Patient ": 577.2, " Discounted Cash Price In Patient ": 577.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.62, " Gross Charge In-Patient ": 2.62, " Discounted Cash Price Out Patient ": 2.62, " Discounted Cash Price In Patient ": 2.62, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 425.5, " Gross Charge In-Patient ": 425.5, " Discounted Cash Price Out Patient ": 425.5, " Discounted Cash Price In Patient ": 425.5, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 1.31, " Min. Price ": 1.31 }, { "Description Of Service ": "FLEXIBLE LASER ENDO PROBE 23GA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 188.7, " Gross Charge In-Patient ": 188.7, " Discounted Cash Price Out Patient ": 188.7, " Discounted Cash Price In Patient ": 188.7, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 188.7, " Min. Price ": 188.7 }, { "Description Of Service ": "FLEXIMA URETERAL STENT", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 277.5, " Min. Price ": 277.5 }, { "Description Of Service ": "FLEXOR INTRODUCER 6FR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 404.8, " Min. Price ": 404.8 }, { "Description Of Service ": "FLEXOR SHUTTLE GUIDING SHEAT", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 344.1, " Gross Charge In-Patient ": 344.1, " Discounted Cash Price Out Patient ": 344.1, " Discounted Cash Price In Patient ": 344.1, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 344.1, " Min. Price ": 344.1 }, { "Description Of Service ": "FLIPPER ARTIC. LARYNG. KIT RUS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 721.5, " Gross Charge In-Patient ": 721.5, " Discounted Cash Price Out Patient ": 721.5, " Discounted Cash Price In Patient ": 721.5, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 721.5, " Min. Price ": 721.5 }, { "Description Of Service ": "FLO TRAC SENSOR W/INTEGRA VAMP", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 255.3, " Gross Charge In-Patient ": 255.3, " Discounted Cash Price Out Patient ": 255.3, " Discounted Cash Price In Patient ": 255.3, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 255.3, " Min. Price ": 255.3 }, { "Description Of Service ": "FLOORMATTS 40\"\"", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.81, " Min. Price ": 0.81 }, { "Description Of Service ": "FLOSEAL ENDOSCOPIC APPLICATOR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 72.15, " Min. Price ": 72.15 }, { "Description Of Service ": "FLOW SENSOR 51000-03", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 31.17, " Min. Price ": 31.17 }, { "Description Of Service ": "FLOW SENSOR GALILEO", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 39.63, " Gross Charge In-Patient ": 39.63, " Discounted Cash Price Out Patient ": 39.63, " Discounted Cash Price In Patient ": 39.63, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 39.63, " Min. Price ": 39.63 }, { "Description Of Service ": "FLUID SHEETS PROCEDU DISP MAS", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.61, " Min. Price ": 0.61 }, { "Description Of Service ": "FLUID SHIELD SURG MASK", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.52, " Gross Charge In-Patient ": 0.52, " Discounted Cash Price Out Patient ": 0.52, " Discounted Cash Price In Patient ": 0.52, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.52, " Min. Price ": 0.52 }, { "Description Of Service ": "FLUID WARMER DISP SET LEVELONE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 109.78, " Gross Charge In-Patient ": 109.78, " Discounted Cash Price Out Patient ": 109.78, " Discounted Cash Price In Patient ": 109.78, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 109.78, " Min. Price ": 109.78 }, { "Description Of Service ": "FLUID WARMER HIGH FLOW", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 16.1, " Gross Charge In-Patient ": 16.1, " Discounted Cash Price Out Patient ": 16.1, " Discounted Cash Price In Patient ": 16.1, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.25, " Gross Charge In-Patient ": 0.25, " Discounted Cash Price Out Patient ": 0.25, " Discounted Cash Price In Patient ": 0.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 143.19, " Min. Price ": 143.19 }, { "Description Of Service ": "FLUTED ROUTED CUTTER 25.4MM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 143.19, " Min. Price ": 143.19 }, { "Description Of Service ": "FLUTED ROUTER 16MM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 132.09, " Min. Price ": 132.09 }, { "Description Of Service ": "FMS MODEL 2516 UNIVERSAL 3-BAG", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 175.56, " Gross Charge In-Patient ": 175.56, " Discounted Cash Price Out Patient ": 175.56, " Discounted Cash Price In Patient ": 175.56, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 142.08, " Gross Charge In-Patient ": 142.08, " Discounted Cash Price Out Patient ": 142.08, " Discounted Cash Price In Patient ": 142.08, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 49.95, " Gross Charge In-Patient ": 49.95, " Discounted Cash Price Out Patient ": 49.95, " Discounted Cash Price In Patient ": 49.95, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1098.9, " Min. Price ": 1098.9 }, { "Description Of Service ": "GDC10 360 12X30 SR M0033461230", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1087.8, " Min. Price ": 1087.8 }, { "Description Of Service ": "GDC10 360 14X30 SR M0033461430", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 198.69, " Min. Price ": 198.69 }, { "Description Of Service ": "GEOMAT COVER NO. SP 759", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 10.36, " Min. Price ": 10.36 }, { "Description Of Service ": "GEOMAT WITH SOFT SKIN", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 70.49, " Min. Price ": 70.49 }, { "Description Of Service ": "GEOMATT OVERLAY 80\"", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 59.66, " Min. Price ": 59.66 }, { "Description Of Service ": "GI-GLI SAW WIRE 12\"\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 44.81, " Gross Charge In-Patient ": 44.81, " Discounted Cash Price Out Patient ": 44.81, " Discounted Cash Price In Patient ": 44.81, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 44.81, " Min. Price ": 44.81 }, { "Description Of Service ": "GLIDE CATH 4FR C2", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 3.77, " Min. Price ": 3.77 }, { "Description Of Service ": "HAND SWITH PENCIL C E-2515", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 549.45, " Min. Price ": 549.45 }, { "Description Of Service ": "HANDPIECE 45 GRADES 14MM DISP", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 549.45, " Min. Price ": 549.45 }, { "Description Of Service ": "HC ACE SHEARS 5MM CURVD 23CM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 552, " Min. Price ": 552 }, { "Description Of Service ": "HEADWAY DUO .0165 X 156CM", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 1054.5, " Min. Price ": 1054.5 }, { "Description Of Service ": "HEADWAY DUO .0165 X 167CM", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 466.2, " Gross Charge In-Patient ": 466.2, " Discounted Cash Price Out Patient ": 466.2, " Discounted Cash Price In Patient ": 466.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 455.1, " Min. Price ": 455.1 }, { "Description Of Service ": "HEALTH CARE PARTICULATE RESP.", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1.05, " Gross Charge In-Patient ": 1.05, " Discounted Cash Price Out Patient ": 1.05, " Discounted Cash Price In Patient ": 1.05, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.05, " Min. Price ": 1.05 }, { "Description Of Service ": "HEATED TUBE SET DISP", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 106.56, " Min. Price ": 106.56 }, { "Description Of Service ": "HEMOCLIPS LIGATION CLIP LARGE", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 1.48, " Min. Price ": 1.48 }, { "Description Of Service ": "HEMOCLIPS SMALL", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 0.72, " Min. Price ": 0.72 }, { "Description Of Service ": "HEMOCOIL", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 141.53, " Min. Price ": 141.53 }, { "Description Of Service ": "HF ELECTRODE BUTTON 30 DEG.", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 184.54, " Gross Charge In-Patient ": 184.54, " Discounted Cash Price Out Patient ": 184.54, " Discounted Cash Price In Patient ": 184.54, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 3.05, " Min. Price ": 3.05 }, { "Description Of Service ": "HIGH PRESSURE CONNECTOR TUBE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.38, " Gross Charge In-Patient ": 11.38, " Discounted Cash Price Out Patient ": 11.38, " Discounted Cash Price In Patient ": 11.38, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 11.38, " Min. Price ": 11.38 }, { "Description Of Service ": "HIGH PRESSURE TUB 30\" 1000 PSI", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 7.77, " Min. Price ": 7.77 }, { "Description Of Service ": "HIGH SPEED DRILL COOLANT", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 68.82, " Gross Charge In-Patient ": 68.82, " Discounted Cash Price Out Patient ": 68.82, " Discounted Cash Price In Patient ": 68.82, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 18.47, " Gross Charge In-Patient ": 18.47, " Discounted Cash Price Out Patient ": 18.47, " Discounted Cash Price In Patient ": 18.47, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 2.89, " Gross Charge In-Patient ": 2.89, " Discounted Cash Price Out Patient ": 2.89, " Discounted Cash Price In Patient ": 2.89, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 30, " Min. Price ": 30 }, { "Description Of Service ": "INSTRUMENT TRACKER", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 205.35, " Gross Charge In-Patient ": 205.35, " Discounted Cash Price Out Patient ": 205.35, " Discounted Cash Price In Patient ": 205.35, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 205.35, " Min. Price ": 205.35 }, { "Description Of Service ": "INSUFFLATION TUBE SET DISP", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 78.81, " Gross Charge In-Patient ": 78.81, " Discounted Cash Price Out Patient ": 78.81, " Discounted Cash Price In Patient ": 78.81, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 78.81, " Min. Price ": 78.81 }, { "Description Of Service ": "INTER COMBITUDE 37FR 5-18537", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 47.18, " Min. Price ": 47.18 }, { "Description Of Service ": "INTERPULSE HAND PIECE SET", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 9.26, " Min. Price ": 9.26 }, { "Description Of Service ": "IRIS RETRACTORS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 24.42, " Gross Charge In-Patient ": 24.42, " Discounted Cash Price Out Patient ": 24.42, " Discounted Cash Price In Patient ": 24.42, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 24.42, " Min. Price ": 24.42 }, { "Description Of Service ": "IRRIGATION AND SUCTION TIPS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 17.25, " Gross Charge In-Patient ": 17.25, " Discounted Cash Price Out Patient ": 17.25, " Discounted Cash Price In Patient ": 17.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 17.25, " Min. Price ": 17.25 }, { "Description Of Service ": "IRRIGATION GLICINE 1.5% 3000M", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 6.07, " Gross Charge In-Patient ": 6.07, " Discounted Cash Price Out Patient ": 6.07, " Discounted Cash Price In Patient ": 6.07, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 6.07, " Min. Price ": 6.07 }, { "Description Of Service ": "IRRIGATION TUBING", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 31.08, " Gross Charge In-Patient ": 31.08, " Discounted Cash Price Out Patient ": 31.08, " Discounted Cash Price In Patient ": 31.08, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 31.08, " Min. Price ": 31.08 }, { "Description Of Service ": "IRRIGATION TUBING IRD350", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 35.74, " Gross Charge In-Patient ": 35.74, " Discounted Cash Price Out Patient ": 35.74, " Discounted Cash Price In Patient ": 35.74, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 35.74, " Min. Price ": 35.74 }, { "Description Of Service ": "IRRISEPT OR", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 1.94, " Min. Price ": 1.94 }, { "Description Of Service ": "JELLY ELECTRODE, 8.45 OZ.", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.24, " Gross Charge In-Patient ": 2.24, " Discounted Cash Price Out Patient ": 2.24, " Discounted Cash Price In Patient ": 2.24, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 2.24, " Min. Price ": 2.24 }, { "Description Of Service ": "JELTRATE 450 GMS", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 12.64, " Gross Charge In-Patient ": 12.64, " Discounted Cash Price Out Patient ": 12.64, " Discounted Cash Price In Patient ": 12.64, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 12.64, " Min. Price ": 12.64 }, { "Description Of Service ": "JERINGUILLAS 60 CC", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 0.43, " Min. Price ": 0.43 }, { "Description Of Service ": "JET D REPERF.CATH. H.FLOW ASPI", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 17.02, " Min. Price ": 17.02 }, { "Description Of Service ": "K WIRE .062 X 9 ROSCA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 17.02, " Gross Charge In-Patient ": 17.02, " Discounted Cash Price Out Patient ": 17.02, " Discounted Cash Price In Patient ": 17.02, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 17.02, " Min. Price ": 17.02 }, { "Description Of Service ": "K WIRE .062X9 LISO 12-8062", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 8.33, " Gross Charge In-Patient ": 8.33, " Discounted Cash Price Out Patient ": 8.33, " Discounted Cash Price In Patient ": 8.33, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 8.33, " Min. Price ": 8.33 }, { "Description Of Service ": "K WIRES 9\"\" 0.35 LISO", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 9.06, " Gross Charge In-Patient ": 9.06, " Discounted Cash Price Out Patient ": 9.06, " Discounted Cash Price In Patient ": 9.06, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 9.06, " Min. Price ": 9.06 }, { "Description Of Service ": "K-WIRE 1.25MM", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 13.26, " Gross Charge In-Patient ": 13.26, " Discounted Cash Price Out Patient ": 13.26, " Discounted Cash Price In Patient ": 13.26, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 52.82, " Min. Price ": 52.82 }, { "Description Of Service ": "LARGE BONE BLADE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 37.3, " Gross Charge In-Patient ": 37.3, " Discounted Cash Price Out Patient ": 37.3, " Discounted Cash Price In Patient ": 37.3, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 27.75, " Min. Price ": 27.75 }, { "Description Of Service ": "LARGE BONE BLADE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 37.3, " Gross Charge In-Patient ": 37.3, " Discounted Cash Price Out Patient ": 37.3, " Discounted Cash Price In Patient ": 37.3, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 37.3, " Min. Price ": 37.3 }, { "Description Of Service ": "LARGE BONE BLADE", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 7.1, " Min. Price ": 7.1 }, { "Description Of Service ": "LARYNGEAL MASK AIRWAY SIZE 4", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 2.78, " Min. Price ": 2.78 }, { "Description Of Service ": "LIGACLIP MEDIUM 102 LC 200", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 399.6, " Min. Price ": 399.6 }, { "Description Of Service ": "LIGASURE BIZACT TONSILLECTOMY", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 469.9, " Min. Price ": 469.9 }, { "Description Of Service ": "LIGASURE BLUNT TIP", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 428.38, " Min. Price ": 428.38 }, { "Description Of Service ": "LIGASURE BLUNT TIP 23CM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 505.05, " Min. Price ": 505.05 }, { "Description Of Service ": "LIGASURE EXACT DISECTOR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 462.5, " Min. Price ": 462.5 }, { "Description Of Service ": "LIGASURE IMPACT", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 477.3, " Min. Price ": 477.3 }, { "Description Of Service ": "LIGASURE LAPAROSCOPIC DEVICE", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 516.15, " Gross Charge In-Patient ": 516.15, " Discounted Cash Price Out Patient ": 516.15, " Discounted Cash Price In Patient ": 516.15, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 516.15, " Min. Price ": 516.15 }, { "Description Of Service ": "LIGASURE MARYLAND 23CM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 505.05, " Min. Price ": 505.05 }, { "Description Of Service ": "LIGASURE MARYLAND 23CM", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 508.75, " Min. Price ": 508.75 }, { "Description Of Service ": "LIGHT WAVE ELECTRODE ONLY", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 38.63, " Min. Price ": 38.63 }, { "Description Of Service ": "LIGHT WAVE SUCTION ABLASTOR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 266.4, " Min. Price ": 266.4 }, { "Description Of Service ": "LINEA SEC. REGULADOR SIN AGUJ", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 3.17, " Min. Price ": 3.17 }, { "Description Of Service ": "LINEA VEN.PRE BOMB FLEX.C CLA", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 2.47, " Min. Price ": 2.47 }, { "Description Of Service ": "LINEAR CUTTER", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 51.06, " Min. Price ": 51.06 }, { "Description Of Service ": "LINEAR CUTTER 100MM", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 38.66, " Gross Charge In-Patient ": 38.66, " Discounted Cash Price Out Patient ": 38.66, " Discounted Cash Price In Patient ": 38.66, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 38.66, " Min. Price ": 38.66 }, { "Description Of Service ": "LONG ROUND DIAMOND BUR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 61.83, " Min. Price ": 61.83 }, { "Description Of Service ": "LOW FLOW ETCO2 SAMPLE LINE KIT", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 32.19, " Min. Price ": 32.19 }, { "Description Of Service ": "LUBRICANT LUB", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 35.15, " Min. Price ": 35.15 }, { "Description Of Service ": "LUDVIK STR WAVE FORM COLD KINF", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 229.4, " Gross Charge In-Patient ": 229.4, " Discounted Cash Price Out Patient ": 229.4, " Discounted Cash Price In Patient ": 229.4, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 229.4, " Min. Price ": 229.4 }, { "Description Of Service ": "LUER LOCK PLASTIC BLUNT CANUL", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1.77, " Gross Charge In-Patient ": 1.77, " Discounted Cash Price Out Patient ": 1.77, " Discounted Cash Price In Patient ": 1.77, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.77, " Min. Price ": 1.77 }, { "Description Of Service ": "LUMBAR PERITONEAL SHUNT", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 264.18, " Gross Charge In-Patient ": 264.18, " Discounted Cash Price Out Patient ": 264.18, " Discounted Cash Price In Patient ": 264.18, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 264.18, " Min. Price ": 264.18 }, { "Description Of Service ": "M100 PRE PUMP INFUSION SET", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 319.13, " Gross Charge In-Patient ": 319.13, " Discounted Cash Price Out Patient ": 319.13, " Discounted Cash Price In Patient ": 319.13, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 319.13, " Min. Price ": 319.13 }, { "Description Of Service ": "MACH1 G.CATH 6FRX55 RESS 19608", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 18.5, " Gross Charge In-Patient ": 18.5, " Discounted Cash Price Out Patient ": 18.5, " Discounted Cash Price In Patient ": 18.5, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 18.5, " Min. Price ": 18.5 }, { "Description Of Service ": "MAGNUM BIOPSY NEEDLE MN1825", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 19.48, " Gross Charge In-Patient ": 19.48, " Discounted Cash Price Out Patient ": 19.48, " Discounted Cash Price In Patient ": 19.48, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 19.48, " Min. Price ": 19.48 }, { "Description Of Service ": "MAGNUM INSTRUMENT 15/22 MG1522", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1332, " Gross Charge In-Patient ": 1332, " Discounted Cash Price Out Patient ": 1332, " Discounted Cash Price In Patient ": 1332, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1332, " Min. Price ": 1332 }, { "Description Of Service ": "MAHURKAR 13.5FR HIGH FLOW DUAL", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 66.6, " Min. Price ": 66.6 }, { "Description Of Service ": "MAIN BODY EXTENSION", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2231.1, " Gross Charge In-Patient ": 2231.1, " Discounted Cash Price Out Patient ": 2231.1, " Discounted Cash Price In Patient ": 2231.1, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 164.84, " Gross Charge In-Patient ": 164.84, " Discounted Cash Price Out Patient ": 164.84, " Discounted Cash Price In Patient ": 164.84, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.25, " Gross Charge In-Patient ": 0.25, " Discounted Cash Price Out Patient ": 0.25, " Discounted Cash Price In Patient ": 0.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 1.3, " Min. Price ": 1.3 }, { "Description Of Service ": "MC GRATH BLADE SIZE 1", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.31, " Min. Price ": 0.31 }, { "Description Of Service ": "NEONATAL QUICK CONNECT SPO2", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 116.55, " Min. Price ": 116.55 }, { "Description Of Service ": "NEPHROMAX PCNL BALLON DILATOR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 249.75, " Gross Charge In-Patient ": 249.75, " Discounted Cash Price Out Patient ": 249.75, " Discounted Cash Price In Patient ": 249.75, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 249.75, " Min. Price ": 249.75 }, { "Description Of Service ": "NEPHROSTOMY SET 8FR. (080008)", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 150.41, " Gross Charge In-Patient ": 150.41, " Discounted Cash Price Out Patient ": 150.41, " Discounted Cash Price In Patient ": 150.41, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 150.41, " Min. Price ": 150.41 }, { "Description Of Service ": "NEURAY ENT-PATTY 1/2\" X 3\"", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1.85, " Gross Charge In-Patient ": 1.85, " Discounted Cash Price Out Patient ": 1.85, " Discounted Cash Price In Patient ": 1.85, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.85, " Min. Price ": 1.85 }, { "Description Of Service ": "ONE SLIDE PAP PACK W/CYSTO BR", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.61, " Min. Price ": 0.61 }, { "Description Of Service ": "ONE WAY STOPCOCK", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 2.22, " Gross Charge In-Patient ": 2.22, " Discounted Cash Price Out Patient ": 2.22, " Discounted Cash Price In Patient ": 2.22, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 2.22, " Min. Price ": 2.22 }, { "Description Of Service ": "OPEN END CATH 4 8FR X 95CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 127.65, " Gross Charge In-Patient ": 127.65, " Discounted Cash Price Out Patient ": 127.65, " Discounted Cash Price In Patient ": 127.65, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 127.65, " Min. Price ": 127.65 }, { "Description Of Service ": "OPEN END CATH 6FR X 95CM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 46.76, " Gross Charge In-Patient ": 46.76, " Discounted Cash Price Out Patient ": 46.76, " Discounted Cash Price In Patient ": 46.76, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 46.76, " Min. Price ": 46.76 }, { "Description Of Service ": "OPHTALMIC DRAPE", "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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 7.77, " Min. Price ": 7.77 }, { "Description Of Service ": "OPMI DRAPE COVER MICROSC.NEUR", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 68.82, " Gross Charge In-Patient ": 68.82, " Discounted Cash Price Out Patient ": 68.82, " Discounted Cash Price In Patient ": 68.82, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 184.63, " Gross Charge In-Patient ": 184.63, " Discounted Cash Price Out Patient ": 184.63, " Discounted Cash Price In Patient ": 184.63, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 140.42, " Gross Charge In-Patient ": 140.42, " Discounted Cash Price Out Patient ": 140.42, " Discounted Cash Price In Patient ": 140.42, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.25, " Gross Charge In-Patient ": 0.25, " Discounted Cash Price Out Patient ": 0.25, " Discounted Cash Price In Patient ": 0.25, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 258.63, " Min. Price ": 258.63 }, { "Description Of Service ": "PATIENT TRACKER FOR ENT NAV.SY", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 277.5, " Min. Price ": 277.5 }, { "Description Of Service ": "PC400 COIL HANDLE", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 277.5, " Min. Price ": 277.5 }, { "Description Of Service ": "PCS 5-0 RB1 Z303H/MAXON 888662", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 4.9, " Gross Charge In-Patient ": 4.9, " Discounted Cash Price Out Patient ": 4.9, " Discounted Cash Price In Patient ": 4.9, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 4.9, " Min. Price ": 4.9 }, { "Description Of Service ": "PDS 0 TP-1", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 6.07, " Gross Charge In-Patient ": 6.07, " Discounted Cash Price Out Patient ": 6.07, " Discounted Cash Price In Patient ": 6.07, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 6.07, " Min. Price ": 6.07 }, { "Description Of Service ": "PDS 1 CTX", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 3.36, " Gross Charge In-Patient ": 3.36, " Discounted Cash Price Out Patient ": 3.36, " Discounted Cash Price In Patient ": 3.36, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 3.36, " Min. Price ": 3.36 }, { "Description Of Service ": "PDS 1 VIL (Z347H)", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 3.34, " Gross Charge In-Patient ": 3.34, " Discounted Cash Price Out Patient ": 3.34, " Discounted Cash Price In Patient ": 3.34, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 3.34, " Min. Price ": 3.34 }, { "Description Of Service ": "PDS 1 XLH", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 6.13, " Gross Charge In-Patient ": 6.13, " Discounted Cash Price Out Patient ": 6.13, " Discounted Cash Price In Patient ": 6.13, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 6.13, " Min. Price ": 6.13 }, { "Description Of Service ": "PDS 1, TP-1", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 5.28, " Gross Charge In-Patient ": 5.28, " Discounted Cash Price Out Patient ": 5.28, " Discounted Cash Price In Patient ": 5.28, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 5.28, " Min. Price ": 5.28 }, { "Description Of Service ": "PED.GOLD CUP EEG ELECTRODE 48\"", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.66, " Gross Charge In-Patient ": 11.66, " Discounted Cash Price Out Patient ": 11.66, " Discounted Cash Price In Patient ": 11.66, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 11.66, " Min. Price ": 11.66 }, { "Description Of Service ": "PEDI CAP CO2 DETECTOR", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 13.26, " Gross Charge In-Patient ": 13.26, " Discounted Cash Price Out Patient ": 13.26, " Discounted Cash Price In Patient ": 13.26, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 13.26, " Min. Price ": 13.26 }, { "Description Of Service ": "PEDI-PADZ MULTI FUNCTION", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 58.33, " Gross Charge In-Patient ": 58.33, " Discounted Cash Price Out Patient ": 58.33, " Discounted Cash Price In Patient ": 58.33, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 58.33, " Min. Price ": 58.33 }, { "Description Of Service ": "PEDI-PADZ PEDIATRIC ELECTRODES", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 818, " Min. Price ": 818 }, { "Description Of Service ": "PHENOM 27 MICROCATH STRAIGHT", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 244.2, " Min. Price ": 244.2 }, { "Description Of Service ": "POWERFLEX P3 10MM X 4MM X110CM", "CPT/HCPCS/DRG/NDC/REV. 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Price ": 431.79, " Min. Price ": 431.79 }, { "Description Of Service ": "PREMIX SURGICAL INSTRUMENT CA", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 44.4, " Min. Price ": 44.4 }, { "Description Of Service ": "PREP IM HIP KIT", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 17.35, " Min. Price ": 17.35 }, { "Description Of Service ": "PRES W OLIGON HF CVP CONT OXIM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 255.3, " Gross Charge In-Patient ": 255.3, " Discounted Cash Price Out Patient ": 255.3, " Discounted Cash Price In Patient ": 255.3, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 115.21, " Gross Charge In-Patient ": 115.21, " Discounted Cash Price Out Patient ": 115.21, " Discounted Cash Price In Patient ": 115.21, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 101.95, " Gross Charge In-Patient ": 101.95, " Discounted Cash Price Out Patient ": 101.95, " Discounted Cash Price In Patient ": 101.95, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 101.95, " Min. Price ": 101.95 }, { "Description Of Service ": "PROBE PLUS SUCTION", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 74.83, " Gross Charge In-Patient ": 74.83, " Discounted Cash Price Out Patient ": 74.83, " Discounted Cash Price In Patient ": 74.83, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 74.83, " Min. Price ": 74.83 }, { "Description Of Service ": "PROBE ULTRAVIT. ANTERIOR 20GA", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 183.15, " Gross Charge In-Patient ": 183.15, " Discounted Cash Price Out Patient ": 183.15, " Discounted Cash Price In Patient ": 183.15, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 114.7, " Gross Charge In-Patient ": 114.7, " Discounted Cash Price Out Patient ": 114.7, " Discounted Cash Price In Patient ": 114.7, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 1.31, " Gross Charge In-Patient ": 1.31, " Discounted Cash Price Out Patient ": 1.31, " Discounted Cash Price In Patient ": 1.31, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.31, " Min. Price ": 1.31 }, { "Description Of Service ": "PW B-95 PAILA 5 GAL FOLTE FLE", "CPT/HCPCS/DRG/NDC/REV. 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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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 46.62, " Gross Charge In-Patient ": 46.62, " Discounted Cash Price Out Patient ": 46.62, " Discounted Cash Price In Patient ": 46.62, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 380.73, " Gross Charge In-Patient ": 380.73, " Discounted Cash Price Out Patient ": 380.73, " Discounted Cash Price In Patient ": 380.73, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 81.03, " Gross Charge In-Patient ": 81.03, " Discounted Cash Price Out Patient ": 81.03, " Discounted Cash Price In Patient ": 81.03, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 0.72, " Gross Charge In-Patient ": 0.72, " Discounted Cash Price Out Patient ": 0.72, " Discounted Cash Price In Patient ": 0.72, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 14.32, " Min. Price ": 14.32 }, { "Description Of Service ": "RAPID 5 ATTEST STEAM PACK", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 10.55, " Gross Charge In-Patient ": 10.55, " Discounted Cash Price Out Patient ": 10.55, " Discounted Cash Price In Patient ": 10.55, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 10.55, " Min. Price ": 10.55 }, { "Description Of Service ": "READY CARE ORAL STARA KIT", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 18.29, " Gross Charge In-Patient ": 18.29, " Discounted Cash Price Out Patient ": 18.29, " Discounted Cash Price In Patient ": 18.29, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 18.29, " Min. Price ": 18.29 }, { "Description Of Service ": "RECEPTAL LINER WITH LID", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1.2, " Gross Charge In-Patient ": 1.2, " Discounted Cash Price Out Patient ": 1.2, " Discounted Cash Price In Patient ": 1.2, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.2, " Min. Price ": 1.2 }, { "Description Of Service ": "RECIPIENTE 2000LT C SOLIDIFICA", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 65.12, " Gross Charge In-Patient ": 65.12, " Discounted Cash Price Out Patient ": 65.12, " Discounted Cash Price In Patient ": 65.12, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 65.12, " Min. Price ": 65.12 }, { "Description Of Service ": "RECIPIENTE 800LT C SOLIDIFICAD", "CPT/HCPCS/DRG/NDC/REV. 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CODE": 270, " Gross Charge Out-Patient ": 388.5, " Gross Charge In-Patient ": 388.5, " Discounted Cash Price Out Patient ": 388.5, " Discounted Cash Price In Patient ": 388.5, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 14.66, " Gross Charge In-Patient ": 14.66, " Discounted Cash Price Out Patient ": 14.66, " Discounted Cash Price In Patient ": 14.66, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 14.66, " Min. Price ": 14.66 }, { "Description Of Service ": "SABANA PARA CAMILLA 40 X 90", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 0.39, " Gross Charge In-Patient ": 0.39, " Discounted Cash Price Out Patient ": 0.39, " Discounted Cash Price In Patient ": 0.39, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 0.39, " Min. Price ": 0.39 }, { "Description Of Service ": "SAF CLEANS CWC #51074", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 5.08, " Gross Charge In-Patient ": 5.08, " Discounted Cash Price Out Patient ": 5.08, " Discounted Cash Price In Patient ": 5.08, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 3.24, " Gross Charge In-Patient ": 3.24, " Discounted Cash Price Out Patient ": 3.24, " Discounted Cash Price In Patient ": 3.24, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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Price ": 68.82, " Min. Price ": 68.82 }, { "Description Of Service ": "SAFETY WIRE INT. SHEATH 8/10FR", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 993.45, " Gross Charge In-Patient ": 993.45, " Discounted Cash Price Out Patient ": 993.45, " Discounted Cash Price In Patient ": 993.45, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 21.98, " Gross Charge In-Patient ": 21.98, " Discounted Cash Price Out Patient ": 21.98, " Discounted Cash Price In Patient ": 21.98, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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CODE": 270, " Gross Charge Out-Patient ": 53.84, " Gross Charge In-Patient ": 53.84, " Discounted Cash Price Out Patient ": 53.84, " Discounted Cash Price In Patient ": 53.84, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 53.84, " Min. Price ": 53.84 }, { "Description Of Service ": "SILICONE OIL 8.5ML", "CPT/HCPCS/DRG/NDC/REV. 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 166.5, " Min. Price ": 166.5 }, { "Description Of Service ": "SILICONE STRIP 1 25MM X 4 0MM", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 11.59, " Gross Charge In-Patient ": 11.59, " Discounted Cash Price Out Patient ": 11.59, " Discounted Cash Price In Patient ": 11.59, " 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 ": "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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 11.59, " Min. Price ": 11.59 }, { "Description Of Service ": "SILK 2-0 MH", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1.74, " Gross Charge In-Patient ": 1.74, " Discounted Cash Price Out Patient ": 1.74, " Discounted Cash Price In Patient ": 1.74, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. Price ": 1.74, " Min. Price ": 1.74 }, { "Description Of Service ": "SILK 2-0 BOX OF 36", "CPT/HCPCS/DRG/NDC/REV. CODE": 270, " Gross Charge Out-Patient ": 1.73, " Gross Charge In-Patient ": 1.73, " Discounted Cash Price Out Patient ": 1.73, " Discounted Cash Price In Patient ": 1.73, " 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 ": "COST EVIDENCE", " Prossam In Patient ": "COST EVIDENCE", " Mapfre Comercial Out Patient ": "COST EVIDENCE", " Mapfre Comercial In Patient ": "COST EVIDENCE", "Auxilio Salud Out Patient ": "COST EVIDENCE", "Auxilio Salud In Patient ": "COST EVIDENCE", " Acaa Out Patient ": "COST EVIDENCE", " Acaa In Patient ": "COST EVIDENCE", " Max. 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