Out of State Inpatient Rates effective 01/01/15

Hospital Name City State Rate Code 2953 (OOS Hospital DRG) Rate Code 2952 (OOS Hospital Exempt) Rate Code 2589 (DME Add-on) Rate Code 2950 and 2954 (ALC RHCF) Rate Code 2951 and 2955 (ALC Home Care) Rate Code 2990 (Capital per Disch) Rate Code 2991 (Capital per Diem) WEF/ISAF for Cost Outlier Claims) High Cost Charge Convertors
AKRON GENERAL MEDICAL CENTER AKRON OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALAMANCE REG MED CTR NC BURLINGTON NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALEGENT HLTH BERGAN MERCY NE OMAHA NE $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALFRED I DUPONT HOSP FOR CHID WILMINGTON DE $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALL CHILDRENS HOSPITAL FL ST PETERSBURG FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALLEGHENY GENERAL HOSPITAL PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALLEGIANCE HLTH/W A FOOT MEM JACKSON MI $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ALLINA HLTH SYS/MERCY HSP MN COON RAPIDS MN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ATHENS REG MED TN ATHENS TN $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ATLANTIC GEN HSP MD BERLIN MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ATLANTICARE REG MED CTR CITY ATLANTIC CITY NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
AULTMAN HOSPITAL OH CANTON OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
AVENTURA HOSP & MED CTR FL AVENTURA FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BALTIMORE WASHINGTON MEDICAL GLEN BURNIE MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BANNER BAYWOOD MED CTR AZ MESA AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BANNER DEL E WEBB MEM HSP AZ SUN CITY AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BANNER IRONWOOD MED CTR AZ SAN TAN VALLEY AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BANNER THUNDERBIRD MED CTR AZ GLENDALE AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BAPTIST ST ANTHONYS MEM HOSP AMARILLO TX $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BARNES-KASSON COUNTY HSP SUSQUEHANNA PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BARTON MEMORIAL HOSPITAL CA SOUTH LAKE TAHOE CA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BAY COUNTY HEALTH SYSTEM FL PANAMA CITY FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BAYHEALTH KENT GEN HSP DE DOVER DE $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BAYLOR MED CTR GARLAND TX GARLAND TX $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BAYLOR MED CTR MCKINNEY TX MCKINNEY TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BAYLOR UNIVERSITY MED CTR TX DALLAS TX $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BAYONNE MEDICAL CENTER NJ BAYONNE NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BAYSHORE COMMUNITY HOSPITAL HOLMDEL NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BAYSTATE MEDICAL CENTER MA SPRINGFIELD MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BELLEVUE MEDICAL CENTER NE BELLEVUE NE $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BERGEN PINES COUNTY HSP NJ PARAMUS NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BERKSHIRE HEALTH SYSTEM MA PITTSFIELD MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BERKSHIRE MEDICAL CTR MA INC PITTSFIELD MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BETH ISRAEL DEACONESS BOSTON BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BORGESS MEDICAL CENTER MI KALAMAZOO MI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BOSTON MEDICAL CENTER MA BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BRADFORD REGIONAL MED CTR PA BRADFORD PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BRATTLEBORO MEM HOSPITAL VT BRATTLEBORO VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BRATTLEBORO RETREAT HSP VT BRATTLEBORO VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BRIDGEPORT HOSPITAL BRIDGEPORT CT $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BRIGHAM AND WOMENS HOSP BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
BRISTOL HOSPITAL BRISTOL CT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BROCKTON HOSP MA BROCKTON MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BROOKEGLEN BEHAVIORAL HOSPITA FORT WASHINGTON PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BROWARD GENERAL MEDICAL CTR FT LAUDERDALE FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BRYN MAWR HOSPITAL PA BRYN MAWR PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
BRYN MAWR REHAB HOSP PA MALVERN PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAPE CANAVERAL HOSP FL COCOA BEACH FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAPE CORAL HSP FL CAPE CORAL FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAPE FEAR VALLEY NC FAYETTEVILLE NC $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAPE REGIONAL MEDICAL CENTER CAPE MAY COURT HOUSE NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAPITAL HEALTH SYS AT FULD TRENTON NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAPITAL HEALTH SYSTEM MERCER TRENTON NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CARILION FRANKLIN MEMORIAL VA ROCKY MOUNT VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CARILION ROANOKE COMM HSP VA ROANOKE VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CARILION ROANOKE MEMORIAL ROANOKE VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CARILION STONEWALL JACKSN VA LEXINGTON VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CARLE FOUNDATION HOSP IL URBANA IL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAROLINAEAST HEALTH SYSTEM NEW BERN NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CAROLINAS HSP SYS SC FLORENCE SC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CARONDELET ST MARYS HOSP AZ TUCSON AZ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CARROLL HOSPITAL CENTER MD WESTMINSTER MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CATHOLIC MED CTR NH MANCHESTER NH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CENTENNIAL MED CTR TN NASHVILLE TN $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CENTRA VIRGINIA BAPTST HSP VA LYNCHBURG VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CENTRAL VERMONT HOSPITAL BARRE VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CENTRASTATE MED CTR NJ FREEHOLD NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CENTURA PENROSE ST FRANCIS HL COLORADO SPRINGS CO $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHARLES COLE MEMORIAL HSP COUDERSPORT PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHARLESTON AREA MED CTR WV CHARLESTON WV $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHARLOTTE HUNGERFORD HOSPITAL TORRINGTON CT $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHESHIRE MEDICAL CTR NH KEENE NH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHESTER COUNTY HOSP PA WEST CHESTER PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS HOSP M C OH CINCINNATI OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS HOSP OF PHILA PA PHILADELPHIA PA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHILDRENS HOSPITAL ALABAMA BIRMINGHAM AL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS HOSPITAL CO AURORA CO $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS HOSPITAL MA BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHILDRENS HOSPITAL MA BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHILDRENS HOSPITAL OF PITTS PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS HOSPITAL OF PITTS PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS HOSPITAL SAN DIEGO SAN DIEGO CA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHILDRENS HSP KINGS DAUGHTER NORFOLK VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS INSTITUTE OF PITTS PITTSBURGH PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CHILDRENS NATIONAL MED CTR WASHINGTON DC $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHILDRENS SPECIALIZED HOSP NJ MOUNTAINSIDE NJ $ - $ 1,629.26 $ - $ 254.96 $ 254.96 $ - $ - 1.0744 0.357482
CHRIST HOSPITAL NJ JERSEY CITY NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
CHRISTIANA CARE HLTH SERV DE WILMINGTON DE $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CITRUS MEMORIAL HOSPITAL FL INVERNESS FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CITY HOSPITAL WV MARTINSBURG WV $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CLARA MAASS MEM HOSP TOMS RIVER NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CLARION HOSPITAL PA CLARION PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CLARION PSYCHIATRIC CTR PA CLARION PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CLEVELAND CLINIC FOUNDATION CLEVELAND OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COLUMBIA WESLEY MEDICAL CENTE WICHITA KS $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COMMUNITY HLTH CTR BRANCH CTY COLDWATER MI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COMMUNITY MED CTR NJ TOMS RIVER NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COMMUNITY MEDICAL CENTER PA SCRANTON PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COMMUNITY MEMORIAL HOSP VA SOUTH HILL VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CONCORD HOSPITAL NH CONCORD NH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CONEMAUGH VALLEY MEM HSP PA JOHNSTOWN PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CONWAY HOSPITAL SC CONWAY SC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COOLEY DICKINSON HOSP MA NORTHAMPTON MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COOPER MED CTR CAMDEN NJ CAMDEN NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
COPLEY HOSPITAL VT INC MORRISVILLE VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CORAL SPRINGS MEDICAL CTR FL CORAL SPRINGS FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CORRY MEMORIAL HOSPITAL PA CORRY PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CROZER-CHESTER MEDICAL CTR PA UPLAND PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
CUMBERLAND HOSP VA NEW KENT VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DAMERON HOSPITAL ASSOC STOCKTON CA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DANA FARBER CANCER INSTITUTE BOSTON MA $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
DANBURY HOSP CT DANBURY CT $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
DAVIS HOSPITAL AND MED CTR UT LAYTON UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DAY KIMBALL HOSPITAL CT PUTNAM CT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DCH REGIONAL MED CTR AL TUSCALOOSA AL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DEACONESS HOSPITAL WA SPOKANE WA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DELAWARE CTY MEMORIAL HSP PA DREXEL HILL PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DELRAY MEDICAL CTR FL DELRAY BEACH FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DESERT REGIONAL MED CTR PALM SPRINGS CA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DIVINE PROVIDENCE HOSP PA WILLIAMSPORT PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DIXIE MEDICAL CENTER UT ST GEORGE UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DOCTORS COMMUNITY HOSPITAL MD LANHAM MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DUBOIS REG MED CTR MERCY DIV DUBOIS PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DUKE UNIVERSITY HOSPITAL NC DURHAM NC $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
DURHAM REGIONAL HOSPITAL NC DURHAM NC $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
EAST JEFFERSON GEN HOSP LA METAIRE LA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
EAST ORANGE GENERAL HOSPITAL EAST ORANGE NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
EAST TENNESSE CHILD HOSP KNOXVILLE TN $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
EASTERN MAINE MED CTR ME BANGOR ME $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
EASTON HOSPITAL PA EASTON PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
EMMA PENDLETON BRADLEY HSP RI RIVERSIDE RI $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ENGLEWOOD HOSP MED CTR NJ ENGLEWOOD NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ERLANGER MED CTR TN CHATTANOOGA TN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FAIRVIEW GENERAL HOSPITAL OH CLEVELAND OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FAIRVIEW HOSPITAL GT BARRINGTON MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FAIRVIEW UNIV MED CTR MN MINNEAPOLIS MN $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FALMOUTH HOSP ASSOC MA FALMOUTH MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLAGLER HOSPITAL FL ST AUGUSTINE FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLETCHER ALLEN HLTH - MCHV BURLINGTON VT $ 7,199.87 $ - $ 1,113.19 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLORIDA HLTH SCI/TAMPA GEN TAMPA FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLORIDA HOSP HEARTLAND FL SEBRING FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLORIDA HOSP MED CTR FL ORLANDO FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLORIDA HOSP WATERMAN FL TAVARES FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLORIDA HOSPITAL ZEPHYR HILLS ZEPHYRHILLS FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FLORIDA HSP FISH MEMORIAL FL ORANGE CITY FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
FRANKLIN SQUARE HOSP MD BALTIMORE MD $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
GARDEN GROVE HOSP MC CA GARDEN GROVE CA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GEISINGER MEDICAL CENTER PA DANVILLE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GEISINGER SOUTH WILKES-BARRE WILKES BARRE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GEORGETOWN UNIVERSITY HOSP DC WASHINGTON DC $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
GETTYSBURG HOSPITAL GETTYSBURG PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GNADEN HUETTEN MEM HOSP PA LEHIGHTON PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GOOD SAMARITAN HOSPITAL OH DAYTON OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GOOD SAMARITAN HSP FL WEST PALM BEACH FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GRADY MEMORIAL HOSPITAL ATLANTA GA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GRANDVIEW HOSPITAL OH DAYTON OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GREAT RIVER MEDICAL CENTER WEST BURLINGTON IA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GREATER BALTIMORE MED CTR MD BALTIMORE MD $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
GREENWICH HOSP CT GREENWICH CT $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
GRIFFIN HOSPITAL CT DERBY CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GROSSMONT HOSPITAL CA LA MESA CA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GWINNETT HOSPITAL SYSTEM GA DULUTH GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
GWINNETT MED CTR GA LAWRENCEVILLE GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HACKENSACK UNIV MED CTR NJ HACKENSACK NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
HACKETTSTOWN REG MED CTR HACKETTSTOWN NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HALIFAX MED CTR FL DAYTONA BEACH FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HALIFAX REGIONAL HOSP VA SOUTH BOSTON VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HAMILTON MEDICAL CENTER GA DALTON GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HAMOT MEDICAL CENTER PA ERIE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HANOVER HOSPITAL PA HANOVER PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HARBORVIEW MED CTR WA SEATTLE WA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
HARDIN MEMORIAL HOSPITAL KY ELIZABETHTOWN KY $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HARFORD MEMORIAL HOSP MD HAVRE DE GRACE MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HARRINGTON MEMORIAL HOSPITAL SOUTHBRIDGE MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HAZLETON GEN HSP PA HAZLETON PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HCA OAK HILL HOSP FL BROOKSVILLE FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HEALTH ALLIANCE HOSP LEOMINSTER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HEALTHSOUTH REHAB HOSP ERIE ERIE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HELEN ELLIS MEM HSP FL TARPON SPRINGS FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HENRY HEYWOOD MEM HOSP MA GARDNER MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HIALEAH HOSPITAL FL HIALEAH FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HIGH POINT REG HEALTH SYS NC HIGH POINT NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOLMES REG MED CTR FL MELBOURNE FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOLY CROSS HSP FL FT LAUDERDALE FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOLY NAME HOSPITAL NJ TEANECK NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
HOLY SPIRIT HOSPITAL CAMP HILL PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOLYOKE HOSP MA HOLYOKE MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOMESTEAD HOSPITAL FL HOMESTEAD FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOSPITAL CORP/LAKEVIEW HSP UT BOUNTIFUL UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOSPITAL OF THE UNIV OF PENN PHILADELPHIA PA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
HOUSTON HOSPITALS INC GA WARNER ROBINS GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HOWARD CTY GENERAL HSP MD COLUMBIA MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
HUGULEY MEMORIAL HOSPITAL TX FT WORTH TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
IMPERIAL POINT HSP FL FT LAUDERDALE FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
INTERMOUNTAIN MEDICAL CENTER MURRAY UT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
JACKSON MEM HSP FL MIAMI FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
JERSEY CITY MEDICAL CTR NJ JERSEY CITY NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
JERSEY SHORE MEDICAL CTR NJ NEPTUNE NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
JOHN C LINCOLN DEERVALLEY AZ PHOENIX AZ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
JOHN C LINCOLN HOSP HLTH AZ PHOENIX AZ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
JOHN DEMPSEY HOSPITAL UNIV CT FARMINGTON CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
JOHN F KENNEDY MED CTR EDISON NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
JOHNS HOPKINS HOSPITAL MD BALTIMORE MD $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
JOHNSON MEM HSP STAFFORD SPRINGS CT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
JORDAN HOSPITAL INC MA PLYMOUTH MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
KENNEDY KRIEGER INSTITUTE MD BALTIMORE MD $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
KENNEDY MEM HOSP/CHERRY HILL CHERRY HILL NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
KENNEDY MEM HOSP/UMC STRATFOR STRATFORD NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
KENNEDY MEM HOSP/WASHINGTON TURNERSVILLE NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
KENT COUNTY MEMORIAL HOSPITAL WARWICK RI $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
KESSLER INSTITUTE FOR REHAB WEST ORANGE NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
KINDRED HOSPITALS EAST LLC IL WILKES BARRE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
KOSAIR CHILDRENS HSP KY LOUISVILLE KY $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
LAKE POINTE MEDICAL CENTER TX ROWLETT TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LAKELAND REG MED CTR FL LAKELAND FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LAKES REGION GEN HOSP-LACONIA LACONIA NH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LAKEWOOD HOSP OH LAKEWOOD OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LANCASTER GENERAL HOSP PA LANCASTER PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LARGO MEDICAL CENTER FL LARGO FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LAWRENCE & MEMORIAL HOSPS CT NEW LONDON CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LAWRENCE GEN HOSP MA LAWRENCE MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LDS HOSPITAL UT SALT LAKE CITY UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LEESBURG REG MED CTR FL LEESBURG FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LEHIGH VALLEY HOSP CTR PA ALLENTOWN PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LEHIGH VALLEY MUHLENBERG PA BETHLEHEM PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LENOIR MEMORIAL HOSP NC KINSTON NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LITTLETON REGIONAL HOSP NH LITTLETON NH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LOGAN REG HOSP UT LOGAN UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LOURDES MED CTR BURLINGTON CT WILLINGBORO NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LOWELL GENERAL HOSPITAL MA LOWELL MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LUTHERAN HOSPITAL IN FORT WAYNE IN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LUTHERAN MEDICAL CENTER OH CLEVELAND OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
LYNCHBURG GENERAL HOSP VA LYNCHBURG VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MAGEE WOMENS HOSPITAL PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MAIN LINE HOSP LANKENAU PA WYNNEWOOD PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MAINE MED CTR ME PORTLAND ME $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MARTHAS VINEYARD HOSPITAL MA OAK BLUFFS MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MARY HITCHCOCK MEM HOSP NH LEBANON NH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MARY WASHINGTON HOSPITAL VA FREDERICKSBURG VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MARYMOUNT HOSPITAL OH CLEVELAND OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MASSACHUSETTS GEN HOSP BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
MAURY REGIONAL HSP TN COLUMBIA TN $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MCKEE MED CTR CO LOVELAND CO $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MCLEOD LORIS SEACOAST HSP SC LORIS SC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MCLEOD MEDICAL CTR DILLON DILLON SC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MCLEOD REG MED CTR SC FLORENCE SC $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEDICAL CENTER AT PRINCETON PRINCETON NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEDICAL CENTER OF MC KINNEY T MCKINNEY TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEDICAL CENTER OF PLANO TX PLANO TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEDICAL CITY DALLAS HOSP TX DALLAS TX $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
MEDICAL CTR CENTRAL GEORGIA MACON GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEDICAL CTR OF ARLINGTON TX ARLINGTON TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEDICAL CTR OF OCEAN CO. BRICK NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSP PEMBROKE FL PEMBROKE PINES FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL FLAGER FL PALM COAST FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL IL BELLEVILLE IL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL PA YORK PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL PA INC TOWANDA PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL RI PAWTUCKET RI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL SOUTH BEND SOUTH BEND IN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL HOSPITAL WEST FL PEMBROKE PINES FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MEMORIAL REG HSP FL HOLLYWOOD FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MERCY MEDICAL CENTER MA SPRINGFIELD MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MERCY MEDICAL CENTER MD BALTIMORE MD $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
MERIDIA EUCLID HSP OH EUCLID OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MERIDIA HILLCREST HSP OH MAYFIELD HTS OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MERRIMACK VALLEY HSP A STEWRD HAVERHILL MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
METHODIST CHARLTON MED CTR DALLAS TX $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
METHODIST HLTHCRE OLIVE BR MS OLIVE BRANCH MS $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
METHODIST HOSP OF MEMPHIS TN MEMPHIS TN $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
METHODIST HOSPITALS INC IN GARY IN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
METRO HEALTH SYSTEM OH CLEVELAND OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
METRO WEST MEDICAL CENTER MA FRAMINGHAM MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
METROPLEX HOSPITAL TX KILLEEN TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MIAMI CHILDRENS HOSPITAL FL MIAMI FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MIDDLESEX HOSPITAL CT MIDDLETOWN CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MILFORD HOSPITAL CT MILFORD CT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MILLCREEK COMMUNITY HOSPITAL ERIE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MILTON S HERSHEY MED CTR PA HERSHEY PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MIRIAM HOSPITAL RI PROVIDENCE RI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MONTCLAIR HOSP/MOUNTAINSIDE MONTCLAIR NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
MONTCLAIR HOSP/MOUNTAINSIDE MONTCLAIR NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
MONTGOMERY GENERAL HOSP MD OLNEY MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MORRISTOWN MEMORIAL HOSP NJ MORRISTOWN NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MOSES H CONE HOSPITAL NC GREENSBORO NC $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MOUNT SINAI MEDICAL CTR OF FL MIAMI BEACH FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MOUNTAIN VISTA MEDICAL CTR AZ MESA AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
MT ASCUTNEY HOSPITAL VT WINDSOR VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NASH GENERAL HOSPITAL NC ROCKY MOUNT NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NEW MILFORD HSP NEW MILFORD CT $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
NEW PT RICHEY/MED CTR OF TRIN TRINITY FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NEWARK BETH ISRAEL MED NJ NEWARK NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
NEWPORT HSP RI NEWPORT RI $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NEWTON WELLESLEY HOSP MA NEWTON MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTH BROWARD MEDICAL CTR FL POMPANO BEACH FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTH COUNTRY HOSPITAL VT NEWPORT VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTH HILLS HOSPITAL TX NORTH RICHLAND HILLS TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTH PHILADELPHIA HLTH SYS PHILADELPHIA PA $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
NORTH SHORE MED CTR FL MIAMI FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTHEAST ALABAMA REG MED ANNISTON AL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTHERN COCHISE COMM HSP AZ WILLCOX AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTHERN UTAH HEALTHCARE UT SALT LAKE CITY UT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTHSHORE UNIVERSITY HEALTH EVANSTON IL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORTHWEST TEXAS HOSPITAL AMARILLO TX $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
NORWALK HOSPITAL NORWALK CT $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
NORWOOD HOSP INC MA NORWOOD MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ORLANDO REG HLTH SYS FL ORLANDO FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
OU MEDICAL CENTER OK OKLAHOMA CITY OK $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
OUR LADY OF LOURDES MED CTR N CAMDEN NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
OVERLOOK HOSPITAL NJ SUMMIT NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PALISADES MEDICAL CENTER NJ NORTH BERGEN NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PALM BAY HOSPITAL FL PALM BAY FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PALM BEACH GARDENS AND MED CT PALM BEACH GARDENS FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PALMERTON HOSPITAL PA PALMERTON PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PAOLI MEMORIAL HOSPITAL PAOLI PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PARKLAND MEM HOSP TX DALLAS TX $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PARKVIEW HOSPITAL INC IN FORT WAYNE IN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PASCACK VALLEY HOSP LLC NJ WESTWOOD NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PENNSYLVANIA HOSP PA PHILADELPHIA PA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PENOBSCOT BAY MED CTR ME ROCKPORT ME $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PHOENIX CHILDRENS HSP AZ PHOENIX AZ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PINNACLE HEALTH HOSPITALS PA HARRISBURG PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PITT COUNTY MEMORIAL HOSP NC GREENVILLE NC $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
POCONO MED CTR PA E STROUDSBURG PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PORTER MEDICAL CENTER INC VT MIDDLEBURY VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PORTER MEDICAL CENTER INC VT MIDDLEBURY VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
POTOMAC HSP OF PRINCE WILL VA WOODBRIDGE VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
POTOMAC VALLEY HSP OF WEST VA KEYSER WV $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
POTTSTOWN MEM MED CTR PA POTTSTOWN PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRESBYTERIAN HOSP NM ALBUQUERQUE NM $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PRESBYTERIAN HSP OF DALLAS DALLAS TX $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
PRESBYTERIAN INTERCOMM HSP CA WHITTIER CA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRESBYTERIAN UNIV HSP PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRESBYTERIAN UNIV HSP PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRESBYTERIAN UNIV HSP PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRESBYTERIAN UNIV HSP PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRESBYTERIAN UNIV HSP PA PITTSBURGH PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PRIMARY CHILDRENS MED CTR UT SALT LAKE CITY UT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
PROVIDENCE ST PETERS HOSP WA OLYMPIA WA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
QUINCY MED CTR A STEWARD FAM QUINCY MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
QUINCY MED CTR A STEWARD FAM QUINCY MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RARITAN BAY HEALTH SERVICES PERTH AMBOY NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
REFUGIO COUNTY MEM HSP TX REFUGIO TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
REG CTR ORANGEBURG CALHOUN SC ORANGEBURG SC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
REGIONAL HSP SCRANTON PA SCRANTON PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
REGIONAL MED CTR AT MEMPHIS MEMPHIS TN $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
REGIONAL MED CTR BAYONET FL HUDSON FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RESEARCH MED CTR MO KANSAS CITY MO $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RHODE ISLAND HOSPITAL RI PROVIDENCE RI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RIDDLE MEMORIAL HOSP PA MEDIA PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RIVERTON HOSPITAL UT RIVERTON UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RIVERVIEW HOSPITAL NJ RED BANK NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ROBERT PACKER HOSP PA SAYRE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ROBERT WOOD JOHNSON UNIV HSP NEW BRUNSWICK NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ROGUE VALLEY MEMORIAL HSP OR MEDFORD OR $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ROSWELL HOSPITAL CORP NM ROSWELL NM $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
RUSH UNIVERSITY MED CTR IL CHICAGO IL $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
RUSH UNIVERSITY MED CTR IL CHICAGO IL $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
RUSH UNIVERSITY MED CTR IL CHICAGO IL $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
RUTLAND REG MED CTR RUTLAND VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SACRED HEART HOSPITAL PA ALLENTOWN PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SACRED HEART MED CTR UNIV DIS EUGENE OR $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SAINT BARNABAS MEDICAL CENTER OCEAN PORT NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SAINT VINCENTS HLTH CTR ERIE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SAINTS MEM MED CTR MA LOWELL MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SALINA REG HLTH CTR KS SALINA KS $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SAN ANTONIO COMM HSP CA UPLAND CA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SARASOTA MEMORIAL HOSPITAL FL SARASOTA FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SCHUYLKILL MED CTR SOUTH PA POTTSVILLE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SCOTTSDALE HLTHCARE SHEA AZ SCOTTSDALE AZ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SELECT SPEC HOSP DANVILLE DANVILLE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SELECT SPEC HOSP ERIE ERIE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SELECT SPEC HOSP NORTHEAST NJ ROCHELLE PARK NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SENTARA BAYSIDE HOSP VA VIRGINIA BEACH VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SENTARA CAREPLEX HOSPITAL VA HAMPTON VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SENTARA HOSPITAL VA SUFFOLK VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SENTARA LEIGH HSP VA NORFOLK VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SENTARA NORFOLK HSP VA NORFOLK VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SENTARA VIRGINIA BEACH GEN HS VIRGINIA BEACH VA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SENTARA WILLIAMSBURG COMM HOS WILLIAMSBURG VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SEVIER VALLEY MEDICAL CTR UT RICHFIELD UT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SHANDS JACKSONVILLE MED FL JACKSONVILLE FL $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SHARON HOSPITAL CT SHARON CT $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SHARP CHULA VISTA CHULA VISTA CA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOLDIERS AND SAILORS MEM HOSP WELLSBORO PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOMERSET MED CENTER NJ SOMERVILLE NJ $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTH BAY HOSP FL SUN CITY CENTER FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTH COUNTY HOSPTAL RI WAKEFIELD RI $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTH LAKE HSP FL CLERMONT FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTH MIAMI HOSPITAL FL SOUTH MIAMI FL $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTH POINTE HOSPITAL OH WARRENSVILLE HTS OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTH SHORE HOSP MA SOUTH WEYMOUTH MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTHEASTERN REG MED CTR NC LUMBERTON NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTHERN HILLS M C TN NASHVILLE TN $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SOUTHERN MARYLAND HOSP INC CLINTON MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTHERN OCEAN MED CTR NJ MANAHAWKIN NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTHSIDE COMM HOSP VA FARMVILLE VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTHWEST GENERAL HOSPITAL CLEVELAND OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SOUTHWESTERN VT MED CTR INC BENNINGTON VT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SPEARE MEMORIAL HOSP NH PLYMOUTH NH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SPECIALTY HOSP OF CLEVELAND CLEVELAND OH $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SPRING VALLEY HOSP MED NV LAS VEGAS NV $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SPRING VALLEY HOSP MED NV LAS VEGAS NV $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST CHRISTOPHERS HSP CHILD PA PHILADELPHIA PA $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST CLARE HOSPITAL WI BARABOO WI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST CLARES HOSPITAL DENVILLE NJ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST FRANCIS HOSP & MED CTR CT HARTFORD CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST FRANCIS HOSPITAL OK TULSA OK $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST FRANCIS HSP DE WILMINGTON DE $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST JOSEPH HOSPITAL PA READING PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST JOSEPHS HOSP MED CTR NJ PATERSON NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST JUDE CHILDRENS RES HSP TN MEMPHIS TN $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST LOUIS CHILDRENS HOSP MO SAINT LOUIS MO $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST LUKES HOSPITAL BETHLEHEM PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST LUKES HOSPITAL MILWAUKEE WI $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST LUKES HOSPITAL MA FALL RIVER MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST LUKES HSP OF KC MO KANSAS CITY MO $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST LUKES NORTHLAND HSP MO SMITHVILLE MO $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST MARY HOSPITAL PA LANGHORNE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST MARY MERCY HSP MI LIVONIA MI $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST MARYS HOSP AND MED CTR GRAND JUNCTION CO $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST MARYS HOSPITAL OF CONN WATERBURY CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST MARYS REG MED CENTER ME LEWISTON ME $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST MICHAEL MED CENTER NJ NEWARK NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST PETERS UNIV HSP NJ NEW BRUNSWICK NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
ST VINCENT HOSPITAL MA WORCESTER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
ST VINCENTS MEDICAL CENTER CT BRIDGEPORT CT $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
STAFFORD HOSPITAL VA STAFFORD VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STAMFORD HOSPITAL CT STAMFORD CT $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
STEWARD CARNEY HOSP INC DORCHESTER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD CARNEY HOSP MA DORCHESTER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD GOOD SAM MED CTR MA BROCKTON MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD GOOD SAM MED CTR MA BROCKTON MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD HOLY FAMILY MA METHUEN MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD NORWOOD HOSP MA NORWOOD MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD ST ANNES HSP MA FALL RIVER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STEWARD ST ELIZABETH MED CTR BOSTON MA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
STORMONT VAIL REG MED CTR KS TOPEKA KS $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
STURDY MEMORIAL HOSP MA ATTLEBORO MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
SUMMERLIN MED CTR NV LAS VEGAS NV $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SUNRISE HOSP & MED CTR NV LAS VEGAS NV $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
SWEETWATER HOSP TN SWEETWATER TN $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
TEMPLE UNIVERSITY HOSPITAL PHILADELPHIA PA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
TEXAS CHILDREN'S HOSP TX HOUSTON TX $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
TEXAS HLTH PRESBYTERIAN HOSP ALLEN TX $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
THE MERCY HOSP/PROVIDENCE HOLYOKE MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
THE SHRINERS HOSP FOR CHILD MA BOSTON MA $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
THE SHRINERS HOSP FOR CHILD MA SPRINGFIELD MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
THOMAS JEFFERSON UNIV HOSP PA PHILADELPHIA PA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
THREE RIVERS COMMUNITY HSP OR GRANTS PASS OR $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
TOLEDO HSP OH TOLEDO OH $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
TRINITAS HSP NJ ELIZABETH NJ $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
TROY COMMUNITY HOSPITAL TROY PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
TUFTS MEDICAL CENTER MA WORCESTER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
TUOMEY REG MED CTR SC SUMTER SC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UMASS MEMORIAL MED CNTR PSYCH WORCESTER MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UMASS MEMORIAL MEDICAL CENTER WORCESTER MA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNION HOSP OF CECIL CTY MD ELKTON MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNITED HOSPITAL MN SAINT PAUL MN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNIV CA DAVIS MED CTR CA SACRAMENTO CA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNIV KENTUCKY HOSPITAL LEXINGTON KY $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNIV OF ALABAMA BIRMINGHAM AL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNIV OF WASHINGTON WA SEATTLE WA $ 8,982.32 $ - $ 1,395.82 $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
UNIVERSITY COMM HOSP FL TAMPA FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNIVERSITY OF KANSAS HOSPITAL KANSAS CITY KS $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UNIVERSITY OF TENNESSEE MEM KNOXVILLE TN $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UPHS PRESBYTERIAN MEDICAL CEN PHILADELPHIA PA $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
UPPER CHESAPEAK MEDICAL CENTE BEL AIR MD $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
UT VALLEY REG MED CTR UT PROVO UT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
VALLEY HOSPITAL RIDGEWOOD NJ $ 7,446.80 $ - $ - $ 254.96 $ 254.96 $ 760.34 $ 154.04 1.0744 0.357482
VALLEY VIEW HOSP ASSOC CO GLENWOOD SPRINGS CO $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
VERDE VALLEY MED CTR AZ COTTONWOOD AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
VIBRA HOSP OF WESTERN MASS SPRINGFIELD MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
VIDANT BEAUFORT HOSP GREENVILLE NC $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
VILLAGES REGIONAL HOSP FL THE VILLAGES FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
VIRGINIA BEACH PSYCHIATRIC VIRGINIA BEACH VA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WARREN GENERAL HOSPITAL PA WARREN PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WARSAW HLTH/KOSCIUSKO COMM WARSAW IN $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WATERBURY HOSPITAL CT WATERBURY CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WAYNE MEMORIAL HOSP PA HONESDALE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WELLSTAR DOUGLAS HOSP GA DOUGLASVILLE GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WELLSTAR KENNESTONE HOSP GA MARIETTA GA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WEST GROVE/JENNERSVILLE PA WEST GROVE PA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WEST KENDALL BAPTIST HOSP FL MIAMI FL $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WEST VIRGINA UNIV HOSP WV MORGANTOWN WV $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WICKENBURG COMM HOSP AZ WICKENBURG AZ $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WILLIAM BACKUS HOSPITAL CT NORWICH CT $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WILLIAM BEAUMONT HOSP ROYAL OAK MI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WING MEMORIAL HOSPITAL MA PALMER MA $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WOMEN & INFANTS HSP RI PROVIDENCE RI $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
WVHCS HOSP WILKES BARRE PA WILKES BARRE PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
YALE NEW HAVEN HOSPITAL CT NEW HAVEN CT $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
YORK HOSPITAL YORK PA $ 6,489.00 $ - $ 463.71 $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464
YORK HOSPITAL ME YORK ME $ 5,812.44 $ - $ - $ 187.52 $ 187.52 $ 617.64 $ 129.64 0.8386 0.442464