|
CIPROFLOXACIN 500 MG TABLET [7555]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 0143992801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Medicare |
$10.14
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.36
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.66
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$9.18
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$9.66
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Medicare |
$9.66
|
| Rate for Payer: WINHealth Partners Commercial |
$15.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
CIRCUIT ADULT HAMILTON G-5 ER
|
Facility
|
OP
|
$19.48
|
|
| Hospital Charge Code |
2100054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.09
|
| Rate for Payer: Aetna of WY Medicare |
$12.86
|
| Rate for Payer: Altius Commercial |
$18.70
|
| Rate for Payer: Beech Street Commercial |
$19.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.90
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.90
|
| Rate for Payer: Cigna of WY Commercial |
$19.09
|
| Rate for Payer: Entrust Commercial |
$18.51
|
| Rate for Payer: First Choice Health Commercial |
$18.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.10
|
| Rate for Payer: HealthUtah PPO |
$19.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.90
|
| Rate for Payer: Multiplan Medicare/VA |
$10.55
|
| Rate for Payer: One Health Plan of WY PPO |
$19.09
|
| Rate for Payer: PacificSource Commercial |
$17.53
|
| Rate for Payer: PHCS PPO |
$19.09
|
| Rate for Payer: Three Rivers PPO |
$14.61
|
| Rate for Payer: TriWest Veterans Administration |
$11.10
|
| Rate for Payer: United Healthcare Commercial |
$18.60
|
| Rate for Payer: United Healthcare Medicare |
$11.10
|
| Rate for Payer: WINHealth Partners Commercial |
$19.09
|
| Rate for Payer: Wise Provider Network Commercial |
$18.51
|
|
|
CIRCUIT ADULT HAMILTON G-5 ER
|
Facility
|
IP
|
$19.48
|
|
| Hospital Charge Code |
2100054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.09
|
| Rate for Payer: Aetna of WY Medicare |
$12.47
|
| Rate for Payer: Altius Commercial |
$18.70
|
| Rate for Payer: Beech Street Commercial |
$19.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.90
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.90
|
| Rate for Payer: Cigna of WY Commercial |
$19.09
|
| Rate for Payer: Entrust Commercial |
$18.51
|
| Rate for Payer: First Choice Health Commercial |
$18.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.88
|
| Rate for Payer: HealthUtah PPO |
$19.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.90
|
| Rate for Payer: Multiplan Medicare/VA |
$11.29
|
| Rate for Payer: One Health Plan of WY PPO |
$19.09
|
| Rate for Payer: PacificSource Commercial |
$17.53
|
| Rate for Payer: PHCS PPO |
$19.09
|
| Rate for Payer: Three Rivers PPO |
$14.61
|
| Rate for Payer: TriWest Veterans Administration |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$18.60
|
| Rate for Payer: United Healthcare Medicare |
$11.88
|
| Rate for Payer: WINHealth Partners Commercial |
$18.51
|
| Rate for Payer: Wise Provider Network Commercial |
$18.51
|
|
|
CIRCUIT BREATHING F2 ADLT 70"
|
Facility
|
OP
|
$10.96
|
|
| Hospital Charge Code |
2500024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.74
|
| Rate for Payer: Aetna of WY Medicare |
$7.23
|
| Rate for Payer: Altius Commercial |
$10.52
|
| Rate for Payer: Beech Street Commercial |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.63
|
| Rate for Payer: Cash Price |
$7.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.63
|
| Rate for Payer: Cigna of WY Commercial |
$10.74
|
| Rate for Payer: Entrust Commercial |
$10.41
|
| Rate for Payer: First Choice Health Commercial |
$10.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.25
|
| Rate for Payer: HealthUtah PPO |
$10.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.63
|
| Rate for Payer: Multiplan Medicare/VA |
$5.93
|
| Rate for Payer: One Health Plan of WY PPO |
$10.74
|
| Rate for Payer: PacificSource Commercial |
$9.86
|
| Rate for Payer: PHCS PPO |
$10.74
|
| Rate for Payer: Three Rivers PPO |
$8.22
|
| Rate for Payer: TriWest Veterans Administration |
$6.25
|
| Rate for Payer: United Healthcare Commercial |
$10.47
|
| Rate for Payer: United Healthcare Medicare |
$6.25
|
| Rate for Payer: WINHealth Partners Commercial |
$10.74
|
| Rate for Payer: Wise Provider Network Commercial |
$10.41
|
|
|
CIRCUIT BREATHING F2 ADLT 70"
|
Facility
|
IP
|
$10.96
|
|
| Hospital Charge Code |
2500024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.74
|
| Rate for Payer: Aetna of WY Medicare |
$7.01
|
| Rate for Payer: Altius Commercial |
$10.52
|
| Rate for Payer: Beech Street Commercial |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.63
|
| Rate for Payer: Cash Price |
$7.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.63
|
| Rate for Payer: Cigna of WY Commercial |
$10.74
|
| Rate for Payer: Entrust Commercial |
$10.41
|
| Rate for Payer: First Choice Health Commercial |
$10.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.69
|
| Rate for Payer: HealthUtah PPO |
$10.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.63
|
| Rate for Payer: Multiplan Medicare/VA |
$6.35
|
| Rate for Payer: One Health Plan of WY PPO |
$10.74
|
| Rate for Payer: PacificSource Commercial |
$9.86
|
| Rate for Payer: PHCS PPO |
$10.74
|
| Rate for Payer: Three Rivers PPO |
$8.22
|
| Rate for Payer: TriWest Veterans Administration |
$6.69
|
| Rate for Payer: United Healthcare Commercial |
$10.47
|
| Rate for Payer: United Healthcare Medicare |
$6.69
|
| Rate for Payer: WINHealth Partners Commercial |
$10.41
|
| Rate for Payer: Wise Provider Network Commercial |
$10.41
|
|
|
CIRCUIT BREATHING F2 PEDS 72"
|
Facility
|
OP
|
$11.56
|
|
| Hospital Charge Code |
2500051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$11.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.33
|
| Rate for Payer: Aetna of WY Medicare |
$7.63
|
| Rate for Payer: Altius Commercial |
$11.10
|
| Rate for Payer: Beech Street Commercial |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.21
|
| Rate for Payer: Cash Price |
$8.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.21
|
| Rate for Payer: Cigna of WY Commercial |
$11.33
|
| Rate for Payer: Entrust Commercial |
$10.98
|
| Rate for Payer: First Choice Health Commercial |
$10.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.59
|
| Rate for Payer: HealthUtah PPO |
$11.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.21
|
| Rate for Payer: Multiplan Medicare/VA |
$6.26
|
| Rate for Payer: One Health Plan of WY PPO |
$11.33
|
| Rate for Payer: PacificSource Commercial |
$10.40
|
| Rate for Payer: PHCS PPO |
$11.33
|
| Rate for Payer: Three Rivers PPO |
$8.67
|
| Rate for Payer: TriWest Veterans Administration |
$6.59
|
| Rate for Payer: United Healthcare Commercial |
$11.04
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WINHealth Partners Commercial |
$11.33
|
| Rate for Payer: Wise Provider Network Commercial |
$10.98
|
|
|
CIRCUIT BREATHING F2 PEDS 72"
|
Facility
|
IP
|
$11.56
|
|
| Hospital Charge Code |
2500051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$11.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.33
|
| Rate for Payer: Aetna of WY Medicare |
$7.40
|
| Rate for Payer: Altius Commercial |
$11.10
|
| Rate for Payer: Beech Street Commercial |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.21
|
| Rate for Payer: Cash Price |
$8.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.21
|
| Rate for Payer: Cigna of WY Commercial |
$11.33
|
| Rate for Payer: Entrust Commercial |
$10.98
|
| Rate for Payer: First Choice Health Commercial |
$10.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.05
|
| Rate for Payer: HealthUtah PPO |
$11.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.21
|
| Rate for Payer: Multiplan Medicare/VA |
$6.70
|
| Rate for Payer: One Health Plan of WY PPO |
$11.33
|
| Rate for Payer: PacificSource Commercial |
$10.40
|
| Rate for Payer: PHCS PPO |
$11.33
|
| Rate for Payer: Three Rivers PPO |
$8.67
|
| Rate for Payer: TriWest Veterans Administration |
$7.05
|
| Rate for Payer: United Healthcare Commercial |
$11.04
|
| Rate for Payer: United Healthcare Medicare |
$7.05
|
| Rate for Payer: WINHealth Partners Commercial |
$10.98
|
| Rate for Payer: Wise Provider Network Commercial |
$10.98
|
|
|
CIRCUIT BREATHING IVENT ER
|
Facility
|
OP
|
$32.59
|
|
| Hospital Charge Code |
2100070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.94
|
| Rate for Payer: Aetna of WY Medicare |
$21.51
|
| Rate for Payer: Altius Commercial |
$31.29
|
| Rate for Payer: Beech Street Commercial |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.61
|
| Rate for Payer: Cigna of WY Commercial |
$31.94
|
| Rate for Payer: Entrust Commercial |
$30.96
|
| Rate for Payer: First Choice Health Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.58
|
| Rate for Payer: HealthUtah PPO |
$32.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.61
|
| Rate for Payer: Multiplan Medicare/VA |
$17.65
|
| Rate for Payer: One Health Plan of WY PPO |
$31.94
|
| Rate for Payer: PacificSource Commercial |
$29.33
|
| Rate for Payer: PHCS PPO |
$31.94
|
| Rate for Payer: Three Rivers PPO |
$24.44
|
| Rate for Payer: TriWest Veterans Administration |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare |
$18.58
|
| Rate for Payer: WINHealth Partners Commercial |
$31.94
|
| Rate for Payer: Wise Provider Network Commercial |
$30.96
|
|
|
CIRCUIT BREATHING IVENT ER
|
Facility
|
IP
|
$32.59
|
|
| Hospital Charge Code |
2100070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.94
|
| Rate for Payer: Aetna of WY Medicare |
$20.86
|
| Rate for Payer: Altius Commercial |
$31.29
|
| Rate for Payer: Beech Street Commercial |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.61
|
| Rate for Payer: Cigna of WY Commercial |
$31.94
|
| Rate for Payer: Entrust Commercial |
$30.96
|
| Rate for Payer: First Choice Health Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.88
|
| Rate for Payer: HealthUtah PPO |
$32.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.61
|
| Rate for Payer: Multiplan Medicare/VA |
$18.89
|
| Rate for Payer: One Health Plan of WY PPO |
$31.94
|
| Rate for Payer: PacificSource Commercial |
$29.33
|
| Rate for Payer: PHCS PPO |
$31.94
|
| Rate for Payer: Three Rivers PPO |
$24.44
|
| Rate for Payer: TriWest Veterans Administration |
$19.88
|
| Rate for Payer: United Healthcare Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare |
$19.88
|
| Rate for Payer: WINHealth Partners Commercial |
$30.96
|
| Rate for Payer: Wise Provider Network Commercial |
$30.96
|
|
|
CIRCUIT HAMILTON T1 NEONATAL
|
Facility
|
OP
|
$217.38
|
|
| Hospital Charge Code |
2100162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$217.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.03
|
| Rate for Payer: Aetna of WY Medicare |
$143.47
|
| Rate for Payer: Altius Commercial |
$208.68
|
| Rate for Payer: Beech Street Commercial |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.86
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.86
|
| Rate for Payer: Cigna of WY Commercial |
$213.03
|
| Rate for Payer: Entrust Commercial |
$206.51
|
| Rate for Payer: First Choice Health Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.91
|
| Rate for Payer: HealthUtah PPO |
$217.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.86
|
| Rate for Payer: Multiplan Medicare/VA |
$117.71
|
| Rate for Payer: One Health Plan of WY PPO |
$213.03
|
| Rate for Payer: PacificSource Commercial |
$195.64
|
| Rate for Payer: PHCS PPO |
$213.03
|
| Rate for Payer: Three Rivers PPO |
$163.04
|
| Rate for Payer: TriWest Veterans Administration |
$123.91
|
| Rate for Payer: United Healthcare Commercial |
$207.60
|
| Rate for Payer: United Healthcare Medicare |
$123.91
|
| Rate for Payer: WINHealth Partners Commercial |
$213.03
|
| Rate for Payer: Wise Provider Network Commercial |
$206.51
|
|
|
CIRCUIT HAMILTON T1 NEONATAL
|
Facility
|
IP
|
$217.38
|
|
| Hospital Charge Code |
2100162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.97 |
| Max. Negotiated Rate |
$217.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.03
|
| Rate for Payer: Aetna of WY Medicare |
$139.12
|
| Rate for Payer: Altius Commercial |
$208.68
|
| Rate for Payer: Beech Street Commercial |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.86
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.86
|
| Rate for Payer: Cigna of WY Commercial |
$213.03
|
| Rate for Payer: Entrust Commercial |
$206.51
|
| Rate for Payer: First Choice Health Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.60
|
| Rate for Payer: HealthUtah PPO |
$217.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.86
|
| Rate for Payer: Multiplan Medicare/VA |
$125.97
|
| Rate for Payer: One Health Plan of WY PPO |
$213.03
|
| Rate for Payer: PacificSource Commercial |
$195.64
|
| Rate for Payer: PHCS PPO |
$213.03
|
| Rate for Payer: Three Rivers PPO |
$163.04
|
| Rate for Payer: TriWest Veterans Administration |
$132.60
|
| Rate for Payer: United Healthcare Commercial |
$207.60
|
| Rate for Payer: United Healthcare Medicare |
$132.60
|
| Rate for Payer: WINHealth Partners Commercial |
$206.51
|
| Rate for Payer: Wise Provider Network Commercial |
$206.51
|
|
|
CIRCUIT HAMILTON T1 PED/ADULT
|
Facility
|
OP
|
$99.72
|
|
| Hospital Charge Code |
2100158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$99.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.73
|
| Rate for Payer: Aetna of WY Medicare |
$65.82
|
| Rate for Payer: Altius Commercial |
$95.73
|
| Rate for Payer: Beech Street Commercial |
$97.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.73
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.73
|
| Rate for Payer: Cigna of WY Commercial |
$97.73
|
| Rate for Payer: Entrust Commercial |
$94.73
|
| Rate for Payer: First Choice Health Commercial |
$94.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.84
|
| Rate for Payer: HealthUtah PPO |
$99.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.73
|
| Rate for Payer: Multiplan Medicare/VA |
$54.00
|
| Rate for Payer: One Health Plan of WY PPO |
$97.73
|
| Rate for Payer: PacificSource Commercial |
$89.75
|
| Rate for Payer: PHCS PPO |
$97.73
|
| Rate for Payer: Three Rivers PPO |
$74.79
|
| Rate for Payer: TriWest Veterans Administration |
$56.84
|
| Rate for Payer: United Healthcare Commercial |
$95.23
|
| Rate for Payer: United Healthcare Medicare |
$56.84
|
| Rate for Payer: WINHealth Partners Commercial |
$97.73
|
| Rate for Payer: Wise Provider Network Commercial |
$94.73
|
|
|
CIRCUIT HAMILTON T1 PED/ADULT
|
Facility
|
IP
|
$99.72
|
|
| Hospital Charge Code |
2100158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.79 |
| Max. Negotiated Rate |
$99.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.73
|
| Rate for Payer: Aetna of WY Medicare |
$63.82
|
| Rate for Payer: Altius Commercial |
$95.73
|
| Rate for Payer: Beech Street Commercial |
$97.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.73
|
| Rate for Payer: Cash Price |
$69.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.73
|
| Rate for Payer: Cigna of WY Commercial |
$97.73
|
| Rate for Payer: Entrust Commercial |
$94.73
|
| Rate for Payer: First Choice Health Commercial |
$94.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.83
|
| Rate for Payer: HealthUtah PPO |
$99.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.73
|
| Rate for Payer: Multiplan Medicare/VA |
$57.79
|
| Rate for Payer: One Health Plan of WY PPO |
$97.73
|
| Rate for Payer: PacificSource Commercial |
$89.75
|
| Rate for Payer: PHCS PPO |
$97.73
|
| Rate for Payer: Three Rivers PPO |
$74.79
|
| Rate for Payer: TriWest Veterans Administration |
$60.83
|
| Rate for Payer: United Healthcare Commercial |
$95.23
|
| Rate for Payer: United Healthcare Medicare |
$60.83
|
| Rate for Payer: WINHealth Partners Commercial |
$94.73
|
| Rate for Payer: Wise Provider Network Commercial |
$94.73
|
|
|
CIRCUIT JACKSON REES 1L ANES
|
Facility
|
OP
|
$40.76
|
|
| Hospital Charge Code |
4500049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.94
|
| Rate for Payer: Aetna of WY Medicare |
$26.90
|
| Rate for Payer: Altius Commercial |
$39.13
|
| Rate for Payer: Beech Street Commercial |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.54
|
| Rate for Payer: Cigna of WY Commercial |
$39.94
|
| Rate for Payer: Entrust Commercial |
$38.72
|
| Rate for Payer: First Choice Health Commercial |
$38.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.23
|
| Rate for Payer: HealthUtah PPO |
$40.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.54
|
| Rate for Payer: Multiplan Medicare/VA |
$22.07
|
| Rate for Payer: One Health Plan of WY PPO |
$39.94
|
| Rate for Payer: PacificSource Commercial |
$36.68
|
| Rate for Payer: PHCS PPO |
$39.94
|
| Rate for Payer: Three Rivers PPO |
$30.57
|
| Rate for Payer: TriWest Veterans Administration |
$23.23
|
| Rate for Payer: United Healthcare Commercial |
$38.93
|
| Rate for Payer: United Healthcare Medicare |
$23.23
|
| Rate for Payer: WINHealth Partners Commercial |
$39.94
|
| Rate for Payer: Wise Provider Network Commercial |
$38.72
|
|
|
CIRCUIT JACKSON REES 1L ANES
|
Facility
|
IP
|
$40.76
|
|
| Hospital Charge Code |
4500049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.94
|
| Rate for Payer: Aetna of WY Medicare |
$26.09
|
| Rate for Payer: Altius Commercial |
$39.13
|
| Rate for Payer: Beech Street Commercial |
$39.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$28.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.54
|
| Rate for Payer: Cigna of WY Commercial |
$39.94
|
| Rate for Payer: Entrust Commercial |
$38.72
|
| Rate for Payer: First Choice Health Commercial |
$38.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.86
|
| Rate for Payer: HealthUtah PPO |
$40.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.54
|
| Rate for Payer: Multiplan Medicare/VA |
$23.62
|
| Rate for Payer: One Health Plan of WY PPO |
$39.94
|
| Rate for Payer: PacificSource Commercial |
$36.68
|
| Rate for Payer: PHCS PPO |
$39.94
|
| Rate for Payer: Three Rivers PPO |
$30.57
|
| Rate for Payer: TriWest Veterans Administration |
$24.86
|
| Rate for Payer: United Healthcare Commercial |
$38.93
|
| Rate for Payer: United Healthcare Medicare |
$24.86
|
| Rate for Payer: WINHealth Partners Commercial |
$38.72
|
| Rate for Payer: Wise Provider Network Commercial |
$38.72
|
|
|
CIRCUIT NEO PANDA W/MASK
|
Facility
|
IP
|
$38.08
|
|
| Hospital Charge Code |
2450102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$38.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.32
|
| Rate for Payer: Aetna of WY Medicare |
$24.37
|
| Rate for Payer: Altius Commercial |
$36.56
|
| Rate for Payer: Beech Street Commercial |
$37.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.94
|
| Rate for Payer: Cigna of WY Commercial |
$37.32
|
| Rate for Payer: Entrust Commercial |
$36.18
|
| Rate for Payer: First Choice Health Commercial |
$36.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.23
|
| Rate for Payer: HealthUtah PPO |
$38.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.94
|
| Rate for Payer: Multiplan Medicare/VA |
$22.07
|
| Rate for Payer: One Health Plan of WY PPO |
$37.32
|
| Rate for Payer: PacificSource Commercial |
$34.27
|
| Rate for Payer: PHCS PPO |
$37.32
|
| Rate for Payer: Three Rivers PPO |
$28.56
|
| Rate for Payer: TriWest Veterans Administration |
$23.23
|
| Rate for Payer: United Healthcare Commercial |
$36.37
|
| Rate for Payer: United Healthcare Medicare |
$23.23
|
| Rate for Payer: WINHealth Partners Commercial |
$36.18
|
| Rate for Payer: Wise Provider Network Commercial |
$36.18
|
|
|
CIRCUIT NEO PANDA W/MASK
|
Facility
|
OP
|
$38.08
|
|
| Hospital Charge Code |
2450102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$38.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.32
|
| Rate for Payer: Aetna of WY Medicare |
$25.13
|
| Rate for Payer: Altius Commercial |
$36.56
|
| Rate for Payer: Beech Street Commercial |
$37.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.94
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.94
|
| Rate for Payer: Cigna of WY Commercial |
$37.32
|
| Rate for Payer: Entrust Commercial |
$36.18
|
| Rate for Payer: First Choice Health Commercial |
$36.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.71
|
| Rate for Payer: HealthUtah PPO |
$38.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.94
|
| Rate for Payer: Multiplan Medicare/VA |
$20.62
|
| Rate for Payer: One Health Plan of WY PPO |
$37.32
|
| Rate for Payer: PacificSource Commercial |
$34.27
|
| Rate for Payer: PHCS PPO |
$37.32
|
| Rate for Payer: Three Rivers PPO |
$28.56
|
| Rate for Payer: TriWest Veterans Administration |
$21.71
|
| Rate for Payer: United Healthcare Commercial |
$36.37
|
| Rate for Payer: United Healthcare Medicare |
$21.71
|
| Rate for Payer: WINHealth Partners Commercial |
$37.32
|
| Rate for Payer: Wise Provider Network Commercial |
$36.18
|
|
|
CIRCUMCISION AGE >28 DAYS
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
HCPCS 54161
|
| Min. Negotiated Rate |
$161.87 |
| Max. Negotiated Rate |
$846.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$829.08
|
| Rate for Payer: Aetna of WY Medicare |
$190.43
|
| Rate for Payer: Beech Street Commercial |
$803.70
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: Cash Price |
$592.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$820.62
|
| Rate for Payer: Cigna of WY Commercial |
$829.08
|
| Rate for Payer: First Choice Health Commercial |
$761.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$803.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.43
|
| Rate for Payer: HealthUtah PPO |
$846.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$820.62
|
| Rate for Payer: Multiplan Medicare/VA |
$161.87
|
| Rate for Payer: One Health Plan of WY PPO |
$829.08
|
| Rate for Payer: PacificSource Commercial |
$761.40
|
| Rate for Payer: PHCS PPO |
$803.70
|
| Rate for Payer: Three Rivers PPO |
$634.50
|
| Rate for Payer: TriWest Veterans Administration |
$190.43
|
| Rate for Payer: United Healthcare Commercial |
$803.70
|
| Rate for Payer: WINHealth Partners Commercial |
$719.10
|
|
|
CIRCUMCISION NEONATE
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
HCPCS 54160
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$622.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$609.56
|
| Rate for Payer: Aetna of WY Medicare |
$140.12
|
| Rate for Payer: Beech Street Commercial |
$590.90
|
| Rate for Payer: Cash Price |
$435.40
|
| Rate for Payer: Cash Price |
$435.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$603.34
|
| Rate for Payer: Cigna of WY Commercial |
$609.56
|
| Rate for Payer: First Choice Health Commercial |
$559.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$590.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.12
|
| Rate for Payer: HealthUtah PPO |
$622.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$603.34
|
| Rate for Payer: Multiplan Medicare/VA |
$119.10
|
| Rate for Payer: One Health Plan of WY PPO |
$609.56
|
| Rate for Payer: PacificSource Commercial |
$559.80
|
| Rate for Payer: PHCS PPO |
$590.90
|
| Rate for Payer: Three Rivers PPO |
$466.50
|
| Rate for Payer: TriWest Veterans Administration |
$140.12
|
| Rate for Payer: United Healthcare Commercial |
$590.90
|
| Rate for Payer: WINHealth Partners Commercial |
$528.70
|
|
|
CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 54150
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$413.56
|
| Rate for Payer: Beech Street Commercial |
$400.90
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$409.34
|
| Rate for Payer: Cigna of WY Commercial |
$413.56
|
| Rate for Payer: First Choice Health Commercial |
$379.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$400.90
|
| Rate for Payer: HealthUtah PPO |
$422.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$409.34
|
| Rate for Payer: One Health Plan of WY PPO |
$413.56
|
| Rate for Payer: PacificSource Commercial |
$379.80
|
| Rate for Payer: PHCS PPO |
$400.90
|
| Rate for Payer: Three Rivers PPO |
$316.50
|
| Rate for Payer: United Healthcare Commercial |
$400.90
|
| Rate for Payer: WINHealth Partners Commercial |
$358.70
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [12719]
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
NDC 0703203303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.99
|
| Rate for Payer: Aetna of WY Medicare |
$16.83
|
| Rate for Payer: Altius Commercial |
$24.48
|
| Rate for Payer: Beech Street Commercial |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.74
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.74
|
| Rate for Payer: Cigna of WY Commercial |
$24.99
|
| Rate for Payer: Entrust Commercial |
$24.22
|
| Rate for Payer: First Choice Health Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.54
|
| Rate for Payer: HealthUtah PPO |
$25.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.74
|
| Rate for Payer: Multiplan Medicare/VA |
$13.81
|
| Rate for Payer: One Health Plan of WY PPO |
$24.99
|
| Rate for Payer: PacificSource Commercial |
$22.95
|
| Rate for Payer: PHCS PPO |
$24.99
|
| Rate for Payer: Three Rivers PPO |
$19.12
|
| Rate for Payer: TriWest Veterans Administration |
$14.54
|
| Rate for Payer: United Healthcare Commercial |
$24.35
|
| Rate for Payer: United Healthcare Medicare |
$14.54
|
| Rate for Payer: WINHealth Partners Commercial |
$24.99
|
| Rate for Payer: Wise Provider Network Commercial |
$24.22
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [12719]
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
NDC 0143939601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.36
|
| Rate for Payer: Aetna of WY Medicare |
$13.04
|
| Rate for Payer: Altius Commercial |
$18.97
|
| Rate for Payer: Beech Street Commercial |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.17
|
| Rate for Payer: Cigna of WY Commercial |
$19.36
|
| Rate for Payer: Entrust Commercial |
$18.77
|
| Rate for Payer: First Choice Health Commercial |
$18.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.26
|
| Rate for Payer: HealthUtah PPO |
$19.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.17
|
| Rate for Payer: Multiplan Medicare/VA |
$10.70
|
| Rate for Payer: One Health Plan of WY PPO |
$19.36
|
| Rate for Payer: PacificSource Commercial |
$17.78
|
| Rate for Payer: PHCS PPO |
$19.36
|
| Rate for Payer: Three Rivers PPO |
$14.82
|
| Rate for Payer: TriWest Veterans Administration |
$11.26
|
| Rate for Payer: United Healthcare Commercial |
$18.87
|
| Rate for Payer: United Healthcare Medicare |
$11.26
|
| Rate for Payer: WINHealth Partners Commercial |
$19.36
|
| Rate for Payer: Wise Provider Network Commercial |
$18.77
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [12719]
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
NDC 0703203303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.99
|
| Rate for Payer: Aetna of WY Medicare |
$16.32
|
| Rate for Payer: Altius Commercial |
$24.48
|
| Rate for Payer: Beech Street Commercial |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.74
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.74
|
| Rate for Payer: Cigna of WY Commercial |
$24.99
|
| Rate for Payer: Entrust Commercial |
$24.22
|
| Rate for Payer: First Choice Health Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.56
|
| Rate for Payer: HealthUtah PPO |
$25.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.74
|
| Rate for Payer: Multiplan Medicare/VA |
$14.78
|
| Rate for Payer: One Health Plan of WY PPO |
$24.99
|
| Rate for Payer: PacificSource Commercial |
$22.95
|
| Rate for Payer: PHCS PPO |
$24.99
|
| Rate for Payer: Three Rivers PPO |
$19.12
|
| Rate for Payer: TriWest Veterans Administration |
$15.56
|
| Rate for Payer: United Healthcare Commercial |
$24.35
|
| Rate for Payer: United Healthcare Medicare |
$15.56
|
| Rate for Payer: WINHealth Partners Commercial |
$24.22
|
| Rate for Payer: Wise Provider Network Commercial |
$24.22
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION [12719]
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
NDC 0143939601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.36
|
| Rate for Payer: Aetna of WY Medicare |
$12.65
|
| Rate for Payer: Altius Commercial |
$18.97
|
| Rate for Payer: Beech Street Commercial |
$19.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.17
|
| Rate for Payer: Cigna of WY Commercial |
$19.36
|
| Rate for Payer: Entrust Commercial |
$18.77
|
| Rate for Payer: First Choice Health Commercial |
$18.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.05
|
| Rate for Payer: HealthUtah PPO |
$19.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.17
|
| Rate for Payer: Multiplan Medicare/VA |
$11.45
|
| Rate for Payer: One Health Plan of WY PPO |
$19.36
|
| Rate for Payer: PacificSource Commercial |
$17.78
|
| Rate for Payer: PHCS PPO |
$19.36
|
| Rate for Payer: Three Rivers PPO |
$14.82
|
| Rate for Payer: TriWest Veterans Administration |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$18.87
|
| Rate for Payer: United Healthcare Medicare |
$12.05
|
| Rate for Payer: WINHealth Partners Commercial |
$18.77
|
| Rate for Payer: Wise Provider Network Commercial |
$18.77
|
|
|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [11330]
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
HCPCS J9060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.32
|
| Rate for Payer: Aetna of WY Medicare |
$10.66
|
| Rate for Payer: Altius Commercial |
$15.98
|
| Rate for Payer: Beech Street Commercial |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.15
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.15
|
| Rate for Payer: Cigna of WY Commercial |
$16.32
|
| Rate for Payer: Entrust Commercial |
$15.82
|
| Rate for Payer: First Choice Health Commercial |
$15.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.16
|
| Rate for Payer: HealthUtah PPO |
$16.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.15
|
| Rate for Payer: Multiplan Medicare/VA |
$9.65
|
| Rate for Payer: One Health Plan of WY PPO |
$16.32
|
| Rate for Payer: PacificSource Commercial |
$14.98
|
| Rate for Payer: PHCS PPO |
$16.32
|
| Rate for Payer: Three Rivers PPO |
$12.49
|
| Rate for Payer: TriWest Veterans Administration |
$10.16
|
| Rate for Payer: United Healthcare Commercial |
$15.90
|
| Rate for Payer: United Healthcare Medicare |
$10.16
|
| Rate for Payer: WINHealth Partners Commercial |
$15.82
|
| Rate for Payer: Wise Provider Network Commercial |
$15.82
|
|
