|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [40256]
|
Facility
|
OP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Aetna of WY Medicare |
$13.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.08
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$11.53
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$18.20
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$20.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [40256]
|
Facility
|
IP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.08
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.81
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$13.12
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$13.81
|
| Rate for Payer: United Healthcare Commercial |
$18.20
|
| Rate for Payer: United Healthcare Medicare |
$13.81
|
| Rate for Payer: WINHealth Partners Commercial |
$19.87
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [40255]
|
Facility
|
OP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Aetna of WY Medicare |
$13.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.08
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$11.53
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$18.20
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$20.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [40255]
|
Facility
|
IP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.08
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.18
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.81
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$13.12
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$13.81
|
| Rate for Payer: United Healthcare Commercial |
$18.20
|
| Rate for Payer: United Healthcare Medicare |
$13.81
|
| Rate for Payer: WINHealth Partners Commercial |
$19.87
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIREFLUX VALVE (SALEM)
|
Facility
|
OP
|
$10.91
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.69
|
| Rate for Payer: Aetna of WY Medicare |
$7.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.47
|
| Rate for Payer: Altius Commercial |
$10.47
|
| Rate for Payer: Beech Street Commercial |
$10.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.96
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.58
|
| Rate for Payer: Cigna of WY Commercial |
$10.69
|
| Rate for Payer: Entrust Commercial |
$10.36
|
| Rate for Payer: First Choice Health Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.33
|
| Rate for Payer: HealthUtah PPO |
$10.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.58
|
| Rate for Payer: Multiplan Medicare/VA |
$6.01
|
| Rate for Payer: One Health Plan of WY PPO |
$10.69
|
| Rate for Payer: PacificSource Commercial |
$9.82
|
| Rate for Payer: PHCS PPO |
$10.69
|
| Rate for Payer: Three Rivers PPO |
$8.18
|
| Rate for Payer: TriWest Veterans Administration |
$6.33
|
| Rate for Payer: United Healthcare Commercial |
$9.49
|
| Rate for Payer: United Healthcare Medicare |
$6.33
|
| Rate for Payer: WINHealth Partners Commercial |
$10.69
|
| Rate for Payer: Wise Provider Network Commercial |
$10.36
|
|
|
ANTIREFLUX VALVE (SALEM)
|
Facility
|
IP
|
$10.91
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.47
|
| Rate for Payer: Altius Commercial |
$10.47
|
| Rate for Payer: Beech Street Commercial |
$10.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.96
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.58
|
| Rate for Payer: Cigna of WY Commercial |
$10.69
|
| Rate for Payer: Entrust Commercial |
$10.36
|
| Rate for Payer: First Choice Health Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.20
|
| Rate for Payer: HealthUtah PPO |
$10.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.58
|
| Rate for Payer: Multiplan Medicare/VA |
$6.84
|
| Rate for Payer: One Health Plan of WY PPO |
$10.69
|
| Rate for Payer: PacificSource Commercial |
$9.82
|
| Rate for Payer: PHCS PPO |
$10.69
|
| Rate for Payer: Three Rivers PPO |
$8.18
|
| Rate for Payer: TriWest Veterans Administration |
$7.20
|
| Rate for Payer: United Healthcare Commercial |
$9.49
|
| Rate for Payer: United Healthcare Medicare |
$7.20
|
| Rate for Payer: WINHealth Partners Commercial |
$10.36
|
| Rate for Payer: Wise Provider Network Commercial |
$10.36
|
|
|
ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$3,531.00
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
51840
|
| Min. Negotiated Rate |
$569.68 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,460.38
|
| Rate for Payer: Aetna of WY Medicare |
$670.21
|
| Rate for Payer: Beech Street Commercial |
$3,354.45
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: Cash Price |
$2,471.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,425.07
|
| Rate for Payer: Cigna of WY Commercial |
$3,460.38
|
| Rate for Payer: First Choice Health Commercial |
$3,177.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,354.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$670.21
|
| Rate for Payer: HealthUtah PPO |
$3,531.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,425.07
|
| Rate for Payer: Multiplan Medicare/VA |
$569.68
|
| Rate for Payer: One Health Plan of WY PPO |
$3,460.38
|
| Rate for Payer: PacificSource Commercial |
$3,177.90
|
| Rate for Payer: PHCS PPO |
$3,354.45
|
| Rate for Payer: Three Rivers PPO |
$2,648.25
|
| Rate for Payer: TriWest Veterans Administration |
$670.21
|
| Rate for Payer: United Healthcare Commercial |
$3,071.97
|
| Rate for Payer: United Healthcare Medicare |
$670.21
|
| Rate for Payer: WINHealth Partners Commercial |
$3,001.35
|
|
|
APIXABAN 2.5 MG TABLET [125708]
|
Facility
|
IP
|
$30.32
|
|
|
Service Code
|
NDC 0003089331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.01 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.11
|
| Rate for Payer: Altius Commercial |
$29.11
|
| Rate for Payer: Beech Street Commercial |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.89
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.41
|
| Rate for Payer: Cigna of WY Commercial |
$29.71
|
| Rate for Payer: Entrust Commercial |
$28.80
|
| Rate for Payer: First Choice Health Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.01
|
| Rate for Payer: HealthUtah PPO |
$30.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.41
|
| Rate for Payer: Multiplan Medicare/VA |
$19.01
|
| Rate for Payer: One Health Plan of WY PPO |
$29.71
|
| Rate for Payer: PacificSource Commercial |
$27.29
|
| Rate for Payer: PHCS PPO |
$29.71
|
| Rate for Payer: Three Rivers PPO |
$22.74
|
| Rate for Payer: TriWest Veterans Administration |
$20.01
|
| Rate for Payer: United Healthcare Commercial |
$26.38
|
| Rate for Payer: United Healthcare Medicare |
$20.01
|
| Rate for Payer: WINHealth Partners Commercial |
$28.80
|
| Rate for Payer: Wise Provider Network Commercial |
$28.80
|
|
|
APIXABAN 2.5 MG TABLET [125708]
|
Facility
|
OP
|
$30.32
|
|
|
Service Code
|
NDC 0003089331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.71
|
| Rate for Payer: Aetna of WY Medicare |
$20.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.11
|
| Rate for Payer: Altius Commercial |
$29.11
|
| Rate for Payer: Beech Street Commercial |
$29.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.89
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.41
|
| Rate for Payer: Cigna of WY Commercial |
$29.71
|
| Rate for Payer: Entrust Commercial |
$28.80
|
| Rate for Payer: First Choice Health Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.59
|
| Rate for Payer: HealthUtah PPO |
$30.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.41
|
| Rate for Payer: Multiplan Medicare/VA |
$16.71
|
| Rate for Payer: One Health Plan of WY PPO |
$29.71
|
| Rate for Payer: PacificSource Commercial |
$27.29
|
| Rate for Payer: PHCS PPO |
$29.71
|
| Rate for Payer: Three Rivers PPO |
$22.74
|
| Rate for Payer: TriWest Veterans Administration |
$17.59
|
| Rate for Payer: United Healthcare Commercial |
$26.38
|
| Rate for Payer: United Healthcare Medicare |
$17.59
|
| Rate for Payer: WINHealth Partners Commercial |
$29.71
|
| Rate for Payer: Wise Provider Network Commercial |
$28.80
|
|
|
APIXABAN 5 MG TABLET [125766]
|
Facility
|
OP
|
$30.31
|
|
|
Service Code
|
NDC 0003089421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$30.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.70
|
| Rate for Payer: Aetna of WY Medicare |
$20.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.10
|
| Rate for Payer: Altius Commercial |
$29.10
|
| Rate for Payer: Beech Street Commercial |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.40
|
| Rate for Payer: Cigna of WY Commercial |
$29.70
|
| Rate for Payer: Entrust Commercial |
$28.79
|
| Rate for Payer: First Choice Health Commercial |
$28.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.58
|
| Rate for Payer: HealthUtah PPO |
$30.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.40
|
| Rate for Payer: Multiplan Medicare/VA |
$16.70
|
| Rate for Payer: One Health Plan of WY PPO |
$29.70
|
| Rate for Payer: PacificSource Commercial |
$27.28
|
| Rate for Payer: PHCS PPO |
$29.70
|
| Rate for Payer: Three Rivers PPO |
$22.73
|
| Rate for Payer: TriWest Veterans Administration |
$17.58
|
| Rate for Payer: United Healthcare Commercial |
$26.37
|
| Rate for Payer: United Healthcare Medicare |
$17.58
|
| Rate for Payer: WINHealth Partners Commercial |
$29.70
|
| Rate for Payer: Wise Provider Network Commercial |
$28.79
|
|
|
APIXABAN 5 MG TABLET [125766]
|
Facility
|
IP
|
$30.31
|
|
|
Service Code
|
NDC 0003089421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$30.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.10
|
| Rate for Payer: Altius Commercial |
$29.10
|
| Rate for Payer: Beech Street Commercial |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.40
|
| Rate for Payer: Cigna of WY Commercial |
$29.70
|
| Rate for Payer: Entrust Commercial |
$28.79
|
| Rate for Payer: First Choice Health Commercial |
$28.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.00
|
| Rate for Payer: HealthUtah PPO |
$30.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.40
|
| Rate for Payer: Multiplan Medicare/VA |
$19.00
|
| Rate for Payer: One Health Plan of WY PPO |
$29.70
|
| Rate for Payer: PacificSource Commercial |
$27.28
|
| Rate for Payer: PHCS PPO |
$29.70
|
| Rate for Payer: Three Rivers PPO |
$22.73
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$26.37
|
| Rate for Payer: United Healthcare Medicare |
$20.00
|
| Rate for Payer: WINHealth Partners Commercial |
$28.79
|
| Rate for Payer: Wise Provider Network Commercial |
$28.79
|
|
|
APIXABAN 5 MG TABLET [125766]
|
Facility
|
OP
|
$33.65
|
|
|
Service Code
|
NDC 0003089431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.98
|
| Rate for Payer: Aetna of WY Medicare |
$22.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.30
|
| Rate for Payer: Altius Commercial |
$32.30
|
| Rate for Payer: Beech Street Commercial |
$32.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.63
|
| Rate for Payer: Cash Price |
$23.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.64
|
| Rate for Payer: Cigna of WY Commercial |
$32.98
|
| Rate for Payer: Entrust Commercial |
$31.97
|
| Rate for Payer: First Choice Health Commercial |
$31.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.52
|
| Rate for Payer: HealthUtah PPO |
$33.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.64
|
| Rate for Payer: Multiplan Medicare/VA |
$18.54
|
| Rate for Payer: One Health Plan of WY PPO |
$32.98
|
| Rate for Payer: PacificSource Commercial |
$30.28
|
| Rate for Payer: PHCS PPO |
$32.98
|
| Rate for Payer: Three Rivers PPO |
$25.24
|
| Rate for Payer: TriWest Veterans Administration |
$19.52
|
| Rate for Payer: United Healthcare Commercial |
$29.28
|
| Rate for Payer: United Healthcare Medicare |
$19.52
|
| Rate for Payer: WINHealth Partners Commercial |
$32.98
|
| Rate for Payer: Wise Provider Network Commercial |
$31.97
|
|
|
APIXABAN 5 MG TABLET [125766]
|
Facility
|
IP
|
$33.65
|
|
|
Service Code
|
NDC 0003089431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.30
|
| Rate for Payer: Altius Commercial |
$32.30
|
| Rate for Payer: Beech Street Commercial |
$32.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.63
|
| Rate for Payer: Cash Price |
$23.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.64
|
| Rate for Payer: Cigna of WY Commercial |
$32.98
|
| Rate for Payer: Entrust Commercial |
$31.97
|
| Rate for Payer: First Choice Health Commercial |
$31.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.21
|
| Rate for Payer: HealthUtah PPO |
$33.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.64
|
| Rate for Payer: Multiplan Medicare/VA |
$21.10
|
| Rate for Payer: One Health Plan of WY PPO |
$32.98
|
| Rate for Payer: PacificSource Commercial |
$30.28
|
| Rate for Payer: PHCS PPO |
$32.98
|
| Rate for Payer: Three Rivers PPO |
$25.24
|
| Rate for Payer: TriWest Veterans Administration |
$22.21
|
| Rate for Payer: United Healthcare Commercial |
$29.28
|
| Rate for Payer: United Healthcare Medicare |
$22.21
|
| Rate for Payer: WINHealth Partners Commercial |
$31.97
|
| Rate for Payer: Wise Provider Network Commercial |
$31.97
|
|
|
APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 44955 AS
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$2,306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,259.88
|
| Rate for Payer: Aetna of WY Medicare |
$78.30
|
| Rate for Payer: Beech Street Commercial |
$2,190.70
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,236.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,259.88
|
| Rate for Payer: First Choice Health Commercial |
$2,075.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,190.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$2,306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,236.82
|
| Rate for Payer: Multiplan Medicare/VA |
$66.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,259.88
|
| Rate for Payer: PacificSource Commercial |
$2,075.40
|
| Rate for Payer: PHCS PPO |
$2,190.70
|
| Rate for Payer: Three Rivers PPO |
$1,729.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$2,006.22
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.10
|
|
|
APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 44955 80
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$2,306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,259.88
|
| Rate for Payer: Aetna of WY Medicare |
$78.30
|
| Rate for Payer: Beech Street Commercial |
$2,190.70
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,236.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,259.88
|
| Rate for Payer: First Choice Health Commercial |
$2,075.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,190.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$2,306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,236.82
|
| Rate for Payer: Multiplan Medicare/VA |
$66.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,259.88
|
| Rate for Payer: PacificSource Commercial |
$2,075.40
|
| Rate for Payer: PHCS PPO |
$2,190.70
|
| Rate for Payer: Three Rivers PPO |
$1,729.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$2,006.22
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.10
|
|
|
APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$2,306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,259.88
|
| Rate for Payer: Aetna of WY Medicare |
$78.30
|
| Rate for Payer: Beech Street Commercial |
$2,190.70
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: Cash Price |
$1,614.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,236.82
|
| Rate for Payer: Cigna of WY Commercial |
$2,259.88
|
| Rate for Payer: First Choice Health Commercial |
$2,075.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,190.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.30
|
| Rate for Payer: HealthUtah PPO |
$2,306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,236.82
|
| Rate for Payer: Multiplan Medicare/VA |
$66.56
|
| Rate for Payer: One Health Plan of WY PPO |
$2,259.88
|
| Rate for Payer: PacificSource Commercial |
$2,075.40
|
| Rate for Payer: PHCS PPO |
$2,190.70
|
| Rate for Payer: Three Rivers PPO |
$1,729.50
|
| Rate for Payer: TriWest Veterans Administration |
$78.30
|
| Rate for Payer: United Healthcare Commercial |
$2,006.22
|
| Rate for Payer: United Healthcare Medicare |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,960.10
|
|
|
APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$4,541.00
|
|
|
Service Code
|
HCPCS 44960 80
|
| Hospital Charge Code |
44960
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$4,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,450.18
|
| Rate for Payer: Aetna of WY Medicare |
$831.79
|
| Rate for Payer: Beech Street Commercial |
$4,313.95
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,404.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,450.18
|
| Rate for Payer: First Choice Health Commercial |
$4,086.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,313.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.79
|
| Rate for Payer: HealthUtah PPO |
$4,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,404.77
|
| Rate for Payer: Multiplan Medicare/VA |
$707.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4,450.18
|
| Rate for Payer: PacificSource Commercial |
$4,086.90
|
| Rate for Payer: PHCS PPO |
$4,313.95
|
| Rate for Payer: Three Rivers PPO |
$3,405.75
|
| Rate for Payer: TriWest Veterans Administration |
$831.79
|
| Rate for Payer: United Healthcare Commercial |
$3,950.67
|
| Rate for Payer: United Healthcare Medicare |
$831.79
|
| Rate for Payer: WINHealth Partners Commercial |
$3,859.85
|
|
|
APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$4,541.00
|
|
|
Service Code
|
HCPCS 44960 AS
|
| Hospital Charge Code |
44960
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$4,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,450.18
|
| Rate for Payer: Aetna of WY Medicare |
$831.79
|
| Rate for Payer: Beech Street Commercial |
$4,313.95
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,404.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,450.18
|
| Rate for Payer: First Choice Health Commercial |
$4,086.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,313.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.79
|
| Rate for Payer: HealthUtah PPO |
$4,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,404.77
|
| Rate for Payer: Multiplan Medicare/VA |
$707.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4,450.18
|
| Rate for Payer: PacificSource Commercial |
$4,086.90
|
| Rate for Payer: PHCS PPO |
$4,313.95
|
| Rate for Payer: Three Rivers PPO |
$3,405.75
|
| Rate for Payer: TriWest Veterans Administration |
$831.79
|
| Rate for Payer: United Healthcare Commercial |
$3,950.67
|
| Rate for Payer: United Healthcare Medicare |
$831.79
|
| Rate for Payer: WINHealth Partners Commercial |
$3,859.85
|
|
|
APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$4,541.00
|
|
|
Service Code
|
HCPCS 44960
|
| Hospital Charge Code |
44960
|
| Min. Negotiated Rate |
$707.02 |
| Max. Negotiated Rate |
$4,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,450.18
|
| Rate for Payer: Aetna of WY Medicare |
$831.79
|
| Rate for Payer: Beech Street Commercial |
$4,313.95
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: Cash Price |
$3,178.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,404.77
|
| Rate for Payer: Cigna of WY Commercial |
$4,450.18
|
| Rate for Payer: First Choice Health Commercial |
$4,086.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,313.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$831.79
|
| Rate for Payer: HealthUtah PPO |
$4,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,404.77
|
| Rate for Payer: Multiplan Medicare/VA |
$707.02
|
| Rate for Payer: One Health Plan of WY PPO |
$4,450.18
|
| Rate for Payer: PacificSource Commercial |
$4,086.90
|
| Rate for Payer: PHCS PPO |
$4,313.95
|
| Rate for Payer: Three Rivers PPO |
$3,405.75
|
| Rate for Payer: TriWest Veterans Administration |
$831.79
|
| Rate for Payer: United Healthcare Commercial |
$3,950.67
|
| Rate for Payer: United Healthcare Medicare |
$831.79
|
| Rate for Payer: WINHealth Partners Commercial |
$3,859.85
|
|
|
APPENDECTOMY
|
Professional
|
Both
|
$3,330.00
|
|
|
Service Code
|
HCPCS 44950 80
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,263.40
|
| Rate for Payer: Aetna of WY Medicare |
$610.31
|
| Rate for Payer: Beech Street Commercial |
$3,163.50
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,230.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,263.40
|
| Rate for Payer: First Choice Health Commercial |
$2,997.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.31
|
| Rate for Payer: HealthUtah PPO |
$3,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,230.10
|
| Rate for Payer: Multiplan Medicare/VA |
$518.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,263.40
|
| Rate for Payer: PacificSource Commercial |
$2,997.00
|
| Rate for Payer: PHCS PPO |
$3,163.50
|
| Rate for Payer: Three Rivers PPO |
$2,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$610.31
|
| Rate for Payer: United Healthcare Commercial |
$2,897.10
|
| Rate for Payer: United Healthcare Medicare |
$610.31
|
| Rate for Payer: WINHealth Partners Commercial |
$2,830.50
|
|
|
APPENDECTOMY
|
Professional
|
Both
|
$3,330.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,263.40
|
| Rate for Payer: Aetna of WY Medicare |
$610.31
|
| Rate for Payer: Beech Street Commercial |
$3,163.50
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: Cash Price |
$2,331.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,230.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,263.40
|
| Rate for Payer: First Choice Health Commercial |
$2,997.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,163.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$610.31
|
| Rate for Payer: HealthUtah PPO |
$3,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,230.10
|
| Rate for Payer: Multiplan Medicare/VA |
$518.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,263.40
|
| Rate for Payer: PacificSource Commercial |
$2,997.00
|
| Rate for Payer: PHCS PPO |
$3,163.50
|
| Rate for Payer: Three Rivers PPO |
$2,497.50
|
| Rate for Payer: TriWest Veterans Administration |
$610.31
|
| Rate for Payer: United Healthcare Commercial |
$2,897.10
|
| Rate for Payer: United Healthcare Medicare |
$610.31
|
| Rate for Payer: WINHealth Partners Commercial |
$2,830.50
|
|
|
APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
29075
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.82
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Beech Street Commercial |
$293.55
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.73
|
| Rate for Payer: Cigna of WY Commercial |
$302.82
|
| Rate for Payer: First Choice Health Commercial |
$278.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: HealthUtah PPO |
$309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.73
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: One Health Plan of WY PPO |
$302.82
|
| Rate for Payer: PacificSource Commercial |
$278.10
|
| Rate for Payer: PHCS PPO |
$293.55
|
| Rate for Payer: Three Rivers PPO |
$231.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$268.83
|
| Rate for Payer: United Healthcare Medicare |
$60.60
|
| Rate for Payer: WINHealth Partners Commercial |
$262.65
|
|
|
APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 29075 50
|
| Hospital Charge Code |
29075
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$60.60
|
| Rate for Payer: Beech Street Commercial |
$587.10
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$599.46
|
| Rate for Payer: Cigna of WY Commercial |
$605.64
|
| Rate for Payer: First Choice Health Commercial |
$556.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$587.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.60
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$51.51
|
| Rate for Payer: One Health Plan of WY PPO |
$605.64
|
| Rate for Payer: PacificSource Commercial |
$556.20
|
| Rate for Payer: PHCS PPO |
$587.10
|
| Rate for Payer: Three Rivers PPO |
$463.50
|
| Rate for Payer: TriWest Veterans Administration |
$60.60
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$60.60
|
| Rate for Payer: WINHealth Partners Commercial |
$525.30
|
|
|
APPLICATION CAST FINGER
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
29086
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.84
|
| Rate for Payer: Aetna of WY Medicare |
$48.19
|
| Rate for Payer: Beech Street Commercial |
$340.10
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$347.26
|
| Rate for Payer: Cigna of WY Commercial |
$350.84
|
| Rate for Payer: First Choice Health Commercial |
$322.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$347.26
|
| Rate for Payer: Multiplan Medicare/VA |
$40.96
|
| Rate for Payer: One Health Plan of WY PPO |
$350.84
|
| Rate for Payer: PacificSource Commercial |
$322.20
|
| Rate for Payer: PHCS PPO |
$340.10
|
| Rate for Payer: Three Rivers PPO |
$268.50
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$311.46
|
| Rate for Payer: United Healthcare Medicare |
$48.19
|
| Rate for Payer: WINHealth Partners Commercial |
$304.30
|
|
|
APPLICATION CAST HAND & LOWER FOREARM GAUNTLET
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
29085
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$333.20
|
| Rate for Payer: Aetna of WY Medicare |
$65.43
|
| Rate for Payer: Beech Street Commercial |
$323.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.80
|
| Rate for Payer: Cigna of WY Commercial |
$333.20
|
| Rate for Payer: First Choice Health Commercial |
$306.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$323.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.43
|
| Rate for Payer: HealthUtah PPO |
$340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.80
|
| Rate for Payer: Multiplan Medicare/VA |
$55.62
|
| Rate for Payer: One Health Plan of WY PPO |
$333.20
|
| Rate for Payer: PacificSource Commercial |
$306.00
|
| Rate for Payer: PHCS PPO |
$323.00
|
| Rate for Payer: Three Rivers PPO |
$255.00
|
| Rate for Payer: TriWest Veterans Administration |
$65.43
|
| Rate for Payer: United Healthcare Commercial |
$295.80
|
| Rate for Payer: United Healthcare Medicare |
$65.43
|
| Rate for Payer: WINHealth Partners Commercial |
$289.00
|
|
