|
ESTRADIOL VALERATE 10 MG INJ
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J1380
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.58
|
| Rate for Payer: Aetna of WY Medicare |
$8.66
|
| Rate for Payer: Beech Street Commercial |
$19.95
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$18.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$21.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.37
|
| Rate for Payer: Multiplan Medicare/VA |
$7.36
|
| Rate for Payer: One Health Plan of WY PPO |
$20.58
|
| Rate for Payer: PacificSource Commercial |
$18.90
|
| Rate for Payer: PHCS PPO |
$19.95
|
| Rate for Payer: Three Rivers PPO |
$15.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$19.95
|
| Rate for Payer: WINHealth Partners Commercial |
$19.95
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL [11312]
|
Facility
|
IP
|
$70.63
|
|
|
Service Code
|
HCPCS J1380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$70.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.22
|
| Rate for Payer: Aetna of WY Medicare |
$45.20
|
| Rate for Payer: Altius Commercial |
$67.80
|
| Rate for Payer: Beech Street Commercial |
$69.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.51
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.51
|
| Rate for Payer: Cigna of WY Commercial |
$69.22
|
| Rate for Payer: Entrust Commercial |
$67.10
|
| Rate for Payer: First Choice Health Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.08
|
| Rate for Payer: HealthUtah PPO |
$70.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.51
|
| Rate for Payer: Multiplan Medicare/VA |
$40.93
|
| Rate for Payer: One Health Plan of WY PPO |
$69.22
|
| Rate for Payer: PacificSource Commercial |
$63.57
|
| Rate for Payer: PHCS PPO |
$69.22
|
| Rate for Payer: Three Rivers PPO |
$52.97
|
| Rate for Payer: TriWest Veterans Administration |
$43.08
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare |
$43.08
|
| Rate for Payer: WINHealth Partners Commercial |
$67.10
|
| Rate for Payer: Wise Provider Network Commercial |
$67.10
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL [11312]
|
Facility
|
OP
|
$70.63
|
|
|
Service Code
|
HCPCS J1380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$70.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.22
|
| Rate for Payer: Aetna of WY Medicare |
$46.62
|
| Rate for Payer: Altius Commercial |
$67.80
|
| Rate for Payer: Beech Street Commercial |
$69.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.51
|
| Rate for Payer: Cash Price |
$49.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.51
|
| Rate for Payer: Cigna of WY Commercial |
$69.22
|
| Rate for Payer: Entrust Commercial |
$67.10
|
| Rate for Payer: First Choice Health Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.26
|
| Rate for Payer: HealthUtah PPO |
$70.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.51
|
| Rate for Payer: Multiplan Medicare/VA |
$38.25
|
| Rate for Payer: One Health Plan of WY PPO |
$69.22
|
| Rate for Payer: PacificSource Commercial |
$63.57
|
| Rate for Payer: PHCS PPO |
$69.22
|
| Rate for Payer: Three Rivers PPO |
$52.97
|
| Rate for Payer: TriWest Veterans Administration |
$40.26
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: United Healthcare Medicare |
$40.26
|
| Rate for Payer: WINHealth Partners Commercial |
$69.22
|
| Rate for Payer: Wise Provider Network Commercial |
$67.10
|
|
|
ETHICON LIGACLIP 10MM ER320
|
Facility
|
IP
|
$195.12
|
|
| Hospital Charge Code |
2650761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.07 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.22
|
| Rate for Payer: Aetna of WY Medicare |
$124.88
|
| Rate for Payer: Altius Commercial |
$187.32
|
| Rate for Payer: Beech Street Commercial |
$191.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$189.27
|
| Rate for Payer: Cash Price |
$136.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.27
|
| Rate for Payer: Cigna of WY Commercial |
$191.22
|
| Rate for Payer: Entrust Commercial |
$185.36
|
| Rate for Payer: First Choice Health Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.02
|
| Rate for Payer: HealthUtah PPO |
$195.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.27
|
| Rate for Payer: Multiplan Medicare/VA |
$113.07
|
| Rate for Payer: One Health Plan of WY PPO |
$191.22
|
| Rate for Payer: PacificSource Commercial |
$175.61
|
| Rate for Payer: PHCS PPO |
$191.22
|
| Rate for Payer: Three Rivers PPO |
$146.34
|
| Rate for Payer: TriWest Veterans Administration |
$119.02
|
| Rate for Payer: United Healthcare Commercial |
$186.34
|
| Rate for Payer: United Healthcare Medicare |
$119.02
|
| Rate for Payer: WINHealth Partners Commercial |
$185.36
|
| Rate for Payer: Wise Provider Network Commercial |
$185.36
|
|
|
ETHICON LIGACLIP 10MM ER320
|
Facility
|
OP
|
$195.12
|
|
| Hospital Charge Code |
2650761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: United Healthcare Commercial |
$186.34
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.22
|
| Rate for Payer: Aetna of WY Medicare |
$128.78
|
| Rate for Payer: Altius Commercial |
$187.32
|
| Rate for Payer: Beech Street Commercial |
$191.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$189.27
|
| Rate for Payer: Cash Price |
$136.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.27
|
| Rate for Payer: Cigna of WY Commercial |
$191.22
|
| Rate for Payer: Entrust Commercial |
$185.36
|
| Rate for Payer: First Choice Health Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.22
|
| Rate for Payer: HealthUtah PPO |
$195.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.27
|
| Rate for Payer: Multiplan Medicare/VA |
$105.66
|
| Rate for Payer: One Health Plan of WY PPO |
$191.22
|
| Rate for Payer: PacificSource Commercial |
$175.61
|
| Rate for Payer: PHCS PPO |
$191.22
|
| Rate for Payer: Three Rivers PPO |
$146.34
|
| Rate for Payer: TriWest Veterans Administration |
$111.22
|
| Rate for Payer: United Healthcare Medicare |
$111.22
|
| Rate for Payer: WINHealth Partners Commercial |
$191.22
|
| Rate for Payer: Wise Provider Network Commercial |
$185.36
|
|
|
ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 31201 50
|
| Min. Negotiated Rate |
$2,533.50 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,310.44
|
| Rate for Payer: Beech Street Commercial |
$3,209.10
|
| Rate for Payer: Cash Price |
$2,364.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,276.66
|
| Rate for Payer: Cigna of WY Commercial |
$3,310.44
|
| Rate for Payer: First Choice Health Commercial |
$3,040.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,209.10
|
| Rate for Payer: HealthUtah PPO |
$3,378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,276.66
|
| Rate for Payer: One Health Plan of WY PPO |
$3,310.44
|
| Rate for Payer: PacificSource Commercial |
$3,040.20
|
| Rate for Payer: PHCS PPO |
$3,209.10
|
| Rate for Payer: Three Rivers PPO |
$2,533.50
|
| Rate for Payer: United Healthcare Commercial |
$3,209.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,871.30
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 0143950610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.54
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: WINHealth Partners Commercial |
$17.14
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 0143950701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.19
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.67
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.14
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.67
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$10.67
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$16.34
|
|
|
Service Code
|
NDC 0143950601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 0143950701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.54
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: WINHealth Partners Commercial |
$17.14
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$16.34
|
|
|
Service Code
|
NDC 0143950601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.46
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION [10495]
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 0143950610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.14
|
| Rate for Payer: Aetna of WY Medicare |
$11.19
|
| Rate for Payer: Altius Commercial |
$16.79
|
| Rate for Payer: Beech Street Commercial |
$17.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.97
|
| Rate for Payer: Cigna of WY Commercial |
$17.14
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.67
|
| Rate for Payer: HealthUtah PPO |
$17.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.14
|
| Rate for Payer: One Health Plan of WY PPO |
$17.14
|
| Rate for Payer: PacificSource Commercial |
$15.74
|
| Rate for Payer: PHCS PPO |
$17.14
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.67
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$10.67
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [41762]
|
Facility
|
OP
|
$1,107.48
|
|
|
Service Code
|
NDC 7820614501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$599.70 |
| Max. Negotiated Rate |
$1,107.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,085.33
|
| Rate for Payer: Aetna of WY Medicare |
$730.94
|
| Rate for Payer: Altius Commercial |
$1,063.18
|
| Rate for Payer: Beech Street Commercial |
$1,085.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,074.26
|
| Rate for Payer: Cash Price |
$775.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,074.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,085.33
|
| Rate for Payer: Entrust Commercial |
$1,052.11
|
| Rate for Payer: First Choice Health Commercial |
$1,052.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,052.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$631.26
|
| Rate for Payer: HealthUtah PPO |
$1,107.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,074.26
|
| Rate for Payer: Multiplan Medicare/VA |
$599.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,085.33
|
| Rate for Payer: PacificSource Commercial |
$996.73
|
| Rate for Payer: PHCS PPO |
$1,085.33
|
| Rate for Payer: Three Rivers PPO |
$830.61
|
| Rate for Payer: TriWest Veterans Administration |
$631.26
|
| Rate for Payer: United Healthcare Commercial |
$1,057.64
|
| Rate for Payer: United Healthcare Medicare |
$631.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1,085.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1,052.11
|
|
|
ETONOGESTREL 68 MG SUBDERMAL IMPLANT [41762]
|
Facility
|
IP
|
$1,107.48
|
|
|
Service Code
|
NDC 7820614501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$641.78 |
| Max. Negotiated Rate |
$1,107.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,085.33
|
| Rate for Payer: Aetna of WY Medicare |
$708.79
|
| Rate for Payer: Altius Commercial |
$1,063.18
|
| Rate for Payer: Beech Street Commercial |
$1,085.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,074.26
|
| Rate for Payer: Cash Price |
$775.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,074.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,085.33
|
| Rate for Payer: Entrust Commercial |
$1,052.11
|
| Rate for Payer: First Choice Health Commercial |
$1,052.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,052.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$675.56
|
| Rate for Payer: HealthUtah PPO |
$1,107.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,074.26
|
| Rate for Payer: Multiplan Medicare/VA |
$641.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,085.33
|
| Rate for Payer: PacificSource Commercial |
$996.73
|
| Rate for Payer: PHCS PPO |
$1,085.33
|
| Rate for Payer: Three Rivers PPO |
$830.61
|
| Rate for Payer: TriWest Veterans Administration |
$675.56
|
| Rate for Payer: United Healthcare Commercial |
$1,057.64
|
| Rate for Payer: United Healthcare Medicare |
$675.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,052.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1,052.11
|
|
|
ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$597.00 |
| Max. Negotiated Rate |
$796.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$780.08
|
| Rate for Payer: Beech Street Commercial |
$756.20
|
| Rate for Payer: Cash Price |
$557.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$772.12
|
| Rate for Payer: Cigna of WY Commercial |
$780.08
|
| Rate for Payer: First Choice Health Commercial |
$716.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$756.20
|
| Rate for Payer: HealthUtah PPO |
$796.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$772.12
|
| Rate for Payer: One Health Plan of WY PPO |
$780.08
|
| Rate for Payer: PacificSource Commercial |
$716.40
|
| Rate for Payer: PHCS PPO |
$756.20
|
| Rate for Payer: Three Rivers PPO |
$597.00
|
| Rate for Payer: United Healthcare Commercial |
$756.20
|
| Rate for Payer: WINHealth Partners Commercial |
$756.20
|
|
|
ET TUBE HOLDER ADULT 600-10000
|
Facility
|
IP
|
$0.34
|
|
| Hospital Charge Code |
2100097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
ET TUBE HOLDER ADULT 600-10000
|
Facility
|
OP
|
$0.34
|
|
| Hospital Charge Code |
2100097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
ET TUBE HOLDER ANCHORFAST 9799
|
Facility
|
IP
|
$26.42
|
|
| Hospital Charge Code |
2100001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$26.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.89
|
| Rate for Payer: Aetna of WY Medicare |
$16.91
|
| Rate for Payer: Altius Commercial |
$25.36
|
| Rate for Payer: Beech Street Commercial |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.63
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.63
|
| Rate for Payer: Cigna of WY Commercial |
$25.89
|
| Rate for Payer: Entrust Commercial |
$25.10
|
| Rate for Payer: First Choice Health Commercial |
$25.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.12
|
| Rate for Payer: HealthUtah PPO |
$26.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.63
|
| Rate for Payer: Multiplan Medicare/VA |
$15.31
|
| Rate for Payer: One Health Plan of WY PPO |
$25.89
|
| Rate for Payer: PacificSource Commercial |
$23.78
|
| Rate for Payer: PHCS PPO |
$25.89
|
| Rate for Payer: Three Rivers PPO |
$19.82
|
| Rate for Payer: TriWest Veterans Administration |
$16.12
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$16.12
|
| Rate for Payer: WINHealth Partners Commercial |
$25.10
|
| Rate for Payer: Wise Provider Network Commercial |
$25.10
|
|
|
ET TUBE HOLDER ANCHORFAST 9799
|
Facility
|
OP
|
$26.42
|
|
| Hospital Charge Code |
2100001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$26.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.89
|
| Rate for Payer: Aetna of WY Medicare |
$17.44
|
| Rate for Payer: Altius Commercial |
$25.36
|
| Rate for Payer: Beech Street Commercial |
$25.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.63
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.63
|
| Rate for Payer: Cigna of WY Commercial |
$25.89
|
| Rate for Payer: Entrust Commercial |
$25.10
|
| Rate for Payer: First Choice Health Commercial |
$25.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.06
|
| Rate for Payer: HealthUtah PPO |
$26.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.63
|
| Rate for Payer: Multiplan Medicare/VA |
$14.31
|
| Rate for Payer: One Health Plan of WY PPO |
$25.89
|
| Rate for Payer: PacificSource Commercial |
$23.78
|
| Rate for Payer: PHCS PPO |
$25.89
|
| Rate for Payer: Three Rivers PPO |
$19.82
|
| Rate for Payer: TriWest Veterans Administration |
$15.06
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$15.06
|
| Rate for Payer: WINHealth Partners Commercial |
$25.89
|
| Rate for Payer: Wise Provider Network Commercial |
$25.10
|
|
|
ET TUBE HOLDER PED
|
Facility
|
OP
|
$11.16
|
|
| Hospital Charge Code |
4600002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$11.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.94
|
| Rate for Payer: Aetna of WY Medicare |
$7.37
|
| Rate for Payer: Altius Commercial |
$10.71
|
| Rate for Payer: Beech Street Commercial |
$10.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.83
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.83
|
| Rate for Payer: Cigna of WY Commercial |
$10.94
|
| Rate for Payer: Entrust Commercial |
$10.60
|
| Rate for Payer: First Choice Health Commercial |
$10.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.36
|
| Rate for Payer: HealthUtah PPO |
$11.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.83
|
| Rate for Payer: Multiplan Medicare/VA |
$6.04
|
| Rate for Payer: One Health Plan of WY PPO |
$10.94
|
| Rate for Payer: PacificSource Commercial |
$10.04
|
| Rate for Payer: PHCS PPO |
$10.94
|
| Rate for Payer: Three Rivers PPO |
$8.37
|
| Rate for Payer: TriWest Veterans Administration |
$6.36
|
| Rate for Payer: United Healthcare Commercial |
$10.66
|
| Rate for Payer: United Healthcare Medicare |
$6.36
|
| Rate for Payer: WINHealth Partners Commercial |
$10.94
|
| Rate for Payer: Wise Provider Network Commercial |
$10.60
|
|
|
ET TUBE HOLDER PED
|
Facility
|
IP
|
$11.16
|
|
| Hospital Charge Code |
4600002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$11.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.94
|
| Rate for Payer: Aetna of WY Medicare |
$7.14
|
| Rate for Payer: Altius Commercial |
$10.71
|
| Rate for Payer: Beech Street Commercial |
$10.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.83
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.83
|
| Rate for Payer: Cigna of WY Commercial |
$10.94
|
| Rate for Payer: Entrust Commercial |
$10.60
|
| Rate for Payer: First Choice Health Commercial |
$10.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.81
|
| Rate for Payer: HealthUtah PPO |
$11.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.83
|
| Rate for Payer: Multiplan Medicare/VA |
$6.47
|
| Rate for Payer: One Health Plan of WY PPO |
$10.94
|
| Rate for Payer: PacificSource Commercial |
$10.04
|
| Rate for Payer: PHCS PPO |
$10.94
|
| Rate for Payer: Three Rivers PPO |
$8.37
|
| Rate for Payer: TriWest Veterans Administration |
$6.81
|
| Rate for Payer: United Healthcare Commercial |
$10.66
|
| Rate for Payer: United Healthcare Medicare |
$6.81
|
| Rate for Payer: WINHealth Partners Commercial |
$10.60
|
| Rate for Payer: Wise Provider Network Commercial |
$10.60
|
|
|
ET TUBE INTRODUCER BOUGIE ADULT
|
Facility
|
IP
|
$18.53
|
|
| Hospital Charge Code |
2500071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.16
|
| Rate for Payer: Aetna of WY Medicare |
$11.86
|
| Rate for Payer: Altius Commercial |
$17.79
|
| Rate for Payer: Beech Street Commercial |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.97
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.97
|
| Rate for Payer: Cigna of WY Commercial |
$18.16
|
| Rate for Payer: Entrust Commercial |
$17.60
|
| Rate for Payer: First Choice Health Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.30
|
| Rate for Payer: HealthUtah PPO |
$18.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.74
|
| Rate for Payer: One Health Plan of WY PPO |
$18.16
|
| Rate for Payer: PacificSource Commercial |
$16.68
|
| Rate for Payer: PHCS PPO |
$18.16
|
| Rate for Payer: Three Rivers PPO |
$13.90
|
| Rate for Payer: TriWest Veterans Administration |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$17.70
|
| Rate for Payer: United Healthcare Medicare |
$11.30
|
| Rate for Payer: WINHealth Partners Commercial |
$17.60
|
| Rate for Payer: Wise Provider Network Commercial |
$17.60
|
|
|
ET TUBE INTRODUCER BOUGIE ADULT
|
Facility
|
OP
|
$18.53
|
|
| Hospital Charge Code |
2500071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.16
|
| Rate for Payer: Aetna of WY Medicare |
$12.23
|
| Rate for Payer: Altius Commercial |
$17.79
|
| Rate for Payer: Beech Street Commercial |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.97
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.97
|
| Rate for Payer: Cigna of WY Commercial |
$18.16
|
| Rate for Payer: Entrust Commercial |
$17.60
|
| Rate for Payer: First Choice Health Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$18.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$18.16
|
| Rate for Payer: PacificSource Commercial |
$16.68
|
| Rate for Payer: PHCS PPO |
$18.16
|
| Rate for Payer: Three Rivers PPO |
$13.90
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$17.70
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$18.16
|
| Rate for Payer: Wise Provider Network Commercial |
$17.60
|
|
|
ET TUBE INTRODUCER BOUGIE PEDIATRIC
|
Facility
|
OP
|
$18.53
|
|
| Hospital Charge Code |
2500069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.16
|
| Rate for Payer: Aetna of WY Medicare |
$12.23
|
| Rate for Payer: Altius Commercial |
$17.79
|
| Rate for Payer: Beech Street Commercial |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.97
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.97
|
| Rate for Payer: Cigna of WY Commercial |
$18.16
|
| Rate for Payer: Entrust Commercial |
$17.60
|
| Rate for Payer: First Choice Health Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$18.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.03
|
| Rate for Payer: One Health Plan of WY PPO |
$18.16
|
| Rate for Payer: PacificSource Commercial |
$16.68
|
| Rate for Payer: PHCS PPO |
$18.16
|
| Rate for Payer: Three Rivers PPO |
$13.90
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$17.70
|
| Rate for Payer: United Healthcare Medicare |
$10.56
|
| Rate for Payer: WINHealth Partners Commercial |
$18.16
|
| Rate for Payer: Wise Provider Network Commercial |
$17.60
|
|
|
ET TUBE INTRODUCER BOUGIE PEDIATRIC
|
Facility
|
IP
|
$18.53
|
|
| Hospital Charge Code |
2500069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.16
|
| Rate for Payer: Aetna of WY Medicare |
$11.86
|
| Rate for Payer: Altius Commercial |
$17.79
|
| Rate for Payer: Beech Street Commercial |
$18.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.97
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.97
|
| Rate for Payer: Cigna of WY Commercial |
$18.16
|
| Rate for Payer: Entrust Commercial |
$17.60
|
| Rate for Payer: First Choice Health Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.30
|
| Rate for Payer: HealthUtah PPO |
$18.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.97
|
| Rate for Payer: Multiplan Medicare/VA |
$10.74
|
| Rate for Payer: One Health Plan of WY PPO |
$18.16
|
| Rate for Payer: PacificSource Commercial |
$16.68
|
| Rate for Payer: PHCS PPO |
$18.16
|
| Rate for Payer: Three Rivers PPO |
$13.90
|
| Rate for Payer: TriWest Veterans Administration |
$11.30
|
| Rate for Payer: United Healthcare Commercial |
$17.70
|
| Rate for Payer: United Healthcare Medicare |
$11.30
|
| Rate for Payer: WINHealth Partners Commercial |
$17.60
|
| Rate for Payer: Wise Provider Network Commercial |
$17.60
|
|
