|
HC PRO COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
HCPCS 57421 NONPBBPAYER
|
| Hospital Charge Code |
9835742101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$618.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$605.64
|
| Rate for Payer: Aetna of WY Medicare |
$116.27
|
| 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 |
$116.27
|
| Rate for Payer: HealthUtah PPO |
$618.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$599.46
|
| Rate for Payer: Multiplan Medicare/VA |
$98.83
|
| 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 |
$116.27
|
| Rate for Payer: United Healthcare Commercial |
$537.66
|
| Rate for Payer: United Healthcare Medicare |
$116.27
|
| Rate for Payer: WINHealth Partners Commercial |
$525.30
|
|
|
HC PRO COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
9835742101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$494.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$484.12
|
| Rate for Payer: Aetna of WY Medicare |
$116.27
|
| Rate for Payer: Beech Street Commercial |
$469.30
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$479.18
|
| Rate for Payer: Cigna of WY Commercial |
$484.12
|
| Rate for Payer: First Choice Health Commercial |
$444.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$469.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.27
|
| Rate for Payer: HealthUtah PPO |
$494.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$479.18
|
| Rate for Payer: Multiplan Medicare/VA |
$98.83
|
| Rate for Payer: One Health Plan of WY PPO |
$484.12
|
| Rate for Payer: PacificSource Commercial |
$444.60
|
| Rate for Payer: PHCS PPO |
$469.30
|
| Rate for Payer: Three Rivers PPO |
$370.50
|
| Rate for Payer: TriWest Veterans Administration |
$116.27
|
| Rate for Payer: United Healthcare Commercial |
$429.78
|
| Rate for Payer: United Healthcare Medicare |
$116.27
|
| Rate for Payer: WINHealth Partners Commercial |
$419.90
|
|
|
HC PRO COLPOSCOPY VULVA
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 56820
|
| Hospital Charge Code |
9825682001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$68.39 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Aetna of WY Medicare |
$80.46
|
| Rate for Payer: Beech Street Commercial |
$495.90
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.34
|
| Rate for Payer: Cigna of WY Commercial |
$511.56
|
| Rate for Payer: First Choice Health Commercial |
$469.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.46
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: Multiplan Medicare/VA |
$68.39
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$495.90
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: TriWest Veterans Administration |
$80.46
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: United Healthcare Medicare |
$80.46
|
| Rate for Payer: WINHealth Partners Commercial |
$443.70
|
|
|
HC PRO COLPOSCOPY,VULVA,W/BIOPSY(S)
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
9835682101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$561.54
|
| Rate for Payer: Aetna of WY Medicare |
$108.34
|
| Rate for Payer: Beech Street Commercial |
$544.35
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.81
|
| Rate for Payer: Cigna of WY Commercial |
$561.54
|
| Rate for Payer: First Choice Health Commercial |
$515.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$544.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.34
|
| Rate for Payer: HealthUtah PPO |
$573.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.81
|
| Rate for Payer: Multiplan Medicare/VA |
$92.09
|
| Rate for Payer: One Health Plan of WY PPO |
$561.54
|
| Rate for Payer: PacificSource Commercial |
$515.70
|
| Rate for Payer: PHCS PPO |
$544.35
|
| Rate for Payer: Three Rivers PPO |
$429.75
|
| Rate for Payer: TriWest Veterans Administration |
$108.34
|
| Rate for Payer: United Healthcare Commercial |
$498.51
|
| Rate for Payer: United Healthcare Medicare |
$108.34
|
| Rate for Payer: WINHealth Partners Commercial |
$487.05
|
|
|
HC PRO COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$2,995.00
|
|
|
Service Code
|
HCPCS 45386
|
| Hospital Charge Code |
9834538601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$2,995.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,935.10
|
| Rate for Payer: Aetna of WY Medicare |
$200.55
|
| Rate for Payer: Beech Street Commercial |
$2,845.25
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,905.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,935.10
|
| Rate for Payer: First Choice Health Commercial |
$2,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,845.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.55
|
| Rate for Payer: HealthUtah PPO |
$2,995.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,905.15
|
| Rate for Payer: Multiplan Medicare/VA |
$170.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,935.10
|
| Rate for Payer: PacificSource Commercial |
$2,695.50
|
| Rate for Payer: PHCS PPO |
$2,845.25
|
| Rate for Payer: Three Rivers PPO |
$2,246.25
|
| Rate for Payer: TriWest Veterans Administration |
$200.55
|
| Rate for Payer: United Healthcare Commercial |
$2,605.65
|
| Rate for Payer: United Healthcare Medicare |
$200.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,545.75
|
|
|
HC PRO COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST - COLONOSCOPY
|
Professional
|
Both
|
$1,342.00
|
|
|
Service Code
|
HCPCS 45381
|
| Hospital Charge Code |
9834538101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$1,342.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,315.16
|
| Rate for Payer: Aetna of WY Medicare |
$189.76
|
| Rate for Payer: Beech Street Commercial |
$1,274.90
|
| Rate for Payer: Cash Price |
$939.40
|
| Rate for Payer: Cash Price |
$939.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,301.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,315.16
|
| Rate for Payer: First Choice Health Commercial |
$1,207.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,274.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.76
|
| Rate for Payer: HealthUtah PPO |
$1,342.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,301.74
|
| Rate for Payer: Multiplan Medicare/VA |
$161.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,315.16
|
| Rate for Payer: PacificSource Commercial |
$1,207.80
|
| Rate for Payer: PHCS PPO |
$1,274.90
|
| Rate for Payer: Three Rivers PPO |
$1,006.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.76
|
| Rate for Payer: United Healthcare Commercial |
$1,167.54
|
| Rate for Payer: United Healthcare Medicare |
$189.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,140.70
|
|
|
HC PRO COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS - COLONOSCOPY
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
HCPCS 45384
|
| Hospital Charge Code |
9834538401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$1,997.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,957.06
|
| Rate for Payer: Aetna of WY Medicare |
$215.40
|
| Rate for Payer: Beech Street Commercial |
$1,897.15
|
| Rate for Payer: Cash Price |
$1,397.90
|
| Rate for Payer: Cash Price |
$1,397.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,937.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,957.06
|
| Rate for Payer: First Choice Health Commercial |
$1,797.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,897.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$215.40
|
| Rate for Payer: HealthUtah PPO |
$1,997.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,937.09
|
| Rate for Payer: Multiplan Medicare/VA |
$183.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,957.06
|
| Rate for Payer: PacificSource Commercial |
$1,797.30
|
| Rate for Payer: PHCS PPO |
$1,897.15
|
| Rate for Payer: Three Rivers PPO |
$1,497.75
|
| Rate for Payer: TriWest Veterans Administration |
$215.40
|
| Rate for Payer: United Healthcare Commercial |
$1,737.39
|
| Rate for Payer: United Healthcare Medicare |
$215.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,697.45
|
|
|
HC PRO COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ - COLONOSCOPY
|
Professional
|
Both
|
$2,289.00
|
|
|
Service Code
|
HCPCS 45385
|
| Hospital Charge Code |
9834538501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,243.22
|
| Rate for Payer: Aetna of WY Medicare |
$240.47
|
| Rate for Payer: Beech Street Commercial |
$2,174.55
|
| Rate for Payer: Cash Price |
$1,602.30
|
| Rate for Payer: Cash Price |
$1,602.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,220.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,243.22
|
| Rate for Payer: First Choice Health Commercial |
$2,060.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,174.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.47
|
| Rate for Payer: HealthUtah PPO |
$2,289.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,220.33
|
| Rate for Payer: Multiplan Medicare/VA |
$204.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,243.22
|
| Rate for Payer: PacificSource Commercial |
$2,060.10
|
| Rate for Payer: PHCS PPO |
$2,174.55
|
| Rate for Payer: Three Rivers PPO |
$1,716.75
|
| Rate for Payer: TriWest Veterans Administration |
$240.47
|
| Rate for Payer: United Healthcare Commercial |
$1,991.43
|
| Rate for Payer: United Healthcare Medicare |
$240.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,945.65
|
|
|
HC PRO COMP ASSES CARE PLAN CCM SVC
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS G0506
|
| Hospital Charge Code |
983G050601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$42.38
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.38
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$36.02
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$42.38
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$42.38
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
|
|
HC PRO COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 99487
|
| Hospital Charge Code |
5109948701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$86.73
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: First Choice Health Commercial |
$44.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.73
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$73.72
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.73
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$86.73
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
|
|
HC PRO COMPLEX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 99489
|
| Hospital Charge Code |
5109948901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$48.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$48.19
|
| Rate for Payer: Beech Street Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: First Choice Health Commercial |
$20.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$40.96
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$21.85
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$48.19
|
| Rate for Payer: WINHealth Partners Commercial |
$21.85
|
|
|
HC PRO COMPLEX UROFLOWMETRY
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 51741 50,NONPBBPAYER
|
| Hospital Charge Code |
9835174101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.76
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Beech Street Commercial |
$106.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.64
|
| Rate for Payer: Cigna of WY Commercial |
$109.76
|
| Rate for Payer: First Choice Health Commercial |
$100.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.82
|
| Rate for Payer: HealthUtah PPO |
$112.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.64
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$109.76
|
| Rate for Payer: PacificSource Commercial |
$100.80
|
| Rate for Payer: PHCS PPO |
$106.40
|
| Rate for Payer: Three Rivers PPO |
$84.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$97.44
|
| Rate for Payer: United Healthcare Medicare |
$13.82
|
| Rate for Payer: WINHealth Partners Commercial |
$95.20
|
|
|
HC PRO COMPLEX UROFLOWMETRY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 51741 NONPBBPAYER
|
| Hospital Charge Code |
9835174101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Beech Street Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: First Choice Health Commercial |
$50.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.82
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$53.20
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$13.82
|
| Rate for Payer: WINHealth Partners Commercial |
$47.60
|
|
|
HC PRO COMPLEX UROFLOWMETRY
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
9835174101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.10
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Beech Street Commercial |
$42.75
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.65
|
| Rate for Payer: Cigna of WY Commercial |
$44.10
|
| Rate for Payer: First Choice Health Commercial |
$40.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.82
|
| Rate for Payer: HealthUtah PPO |
$45.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.65
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$44.10
|
| Rate for Payer: PacificSource Commercial |
$40.50
|
| Rate for Payer: PHCS PPO |
$42.75
|
| Rate for Payer: Three Rivers PPO |
$33.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$39.15
|
| Rate for Payer: United Healthcare Medicare |
$13.82
|
| Rate for Payer: WINHealth Partners Commercial |
$38.25
|
|
|
HC PRO COMPLEX UROFLOWMETRY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 51741 26
|
| Hospital Charge Code |
9835174101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$8.02
|
| Rate for Payer: Beech Street Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: First Choice Health Commercial |
$50.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.02
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$6.82
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$53.20
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$48.72
|
| Rate for Payer: United Healthcare Medicare |
$8.02
|
| Rate for Payer: WINHealth Partners Commercial |
$47.60
|
|
|
HC PRO CONIZATION OF CERVIX
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 57520 NONPBBPAYER
|
| Hospital Charge Code |
9835752001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$245.41 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,967.84
|
| Rate for Payer: Aetna of WY Medicare |
$288.72
|
| Rate for Payer: Beech Street Commercial |
$1,907.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,947.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,967.84
|
| Rate for Payer: First Choice Health Commercial |
$1,807.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,907.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$288.72
|
| Rate for Payer: HealthUtah PPO |
$2,008.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,947.76
|
| Rate for Payer: Multiplan Medicare/VA |
$245.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,967.84
|
| Rate for Payer: PacificSource Commercial |
$1,807.20
|
| Rate for Payer: PHCS PPO |
$1,907.60
|
| Rate for Payer: Three Rivers PPO |
$1,506.00
|
| Rate for Payer: TriWest Veterans Administration |
$288.72
|
| Rate for Payer: United Healthcare Commercial |
$1,746.96
|
| Rate for Payer: United Healthcare Medicare |
$288.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,706.80
|
|
|
HC PRO CONIZATION OF CERVIX
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 57522 NONPBBPAYER
|
| Hospital Charge Code |
9835752201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$2,248.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,203.04
|
| Rate for Payer: Aetna of WY Medicare |
$248.23
|
| Rate for Payer: Beech Street Commercial |
$2,135.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,180.56
|
| Rate for Payer: Cigna of WY Commercial |
$2,203.04
|
| Rate for Payer: First Choice Health Commercial |
$2,023.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,135.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$248.23
|
| Rate for Payer: HealthUtah PPO |
$2,248.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,180.56
|
| Rate for Payer: Multiplan Medicare/VA |
$211.00
|
| Rate for Payer: One Health Plan of WY PPO |
$2,203.04
|
| Rate for Payer: PacificSource Commercial |
$2,023.20
|
| Rate for Payer: PHCS PPO |
$2,135.60
|
| Rate for Payer: Three Rivers PPO |
$1,686.00
|
| Rate for Payer: TriWest Veterans Administration |
$248.23
|
| Rate for Payer: United Healthcare Commercial |
$1,955.76
|
| Rate for Payer: United Healthcare Medicare |
$248.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,910.80
|
|
|
HC PRO CONIZATION OF CERVIX
|
Professional
|
Both
|
$1,606.00
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
9835752001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$245.41 |
| Max. Negotiated Rate |
$1,606.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,573.88
|
| Rate for Payer: Aetna of WY Medicare |
$288.72
|
| Rate for Payer: Beech Street Commercial |
$1,525.70
|
| Rate for Payer: Cash Price |
$1,124.20
|
| Rate for Payer: Cash Price |
$1,124.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,557.82
|
| Rate for Payer: Cigna of WY Commercial |
$1,573.88
|
| Rate for Payer: First Choice Health Commercial |
$1,445.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,525.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$288.72
|
| Rate for Payer: HealthUtah PPO |
$1,606.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,557.82
|
| Rate for Payer: Multiplan Medicare/VA |
$245.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,573.88
|
| Rate for Payer: PacificSource Commercial |
$1,445.40
|
| Rate for Payer: PHCS PPO |
$1,525.70
|
| Rate for Payer: Three Rivers PPO |
$1,204.50
|
| Rate for Payer: TriWest Veterans Administration |
$288.72
|
| Rate for Payer: United Healthcare Commercial |
$1,397.22
|
| Rate for Payer: United Healthcare Medicare |
$288.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,365.10
|
|
|
HC PRO CONIZATION OF CERVIX
|
Professional
|
Both
|
$1,798.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
9835752201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$1,798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,762.04
|
| Rate for Payer: Aetna of WY Medicare |
$248.23
|
| Rate for Payer: Beech Street Commercial |
$1,708.10
|
| Rate for Payer: Cash Price |
$1,258.60
|
| Rate for Payer: Cash Price |
$1,258.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,744.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,762.04
|
| Rate for Payer: First Choice Health Commercial |
$1,618.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,708.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$248.23
|
| Rate for Payer: HealthUtah PPO |
$1,798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,744.06
|
| Rate for Payer: Multiplan Medicare/VA |
$211.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,762.04
|
| Rate for Payer: PacificSource Commercial |
$1,618.20
|
| Rate for Payer: PHCS PPO |
$1,708.10
|
| Rate for Payer: Three Rivers PPO |
$1,348.50
|
| Rate for Payer: TriWest Veterans Administration |
$248.23
|
| Rate for Payer: United Healthcare Commercial |
$1,564.26
|
| Rate for Payer: United Healthcare Medicare |
$248.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,528.30
|
|
|
HC PRO CONTROL THROAT BLEED,SIMPLE
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
9834296001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.93 |
| Max. Negotiated Rate |
$1,244.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,219.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$790.86
|
| Rate for Payer: Aetna of WY Medicare |
$156.39
|
| Rate for Payer: Aetna of WY Medicare |
$156.39
|
| Rate for Payer: Beech Street Commercial |
$766.65
|
| Rate for Payer: Beech Street Commercial |
$1,181.80
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: Cash Price |
$870.80
|
| Rate for Payer: Cash Price |
$870.80
|
| Rate for Payer: Cash Price |
$564.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$782.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,206.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,219.12
|
| Rate for Payer: Cigna of WY Commercial |
$790.86
|
| Rate for Payer: First Choice Health Commercial |
$726.30
|
| Rate for Payer: First Choice Health Commercial |
$1,119.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,181.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$766.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.39
|
| Rate for Payer: HealthUtah PPO |
$1,244.00
|
| Rate for Payer: HealthUtah PPO |
$807.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$782.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,206.68
|
| Rate for Payer: Multiplan Medicare/VA |
$132.93
|
| Rate for Payer: Multiplan Medicare/VA |
$132.93
|
| Rate for Payer: One Health Plan of WY PPO |
$790.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,219.12
|
| Rate for Payer: PacificSource Commercial |
$1,119.60
|
| Rate for Payer: PacificSource Commercial |
$726.30
|
| Rate for Payer: PHCS PPO |
$1,181.80
|
| Rate for Payer: PHCS PPO |
$766.65
|
| Rate for Payer: Three Rivers PPO |
$933.00
|
| Rate for Payer: Three Rivers PPO |
$605.25
|
| Rate for Payer: TriWest Veterans Administration |
$156.39
|
| Rate for Payer: TriWest Veterans Administration |
$156.39
|
| Rate for Payer: United Healthcare Commercial |
$702.09
|
| Rate for Payer: United Healthcare Commercial |
$1,082.28
|
| Rate for Payer: United Healthcare Medicare |
$156.39
|
| Rate for Payer: United Healthcare Medicare |
$156.39
|
| Rate for Payer: WINHealth Partners Commercial |
$1,057.40
|
| Rate for Payer: WINHealth Partners Commercial |
$685.95
|
|
|
HC PRO CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGFT
|
Professional
|
Both
|
$8,646.00
|
|
|
Service Code
|
HCPCS 27132
|
| Hospital Charge Code |
9832713201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$1,357.72 |
| Max. Negotiated Rate |
$8,646.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,473.08
|
| Rate for Payer: Aetna of WY Medicare |
$1,597.32
|
| Rate for Payer: Beech Street Commercial |
$8,213.70
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: Cash Price |
$6,052.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,386.62
|
| Rate for Payer: Cigna of WY Commercial |
$8,473.08
|
| Rate for Payer: First Choice Health Commercial |
$7,781.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,213.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,597.32
|
| Rate for Payer: HealthUtah PPO |
$8,646.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,386.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,357.72
|
| Rate for Payer: One Health Plan of WY PPO |
$8,473.08
|
| Rate for Payer: PacificSource Commercial |
$7,781.40
|
| Rate for Payer: PHCS PPO |
$8,213.70
|
| Rate for Payer: Three Rivers PPO |
$6,484.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,597.32
|
| Rate for Payer: United Healthcare Commercial |
$7,522.02
|
| Rate for Payer: United Healthcare Medicare |
$1,597.32
|
| Rate for Payer: WINHealth Partners Commercial |
$7,349.10
|
|
|
HC PRO CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY
|
Professional
|
Both
|
$3,572.00
|
|
|
Service Code
|
HCPCS 23415
|
| Hospital Charge Code |
9832341501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$578.14 |
| Max. Negotiated Rate |
$3,572.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,500.56
|
| Rate for Payer: Aetna of WY Medicare |
$680.16
|
| Rate for Payer: Beech Street Commercial |
$3,393.40
|
| Rate for Payer: Cash Price |
$2,500.40
|
| Rate for Payer: Cash Price |
$2,500.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,464.84
|
| Rate for Payer: Cigna of WY Commercial |
$3,500.56
|
| Rate for Payer: First Choice Health Commercial |
$3,214.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,393.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$680.16
|
| Rate for Payer: HealthUtah PPO |
$3,572.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,464.84
|
| Rate for Payer: Multiplan Medicare/VA |
$578.14
|
| Rate for Payer: One Health Plan of WY PPO |
$3,500.56
|
| Rate for Payer: PacificSource Commercial |
$3,214.80
|
| Rate for Payer: PHCS PPO |
$3,393.40
|
| Rate for Payer: Three Rivers PPO |
$2,679.00
|
| Rate for Payer: TriWest Veterans Administration |
$680.16
|
| Rate for Payer: United Healthcare Commercial |
$3,107.64
|
| Rate for Payer: United Healthcare Medicare |
$680.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3,036.20
|
|
|
HC PRO CORRECTION HAMMERTOE
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 28285
|
| Hospital Charge Code |
9752828501
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$322.19 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,116.80
|
| Rate for Payer: Aetna of WY Medicare |
$379.05
|
| Rate for Payer: Beech Street Commercial |
$2,052.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,095.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,116.80
|
| Rate for Payer: First Choice Health Commercial |
$1,944.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,052.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.05
|
| Rate for Payer: HealthUtah PPO |
$2,160.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,095.20
|
| Rate for Payer: Multiplan Medicare/VA |
$322.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,116.80
|
| Rate for Payer: PacificSource Commercial |
$1,944.00
|
| Rate for Payer: PHCS PPO |
$2,052.00
|
| Rate for Payer: Three Rivers PPO |
$1,620.00
|
| Rate for Payer: TriWest Veterans Administration |
$379.05
|
| Rate for Payer: United Healthcare Commercial |
$1,879.20
|
| Rate for Payer: United Healthcare Medicare |
$379.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,836.00
|
|
|
HC PRO CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT
|
Professional
|
Both
|
$5,451.00
|
|
|
Service Code
|
HCPCS 28296
|
| Hospital Charge Code |
9832829601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$426.65 |
| Max. Negotiated Rate |
$5,451.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,341.98
|
| Rate for Payer: Aetna of WY Medicare |
$501.94
|
| Rate for Payer: Beech Street Commercial |
$5,178.45
|
| Rate for Payer: Cash Price |
$3,815.70
|
| Rate for Payer: Cash Price |
$3,815.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,287.47
|
| Rate for Payer: Cigna of WY Commercial |
$5,341.98
|
| Rate for Payer: First Choice Health Commercial |
$4,905.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,178.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.94
|
| Rate for Payer: HealthUtah PPO |
$5,451.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,287.47
|
| Rate for Payer: Multiplan Medicare/VA |
$426.65
|
| Rate for Payer: One Health Plan of WY PPO |
$5,341.98
|
| Rate for Payer: PacificSource Commercial |
$4,905.90
|
| Rate for Payer: PHCS PPO |
$5,178.45
|
| Rate for Payer: Three Rivers PPO |
$4,088.25
|
| Rate for Payer: TriWest Veterans Administration |
$501.94
|
| Rate for Payer: United Healthcare Commercial |
$4,742.37
|
| Rate for Payer: United Healthcare Medicare |
$501.94
|
| Rate for Payer: WINHealth Partners Commercial |
$4,633.35
|
|
|
HC PRO CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL
|
Professional
|
Both
|
$4,325.00
|
|
|
Service Code
|
HCPCS 28292
|
| Hospital Charge Code |
9832829201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$404.32 |
| Max. Negotiated Rate |
$4,325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,238.50
|
| Rate for Payer: Aetna of WY Medicare |
$475.67
|
| Rate for Payer: Beech Street Commercial |
$4,108.75
|
| Rate for Payer: Cash Price |
$3,027.50
|
| Rate for Payer: Cash Price |
$3,027.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,195.25
|
| Rate for Payer: Cigna of WY Commercial |
$4,238.50
|
| Rate for Payer: First Choice Health Commercial |
$3,892.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,108.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$475.67
|
| Rate for Payer: HealthUtah PPO |
$4,325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,195.25
|
| Rate for Payer: Multiplan Medicare/VA |
$404.32
|
| Rate for Payer: One Health Plan of WY PPO |
$4,238.50
|
| Rate for Payer: PacificSource Commercial |
$3,892.50
|
| Rate for Payer: PHCS PPO |
$4,108.75
|
| Rate for Payer: Three Rivers PPO |
$3,243.75
|
| Rate for Payer: TriWest Veterans Administration |
$475.67
|
| Rate for Payer: United Healthcare Commercial |
$3,762.75
|
| Rate for Payer: United Healthcare Medicare |
$475.67
|
| Rate for Payer: WINHealth Partners Commercial |
$3,676.25
|
|
