|
KIT PATIENT CARE SPINE TABLE
|
Facility
|
OP
|
$102.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$102.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.97
|
| Rate for Payer: Aetna of WY Medicare |
$67.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.93
|
| Rate for Payer: Altius Commercial |
$97.93
|
| Rate for Payer: Beech Street Commercial |
$99.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.75
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.95
|
| Rate for Payer: Cigna of WY Commercial |
$99.97
|
| Rate for Payer: Entrust Commercial |
$96.91
|
| Rate for Payer: First Choice Health Commercial |
$96.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.17
|
| Rate for Payer: HealthUtah PPO |
$102.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.95
|
| Rate for Payer: Multiplan Medicare/VA |
$56.21
|
| Rate for Payer: One Health Plan of WY PPO |
$99.97
|
| Rate for Payer: PacificSource Commercial |
$91.81
|
| Rate for Payer: PHCS PPO |
$99.97
|
| Rate for Payer: Three Rivers PPO |
$76.51
|
| Rate for Payer: TriWest Veterans Administration |
$59.17
|
| Rate for Payer: United Healthcare Commercial |
$88.75
|
| Rate for Payer: United Healthcare Medicare |
$59.17
|
| Rate for Payer: WINHealth Partners Commercial |
$99.97
|
| Rate for Payer: Wise Provider Network Commercial |
$96.91
|
|
|
KIT PATIENT CARE SPINE TABLE
|
Facility
|
IP
|
$102.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$102.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.93
|
| Rate for Payer: Altius Commercial |
$97.93
|
| Rate for Payer: Beech Street Commercial |
$99.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.75
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.95
|
| Rate for Payer: Cigna of WY Commercial |
$99.97
|
| Rate for Payer: Entrust Commercial |
$96.91
|
| Rate for Payer: First Choice Health Commercial |
$96.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.33
|
| Rate for Payer: HealthUtah PPO |
$102.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.95
|
| Rate for Payer: Multiplan Medicare/VA |
$63.96
|
| Rate for Payer: One Health Plan of WY PPO |
$99.97
|
| Rate for Payer: PacificSource Commercial |
$91.81
|
| Rate for Payer: PHCS PPO |
$99.97
|
| Rate for Payer: Three Rivers PPO |
$76.51
|
| Rate for Payer: TriWest Veterans Administration |
$67.33
|
| Rate for Payer: United Healthcare Commercial |
$88.75
|
| Rate for Payer: United Healthcare Medicare |
$67.33
|
| Rate for Payer: WINHealth Partners Commercial |
$96.91
|
| Rate for Payer: Wise Provider Network Commercial |
$96.91
|
|
|
KIT THORA-PARACENTESIS 8FR
|
Facility
|
OP
|
$56.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.27 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.62
|
| Rate for Payer: Aetna of WY Medicare |
$37.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.49
|
| Rate for Payer: Altius Commercial |
$54.49
|
| Rate for Payer: Beech Street Commercial |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.06
|
| Rate for Payer: Cigna of WY Commercial |
$55.62
|
| Rate for Payer: Entrust Commercial |
$53.92
|
| Rate for Payer: First Choice Health Commercial |
$53.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.92
|
| Rate for Payer: HealthUtah PPO |
$56.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.06
|
| Rate for Payer: Multiplan Medicare/VA |
$31.27
|
| Rate for Payer: One Health Plan of WY PPO |
$55.62
|
| Rate for Payer: PacificSource Commercial |
$51.08
|
| Rate for Payer: PHCS PPO |
$55.62
|
| Rate for Payer: Three Rivers PPO |
$42.57
|
| Rate for Payer: TriWest Veterans Administration |
$32.92
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
| Rate for Payer: United Healthcare Medicare |
$32.92
|
| Rate for Payer: WINHealth Partners Commercial |
$55.62
|
| Rate for Payer: Wise Provider Network Commercial |
$53.92
|
|
|
KIT THORA-PARACENTESIS 8FR
|
Facility
|
IP
|
$56.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.49
|
| Rate for Payer: Altius Commercial |
$54.49
|
| Rate for Payer: Beech Street Commercial |
$55.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.06
|
| Rate for Payer: Cigna of WY Commercial |
$55.62
|
| Rate for Payer: Entrust Commercial |
$53.92
|
| Rate for Payer: First Choice Health Commercial |
$53.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.46
|
| Rate for Payer: HealthUtah PPO |
$56.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.06
|
| Rate for Payer: Multiplan Medicare/VA |
$35.59
|
| Rate for Payer: One Health Plan of WY PPO |
$55.62
|
| Rate for Payer: PacificSource Commercial |
$51.08
|
| Rate for Payer: PHCS PPO |
$55.62
|
| Rate for Payer: Three Rivers PPO |
$42.57
|
| Rate for Payer: TriWest Veterans Administration |
$37.46
|
| Rate for Payer: United Healthcare Commercial |
$49.38
|
| Rate for Payer: United Healthcare Medicare |
$37.46
|
| Rate for Payer: WINHealth Partners Commercial |
$53.92
|
| Rate for Payer: Wise Provider Network Commercial |
$53.92
|
|
|
KITTNER LAPAROSCOPIC DISSECTOR
|
Facility
|
IP
|
$30.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.84
|
| Rate for Payer: Altius Commercial |
$28.84
|
| Rate for Payer: Beech Street Commercial |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.66
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.14
|
| Rate for Payer: Cigna of WY Commercial |
$29.44
|
| Rate for Payer: Entrust Commercial |
$28.54
|
| Rate for Payer: First Choice Health Commercial |
$28.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.83
|
| Rate for Payer: HealthUtah PPO |
$30.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.14
|
| Rate for Payer: Multiplan Medicare/VA |
$18.84
|
| Rate for Payer: One Health Plan of WY PPO |
$29.44
|
| Rate for Payer: PacificSource Commercial |
$27.04
|
| Rate for Payer: PHCS PPO |
$29.44
|
| Rate for Payer: Three Rivers PPO |
$22.53
|
| Rate for Payer: TriWest Veterans Administration |
$19.83
|
| Rate for Payer: United Healthcare Commercial |
$26.13
|
| Rate for Payer: United Healthcare Medicare |
$19.83
|
| Rate for Payer: WINHealth Partners Commercial |
$28.54
|
| Rate for Payer: Wise Provider Network Commercial |
$28.54
|
|
|
KITTNER LAPAROSCOPIC DISSECTOR
|
Facility
|
OP
|
$30.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.44
|
| Rate for Payer: Aetna of WY Medicare |
$19.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.84
|
| Rate for Payer: Altius Commercial |
$28.84
|
| Rate for Payer: Beech Street Commercial |
$29.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.66
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.14
|
| Rate for Payer: Cigna of WY Commercial |
$29.44
|
| Rate for Payer: Entrust Commercial |
$28.54
|
| Rate for Payer: First Choice Health Commercial |
$28.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.42
|
| Rate for Payer: HealthUtah PPO |
$30.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.14
|
| Rate for Payer: Multiplan Medicare/VA |
$16.55
|
| Rate for Payer: One Health Plan of WY PPO |
$29.44
|
| Rate for Payer: PacificSource Commercial |
$27.04
|
| Rate for Payer: PHCS PPO |
$29.44
|
| Rate for Payer: Three Rivers PPO |
$22.53
|
| Rate for Payer: TriWest Veterans Administration |
$17.42
|
| Rate for Payer: United Healthcare Commercial |
$26.13
|
| Rate for Payer: United Healthcare Medicare |
$17.42
|
| Rate for Payer: WINHealth Partners Commercial |
$29.44
|
| Rate for Payer: Wise Provider Network Commercial |
$28.54
|
|
|
KIWI OMNICUP FORCE VAC-6000MT
|
Facility
|
OP
|
$101.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$101.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.32
|
| Rate for Payer: Aetna of WY Medicare |
$66.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.30
|
| Rate for Payer: Altius Commercial |
$97.30
|
| Rate for Payer: Beech Street Commercial |
$99.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.21
|
| Rate for Payer: Cash Price |
$70.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.31
|
| Rate for Payer: Cigna of WY Commercial |
$99.32
|
| Rate for Payer: Entrust Commercial |
$96.28
|
| Rate for Payer: First Choice Health Commercial |
$96.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.78
|
| Rate for Payer: HealthUtah PPO |
$101.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.31
|
| Rate for Payer: Multiplan Medicare/VA |
$55.84
|
| Rate for Payer: One Health Plan of WY PPO |
$99.32
|
| Rate for Payer: PacificSource Commercial |
$91.22
|
| Rate for Payer: PHCS PPO |
$99.32
|
| Rate for Payer: Three Rivers PPO |
$76.01
|
| Rate for Payer: TriWest Veterans Administration |
$58.78
|
| Rate for Payer: United Healthcare Commercial |
$88.17
|
| Rate for Payer: United Healthcare Medicare |
$58.78
|
| Rate for Payer: WINHealth Partners Commercial |
$99.32
|
| Rate for Payer: Wise Provider Network Commercial |
$96.28
|
|
|
KIWI OMNICUP FORCE VAC-6000MT
|
Facility
|
IP
|
$101.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$101.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$97.30
|
| Rate for Payer: Altius Commercial |
$97.30
|
| Rate for Payer: Beech Street Commercial |
$99.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.21
|
| Rate for Payer: Cash Price |
$70.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.31
|
| Rate for Payer: Cigna of WY Commercial |
$99.32
|
| Rate for Payer: Entrust Commercial |
$96.28
|
| Rate for Payer: First Choice Health Commercial |
$96.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.89
|
| Rate for Payer: HealthUtah PPO |
$101.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.31
|
| Rate for Payer: Multiplan Medicare/VA |
$63.55
|
| Rate for Payer: One Health Plan of WY PPO |
$99.32
|
| Rate for Payer: PacificSource Commercial |
$91.22
|
| Rate for Payer: PHCS PPO |
$99.32
|
| Rate for Payer: Three Rivers PPO |
$76.01
|
| Rate for Payer: TriWest Veterans Administration |
$66.89
|
| Rate for Payer: United Healthcare Commercial |
$88.17
|
| Rate for Payer: United Healthcare Medicare |
$66.89
|
| Rate for Payer: WINHealth Partners Commercial |
$96.28
|
| Rate for Payer: Wise Provider Network Commercial |
$96.28
|
|
|
KIWI PRO CUP VAC-6000S
|
Facility
|
OP
|
$85.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Aetna of WY Medicare |
$56.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.61
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$49.61
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$49.61
|
| Rate for Payer: WINHealth Partners Commercial |
$83.83
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
KIWI PRO CUP VAC-6000S
|
Facility
|
IP
|
$85.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$85.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.12
|
| Rate for Payer: Altius Commercial |
$82.12
|
| Rate for Payer: Beech Street Commercial |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.23
|
| Rate for Payer: Cash Price |
$59.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.97
|
| Rate for Payer: Cigna of WY Commercial |
$83.83
|
| Rate for Payer: Entrust Commercial |
$81.26
|
| Rate for Payer: First Choice Health Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.46
|
| Rate for Payer: HealthUtah PPO |
$85.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.97
|
| Rate for Payer: Multiplan Medicare/VA |
$53.63
|
| Rate for Payer: One Health Plan of WY PPO |
$83.83
|
| Rate for Payer: PacificSource Commercial |
$76.99
|
| Rate for Payer: PHCS PPO |
$83.83
|
| Rate for Payer: Three Rivers PPO |
$64.16
|
| Rate for Payer: TriWest Veterans Administration |
$56.46
|
| Rate for Payer: United Healthcare Commercial |
$74.42
|
| Rate for Payer: United Healthcare Medicare |
$56.46
|
| Rate for Payer: WINHealth Partners Commercial |
$81.26
|
| Rate for Payer: Wise Provider Network Commercial |
$81.26
|
|
|
KNEE POSITIONER WRAP IMP
|
Facility
|
OP
|
$120.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.34
|
| Rate for Payer: Aetna of WY Medicare |
$79.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.92
|
| Rate for Payer: Altius Commercial |
$115.92
|
| Rate for Payer: Beech Street Commercial |
$118.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.14
|
| Rate for Payer: Cash Price |
$84.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.13
|
| Rate for Payer: Cigna of WY Commercial |
$118.34
|
| Rate for Payer: Entrust Commercial |
$114.71
|
| Rate for Payer: First Choice Health Commercial |
$114.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.04
|
| Rate for Payer: HealthUtah PPO |
$120.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.13
|
| Rate for Payer: Multiplan Medicare/VA |
$66.53
|
| Rate for Payer: One Health Plan of WY PPO |
$118.34
|
| Rate for Payer: PacificSource Commercial |
$108.68
|
| Rate for Payer: PHCS PPO |
$118.34
|
| Rate for Payer: Three Rivers PPO |
$90.56
|
| Rate for Payer: TriWest Veterans Administration |
$70.04
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$70.04
|
| Rate for Payer: WINHealth Partners Commercial |
$118.34
|
| Rate for Payer: Wise Provider Network Commercial |
$114.71
|
|
|
KNEE POSITIONER WRAP IMP
|
Facility
|
IP
|
$120.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$120.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$118.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$115.92
|
| Rate for Payer: Altius Commercial |
$115.92
|
| Rate for Payer: Beech Street Commercial |
$118.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$99.14
|
| Rate for Payer: Cash Price |
$84.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$117.13
|
| Rate for Payer: Cigna of WY Commercial |
$118.34
|
| Rate for Payer: Entrust Commercial |
$114.71
|
| Rate for Payer: First Choice Health Commercial |
$114.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.70
|
| Rate for Payer: HealthUtah PPO |
$120.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$117.13
|
| Rate for Payer: Multiplan Medicare/VA |
$75.71
|
| Rate for Payer: One Health Plan of WY PPO |
$118.34
|
| Rate for Payer: PacificSource Commercial |
$108.68
|
| Rate for Payer: PHCS PPO |
$118.34
|
| Rate for Payer: Three Rivers PPO |
$90.56
|
| Rate for Payer: TriWest Veterans Administration |
$79.70
|
| Rate for Payer: United Healthcare Commercial |
$105.05
|
| Rate for Payer: United Healthcare Medicare |
$79.70
|
| Rate for Payer: WINHealth Partners Commercial |
$114.71
|
| Rate for Payer: Wise Provider Network Commercial |
$114.71
|
|
|
KNEE WRAP NEOPRENE UNIVERSAL
|
Facility
|
IP
|
$23.62
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.68
|
| Rate for Payer: Altius Commercial |
$22.68
|
| Rate for Payer: Beech Street Commercial |
$23.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.39
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.91
|
| Rate for Payer: Cigna of WY Commercial |
$23.15
|
| Rate for Payer: Entrust Commercial |
$22.44
|
| Rate for Payer: First Choice Health Commercial |
$22.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.59
|
| Rate for Payer: HealthUtah PPO |
$23.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.91
|
| Rate for Payer: Multiplan Medicare/VA |
$14.81
|
| Rate for Payer: One Health Plan of WY PPO |
$23.15
|
| Rate for Payer: PacificSource Commercial |
$21.26
|
| Rate for Payer: PHCS PPO |
$23.15
|
| Rate for Payer: Three Rivers PPO |
$17.72
|
| Rate for Payer: TriWest Veterans Administration |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$20.55
|
| Rate for Payer: United Healthcare Medicare |
$15.59
|
| Rate for Payer: WINHealth Partners Commercial |
$22.44
|
| Rate for Payer: Wise Provider Network Commercial |
$22.44
|
|
|
KNEE WRAP NEOPRENE UNIVERSAL
|
Facility
|
OP
|
$23.62
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.15
|
| Rate for Payer: Aetna of WY Medicare |
$15.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.68
|
| Rate for Payer: Altius Commercial |
$22.68
|
| Rate for Payer: Beech Street Commercial |
$23.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.39
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.91
|
| Rate for Payer: Cigna of WY Commercial |
$23.15
|
| Rate for Payer: Entrust Commercial |
$22.44
|
| Rate for Payer: First Choice Health Commercial |
$22.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.70
|
| Rate for Payer: HealthUtah PPO |
$23.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.91
|
| Rate for Payer: Multiplan Medicare/VA |
$13.01
|
| Rate for Payer: One Health Plan of WY PPO |
$23.15
|
| Rate for Payer: PacificSource Commercial |
$21.26
|
| Rate for Payer: PHCS PPO |
$23.15
|
| Rate for Payer: Three Rivers PPO |
$17.72
|
| Rate for Payer: TriWest Veterans Administration |
$13.70
|
| Rate for Payer: United Healthcare Commercial |
$20.55
|
| Rate for Payer: United Healthcare Medicare |
$13.70
|
| Rate for Payer: WINHealth Partners Commercial |
$23.15
|
| Rate for Payer: Wise Provider Network Commercial |
$22.44
|
|
|
KNOT PUSHER SUTURE CUTTER SKID
|
Facility
|
IP
|
$899.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.90 |
| Max. Negotiated Rate |
$899.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$881.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$863.39
|
| Rate for Payer: Altius Commercial |
$863.39
|
| Rate for Payer: Beech Street Commercial |
$881.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.37
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$872.38
|
| Rate for Payer: Cigna of WY Commercial |
$881.37
|
| Rate for Payer: Entrust Commercial |
$854.39
|
| Rate for Payer: First Choice Health Commercial |
$854.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$854.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.58
|
| Rate for Payer: HealthUtah PPO |
$899.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$872.38
|
| Rate for Payer: Multiplan Medicare/VA |
$563.90
|
| Rate for Payer: One Health Plan of WY PPO |
$881.37
|
| Rate for Payer: PacificSource Commercial |
$809.42
|
| Rate for Payer: PHCS PPO |
$881.37
|
| Rate for Payer: Three Rivers PPO |
$674.52
|
| Rate for Payer: TriWest Veterans Administration |
$593.58
|
| Rate for Payer: United Healthcare Commercial |
$782.44
|
| Rate for Payer: United Healthcare Medicare |
$593.58
|
| Rate for Payer: WINHealth Partners Commercial |
$854.39
|
| Rate for Payer: Wise Provider Network Commercial |
$854.39
|
|
|
KNOT PUSHER SUTURE CUTTER SKID
|
Facility
|
OP
|
$899.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.55 |
| Max. Negotiated Rate |
$899.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$881.37
|
| Rate for Payer: Aetna of WY Medicare |
$593.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$863.39
|
| Rate for Payer: Altius Commercial |
$863.39
|
| Rate for Payer: Beech Street Commercial |
$881.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$738.37
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$872.38
|
| Rate for Payer: Cigna of WY Commercial |
$881.37
|
| Rate for Payer: Entrust Commercial |
$854.39
|
| Rate for Payer: First Choice Health Commercial |
$854.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$854.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$521.63
|
| Rate for Payer: HealthUtah PPO |
$899.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$872.38
|
| Rate for Payer: Multiplan Medicare/VA |
$495.55
|
| Rate for Payer: One Health Plan of WY PPO |
$881.37
|
| Rate for Payer: PacificSource Commercial |
$809.42
|
| Rate for Payer: PHCS PPO |
$881.37
|
| Rate for Payer: Three Rivers PPO |
$674.52
|
| Rate for Payer: TriWest Veterans Administration |
$521.63
|
| Rate for Payer: United Healthcare Commercial |
$782.44
|
| Rate for Payer: United Healthcare Medicare |
$521.63
|
| Rate for Payer: WINHealth Partners Commercial |
$881.37
|
| Rate for Payer: Wise Provider Network Commercial |
$854.39
|
|
|
KO ADJ JNT POS R SUP PRE CST
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS L1832
|
| Hospital Charge Code |
L1832
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$668.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
| Rate for Payer: Aetna of WY Medicare |
$668.88
|
| Rate for Payer: Beech Street Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
| Rate for Payer: Cigna of WY Commercial |
$150.92
|
| Rate for Payer: First Choice Health Commercial |
$138.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$668.88
|
| Rate for Payer: HealthUtah PPO |
$154.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
| Rate for Payer: Multiplan Medicare/VA |
$568.55
|
| Rate for Payer: One Health Plan of WY PPO |
$150.92
|
| Rate for Payer: PacificSource Commercial |
$138.60
|
| Rate for Payer: PHCS PPO |
$146.30
|
| Rate for Payer: Three Rivers PPO |
$115.50
|
| Rate for Payer: TriWest Veterans Administration |
$668.88
|
| Rate for Payer: United Healthcare Commercial |
$133.98
|
| Rate for Payer: United Healthcare Medicare |
$668.88
|
| Rate for Payer: WINHealth Partners Commercial |
$146.30
|
|
|
KO ELASTIC WITH JOINTS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS L1810
|
| Hospital Charge Code |
L1810
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$111.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$111.09
|
| Rate for Payer: Beech Street Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: First Choice Health Commercial |
$35.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.09
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$94.43
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$37.05
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$111.09
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$111.09
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
|
|
KO ELASTIC W/JOINTS PRE OTS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS L1812
|
| Hospital Charge Code |
L1812
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.54
|
| Rate for Payer: Beech Street Commercial |
$145.35
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.41
|
| Rate for Payer: Cigna of WY Commercial |
$149.94
|
| Rate for Payer: First Choice Health Commercial |
$137.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.54
|
| Rate for Payer: HealthUtah PPO |
$153.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.41
|
| Rate for Payer: Multiplan Medicare/VA |
$57.41
|
| Rate for Payer: One Health Plan of WY PPO |
$149.94
|
| Rate for Payer: PacificSource Commercial |
$137.70
|
| Rate for Payer: PHCS PPO |
$145.35
|
| Rate for Payer: Three Rivers PPO |
$114.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.54
|
| Rate for Payer: United Healthcare Commercial |
$133.11
|
| Rate for Payer: United Healthcare Medicare |
$67.54
|
| Rate for Payer: WINHealth Partners Commercial |
$145.35
|
|
|
KO ELAS W/ CONDYLE PADS & JO
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS L1820
|
| Hospital Charge Code |
L1820
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$156.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.16
|
| Rate for Payer: Aetna of WY Medicare |
$156.01
|
| Rate for Payer: Beech Street Commercial |
$87.40
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.24
|
| Rate for Payer: Cigna of WY Commercial |
$90.16
|
| Rate for Payer: First Choice Health Commercial |
$82.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$87.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.01
|
| Rate for Payer: HealthUtah PPO |
$92.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.24
|
| Rate for Payer: Multiplan Medicare/VA |
$132.61
|
| Rate for Payer: One Health Plan of WY PPO |
$90.16
|
| Rate for Payer: PacificSource Commercial |
$82.80
|
| Rate for Payer: PHCS PPO |
$87.40
|
| Rate for Payer: Three Rivers PPO |
$69.00
|
| Rate for Payer: TriWest Veterans Administration |
$156.01
|
| Rate for Payer: United Healthcare Commercial |
$80.04
|
| Rate for Payer: United Healthcare Medicare |
$156.01
|
| Rate for Payer: WINHealth Partners Commercial |
$87.40
|
|
|
KO IMMOB CANVAS LONG PRE OTS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS L1830
|
| Hospital Charge Code |
L1830
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$60.86
|
| Rate for Payer: Beech Street Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: First Choice Health Commercial |
$75.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.86
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$51.73
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$79.80
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$60.86
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$60.86
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
|
|
KO SWEDISH TYPE PRE OTS
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS L1850
|
| Hospital Charge Code |
L1850
|
| Min. Negotiated Rate |
$254.32 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$467.46
|
| Rate for Payer: Aetna of WY Medicare |
$299.20
|
| Rate for Payer: Beech Street Commercial |
$453.15
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$462.69
|
| Rate for Payer: Cigna of WY Commercial |
$467.46
|
| Rate for Payer: First Choice Health Commercial |
$429.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$453.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.20
|
| Rate for Payer: HealthUtah PPO |
$477.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$462.69
|
| Rate for Payer: Multiplan Medicare/VA |
$254.32
|
| Rate for Payer: One Health Plan of WY PPO |
$467.46
|
| Rate for Payer: PacificSource Commercial |
$429.30
|
| Rate for Payer: PHCS PPO |
$453.15
|
| Rate for Payer: Three Rivers PPO |
$357.75
|
| Rate for Payer: TriWest Veterans Administration |
$299.20
|
| Rate for Payer: United Healthcare Commercial |
$414.99
|
| Rate for Payer: United Healthcare Medicare |
$299.20
|
| Rate for Payer: WINHealth Partners Commercial |
$453.15
|
|
|
KUMAR CATHETER CC-019
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.28 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.14
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$73.28
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.14
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$77.14
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
KUMAR CATHETER CC-019
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
KYLEENA, 19.5 MG
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
J7296
|
| Min. Negotiated Rate |
$1,209.75 |
| Max. Negotiated Rate |
$1,613.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,580.74
|
| Rate for Payer: Beech Street Commercial |
$1,532.35
|
| Rate for Payer: Cash Price |
$1,129.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,564.61
|
| Rate for Payer: Cigna of WY Commercial |
$1,580.74
|
| Rate for Payer: First Choice Health Commercial |
$1,451.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,532.35
|
| Rate for Payer: HealthUtah PPO |
$1,613.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,564.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,580.74
|
| Rate for Payer: PacificSource Commercial |
$1,451.70
|
| Rate for Payer: PHCS PPO |
$1,532.35
|
| Rate for Payer: Three Rivers PPO |
$1,209.75
|
| Rate for Payer: United Healthcare Commercial |
$1,403.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,532.35
|
|
