|
O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 94690
|
| Hospital Charge Code |
94690
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.12
|
| Rate for Payer: Aetna of WY Medicare |
$47.64
|
| Rate for Payer: Beech Street Commercial |
$184.30
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: Cash Price |
$135.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.18
|
| Rate for Payer: Cigna of WY Commercial |
$190.12
|
| Rate for Payer: First Choice Health Commercial |
$174.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.64
|
| Rate for Payer: HealthUtah PPO |
$194.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.18
|
| Rate for Payer: Multiplan Medicare/VA |
$40.49
|
| Rate for Payer: One Health Plan of WY PPO |
$190.12
|
| Rate for Payer: PacificSource Commercial |
$174.60
|
| Rate for Payer: PHCS PPO |
$184.30
|
| Rate for Payer: Three Rivers PPO |
$145.50
|
| Rate for Payer: TriWest Veterans Administration |
$47.64
|
| Rate for Payer: United Healthcare Commercial |
$168.78
|
| Rate for Payer: United Healthcare Medicare |
$47.64
|
| Rate for Payer: WINHealth Partners Commercial |
$184.30
|
|
|
OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$7,066.00
|
|
|
Service Code
|
HCPCS 59510
|
| Hospital Charge Code |
59510
|
| Min. Negotiated Rate |
$2,168.44 |
| Max. Negotiated Rate |
$6,924.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,924.68
|
| Rate for Payer: Aetna of WY Medicare |
$2,551.10
|
| Rate for Payer: Beech Street Commercial |
$6,712.70
|
| Rate for Payer: Cash Price |
$4,946.20
|
| Rate for Payer: Cash Price |
$4,946.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,854.02
|
| Rate for Payer: Cigna of WY Commercial |
$6,924.68
|
| Rate for Payer: First Choice Health Commercial |
$6,359.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,712.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,551.10
|
| Rate for Payer: HealthUtah PPO |
$2,765.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,854.02
|
| Rate for Payer: Multiplan Medicare/VA |
$2,168.44
|
| Rate for Payer: One Health Plan of WY PPO |
$6,924.68
|
| Rate for Payer: PacificSource Commercial |
$6,359.40
|
| Rate for Payer: PHCS PPO |
$6,712.70
|
| Rate for Payer: Three Rivers PPO |
$5,299.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,551.10
|
| Rate for Payer: United Healthcare Commercial |
$6,147.42
|
| Rate for Payer: United Healthcare Medicare |
$2,551.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6,006.10
|
|
|
OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$6,379.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
59400
|
| Min. Negotiated Rate |
$1,957.68 |
| Max. Negotiated Rate |
$6,251.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,251.42
|
| Rate for Payer: Aetna of WY Medicare |
$2,303.15
|
| Rate for Payer: Beech Street Commercial |
$6,060.05
|
| Rate for Payer: Cash Price |
$4,465.30
|
| Rate for Payer: Cash Price |
$4,465.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,187.63
|
| Rate for Payer: Cigna of WY Commercial |
$6,251.42
|
| Rate for Payer: First Choice Health Commercial |
$5,741.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,060.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,303.15
|
| Rate for Payer: HealthUtah PPO |
$2,213.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,187.63
|
| Rate for Payer: Multiplan Medicare/VA |
$1,957.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6,251.42
|
| Rate for Payer: PacificSource Commercial |
$5,741.10
|
| Rate for Payer: PHCS PPO |
$6,060.05
|
| Rate for Payer: Three Rivers PPO |
$4,784.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,303.15
|
| Rate for Payer: United Healthcare Commercial |
$5,549.73
|
| Rate for Payer: United Healthcare Medicare |
$2,303.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,422.15
|
|
|
OB DELIVERY PACK
|
Facility
|
OP
|
$64.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$64.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.86
|
| Rate for Payer: Aetna of WY Medicare |
$42.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.57
|
| Rate for Payer: Altius Commercial |
$61.57
|
| Rate for Payer: Beech Street Commercial |
$62.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.66
|
| Rate for Payer: Cash Price |
$44.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.22
|
| Rate for Payer: Cigna of WY Commercial |
$62.86
|
| Rate for Payer: Entrust Commercial |
$60.93
|
| Rate for Payer: First Choice Health Commercial |
$60.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.20
|
| Rate for Payer: HealthUtah PPO |
$64.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.22
|
| Rate for Payer: Multiplan Medicare/VA |
$35.34
|
| Rate for Payer: One Health Plan of WY PPO |
$62.86
|
| Rate for Payer: PacificSource Commercial |
$57.73
|
| Rate for Payer: PHCS PPO |
$62.86
|
| Rate for Payer: Three Rivers PPO |
$48.10
|
| Rate for Payer: TriWest Veterans Administration |
$37.20
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Medicare |
$37.20
|
| Rate for Payer: WINHealth Partners Commercial |
$62.86
|
| Rate for Payer: Wise Provider Network Commercial |
$60.93
|
|
|
OB DELIVERY PACK
|
Facility
|
IP
|
$64.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$64.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$61.57
|
| Rate for Payer: Altius Commercial |
$61.57
|
| Rate for Payer: Beech Street Commercial |
$62.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$52.66
|
| Rate for Payer: Cash Price |
$44.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.22
|
| Rate for Payer: Cigna of WY Commercial |
$62.86
|
| Rate for Payer: Entrust Commercial |
$60.93
|
| Rate for Payer: First Choice Health Commercial |
$60.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.33
|
| Rate for Payer: HealthUtah PPO |
$64.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.22
|
| Rate for Payer: Multiplan Medicare/VA |
$40.22
|
| Rate for Payer: One Health Plan of WY PPO |
$62.86
|
| Rate for Payer: PacificSource Commercial |
$57.73
|
| Rate for Payer: PHCS PPO |
$62.86
|
| Rate for Payer: Three Rivers PPO |
$48.10
|
| Rate for Payer: TriWest Veterans Administration |
$42.33
|
| Rate for Payer: United Healthcare Commercial |
$55.80
|
| Rate for Payer: United Healthcare Medicare |
$42.33
|
| Rate for Payer: WINHealth Partners Commercial |
$60.93
|
| Rate for Payer: Wise Provider Network Commercial |
$60.93
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [131187]
|
Facility
|
OP
|
$284.15
|
|
|
Service Code
|
HCPCS J9301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$284.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$278.47
|
| Rate for Payer: Aetna of WY Medicare |
$187.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$272.78
|
| Rate for Payer: Altius Commercial |
$272.78
|
| Rate for Payer: Beech Street Commercial |
$278.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.29
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$275.63
|
| Rate for Payer: Cigna of WY Commercial |
$278.47
|
| Rate for Payer: Entrust Commercial |
$269.94
|
| Rate for Payer: First Choice Health Commercial |
$269.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$269.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.81
|
| Rate for Payer: HealthUtah PPO |
$284.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$275.63
|
| Rate for Payer: Multiplan Medicare/VA |
$156.57
|
| Rate for Payer: One Health Plan of WY PPO |
$278.47
|
| Rate for Payer: PacificSource Commercial |
$255.74
|
| Rate for Payer: PHCS PPO |
$278.47
|
| Rate for Payer: Three Rivers PPO |
$213.11
|
| Rate for Payer: TriWest Veterans Administration |
$164.81
|
| Rate for Payer: United Healthcare Commercial |
$247.21
|
| Rate for Payer: United Healthcare Medicare |
$164.81
|
| Rate for Payer: WINHealth Partners Commercial |
$278.47
|
| Rate for Payer: Wise Provider Network Commercial |
$269.94
|
|
|
OBINUTUZUMAB 1,000 MG/40 ML INTRAVENOUS SOLUTION [131187]
|
Facility
|
IP
|
$284.15
|
|
|
Service Code
|
HCPCS J9301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.16 |
| Max. Negotiated Rate |
$284.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$278.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$272.78
|
| Rate for Payer: Altius Commercial |
$272.78
|
| Rate for Payer: Beech Street Commercial |
$278.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$233.29
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$275.63
|
| Rate for Payer: Cigna of WY Commercial |
$278.47
|
| Rate for Payer: Entrust Commercial |
$269.94
|
| Rate for Payer: First Choice Health Commercial |
$269.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$269.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$187.54
|
| Rate for Payer: HealthUtah PPO |
$284.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$275.63
|
| Rate for Payer: Multiplan Medicare/VA |
$178.16
|
| Rate for Payer: One Health Plan of WY PPO |
$278.47
|
| Rate for Payer: PacificSource Commercial |
$255.74
|
| Rate for Payer: PHCS PPO |
$278.47
|
| Rate for Payer: Three Rivers PPO |
$213.11
|
| Rate for Payer: TriWest Veterans Administration |
$187.54
|
| Rate for Payer: United Healthcare Commercial |
$247.21
|
| Rate for Payer: United Healthcare Medicare |
$187.54
|
| Rate for Payer: WINHealth Partners Commercial |
$269.94
|
| Rate for Payer: Wise Provider Network Commercial |
$269.94
|
|
|
OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 99217
|
| Hospital Charge Code |
99217
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$216.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Beech Street Commercial |
$209.95
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: First Choice Health Commercial |
$198.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: HealthUtah PPO |
$81.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$209.95
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: United Healthcare Commercial |
$192.27
|
| Rate for Payer: WINHealth Partners Commercial |
$209.95
|
|
|
OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
Q0091
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$17.51
|
| Rate for Payer: Beech Street Commercial |
$39.90
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: First Choice Health Commercial |
$37.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.51
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$39.90
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: United Healthcare Medicare |
$17.51
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
|
|
OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$1,041.00
|
|
|
Service Code
|
HCPCS 58615
|
| Hospital Charge Code |
58615
|
| Min. Negotiated Rate |
$208.61 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,020.18
|
| Rate for Payer: Aetna of WY Medicare |
$245.42
|
| Rate for Payer: Beech Street Commercial |
$988.95
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,009.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,020.18
|
| Rate for Payer: First Choice Health Commercial |
$936.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.42
|
| Rate for Payer: HealthUtah PPO |
$1,041.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,009.77
|
| Rate for Payer: Multiplan Medicare/VA |
$208.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,020.18
|
| Rate for Payer: PacificSource Commercial |
$936.90
|
| Rate for Payer: PHCS PPO |
$988.95
|
| Rate for Payer: Three Rivers PPO |
$780.75
|
| Rate for Payer: TriWest Veterans Administration |
$245.42
|
| Rate for Payer: United Healthcare Commercial |
$905.67
|
| Rate for Payer: United Healthcare Medicare |
$245.42
|
| Rate for Payer: WINHealth Partners Commercial |
$884.85
|
|
|
OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$1,041.00
|
|
|
Service Code
|
HCPCS 58615 80
|
| Hospital Charge Code |
58615
|
| Min. Negotiated Rate |
$208.61 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,020.18
|
| Rate for Payer: Aetna of WY Medicare |
$245.42
|
| Rate for Payer: Beech Street Commercial |
$988.95
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,009.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,020.18
|
| Rate for Payer: First Choice Health Commercial |
$936.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.42
|
| Rate for Payer: HealthUtah PPO |
$1,041.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,009.77
|
| Rate for Payer: Multiplan Medicare/VA |
$208.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,020.18
|
| Rate for Payer: PacificSource Commercial |
$936.90
|
| Rate for Payer: PHCS PPO |
$988.95
|
| Rate for Payer: Three Rivers PPO |
$780.75
|
| Rate for Payer: TriWest Veterans Administration |
$245.42
|
| Rate for Payer: United Healthcare Commercial |
$905.67
|
| Rate for Payer: United Healthcare Medicare |
$245.42
|
| Rate for Payer: WINHealth Partners Commercial |
$884.85
|
|
|
OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 97165
|
| Hospital Charge Code |
97165
|
| Min. Negotiated Rate |
$84.32 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$99.20
|
| Rate for Payer: Beech Street Commercial |
$289.75
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: First Choice Health Commercial |
$274.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.20
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$84.32
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$289.75
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$99.20
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$99.20
|
| Rate for Payer: WINHealth Partners Commercial |
$289.75
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [148429]
|
Facility
|
OP
|
$2,079.10
|
|
|
Service Code
|
HCPCS J2350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,145.58 |
| Max. Negotiated Rate |
$2,079.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,037.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,372.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,995.94
|
| Rate for Payer: Altius Commercial |
$1,995.94
|
| Rate for Payer: Beech Street Commercial |
$2,037.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,706.94
|
| Rate for Payer: Cash Price |
$1,455.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,016.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,037.52
|
| Rate for Payer: Entrust Commercial |
$1,975.14
|
| Rate for Payer: First Choice Health Commercial |
$1,975.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,975.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,205.88
|
| Rate for Payer: HealthUtah PPO |
$2,079.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,016.73
|
| Rate for Payer: Multiplan Medicare/VA |
$1,145.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,037.52
|
| Rate for Payer: PacificSource Commercial |
$1,871.19
|
| Rate for Payer: PHCS PPO |
$2,037.52
|
| Rate for Payer: Three Rivers PPO |
$1,559.32
|
| Rate for Payer: TriWest Veterans Administration |
$1,205.88
|
| Rate for Payer: United Healthcare Commercial |
$1,808.82
|
| Rate for Payer: United Healthcare Medicare |
$1,205.88
|
| Rate for Payer: WINHealth Partners Commercial |
$2,037.52
|
| Rate for Payer: Wise Provider Network Commercial |
$1,975.14
|
|
|
OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION [148429]
|
Facility
|
IP
|
$2,079.10
|
|
|
Service Code
|
HCPCS J2350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,303.60 |
| Max. Negotiated Rate |
$2,079.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,037.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,995.94
|
| Rate for Payer: Altius Commercial |
$1,995.94
|
| Rate for Payer: Beech Street Commercial |
$2,037.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,706.94
|
| Rate for Payer: Cash Price |
$1,455.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,016.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,037.52
|
| Rate for Payer: Entrust Commercial |
$1,975.14
|
| Rate for Payer: First Choice Health Commercial |
$1,975.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,975.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,372.21
|
| Rate for Payer: HealthUtah PPO |
$2,079.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,016.73
|
| Rate for Payer: Multiplan Medicare/VA |
$1,303.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,037.52
|
| Rate for Payer: PacificSource Commercial |
$1,871.19
|
| Rate for Payer: PHCS PPO |
$2,037.52
|
| Rate for Payer: Three Rivers PPO |
$1,559.32
|
| Rate for Payer: TriWest Veterans Administration |
$1,372.21
|
| Rate for Payer: United Healthcare Commercial |
$1,808.82
|
| Rate for Payer: United Healthcare Medicare |
$1,372.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,975.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1,975.14
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [344]
|
Facility
|
OP
|
$47.30
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$47.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.35
|
| Rate for Payer: Aetna of WY Medicare |
$31.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.41
|
| Rate for Payer: Altius Commercial |
$45.41
|
| Rate for Payer: Beech Street Commercial |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.83
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.88
|
| Rate for Payer: Cigna of WY Commercial |
$46.35
|
| Rate for Payer: Entrust Commercial |
$44.94
|
| Rate for Payer: First Choice Health Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.43
|
| Rate for Payer: HealthUtah PPO |
$47.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.88
|
| Rate for Payer: Multiplan Medicare/VA |
$26.06
|
| Rate for Payer: One Health Plan of WY PPO |
$46.35
|
| Rate for Payer: PacificSource Commercial |
$42.57
|
| Rate for Payer: PHCS PPO |
$46.35
|
| Rate for Payer: Three Rivers PPO |
$35.48
|
| Rate for Payer: TriWest Veterans Administration |
$27.43
|
| Rate for Payer: United Healthcare Commercial |
$41.15
|
| Rate for Payer: United Healthcare Medicare |
$27.43
|
| Rate for Payer: WINHealth Partners Commercial |
$46.35
|
| Rate for Payer: Wise Provider Network Commercial |
$44.94
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION [344]
|
Facility
|
IP
|
$47.30
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$47.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.41
|
| Rate for Payer: Altius Commercial |
$45.41
|
| Rate for Payer: Beech Street Commercial |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.83
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.88
|
| Rate for Payer: Cigna of WY Commercial |
$46.35
|
| Rate for Payer: Entrust Commercial |
$44.94
|
| Rate for Payer: First Choice Health Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.22
|
| Rate for Payer: HealthUtah PPO |
$47.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.88
|
| Rate for Payer: Multiplan Medicare/VA |
$29.66
|
| Rate for Payer: One Health Plan of WY PPO |
$46.35
|
| Rate for Payer: PacificSource Commercial |
$42.57
|
| Rate for Payer: PHCS PPO |
$46.35
|
| Rate for Payer: Three Rivers PPO |
$35.48
|
| Rate for Payer: TriWest Veterans Administration |
$31.22
|
| Rate for Payer: United Healthcare Commercial |
$41.15
|
| Rate for Payer: United Healthcare Medicare |
$31.22
|
| Rate for Payer: WINHealth Partners Commercial |
$44.94
|
| Rate for Payer: Wise Provider Network Commercial |
$44.94
|
|
|
OCTREOTIDE IVPB BOLUS [4090000080]
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
NDC 0641617501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.30
|
| Rate for Payer: Aetna of WY Medicare |
$15.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.84
|
| Rate for Payer: Altius Commercial |
$21.84
|
| Rate for Payer: Beech Street Commercial |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.07
|
| Rate for Payer: Cigna of WY Commercial |
$22.30
|
| Rate for Payer: Entrust Commercial |
$21.61
|
| Rate for Payer: First Choice Health Commercial |
$21.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.20
|
| Rate for Payer: HealthUtah PPO |
$22.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.07
|
| Rate for Payer: Multiplan Medicare/VA |
$12.54
|
| Rate for Payer: One Health Plan of WY PPO |
$22.30
|
| Rate for Payer: PacificSource Commercial |
$20.48
|
| Rate for Payer: PHCS PPO |
$22.30
|
| Rate for Payer: Three Rivers PPO |
$17.06
|
| Rate for Payer: TriWest Veterans Administration |
$13.20
|
| Rate for Payer: United Healthcare Commercial |
$19.79
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| Rate for Payer: WINHealth Partners Commercial |
$22.30
|
| Rate for Payer: Wise Provider Network Commercial |
$21.61
|
|
|
OCTREOTIDE IVPB BOLUS [4090000080]
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
NDC 0641617501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.84
|
| Rate for Payer: Altius Commercial |
$21.84
|
| Rate for Payer: Beech Street Commercial |
$22.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.07
|
| Rate for Payer: Cigna of WY Commercial |
$22.30
|
| Rate for Payer: Entrust Commercial |
$21.61
|
| Rate for Payer: First Choice Health Commercial |
$21.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.02
|
| Rate for Payer: HealthUtah PPO |
$22.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.07
|
| Rate for Payer: Multiplan Medicare/VA |
$14.26
|
| Rate for Payer: One Health Plan of WY PPO |
$22.30
|
| Rate for Payer: PacificSource Commercial |
$20.48
|
| Rate for Payer: PHCS PPO |
$22.30
|
| Rate for Payer: Three Rivers PPO |
$17.06
|
| Rate for Payer: TriWest Veterans Administration |
$15.02
|
| Rate for Payer: United Healthcare Commercial |
$19.79
|
| Rate for Payer: United Healthcare Medicare |
$15.02
|
| Rate for Payer: WINHealth Partners Commercial |
$21.61
|
| Rate for Payer: Wise Provider Network Commercial |
$21.61
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [140290]
|
Facility
|
IP
|
$6,939.45
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,351.04 |
| Max. Negotiated Rate |
$6,939.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,800.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,661.87
|
| Rate for Payer: Altius Commercial |
$6,661.87
|
| Rate for Payer: Beech Street Commercial |
$6,800.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,697.29
|
| Rate for Payer: Cash Price |
$4,857.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,731.27
|
| Rate for Payer: Cigna of WY Commercial |
$6,800.66
|
| Rate for Payer: Entrust Commercial |
$6,592.48
|
| Rate for Payer: First Choice Health Commercial |
$6,592.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,592.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,580.04
|
| Rate for Payer: HealthUtah PPO |
$6,939.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,731.27
|
| Rate for Payer: Multiplan Medicare/VA |
$4,351.04
|
| Rate for Payer: One Health Plan of WY PPO |
$6,800.66
|
| Rate for Payer: PacificSource Commercial |
$6,245.50
|
| Rate for Payer: PHCS PPO |
$6,800.66
|
| Rate for Payer: Three Rivers PPO |
$5,204.59
|
| Rate for Payer: TriWest Veterans Administration |
$4,580.04
|
| Rate for Payer: United Healthcare Commercial |
$6,037.32
|
| Rate for Payer: United Healthcare Medicare |
$4,580.04
|
| Rate for Payer: WINHealth Partners Commercial |
$6,592.48
|
| Rate for Payer: Wise Provider Network Commercial |
$6,592.48
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [140290]
|
Facility
|
OP
|
$6,939.45
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,823.64 |
| Max. Negotiated Rate |
$6,939.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,800.66
|
| Rate for Payer: Aetna of WY Medicare |
$4,580.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6,661.87
|
| Rate for Payer: Altius Commercial |
$6,661.87
|
| Rate for Payer: Beech Street Commercial |
$6,800.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,697.29
|
| Rate for Payer: Cash Price |
$4,857.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,731.27
|
| Rate for Payer: Cigna of WY Commercial |
$6,800.66
|
| Rate for Payer: Entrust Commercial |
$6,592.48
|
| Rate for Payer: First Choice Health Commercial |
$6,592.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,592.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,024.88
|
| Rate for Payer: HealthUtah PPO |
$6,939.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,731.27
|
| Rate for Payer: Multiplan Medicare/VA |
$3,823.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,800.66
|
| Rate for Payer: PacificSource Commercial |
$6,245.50
|
| Rate for Payer: PHCS PPO |
$6,800.66
|
| Rate for Payer: Three Rivers PPO |
$5,204.59
|
| Rate for Payer: TriWest Veterans Administration |
$4,024.88
|
| Rate for Payer: United Healthcare Commercial |
$6,037.32
|
| Rate for Payer: United Healthcare Medicare |
$4,024.88
|
| Rate for Payer: WINHealth Partners Commercial |
$6,800.66
|
| Rate for Payer: Wise Provider Network Commercial |
$6,592.48
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [140291]
|
Facility
|
OP
|
$10,383.84
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,721.50 |
| Max. Negotiated Rate |
$10,383.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,176.16
|
| Rate for Payer: Aetna of WY Medicare |
$6,853.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,968.49
|
| Rate for Payer: Altius Commercial |
$9,968.49
|
| Rate for Payer: Beech Street Commercial |
$10,176.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,525.13
|
| Rate for Payer: Cash Price |
$7,268.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,072.32
|
| Rate for Payer: Cigna of WY Commercial |
$10,176.16
|
| Rate for Payer: Entrust Commercial |
$9,864.65
|
| Rate for Payer: First Choice Health Commercial |
$9,864.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,864.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,022.63
|
| Rate for Payer: HealthUtah PPO |
$10,383.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,072.32
|
| Rate for Payer: Multiplan Medicare/VA |
$5,721.50
|
| Rate for Payer: One Health Plan of WY PPO |
$10,176.16
|
| Rate for Payer: PacificSource Commercial |
$9,345.46
|
| Rate for Payer: PHCS PPO |
$10,176.16
|
| Rate for Payer: Three Rivers PPO |
$7,787.88
|
| Rate for Payer: TriWest Veterans Administration |
$6,022.63
|
| Rate for Payer: United Healthcare Commercial |
$9,033.94
|
| Rate for Payer: United Healthcare Medicare |
$6,022.63
|
| Rate for Payer: WINHealth Partners Commercial |
$10,176.16
|
| Rate for Payer: Wise Provider Network Commercial |
$9,864.65
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE [140291]
|
Facility
|
IP
|
$10,383.84
|
|
|
Service Code
|
HCPCS J2353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,510.67 |
| Max. Negotiated Rate |
$10,383.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10,176.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9,968.49
|
| Rate for Payer: Altius Commercial |
$9,968.49
|
| Rate for Payer: Beech Street Commercial |
$10,176.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,525.13
|
| Rate for Payer: Cash Price |
$7,268.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$10,072.32
|
| Rate for Payer: Cigna of WY Commercial |
$10,176.16
|
| Rate for Payer: Entrust Commercial |
$9,864.65
|
| Rate for Payer: First Choice Health Commercial |
$9,864.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,864.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,853.33
|
| Rate for Payer: HealthUtah PPO |
$10,383.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10,072.32
|
| Rate for Payer: Multiplan Medicare/VA |
$6,510.67
|
| Rate for Payer: One Health Plan of WY PPO |
$10,176.16
|
| Rate for Payer: PacificSource Commercial |
$9,345.46
|
| Rate for Payer: PHCS PPO |
$10,176.16
|
| Rate for Payer: Three Rivers PPO |
$7,787.88
|
| Rate for Payer: TriWest Veterans Administration |
$6,853.33
|
| Rate for Payer: United Healthcare Commercial |
$9,033.94
|
| Rate for Payer: United Healthcare Medicare |
$6,853.33
|
| Rate for Payer: WINHealth Partners Commercial |
$9,864.65
|
| Rate for Payer: Wise Provider Network Commercial |
$9,864.65
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 99243
|
| Hospital Charge Code |
99243
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$402.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$402.78
|
| Rate for Payer: Beech Street Commercial |
$390.45
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$398.67
|
| Rate for Payer: Cigna of WY Commercial |
$402.78
|
| Rate for Payer: First Choice Health Commercial |
$369.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$390.45
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$398.67
|
| Rate for Payer: One Health Plan of WY PPO |
$402.78
|
| Rate for Payer: PacificSource Commercial |
$369.90
|
| Rate for Payer: PHCS PPO |
$390.45
|
| Rate for Payer: Three Rivers PPO |
$308.25
|
| Rate for Payer: United Healthcare Commercial |
$357.57
|
| Rate for Payer: WINHealth Partners Commercial |
$390.45
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 99242
|
| Hospital Charge Code |
99242
|
| Min. Negotiated Rate |
$109.74 |
| Max. Negotiated Rate |
$336.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: First Choice Health Commercial |
$308.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: HealthUtah PPO |
$109.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: United Healthcare Commercial |
$298.41
|
| Rate for Payer: WINHealth Partners Commercial |
$325.85
|
|
|
OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
99215
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$395.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$395.92
|
| Rate for Payer: Aetna of WY Medicare |
$138.59
|
| Rate for Payer: Beech Street Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: Cash Price |
$282.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$391.88
|
| Rate for Payer: Cigna of WY Commercial |
$395.92
|
| Rate for Payer: First Choice Health Commercial |
$363.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$383.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.59
|
| Rate for Payer: HealthUtah PPO |
$146.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$391.88
|
| Rate for Payer: Multiplan Medicare/VA |
$117.80
|
| Rate for Payer: One Health Plan of WY PPO |
$395.92
|
| Rate for Payer: PacificSource Commercial |
$363.60
|
| Rate for Payer: PHCS PPO |
$383.80
|
| Rate for Payer: Three Rivers PPO |
$303.00
|
| Rate for Payer: TriWest Veterans Administration |
$138.59
|
| Rate for Payer: United Healthcare Commercial |
$351.48
|
| Rate for Payer: United Healthcare Medicare |
$138.59
|
| Rate for Payer: WINHealth Partners Commercial |
$383.80
|
|
