|
OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$3,943.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
25525
|
| Min. Negotiated Rate |
$654.95 |
| Max. Negotiated Rate |
$3,943.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,864.14
|
| Rate for Payer: Aetna of WY Medicare |
$770.53
|
| Rate for Payer: Beech Street Commercial |
$3,745.85
|
| Rate for Payer: Cash Price |
$2,760.10
|
| Rate for Payer: Cash Price |
$2,760.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,824.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,864.14
|
| Rate for Payer: First Choice Health Commercial |
$3,548.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,745.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.53
|
| Rate for Payer: HealthUtah PPO |
$3,943.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,824.71
|
| Rate for Payer: Multiplan Medicare/VA |
$654.95
|
| Rate for Payer: One Health Plan of WY PPO |
$3,864.14
|
| Rate for Payer: PacificSource Commercial |
$3,548.70
|
| Rate for Payer: PHCS PPO |
$3,745.85
|
| Rate for Payer: Three Rivers PPO |
$2,957.25
|
| Rate for Payer: TriWest Veterans Administration |
$770.53
|
| Rate for Payer: United Healthcare Commercial |
$3,430.41
|
| Rate for Payer: United Healthcare Medicare |
$770.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,351.55
|
|
|
OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC
|
Professional
|
Both
|
$3,943.00
|
|
|
Service Code
|
HCPCS 25525 AS
|
| Hospital Charge Code |
25525
|
| Min. Negotiated Rate |
$654.95 |
| Max. Negotiated Rate |
$3,943.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,864.14
|
| Rate for Payer: Aetna of WY Medicare |
$770.53
|
| Rate for Payer: Beech Street Commercial |
$3,745.85
|
| Rate for Payer: Cash Price |
$2,760.10
|
| Rate for Payer: Cash Price |
$2,760.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,824.71
|
| Rate for Payer: Cigna of WY Commercial |
$3,864.14
|
| Rate for Payer: First Choice Health Commercial |
$3,548.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,745.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.53
|
| Rate for Payer: HealthUtah PPO |
$3,943.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,824.71
|
| Rate for Payer: Multiplan Medicare/VA |
$654.95
|
| Rate for Payer: One Health Plan of WY PPO |
$3,864.14
|
| Rate for Payer: PacificSource Commercial |
$3,548.70
|
| Rate for Payer: PHCS PPO |
$3,745.85
|
| Rate for Payer: Three Rivers PPO |
$2,957.25
|
| Rate for Payer: TriWest Veterans Administration |
$770.53
|
| Rate for Payer: United Healthcare Commercial |
$3,430.41
|
| Rate for Payer: United Healthcare Medicare |
$770.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,351.55
|
|
|
OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
27536
|
| Min. Negotiated Rate |
$971.58 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.04
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,143.04
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$971.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,143.04
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,143.04
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 27536 AS
|
| Hospital Charge Code |
27536
|
| Min. Negotiated Rate |
$971.58 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.04
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,143.04
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$971.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,143.04
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,143.04
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$6,132.00
|
|
|
Service Code
|
HCPCS 27536 80
|
| Hospital Charge Code |
27536
|
| Min. Negotiated Rate |
$971.58 |
| Max. Negotiated Rate |
$6,132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,009.36
|
| Rate for Payer: Aetna of WY Medicare |
$1,143.04
|
| Rate for Payer: Beech Street Commercial |
$5,825.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: Cash Price |
$4,292.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,948.04
|
| Rate for Payer: Cigna of WY Commercial |
$6,009.36
|
| Rate for Payer: First Choice Health Commercial |
$5,518.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,825.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,143.04
|
| Rate for Payer: HealthUtah PPO |
$6,132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,948.04
|
| Rate for Payer: Multiplan Medicare/VA |
$971.58
|
| Rate for Payer: One Health Plan of WY PPO |
$6,009.36
|
| Rate for Payer: PacificSource Commercial |
$5,518.80
|
| Rate for Payer: PHCS PPO |
$5,825.40
|
| Rate for Payer: Three Rivers PPO |
$4,599.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,143.04
|
| Rate for Payer: United Healthcare Commercial |
$5,334.84
|
| Rate for Payer: United Healthcare Medicare |
$1,143.04
|
| Rate for Payer: WINHealth Partners Commercial |
$5,212.20
|
|
|
OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 27758 AS
|
| Hospital Charge Code |
27758
|
| Min. Negotiated Rate |
$737.61 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$867.78
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.78
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$737.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$867.78
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$867.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 27758 80
|
| Hospital Charge Code |
27758
|
| Min. Negotiated Rate |
$737.61 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$867.78
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.78
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$737.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$867.78
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$867.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$4,080.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
27758
|
| Min. Negotiated Rate |
$737.61 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,998.40
|
| Rate for Payer: Aetna of WY Medicare |
$867.78
|
| Rate for Payer: Beech Street Commercial |
$3,876.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,957.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,998.40
|
| Rate for Payer: First Choice Health Commercial |
$3,672.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,876.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$867.78
|
| Rate for Payer: HealthUtah PPO |
$4,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,957.60
|
| Rate for Payer: Multiplan Medicare/VA |
$737.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,998.40
|
| Rate for Payer: PacificSource Commercial |
$3,672.00
|
| Rate for Payer: PHCS PPO |
$3,876.00
|
| Rate for Payer: Three Rivers PPO |
$3,060.00
|
| Rate for Payer: TriWest Veterans Administration |
$867.78
|
| Rate for Payer: United Healthcare Commercial |
$3,549.60
|
| Rate for Payer: United Healthcare Medicare |
$867.78
|
| Rate for Payer: WINHealth Partners Commercial |
$3,468.00
|
|
|
ORAL DEXAMETHASONE
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8540
|
| Hospital Charge Code |
J8540
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
| Rate for Payer: Cigna of WY Commercial |
$3.92
|
| Rate for Payer: First Choice Health Commercial |
$3.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$4.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3.92
|
| Rate for Payer: PacificSource Commercial |
$3.60
|
| Rate for Payer: PHCS PPO |
$3.80
|
| Rate for Payer: Three Rivers PPO |
$3.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$3.48
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3.80
|
|
|
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$1,639.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
54520
|
| Min. Negotiated Rate |
$270.04 |
| Max. Negotiated Rate |
$1,639.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,606.22
|
| Rate for Payer: Aetna of WY Medicare |
$317.69
|
| Rate for Payer: Beech Street Commercial |
$1,557.05
|
| Rate for Payer: Cash Price |
$1,147.30
|
| Rate for Payer: Cash Price |
$1,147.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,589.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,606.22
|
| Rate for Payer: First Choice Health Commercial |
$1,475.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,557.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$317.69
|
| Rate for Payer: HealthUtah PPO |
$1,639.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,589.83
|
| Rate for Payer: Multiplan Medicare/VA |
$270.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,606.22
|
| Rate for Payer: PacificSource Commercial |
$1,475.10
|
| Rate for Payer: PHCS PPO |
$1,557.05
|
| Rate for Payer: Three Rivers PPO |
$1,229.25
|
| Rate for Payer: TriWest Veterans Administration |
$317.69
|
| Rate for Payer: United Healthcare Commercial |
$1,425.93
|
| Rate for Payer: United Healthcare Medicare |
$317.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1,393.15
|
|
|
ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
54640
|
| Min. Negotiated Rate |
$352.19 |
| Max. Negotiated Rate |
$2,186.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,142.28
|
| Rate for Payer: Aetna of WY Medicare |
$414.34
|
| Rate for Payer: Beech Street Commercial |
$2,076.70
|
| Rate for Payer: Cash Price |
$1,530.20
|
| Rate for Payer: Cash Price |
$1,530.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,120.42
|
| Rate for Payer: Cigna of WY Commercial |
$2,142.28
|
| Rate for Payer: First Choice Health Commercial |
$1,967.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,076.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.34
|
| Rate for Payer: HealthUtah PPO |
$2,186.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,120.42
|
| Rate for Payer: Multiplan Medicare/VA |
$352.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,142.28
|
| Rate for Payer: PacificSource Commercial |
$1,967.40
|
| Rate for Payer: PHCS PPO |
$2,076.70
|
| Rate for Payer: Three Rivers PPO |
$1,639.50
|
| Rate for Payer: TriWest Veterans Administration |
$414.34
|
| Rate for Payer: United Healthcare Commercial |
$1,901.82
|
| Rate for Payer: United Healthcare Medicare |
$414.34
|
| Rate for Payer: WINHealth Partners Commercial |
$1,858.10
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [8358]
|
Facility
|
IP
|
$40.35
|
|
|
Service Code
|
HCPCS J2360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$40.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.74
|
| Rate for Payer: Altius Commercial |
$38.74
|
| Rate for Payer: Beech Street Commercial |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.13
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.14
|
| Rate for Payer: Cigna of WY Commercial |
$39.54
|
| Rate for Payer: Entrust Commercial |
$38.33
|
| Rate for Payer: First Choice Health Commercial |
$38.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.63
|
| Rate for Payer: HealthUtah PPO |
$40.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.14
|
| Rate for Payer: Multiplan Medicare/VA |
$25.30
|
| Rate for Payer: One Health Plan of WY PPO |
$39.54
|
| Rate for Payer: PacificSource Commercial |
$36.32
|
| Rate for Payer: PHCS PPO |
$39.54
|
| Rate for Payer: Three Rivers PPO |
$30.26
|
| Rate for Payer: TriWest Veterans Administration |
$26.63
|
| Rate for Payer: United Healthcare Commercial |
$35.10
|
| Rate for Payer: United Healthcare Medicare |
$26.63
|
| Rate for Payer: WINHealth Partners Commercial |
$38.33
|
| Rate for Payer: Wise Provider Network Commercial |
$38.33
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION [8358]
|
Facility
|
OP
|
$40.35
|
|
|
Service Code
|
HCPCS J2360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$40.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.54
|
| Rate for Payer: Aetna of WY Medicare |
$26.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.74
|
| Rate for Payer: Altius Commercial |
$38.74
|
| Rate for Payer: Beech Street Commercial |
$39.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.13
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.14
|
| Rate for Payer: Cigna of WY Commercial |
$39.54
|
| Rate for Payer: Entrust Commercial |
$38.33
|
| Rate for Payer: First Choice Health Commercial |
$38.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.40
|
| Rate for Payer: HealthUtah PPO |
$40.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.14
|
| Rate for Payer: Multiplan Medicare/VA |
$22.23
|
| Rate for Payer: One Health Plan of WY PPO |
$39.54
|
| Rate for Payer: PacificSource Commercial |
$36.32
|
| Rate for Payer: PHCS PPO |
$39.54
|
| Rate for Payer: Three Rivers PPO |
$30.26
|
| Rate for Payer: TriWest Veterans Administration |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$35.10
|
| Rate for Payer: United Healthcare Medicare |
$23.40
|
| Rate for Payer: WINHealth Partners Commercial |
$39.54
|
| Rate for Payer: Wise Provider Network Commercial |
$38.33
|
|
|
ORPHENADRINE INJECTION
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
J2360
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.26
|
| Rate for Payer: Aetna of WY Medicare |
$9.12
|
| Rate for Payer: Beech Street Commercial |
$82.65
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: Cash Price |
$60.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.39
|
| Rate for Payer: Cigna of WY Commercial |
$85.26
|
| Rate for Payer: First Choice Health Commercial |
$78.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.12
|
| Rate for Payer: HealthUtah PPO |
$87.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.39
|
| Rate for Payer: Multiplan Medicare/VA |
$7.75
|
| Rate for Payer: One Health Plan of WY PPO |
$85.26
|
| Rate for Payer: PacificSource Commercial |
$78.30
|
| Rate for Payer: PHCS PPO |
$82.65
|
| Rate for Payer: Three Rivers PPO |
$65.25
|
| Rate for Payer: TriWest Veterans Administration |
$9.12
|
| Rate for Payer: United Healthcare Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicare |
$9.12
|
| Rate for Payer: WINHealth Partners Commercial |
$82.65
|
|
|
ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 97760
|
| Hospital Charge Code |
97760
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Aetna of WY Medicare |
$46.74
|
| Rate for Payer: Beech Street Commercial |
$164.35
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: First Choice Health Commercial |
$155.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.74
|
| Rate for Payer: HealthUtah PPO |
$173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: Multiplan Medicare/VA |
$39.73
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PHCS PPO |
$164.35
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.74
|
| Rate for Payer: United Healthcare Commercial |
$150.51
|
| Rate for Payer: United Healthcare Medicare |
$46.74
|
| Rate for Payer: WINHealth Partners Commercial |
$164.35
|
|
|
ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$1,309.00
|
|
|
Service Code
|
HCPCS J7324
|
| Hospital Charge Code |
J7324
|
| Min. Negotiated Rate |
$111.83 |
| Max. Negotiated Rate |
$1,309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,282.82
|
| Rate for Payer: Aetna of WY Medicare |
$131.56
|
| Rate for Payer: Beech Street Commercial |
$1,243.55
|
| Rate for Payer: Cash Price |
$916.30
|
| Rate for Payer: Cash Price |
$916.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,269.73
|
| Rate for Payer: Cigna of WY Commercial |
$1,282.82
|
| Rate for Payer: First Choice Health Commercial |
$1,178.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,243.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.56
|
| Rate for Payer: HealthUtah PPO |
$1,309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,269.73
|
| Rate for Payer: Multiplan Medicare/VA |
$111.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,282.82
|
| Rate for Payer: PacificSource Commercial |
$1,178.10
|
| Rate for Payer: PHCS PPO |
$1,243.55
|
| Rate for Payer: Three Rivers PPO |
$981.75
|
| Rate for Payer: TriWest Veterans Administration |
$131.56
|
| Rate for Payer: United Healthcare Commercial |
$1,138.83
|
| Rate for Payer: United Healthcare Medicare |
$131.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,243.55
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [92924]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 2724113909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
| Rate for Payer: Aetna of WY Medicare |
$1.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
| Rate for Payer: Altius Commercial |
$1.92
|
| Rate for Payer: Beech Street Commercial |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: Entrust Commercial |
$1.90
|
| Rate for Payer: First Choice Health Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PHCS PPO |
$1.96
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.96
|
| Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [92924]
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
NDC 6923812736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.55
|
| Rate for Payer: Aetna of WY Medicare |
$4.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.41
|
| Rate for Payer: Altius Commercial |
$6.41
|
| Rate for Payer: Beech Street Commercial |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.48
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.48
|
| Rate for Payer: Cigna of WY Commercial |
$6.55
|
| Rate for Payer: Entrust Commercial |
$6.35
|
| Rate for Payer: First Choice Health Commercial |
$6.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.87
|
| Rate for Payer: HealthUtah PPO |
$6.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.48
|
| Rate for Payer: Multiplan Medicare/VA |
$3.68
|
| Rate for Payer: One Health Plan of WY PPO |
$6.55
|
| Rate for Payer: PacificSource Commercial |
$6.01
|
| Rate for Payer: PHCS PPO |
$6.55
|
| Rate for Payer: Three Rivers PPO |
$5.01
|
| Rate for Payer: TriWest Veterans Administration |
$3.87
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
| Rate for Payer: United Healthcare Medicare |
$3.87
|
| Rate for Payer: WINHealth Partners Commercial |
$6.55
|
| Rate for Payer: Wise Provider Network Commercial |
$6.35
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [92924]
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 7071011656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.59
|
| Rate for Payer: Aetna of WY Medicare |
$3.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.49
|
| Rate for Payer: Altius Commercial |
$4.49
|
| Rate for Payer: Beech Street Commercial |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.54
|
| Rate for Payer: Cigna of WY Commercial |
$4.59
|
| Rate for Payer: Entrust Commercial |
$4.45
|
| Rate for Payer: First Choice Health Commercial |
$4.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.71
|
| Rate for Payer: HealthUtah PPO |
$4.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.54
|
| Rate for Payer: Multiplan Medicare/VA |
$2.58
|
| Rate for Payer: One Health Plan of WY PPO |
$4.59
|
| Rate for Payer: PacificSource Commercial |
$4.21
|
| Rate for Payer: PHCS PPO |
$4.59
|
| Rate for Payer: Three Rivers PPO |
$3.51
|
| Rate for Payer: TriWest Veterans Administration |
$2.71
|
| Rate for Payer: United Healthcare Commercial |
$4.07
|
| Rate for Payer: United Healthcare Medicare |
$2.71
|
| Rate for Payer: WINHealth Partners Commercial |
$4.59
|
| Rate for Payer: Wise Provider Network Commercial |
$4.45
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [92924]
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 7071011656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.49
|
| Rate for Payer: Altius Commercial |
$4.49
|
| Rate for Payer: Beech Street Commercial |
$4.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.54
|
| Rate for Payer: Cigna of WY Commercial |
$4.59
|
| Rate for Payer: Entrust Commercial |
$4.45
|
| Rate for Payer: First Choice Health Commercial |
$4.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.09
|
| Rate for Payer: HealthUtah PPO |
$4.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.54
|
| Rate for Payer: Multiplan Medicare/VA |
$2.93
|
| Rate for Payer: One Health Plan of WY PPO |
$4.59
|
| Rate for Payer: PacificSource Commercial |
$4.21
|
| Rate for Payer: PHCS PPO |
$4.59
|
| Rate for Payer: Three Rivers PPO |
$3.51
|
| Rate for Payer: TriWest Veterans Administration |
$3.09
|
| Rate for Payer: United Healthcare Commercial |
$4.07
|
| Rate for Payer: United Healthcare Medicare |
$3.09
|
| Rate for Payer: WINHealth Partners Commercial |
$4.45
|
| Rate for Payer: Wise Provider Network Commercial |
$4.45
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [92924]
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
NDC 6923812736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.41
|
| Rate for Payer: Altius Commercial |
$6.41
|
| Rate for Payer: Beech Street Commercial |
$6.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.48
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.48
|
| Rate for Payer: Cigna of WY Commercial |
$6.55
|
| Rate for Payer: Entrust Commercial |
$6.35
|
| Rate for Payer: First Choice Health Commercial |
$6.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.41
|
| Rate for Payer: HealthUtah PPO |
$6.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.48
|
| Rate for Payer: Multiplan Medicare/VA |
$4.19
|
| Rate for Payer: One Health Plan of WY PPO |
$6.55
|
| Rate for Payer: PacificSource Commercial |
$6.01
|
| Rate for Payer: PHCS PPO |
$6.55
|
| Rate for Payer: Three Rivers PPO |
$5.01
|
| Rate for Payer: TriWest Veterans Administration |
$4.41
|
| Rate for Payer: United Healthcare Commercial |
$5.81
|
| Rate for Payer: United Healthcare Medicare |
$4.41
|
| Rate for Payer: WINHealth Partners Commercial |
$6.35
|
| Rate for Payer: Wise Provider Network Commercial |
$6.35
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [92924]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 2724113909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.92
|
| Rate for Payer: Altius Commercial |
$1.92
|
| Rate for Payer: Beech Street Commercial |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.94
|
| Rate for Payer: Cigna of WY Commercial |
$1.96
|
| Rate for Payer: Entrust Commercial |
$1.90
|
| Rate for Payer: First Choice Health Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
| Rate for Payer: HealthUtah PPO |
$2.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1.96
|
| Rate for Payer: PacificSource Commercial |
$1.80
|
| Rate for Payer: PHCS PPO |
$1.96
|
| Rate for Payer: Three Rivers PPO |
$1.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1.90
|
|
|
OSELTAMIVIR 75 MG CAPSULE [12331]
|
Facility
|
IP
|
$7.40
|
|
|
Service Code
|
NDC 6438079901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.10
|
| Rate for Payer: Altius Commercial |
$7.10
|
| Rate for Payer: Beech Street Commercial |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.08
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.18
|
| Rate for Payer: Cigna of WY Commercial |
$7.25
|
| Rate for Payer: Entrust Commercial |
$7.03
|
| Rate for Payer: First Choice Health Commercial |
$7.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.88
|
| Rate for Payer: HealthUtah PPO |
$7.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.18
|
| Rate for Payer: Multiplan Medicare/VA |
$4.64
|
| Rate for Payer: One Health Plan of WY PPO |
$7.25
|
| Rate for Payer: PacificSource Commercial |
$6.66
|
| Rate for Payer: PHCS PPO |
$7.25
|
| Rate for Payer: Three Rivers PPO |
$5.55
|
| Rate for Payer: TriWest Veterans Administration |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$6.44
|
| Rate for Payer: United Healthcare Medicare |
$4.88
|
| Rate for Payer: WINHealth Partners Commercial |
$7.03
|
| Rate for Payer: Wise Provider Network Commercial |
$7.03
|
|
|
OSELTAMIVIR 75 MG CAPSULE [12331]
|
Facility
|
OP
|
$9.75
|
|
|
Service Code
|
NDC 6818067711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.56
|
| Rate for Payer: Aetna of WY Medicare |
$6.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.36
|
| Rate for Payer: Altius Commercial |
$9.36
|
| Rate for Payer: Beech Street Commercial |
$9.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.46
|
| Rate for Payer: Cigna of WY Commercial |
$9.56
|
| Rate for Payer: Entrust Commercial |
$9.26
|
| Rate for Payer: First Choice Health Commercial |
$9.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.66
|
| Rate for Payer: HealthUtah PPO |
$9.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.46
|
| Rate for Payer: Multiplan Medicare/VA |
$5.37
|
| Rate for Payer: One Health Plan of WY PPO |
$9.56
|
| Rate for Payer: PacificSource Commercial |
$8.78
|
| Rate for Payer: PHCS PPO |
$9.56
|
| Rate for Payer: Three Rivers PPO |
$7.31
|
| Rate for Payer: TriWest Veterans Administration |
$5.66
|
| Rate for Payer: United Healthcare Commercial |
$8.48
|
| Rate for Payer: United Healthcare Medicare |
$5.66
|
| Rate for Payer: WINHealth Partners Commercial |
$9.56
|
| Rate for Payer: Wise Provider Network Commercial |
$9.26
|
|
|
OSELTAMIVIR 75 MG CAPSULE [12331]
|
Facility
|
OP
|
$7.40
|
|
|
Service Code
|
NDC 6438079901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.25
|
| Rate for Payer: Aetna of WY Medicare |
$4.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.10
|
| Rate for Payer: Altius Commercial |
$7.10
|
| Rate for Payer: Beech Street Commercial |
$7.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.08
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.18
|
| Rate for Payer: Cigna of WY Commercial |
$7.25
|
| Rate for Payer: Entrust Commercial |
$7.03
|
| Rate for Payer: First Choice Health Commercial |
$7.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.29
|
| Rate for Payer: HealthUtah PPO |
$7.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.18
|
| Rate for Payer: Multiplan Medicare/VA |
$4.08
|
| Rate for Payer: One Health Plan of WY PPO |
$7.25
|
| Rate for Payer: PacificSource Commercial |
$6.66
|
| Rate for Payer: PHCS PPO |
$7.25
|
| Rate for Payer: Three Rivers PPO |
$5.55
|
| Rate for Payer: TriWest Veterans Administration |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$6.44
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
| Rate for Payer: WINHealth Partners Commercial |
$7.25
|
| Rate for Payer: Wise Provider Network Commercial |
$7.03
|
|
