|
SERTRALINE 50 MG TABLET [18988]
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 6068724211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.51
|
| Rate for Payer: Altius Commercial |
$1.51
|
| Rate for Payer: Beech Street Commercial |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.52
|
| Rate for Payer: Cigna of WY Commercial |
$1.54
|
| Rate for Payer: Entrust Commercial |
$1.49
|
| Rate for Payer: First Choice Health Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.52
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.54
|
| Rate for Payer: PacificSource Commercial |
$1.41
|
| Rate for Payer: PHCS PPO |
$1.54
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1.49
|
|
|
SERTRALINE 50 MG TABLET [18988]
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 6068724201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.51
|
| Rate for Payer: Altius Commercial |
$1.51
|
| Rate for Payer: Beech Street Commercial |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.52
|
| Rate for Payer: Cigna of WY Commercial |
$1.54
|
| Rate for Payer: Entrust Commercial |
$1.49
|
| Rate for Payer: First Choice Health Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.52
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.54
|
| Rate for Payer: PacificSource Commercial |
$1.41
|
| Rate for Payer: PHCS PPO |
$1.54
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1.49
|
|
|
SERTRALINE 50 MG TABLET [18988]
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 6068724201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.54
|
| Rate for Payer: Aetna of WY Medicare |
$1.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.51
|
| Rate for Payer: Altius Commercial |
$1.51
|
| Rate for Payer: Beech Street Commercial |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.52
|
| Rate for Payer: Cigna of WY Commercial |
$1.54
|
| Rate for Payer: Entrust Commercial |
$1.49
|
| Rate for Payer: First Choice Health Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.91
|
| Rate for Payer: HealthUtah PPO |
$1.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.52
|
| Rate for Payer: Multiplan Medicare/VA |
$0.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1.54
|
| Rate for Payer: PacificSource Commercial |
$1.41
|
| Rate for Payer: PHCS PPO |
$1.54
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1.54
|
| Rate for Payer: Wise Provider Network Commercial |
$1.49
|
|
|
SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
HCPCS 28315
|
| Hospital Charge Code |
28315
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$5,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,964.68
|
| Rate for Payer: Aetna of WY Medicare |
$318.83
|
| Rate for Payer: Beech Street Commercial |
$4,812.70
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: Cash Price |
$3,546.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,914.02
|
| Rate for Payer: Cigna of WY Commercial |
$4,964.68
|
| Rate for Payer: First Choice Health Commercial |
$4,559.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,812.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$318.83
|
| Rate for Payer: HealthUtah PPO |
$5,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,914.02
|
| Rate for Payer: Multiplan Medicare/VA |
$271.01
|
| Rate for Payer: One Health Plan of WY PPO |
$4,964.68
|
| Rate for Payer: PacificSource Commercial |
$4,559.40
|
| Rate for Payer: PHCS PPO |
$4,812.70
|
| Rate for Payer: Three Rivers PPO |
$3,799.50
|
| Rate for Payer: TriWest Veterans Administration |
$318.83
|
| Rate for Payer: United Healthcare Commercial |
$4,407.42
|
| Rate for Payer: United Healthcare Medicare |
$318.83
|
| Rate for Payer: WINHealth Partners Commercial |
$4,306.10
|
|
|
SET UP SURGICAL PACK W/DRAPE
|
Facility
|
OP
|
$8.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.69
|
| Rate for Payer: Aetna of WY Medicare |
$5.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.52
|
| Rate for Payer: Altius Commercial |
$8.52
|
| Rate for Payer: Beech Street Commercial |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.60
|
| Rate for Payer: Cigna of WY Commercial |
$8.69
|
| Rate for Payer: Entrust Commercial |
$8.43
|
| Rate for Payer: First Choice Health Commercial |
$8.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.14
|
| Rate for Payer: HealthUtah PPO |
$8.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.60
|
| Rate for Payer: Multiplan Medicare/VA |
$4.89
|
| Rate for Payer: One Health Plan of WY PPO |
$8.69
|
| Rate for Payer: PacificSource Commercial |
$7.98
|
| Rate for Payer: PHCS PPO |
$8.69
|
| Rate for Payer: Three Rivers PPO |
$6.65
|
| Rate for Payer: TriWest Veterans Administration |
$5.14
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$5.14
|
| Rate for Payer: WINHealth Partners Commercial |
$8.69
|
| Rate for Payer: Wise Provider Network Commercial |
$8.43
|
|
|
SET UP SURGICAL PACK W/DRAPE
|
Facility
|
IP
|
$8.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.52
|
| Rate for Payer: Altius Commercial |
$8.52
|
| Rate for Payer: Beech Street Commercial |
$8.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$6.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.60
|
| Rate for Payer: Cigna of WY Commercial |
$8.69
|
| Rate for Payer: Entrust Commercial |
$8.43
|
| Rate for Payer: First Choice Health Commercial |
$8.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.85
|
| Rate for Payer: HealthUtah PPO |
$8.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.60
|
| Rate for Payer: Multiplan Medicare/VA |
$5.56
|
| Rate for Payer: One Health Plan of WY PPO |
$8.69
|
| Rate for Payer: PacificSource Commercial |
$7.98
|
| Rate for Payer: PHCS PPO |
$8.69
|
| Rate for Payer: Three Rivers PPO |
$6.65
|
| Rate for Payer: TriWest Veterans Administration |
$5.85
|
| Rate for Payer: United Healthcare Commercial |
$7.72
|
| Rate for Payer: United Healthcare Medicare |
$5.85
|
| Rate for Payer: WINHealth Partners Commercial |
$8.43
|
| Rate for Payer: Wise Provider Network Commercial |
$8.43
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [46015]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
NDC 6516205827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.53
|
| Rate for Payer: Aetna of WY Medicare |
$1.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.50
|
| Rate for Payer: Altius Commercial |
$1.50
|
| Rate for Payer: Beech Street Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.51
|
| Rate for Payer: Cigna of WY Commercial |
$1.53
|
| Rate for Payer: Entrust Commercial |
$1.48
|
| Rate for Payer: First Choice Health Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.90
|
| Rate for Payer: HealthUtah PPO |
$1.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1.53
|
| Rate for Payer: PacificSource Commercial |
$1.40
|
| Rate for Payer: PHCS PPO |
$1.53
|
| Rate for Payer: Three Rivers PPO |
$1.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1.53
|
| Rate for Payer: Wise Provider Network Commercial |
$1.48
|
|
|
SEVELAMER CARBONATE 800 MG TABLET [46015]
|
Facility
|
IP
|
$1.56
|
|
|
Service Code
|
NDC 6516205827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.50
|
| Rate for Payer: Altius Commercial |
$1.50
|
| Rate for Payer: Beech Street Commercial |
$1.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.28
|
| Rate for Payer: Cash Price |
$1.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.51
|
| Rate for Payer: Cigna of WY Commercial |
$1.53
|
| Rate for Payer: Entrust Commercial |
$1.48
|
| Rate for Payer: First Choice Health Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.53
|
| Rate for Payer: PacificSource Commercial |
$1.40
|
| Rate for Payer: PHCS PPO |
$1.53
|
| Rate for Payer: Three Rivers PPO |
$1.17
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.36
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1.48
|
|
|
SEVOFLURANE INHALATION LIQUID [12024]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 1001965164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.02
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
SEVOFLURANE INHALATION LIQUID [12024]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 1001965164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.69
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.16
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
HCPCS 45338
|
| Hospital Charge Code |
45338
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$1,805.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,768.90
|
| Rate for Payer: Aetna of WY Medicare |
$114.35
|
| Rate for Payer: Beech Street Commercial |
$1,714.75
|
| Rate for Payer: Cash Price |
$1,263.50
|
| Rate for Payer: Cash Price |
$1,263.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,750.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,768.90
|
| Rate for Payer: First Choice Health Commercial |
$1,624.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,714.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.35
|
| Rate for Payer: HealthUtah PPO |
$1,805.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,750.85
|
| Rate for Payer: Multiplan Medicare/VA |
$97.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1,768.90
|
| Rate for Payer: PacificSource Commercial |
$1,624.50
|
| Rate for Payer: PHCS PPO |
$1,714.75
|
| Rate for Payer: Three Rivers PPO |
$1,353.75
|
| Rate for Payer: TriWest Veterans Administration |
$114.35
|
| Rate for Payer: United Healthcare Commercial |
$1,570.35
|
| Rate for Payer: United Healthcare Medicare |
$114.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,534.25
|
|
|
SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 11310
|
| Hospital Charge Code |
11310
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.32
|
| Rate for Payer: Aetna of WY Medicare |
$43.44
|
| Rate for Payer: Beech Street Commercial |
$222.30
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.98
|
| Rate for Payer: Cigna of WY Commercial |
$229.32
|
| Rate for Payer: First Choice Health Commercial |
$210.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.44
|
| Rate for Payer: HealthUtah PPO |
$234.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.98
|
| Rate for Payer: Multiplan Medicare/VA |
$36.92
|
| Rate for Payer: One Health Plan of WY PPO |
$229.32
|
| Rate for Payer: PacificSource Commercial |
$210.60
|
| Rate for Payer: PHCS PPO |
$222.30
|
| Rate for Payer: Three Rivers PPO |
$175.50
|
| Rate for Payer: TriWest Veterans Administration |
$43.44
|
| Rate for Payer: United Healthcare Commercial |
$203.58
|
| Rate for Payer: United Healthcare Medicare |
$43.44
|
| Rate for Payer: WINHealth Partners Commercial |
$198.90
|
|
|
SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 11313
|
| Hospital Charge Code |
11313
|
| Min. Negotiated Rate |
$77.94 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$385.14
|
| Rate for Payer: Aetna of WY Medicare |
$91.70
|
| Rate for Payer: Beech Street Commercial |
$373.35
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$381.21
|
| Rate for Payer: Cigna of WY Commercial |
$385.14
|
| Rate for Payer: First Choice Health Commercial |
$353.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.70
|
| Rate for Payer: HealthUtah PPO |
$393.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$381.21
|
| Rate for Payer: Multiplan Medicare/VA |
$77.94
|
| Rate for Payer: One Health Plan of WY PPO |
$385.14
|
| Rate for Payer: PacificSource Commercial |
$353.70
|
| Rate for Payer: PHCS PPO |
$373.35
|
| Rate for Payer: Three Rivers PPO |
$294.75
|
| Rate for Payer: TriWest Veterans Administration |
$91.70
|
| Rate for Payer: United Healthcare Commercial |
$341.91
|
| Rate for Payer: United Healthcare Medicare |
$91.70
|
| Rate for Payer: WINHealth Partners Commercial |
$334.05
|
|
|
SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 11305
|
| Hospital Charge Code |
11305
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$197.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.06
|
| Rate for Payer: Aetna of WY Medicare |
$35.75
|
| Rate for Payer: Beech Street Commercial |
$187.15
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.09
|
| Rate for Payer: Cigna of WY Commercial |
$193.06
|
| Rate for Payer: First Choice Health Commercial |
$177.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.75
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.09
|
| Rate for Payer: Multiplan Medicare/VA |
$30.39
|
| Rate for Payer: One Health Plan of WY PPO |
$193.06
|
| Rate for Payer: PacificSource Commercial |
$177.30
|
| Rate for Payer: PHCS PPO |
$187.15
|
| Rate for Payer: Three Rivers PPO |
$147.75
|
| Rate for Payer: TriWest Veterans Administration |
$35.75
|
| Rate for Payer: United Healthcare Commercial |
$171.39
|
| Rate for Payer: United Healthcare Medicare |
$35.75
|
| Rate for Payer: WINHealth Partners Commercial |
$167.45
|
|
|
SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 11306
|
| Hospital Charge Code |
11306
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$248.92
|
| Rate for Payer: Aetna of WY Medicare |
$46.71
|
| Rate for Payer: Beech Street Commercial |
$241.30
|
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: Cash Price |
$177.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$246.38
|
| Rate for Payer: Cigna of WY Commercial |
$248.92
|
| Rate for Payer: First Choice Health Commercial |
$228.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$241.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.71
|
| Rate for Payer: HealthUtah PPO |
$254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$246.38
|
| Rate for Payer: Multiplan Medicare/VA |
$39.70
|
| Rate for Payer: One Health Plan of WY PPO |
$248.92
|
| Rate for Payer: PacificSource Commercial |
$228.60
|
| Rate for Payer: PHCS PPO |
$241.30
|
| Rate for Payer: Three Rivers PPO |
$190.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.71
|
| Rate for Payer: United Healthcare Commercial |
$220.98
|
| Rate for Payer: United Healthcare Medicare |
$46.71
|
| Rate for Payer: WINHealth Partners Commercial |
$215.90
|
|
|
SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
11307
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$326.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$319.48
|
| Rate for Payer: Aetna of WY Medicare |
$59.55
|
| Rate for Payer: Beech Street Commercial |
$309.70
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$316.22
|
| Rate for Payer: Cigna of WY Commercial |
$319.48
|
| Rate for Payer: First Choice Health Commercial |
$293.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$309.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.55
|
| Rate for Payer: HealthUtah PPO |
$326.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$316.22
|
| Rate for Payer: Multiplan Medicare/VA |
$50.62
|
| Rate for Payer: One Health Plan of WY PPO |
$319.48
|
| Rate for Payer: PacificSource Commercial |
$293.40
|
| Rate for Payer: PHCS PPO |
$309.70
|
| Rate for Payer: Three Rivers PPO |
$244.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.55
|
| Rate for Payer: United Healthcare Commercial |
$283.62
|
| Rate for Payer: United Healthcare Medicare |
$59.55
|
| Rate for Payer: WINHealth Partners Commercial |
$277.10
|
|
|
SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
11308
|
| Min. Negotiated Rate |
$56.67 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$362.60
|
| Rate for Payer: Aetna of WY Medicare |
$66.67
|
| Rate for Payer: Beech Street Commercial |
$351.50
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$358.90
|
| Rate for Payer: Cigna of WY Commercial |
$362.60
|
| Rate for Payer: First Choice Health Commercial |
$333.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$351.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.67
|
| Rate for Payer: HealthUtah PPO |
$370.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$358.90
|
| Rate for Payer: Multiplan Medicare/VA |
$56.67
|
| Rate for Payer: One Health Plan of WY PPO |
$362.60
|
| Rate for Payer: PacificSource Commercial |
$333.00
|
| Rate for Payer: PHCS PPO |
$351.50
|
| Rate for Payer: Three Rivers PPO |
$277.50
|
| Rate for Payer: TriWest Veterans Administration |
$66.67
|
| Rate for Payer: United Healthcare Commercial |
$321.90
|
| Rate for Payer: United Healthcare Medicare |
$66.67
|
| Rate for Payer: WINHealth Partners Commercial |
$314.50
|
|
|
SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 11300
|
| Hospital Charge Code |
11300
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.56
|
| Rate for Payer: Aetna of WY Medicare |
$32.47
|
| Rate for Payer: Beech Street Commercial |
$163.40
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: Cash Price |
$120.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.84
|
| Rate for Payer: Cigna of WY Commercial |
$168.56
|
| Rate for Payer: First Choice Health Commercial |
$154.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.47
|
| Rate for Payer: HealthUtah PPO |
$172.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.84
|
| Rate for Payer: Multiplan Medicare/VA |
$27.60
|
| Rate for Payer: One Health Plan of WY PPO |
$168.56
|
| Rate for Payer: PacificSource Commercial |
$154.80
|
| Rate for Payer: PHCS PPO |
$163.40
|
| Rate for Payer: Three Rivers PPO |
$129.00
|
| Rate for Payer: TriWest Veterans Administration |
$32.47
|
| Rate for Payer: United Healthcare Commercial |
$149.64
|
| Rate for Payer: United Healthcare Medicare |
$32.47
|
| Rate for Payer: WINHealth Partners Commercial |
$146.20
|
|
|
SHEATH 4MM 0 DEG 1912000
|
Facility
|
OP
|
$220.68
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.59 |
| Max. Negotiated Rate |
$220.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.27
|
| Rate for Payer: Aetna of WY Medicare |
$145.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.85
|
| Rate for Payer: Altius Commercial |
$211.85
|
| Rate for Payer: Beech Street Commercial |
$216.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$181.18
|
| Rate for Payer: Cash Price |
$154.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.06
|
| Rate for Payer: Cigna of WY Commercial |
$216.27
|
| Rate for Payer: Entrust Commercial |
$209.65
|
| Rate for Payer: First Choice Health Commercial |
$209.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.99
|
| Rate for Payer: HealthUtah PPO |
$220.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.06
|
| Rate for Payer: Multiplan Medicare/VA |
$121.59
|
| Rate for Payer: One Health Plan of WY PPO |
$216.27
|
| Rate for Payer: PacificSource Commercial |
$198.61
|
| Rate for Payer: PHCS PPO |
$216.27
|
| Rate for Payer: Three Rivers PPO |
$165.51
|
| Rate for Payer: TriWest Veterans Administration |
$127.99
|
| Rate for Payer: United Healthcare Commercial |
$191.99
|
| Rate for Payer: United Healthcare Medicare |
$127.99
|
| Rate for Payer: WINHealth Partners Commercial |
$216.27
|
| Rate for Payer: Wise Provider Network Commercial |
$209.65
|
|
|
SHEATH 4MM 0 DEG 1912000
|
Facility
|
IP
|
$220.68
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.37 |
| Max. Negotiated Rate |
$220.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$211.85
|
| Rate for Payer: Altius Commercial |
$211.85
|
| Rate for Payer: Beech Street Commercial |
$216.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$181.18
|
| Rate for Payer: Cash Price |
$154.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.06
|
| Rate for Payer: Cigna of WY Commercial |
$216.27
|
| Rate for Payer: Entrust Commercial |
$209.65
|
| Rate for Payer: First Choice Health Commercial |
$209.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.65
|
| Rate for Payer: HealthUtah PPO |
$220.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.06
|
| Rate for Payer: Multiplan Medicare/VA |
$138.37
|
| Rate for Payer: One Health Plan of WY PPO |
$216.27
|
| Rate for Payer: PacificSource Commercial |
$198.61
|
| Rate for Payer: PHCS PPO |
$216.27
|
| Rate for Payer: Three Rivers PPO |
$165.51
|
| Rate for Payer: TriWest Veterans Administration |
$145.65
|
| Rate for Payer: United Healthcare Commercial |
$191.99
|
| Rate for Payer: United Healthcare Medicare |
$145.65
|
| Rate for Payer: WINHealth Partners Commercial |
$209.65
|
| Rate for Payer: Wise Provider Network Commercial |
$209.65
|
|
|
SHEATH 4MM 30 DEG
|
Facility
|
IP
|
$178.29
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.79 |
| Max. Negotiated Rate |
$178.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.16
|
| Rate for Payer: Altius Commercial |
$171.16
|
| Rate for Payer: Beech Street Commercial |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.38
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.94
|
| Rate for Payer: Cigna of WY Commercial |
$174.72
|
| Rate for Payer: Entrust Commercial |
$169.38
|
| Rate for Payer: First Choice Health Commercial |
$169.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.67
|
| Rate for Payer: HealthUtah PPO |
$178.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.94
|
| Rate for Payer: Multiplan Medicare/VA |
$111.79
|
| Rate for Payer: One Health Plan of WY PPO |
$174.72
|
| Rate for Payer: PacificSource Commercial |
$160.46
|
| Rate for Payer: PHCS PPO |
$174.72
|
| Rate for Payer: Three Rivers PPO |
$133.72
|
| Rate for Payer: TriWest Veterans Administration |
$117.67
|
| Rate for Payer: United Healthcare Commercial |
$155.11
|
| Rate for Payer: United Healthcare Medicare |
$117.67
|
| Rate for Payer: WINHealth Partners Commercial |
$169.38
|
| Rate for Payer: Wise Provider Network Commercial |
$169.38
|
|
|
SHEATH 4MM 30 DEG
|
Facility
|
OP
|
$178.29
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.24 |
| Max. Negotiated Rate |
$178.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.72
|
| Rate for Payer: Aetna of WY Medicare |
$117.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.16
|
| Rate for Payer: Altius Commercial |
$171.16
|
| Rate for Payer: Beech Street Commercial |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.38
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.94
|
| Rate for Payer: Cigna of WY Commercial |
$174.72
|
| Rate for Payer: Entrust Commercial |
$169.38
|
| Rate for Payer: First Choice Health Commercial |
$169.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.41
|
| Rate for Payer: HealthUtah PPO |
$178.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.94
|
| Rate for Payer: Multiplan Medicare/VA |
$98.24
|
| Rate for Payer: One Health Plan of WY PPO |
$174.72
|
| Rate for Payer: PacificSource Commercial |
$160.46
|
| Rate for Payer: PHCS PPO |
$174.72
|
| Rate for Payer: Three Rivers PPO |
$133.72
|
| Rate for Payer: TriWest Veterans Administration |
$103.41
|
| Rate for Payer: United Healthcare Commercial |
$155.11
|
| Rate for Payer: United Healthcare Medicare |
$103.41
|
| Rate for Payer: WINHealth Partners Commercial |
$174.72
|
| Rate for Payer: Wise Provider Network Commercial |
$169.38
|
|
|
SHILEY TRACH TUBE SZ 50
|
Facility
|
IP
|
$179.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.71 |
| Max. Negotiated Rate |
$179.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.57
|
| Rate for Payer: Altius Commercial |
$172.57
|
| Rate for Payer: Beech Street Commercial |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$125.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.37
|
| Rate for Payer: Cigna of WY Commercial |
$176.16
|
| Rate for Payer: Entrust Commercial |
$170.77
|
| Rate for Payer: First Choice Health Commercial |
$170.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.64
|
| Rate for Payer: HealthUtah PPO |
$179.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.37
|
| Rate for Payer: Multiplan Medicare/VA |
$112.71
|
| Rate for Payer: One Health Plan of WY PPO |
$176.16
|
| Rate for Payer: PacificSource Commercial |
$161.78
|
| Rate for Payer: PHCS PPO |
$176.16
|
| Rate for Payer: Three Rivers PPO |
$134.82
|
| Rate for Payer: TriWest Veterans Administration |
$118.64
|
| Rate for Payer: United Healthcare Commercial |
$156.39
|
| Rate for Payer: United Healthcare Medicare |
$118.64
|
| Rate for Payer: WINHealth Partners Commercial |
$170.77
|
| Rate for Payer: Wise Provider Network Commercial |
$170.77
|
|
|
SHILEY TRACH TUBE SZ 50
|
Facility
|
OP
|
$179.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.05 |
| Max. Negotiated Rate |
$179.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$176.16
|
| Rate for Payer: Aetna of WY Medicare |
$118.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$172.57
|
| Rate for Payer: Altius Commercial |
$172.57
|
| Rate for Payer: Beech Street Commercial |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$147.58
|
| Rate for Payer: Cash Price |
$125.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$174.37
|
| Rate for Payer: Cigna of WY Commercial |
$176.16
|
| Rate for Payer: Entrust Commercial |
$170.77
|
| Rate for Payer: First Choice Health Commercial |
$170.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$170.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.26
|
| Rate for Payer: HealthUtah PPO |
$179.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$174.37
|
| Rate for Payer: Multiplan Medicare/VA |
$99.05
|
| Rate for Payer: One Health Plan of WY PPO |
$176.16
|
| Rate for Payer: PacificSource Commercial |
$161.78
|
| Rate for Payer: PHCS PPO |
$176.16
|
| Rate for Payer: Three Rivers PPO |
$134.82
|
| Rate for Payer: TriWest Veterans Administration |
$104.26
|
| Rate for Payer: United Healthcare Commercial |
$156.39
|
| Rate for Payer: United Healthcare Medicare |
$104.26
|
| Rate for Payer: WINHealth Partners Commercial |
$176.16
|
| Rate for Payer: Wise Provider Network Commercial |
$170.77
|
|
|
SHILEY TRACH TUBE SZ 60
|
Facility
|
IP
|
$187.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.41 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$179.76
|
| Rate for Payer: Altius Commercial |
$179.76
|
| Rate for Payer: Beech Street Commercial |
$183.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.73
|
| Rate for Payer: Cash Price |
$131.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.63
|
| Rate for Payer: Cigna of WY Commercial |
$183.50
|
| Rate for Payer: Entrust Commercial |
$177.89
|
| Rate for Payer: First Choice Health Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.58
|
| Rate for Payer: HealthUtah PPO |
$187.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.63
|
| Rate for Payer: Multiplan Medicare/VA |
$117.41
|
| Rate for Payer: One Health Plan of WY PPO |
$183.50
|
| Rate for Payer: PacificSource Commercial |
$168.52
|
| Rate for Payer: PHCS PPO |
$183.50
|
| Rate for Payer: Three Rivers PPO |
$140.44
|
| Rate for Payer: TriWest Veterans Administration |
$123.58
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
| Rate for Payer: WINHealth Partners Commercial |
$177.89
|
| Rate for Payer: Wise Provider Network Commercial |
$177.89
|
|
