|
SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Professional
|
Both
|
$5,522.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
29827
|
| Min. Negotiated Rate |
$875.58 |
| Max. Negotiated Rate |
$5,522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,411.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,030.09
|
| Rate for Payer: Beech Street Commercial |
$5,245.90
|
| Rate for Payer: Cash Price |
$3,865.40
|
| Rate for Payer: Cash Price |
$3,865.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,356.34
|
| Rate for Payer: Cigna of WY Commercial |
$5,411.56
|
| Rate for Payer: First Choice Health Commercial |
$4,969.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,245.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.09
|
| Rate for Payer: HealthUtah PPO |
$5,522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,356.34
|
| Rate for Payer: Multiplan Medicare/VA |
$875.58
|
| Rate for Payer: One Health Plan of WY PPO |
$5,411.56
|
| Rate for Payer: PacificSource Commercial |
$4,969.80
|
| Rate for Payer: PHCS PPO |
$5,245.90
|
| Rate for Payer: Three Rivers PPO |
$4,141.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.09
|
| Rate for Payer: United Healthcare Commercial |
$4,804.14
|
| Rate for Payer: United Healthcare Medicare |
$1,030.09
|
| Rate for Payer: WINHealth Partners Commercial |
$4,693.70
|
|
|
SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR
|
Professional
|
Both
|
$5,522.00
|
|
|
Service Code
|
HCPCS 29827 AS
|
| Hospital Charge Code |
29827
|
| Min. Negotiated Rate |
$875.58 |
| Max. Negotiated Rate |
$5,522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,411.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,030.09
|
| Rate for Payer: Beech Street Commercial |
$5,245.90
|
| Rate for Payer: Cash Price |
$3,865.40
|
| Rate for Payer: Cash Price |
$3,865.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,356.34
|
| Rate for Payer: Cigna of WY Commercial |
$5,411.56
|
| Rate for Payer: First Choice Health Commercial |
$4,969.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,245.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,030.09
|
| Rate for Payer: HealthUtah PPO |
$5,522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,356.34
|
| Rate for Payer: Multiplan Medicare/VA |
$875.58
|
| Rate for Payer: One Health Plan of WY PPO |
$5,411.56
|
| Rate for Payer: PacificSource Commercial |
$4,969.80
|
| Rate for Payer: PHCS PPO |
$5,245.90
|
| Rate for Payer: Three Rivers PPO |
$4,141.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,030.09
|
| Rate for Payer: United Healthcare Commercial |
$4,804.14
|
| Rate for Payer: United Healthcare Medicare |
$1,030.09
|
| Rate for Payer: WINHealth Partners Commercial |
$4,693.70
|
|
|
SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$3,237.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,172.26
|
| Rate for Payer: Aetna of WY Medicare |
$577.29
|
| Rate for Payer: Beech Street Commercial |
$3,075.15
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,139.89
|
| Rate for Payer: Cigna of WY Commercial |
$3,172.26
|
| Rate for Payer: First Choice Health Commercial |
$2,913.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,075.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.29
|
| Rate for Payer: HealthUtah PPO |
$3,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,139.89
|
| Rate for Payer: Multiplan Medicare/VA |
$490.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,172.26
|
| Rate for Payer: PacificSource Commercial |
$2,913.30
|
| Rate for Payer: PHCS PPO |
$3,075.15
|
| Rate for Payer: Three Rivers PPO |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration |
$577.29
|
| Rate for Payer: United Healthcare Commercial |
$2,816.19
|
| Rate for Payer: United Healthcare Medicare |
$577.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,751.45
|
|
|
SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$3,237.00
|
|
|
Service Code
|
HCPCS 29823 AS
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,172.26
|
| Rate for Payer: Aetna of WY Medicare |
$577.29
|
| Rate for Payer: Beech Street Commercial |
$3,075.15
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,139.89
|
| Rate for Payer: Cigna of WY Commercial |
$3,172.26
|
| Rate for Payer: First Choice Health Commercial |
$2,913.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,075.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.29
|
| Rate for Payer: HealthUtah PPO |
$3,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,139.89
|
| Rate for Payer: Multiplan Medicare/VA |
$490.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,172.26
|
| Rate for Payer: PacificSource Commercial |
$2,913.30
|
| Rate for Payer: PHCS PPO |
$3,075.15
|
| Rate for Payer: Three Rivers PPO |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration |
$577.29
|
| Rate for Payer: United Healthcare Commercial |
$2,816.19
|
| Rate for Payer: United Healthcare Medicare |
$577.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,751.45
|
|
|
SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+
|
Professional
|
Both
|
$3,237.00
|
|
|
Service Code
|
HCPCS 29823 80
|
| Hospital Charge Code |
29823
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,172.26
|
| Rate for Payer: Aetna of WY Medicare |
$577.29
|
| Rate for Payer: Beech Street Commercial |
$3,075.15
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: Cash Price |
$2,265.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,139.89
|
| Rate for Payer: Cigna of WY Commercial |
$3,172.26
|
| Rate for Payer: First Choice Health Commercial |
$2,913.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,075.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.29
|
| Rate for Payer: HealthUtah PPO |
$3,237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,139.89
|
| Rate for Payer: Multiplan Medicare/VA |
$490.70
|
| Rate for Payer: One Health Plan of WY PPO |
$3,172.26
|
| Rate for Payer: PacificSource Commercial |
$2,913.30
|
| Rate for Payer: PHCS PPO |
$3,075.15
|
| Rate for Payer: Three Rivers PPO |
$2,427.75
|
| Rate for Payer: TriWest Veterans Administration |
$577.29
|
| Rate for Payer: United Healthcare Commercial |
$2,816.19
|
| Rate for Payer: United Healthcare Medicare |
$577.29
|
| Rate for Payer: WINHealth Partners Commercial |
$2,751.45
|
|
|
SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$162.04
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.04
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$137.73
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.04
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$162.04
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 29826 80
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$162.04
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.04
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$137.73
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.04
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$162.04
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 29826 AS
|
| Hospital Charge Code |
29826
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$162.04
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.04
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$137.73
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$162.04
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$162.04
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
SURGICAL TRAYS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS A4550
|
| Hospital Charge Code |
A4550
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: First Choice Health Commercial |
$44.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
|
|
SURGICEL FIBRILLAR 2"X4"
|
Facility
|
IP
|
$252.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$241.92
|
| Rate for Payer: Altius Commercial |
$241.92
|
| Rate for Payer: Beech Street Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$206.89
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: Entrust Commercial |
$239.40
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.32
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$158.00
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$246.96
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$166.32
|
| Rate for Payer: United Healthcare Commercial |
$219.24
|
| Rate for Payer: United Healthcare Medicare |
$166.32
|
| Rate for Payer: WINHealth Partners Commercial |
$239.40
|
| Rate for Payer: Wise Provider Network Commercial |
$239.40
|
|
|
SURGICEL FIBRILLAR 2"X4"
|
Facility
|
OP
|
$252.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.85 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$246.96
|
| Rate for Payer: Aetna of WY Medicare |
$166.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$241.92
|
| Rate for Payer: Altius Commercial |
$241.92
|
| Rate for Payer: Beech Street Commercial |
$246.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$206.89
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$244.44
|
| Rate for Payer: Cigna of WY Commercial |
$246.96
|
| Rate for Payer: Entrust Commercial |
$239.40
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$146.16
|
| Rate for Payer: HealthUtah PPO |
$252.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$244.44
|
| Rate for Payer: Multiplan Medicare/VA |
$138.85
|
| Rate for Payer: One Health Plan of WY PPO |
$246.96
|
| Rate for Payer: PacificSource Commercial |
$226.80
|
| Rate for Payer: PHCS PPO |
$246.96
|
| Rate for Payer: Three Rivers PPO |
$189.00
|
| Rate for Payer: TriWest Veterans Administration |
$146.16
|
| Rate for Payer: United Healthcare Commercial |
$219.24
|
| Rate for Payer: United Healthcare Medicare |
$146.16
|
| Rate for Payer: WINHealth Partners Commercial |
$246.96
|
| Rate for Payer: Wise Provider Network Commercial |
$239.40
|
|
|
SURGICEL HEMOSTAT 4"X8"
|
Facility
|
OP
|
$365.13
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.19 |
| Max. Negotiated Rate |
$365.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.83
|
| Rate for Payer: Aetna of WY Medicare |
$240.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.52
|
| Rate for Payer: Altius Commercial |
$350.52
|
| Rate for Payer: Beech Street Commercial |
$357.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.77
|
| Rate for Payer: Cash Price |
$255.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.18
|
| Rate for Payer: Cigna of WY Commercial |
$357.83
|
| Rate for Payer: Entrust Commercial |
$346.87
|
| Rate for Payer: First Choice Health Commercial |
$346.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.78
|
| Rate for Payer: HealthUtah PPO |
$365.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.18
|
| Rate for Payer: Multiplan Medicare/VA |
$201.19
|
| Rate for Payer: One Health Plan of WY PPO |
$357.83
|
| Rate for Payer: PacificSource Commercial |
$328.62
|
| Rate for Payer: PHCS PPO |
$357.83
|
| Rate for Payer: Three Rivers PPO |
$273.85
|
| Rate for Payer: TriWest Veterans Administration |
$211.78
|
| Rate for Payer: United Healthcare Commercial |
$317.66
|
| Rate for Payer: United Healthcare Medicare |
$211.78
|
| Rate for Payer: WINHealth Partners Commercial |
$357.83
|
| Rate for Payer: Wise Provider Network Commercial |
$346.87
|
|
|
SURGICEL HEMOSTAT 4"X8"
|
Facility
|
IP
|
$365.13
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.94 |
| Max. Negotiated Rate |
$365.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$350.52
|
| Rate for Payer: Altius Commercial |
$350.52
|
| Rate for Payer: Beech Street Commercial |
$357.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.77
|
| Rate for Payer: Cash Price |
$255.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.18
|
| Rate for Payer: Cigna of WY Commercial |
$357.83
|
| Rate for Payer: Entrust Commercial |
$346.87
|
| Rate for Payer: First Choice Health Commercial |
$346.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.99
|
| Rate for Payer: HealthUtah PPO |
$365.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.18
|
| Rate for Payer: Multiplan Medicare/VA |
$228.94
|
| Rate for Payer: One Health Plan of WY PPO |
$357.83
|
| Rate for Payer: PacificSource Commercial |
$328.62
|
| Rate for Payer: PHCS PPO |
$357.83
|
| Rate for Payer: Three Rivers PPO |
$273.85
|
| Rate for Payer: TriWest Veterans Administration |
$240.99
|
| Rate for Payer: United Healthcare Commercial |
$317.66
|
| Rate for Payer: United Healthcare Medicare |
$240.99
|
| Rate for Payer: WINHealth Partners Commercial |
$346.87
|
| Rate for Payer: Wise Provider Network Commercial |
$346.87
|
|
|
SURGICEL HEMOSTAT .5"X2"
|
Facility
|
IP
|
$97.93
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$97.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.01
|
| Rate for Payer: Altius Commercial |
$94.01
|
| Rate for Payer: Beech Street Commercial |
$95.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$68.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.99
|
| Rate for Payer: Cigna of WY Commercial |
$95.97
|
| Rate for Payer: Entrust Commercial |
$93.03
|
| Rate for Payer: First Choice Health Commercial |
$93.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.63
|
| Rate for Payer: HealthUtah PPO |
$97.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.99
|
| Rate for Payer: Multiplan Medicare/VA |
$61.40
|
| Rate for Payer: One Health Plan of WY PPO |
$95.97
|
| Rate for Payer: PacificSource Commercial |
$88.14
|
| Rate for Payer: PHCS PPO |
$95.97
|
| Rate for Payer: Three Rivers PPO |
$73.45
|
| Rate for Payer: TriWest Veterans Administration |
$64.63
|
| Rate for Payer: United Healthcare Commercial |
$85.20
|
| Rate for Payer: United Healthcare Medicare |
$64.63
|
| Rate for Payer: WINHealth Partners Commercial |
$93.03
|
| Rate for Payer: Wise Provider Network Commercial |
$93.03
|
|
|
SURGICEL HEMOSTAT .5"X2"
|
Facility
|
OP
|
$97.93
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.96 |
| Max. Negotiated Rate |
$97.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.97
|
| Rate for Payer: Aetna of WY Medicare |
$64.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$94.01
|
| Rate for Payer: Altius Commercial |
$94.01
|
| Rate for Payer: Beech Street Commercial |
$95.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$68.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.99
|
| Rate for Payer: Cigna of WY Commercial |
$95.97
|
| Rate for Payer: Entrust Commercial |
$93.03
|
| Rate for Payer: First Choice Health Commercial |
$93.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$93.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.80
|
| Rate for Payer: HealthUtah PPO |
$97.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.99
|
| Rate for Payer: Multiplan Medicare/VA |
$53.96
|
| Rate for Payer: One Health Plan of WY PPO |
$95.97
|
| Rate for Payer: PacificSource Commercial |
$88.14
|
| Rate for Payer: PHCS PPO |
$95.97
|
| Rate for Payer: Three Rivers PPO |
$73.45
|
| Rate for Payer: TriWest Veterans Administration |
$56.80
|
| Rate for Payer: United Healthcare Commercial |
$85.20
|
| Rate for Payer: United Healthcare Medicare |
$56.80
|
| Rate for Payer: WINHealth Partners Commercial |
$95.97
|
| Rate for Payer: Wise Provider Network Commercial |
$93.03
|
|
|
SURGIFOAM POWDER 1 GRAM 1978
|
Facility
|
IP
|
$365.64
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$365.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$358.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$351.01
|
| Rate for Payer: Altius Commercial |
$351.01
|
| Rate for Payer: Beech Street Commercial |
$358.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$300.19
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.67
|
| Rate for Payer: Cigna of WY Commercial |
$358.33
|
| Rate for Payer: Entrust Commercial |
$347.36
|
| Rate for Payer: First Choice Health Commercial |
$347.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$347.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$241.32
|
| Rate for Payer: HealthUtah PPO |
$365.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.67
|
| Rate for Payer: Multiplan Medicare/VA |
$229.26
|
| Rate for Payer: One Health Plan of WY PPO |
$358.33
|
| Rate for Payer: PacificSource Commercial |
$329.08
|
| Rate for Payer: PHCS PPO |
$358.33
|
| Rate for Payer: Three Rivers PPO |
$274.23
|
| Rate for Payer: TriWest Veterans Administration |
$241.32
|
| Rate for Payer: United Healthcare Commercial |
$318.11
|
| Rate for Payer: United Healthcare Medicare |
$241.32
|
| Rate for Payer: WINHealth Partners Commercial |
$347.36
|
| Rate for Payer: Wise Provider Network Commercial |
$347.36
|
|
|
SURGIFOAM POWDER 1 GRAM 1978
|
Facility
|
OP
|
$365.64
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.47 |
| Max. Negotiated Rate |
$365.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$358.33
|
| Rate for Payer: Aetna of WY Medicare |
$241.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$351.01
|
| Rate for Payer: Altius Commercial |
$351.01
|
| Rate for Payer: Beech Street Commercial |
$358.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$300.19
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.67
|
| Rate for Payer: Cigna of WY Commercial |
$358.33
|
| Rate for Payer: Entrust Commercial |
$347.36
|
| Rate for Payer: First Choice Health Commercial |
$347.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$347.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$212.07
|
| Rate for Payer: HealthUtah PPO |
$365.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.67
|
| Rate for Payer: Multiplan Medicare/VA |
$201.47
|
| Rate for Payer: One Health Plan of WY PPO |
$358.33
|
| Rate for Payer: PacificSource Commercial |
$329.08
|
| Rate for Payer: PHCS PPO |
$358.33
|
| Rate for Payer: Three Rivers PPO |
$274.23
|
| Rate for Payer: TriWest Veterans Administration |
$212.07
|
| Rate for Payer: United Healthcare Commercial |
$318.11
|
| Rate for Payer: United Healthcare Medicare |
$212.07
|
| Rate for Payer: WINHealth Partners Commercial |
$358.33
|
| Rate for Payer: Wise Provider Network Commercial |
$347.36
|
|
|
SURGIFOAM SPONGE 2X6X7 1972
|
Facility
|
IP
|
$24.77
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.78
|
| Rate for Payer: Altius Commercial |
$23.78
|
| Rate for Payer: Beech Street Commercial |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.34
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.03
|
| Rate for Payer: Cigna of WY Commercial |
$24.27
|
| Rate for Payer: Entrust Commercial |
$23.53
|
| Rate for Payer: First Choice Health Commercial |
$23.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.35
|
| Rate for Payer: HealthUtah PPO |
$24.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.03
|
| Rate for Payer: Multiplan Medicare/VA |
$15.53
|
| Rate for Payer: One Health Plan of WY PPO |
$24.27
|
| Rate for Payer: PacificSource Commercial |
$22.29
|
| Rate for Payer: PHCS PPO |
$24.27
|
| Rate for Payer: Three Rivers PPO |
$18.58
|
| Rate for Payer: TriWest Veterans Administration |
$16.35
|
| Rate for Payer: United Healthcare Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare |
$16.35
|
| Rate for Payer: WINHealth Partners Commercial |
$23.53
|
| Rate for Payer: Wise Provider Network Commercial |
$23.53
|
|
|
SURGIFOAM SPONGE 2X6X7 1972
|
Facility
|
OP
|
$24.77
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.27
|
| Rate for Payer: Aetna of WY Medicare |
$16.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.78
|
| Rate for Payer: Altius Commercial |
$23.78
|
| Rate for Payer: Beech Street Commercial |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.34
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.03
|
| Rate for Payer: Cigna of WY Commercial |
$24.27
|
| Rate for Payer: Entrust Commercial |
$23.53
|
| Rate for Payer: First Choice Health Commercial |
$23.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.37
|
| Rate for Payer: HealthUtah PPO |
$24.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.03
|
| Rate for Payer: Multiplan Medicare/VA |
$13.65
|
| Rate for Payer: One Health Plan of WY PPO |
$24.27
|
| Rate for Payer: PacificSource Commercial |
$22.29
|
| Rate for Payer: PHCS PPO |
$24.27
|
| Rate for Payer: Three Rivers PPO |
$18.58
|
| Rate for Payer: TriWest Veterans Administration |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare |
$14.37
|
| Rate for Payer: WINHealth Partners Commercial |
$24.27
|
| Rate for Payer: Wise Provider Network Commercial |
$23.53
|
|
|
SURGIFOAM SPONGE 8X12.5X2
|
Facility
|
OP
|
$124.70
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$124.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.21
|
| Rate for Payer: Aetna of WY Medicare |
$82.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.71
|
| Rate for Payer: Altius Commercial |
$119.71
|
| Rate for Payer: Beech Street Commercial |
$122.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.38
|
| Rate for Payer: Cash Price |
$87.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.96
|
| Rate for Payer: Cigna of WY Commercial |
$122.21
|
| Rate for Payer: Entrust Commercial |
$118.46
|
| Rate for Payer: First Choice Health Commercial |
$118.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.33
|
| Rate for Payer: HealthUtah PPO |
$124.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.96
|
| Rate for Payer: Multiplan Medicare/VA |
$68.71
|
| Rate for Payer: One Health Plan of WY PPO |
$122.21
|
| Rate for Payer: PacificSource Commercial |
$112.23
|
| Rate for Payer: PHCS PPO |
$122.21
|
| Rate for Payer: Three Rivers PPO |
$93.52
|
| Rate for Payer: TriWest Veterans Administration |
$72.33
|
| Rate for Payer: United Healthcare Commercial |
$108.49
|
| Rate for Payer: United Healthcare Medicare |
$72.33
|
| Rate for Payer: WINHealth Partners Commercial |
$122.21
|
| Rate for Payer: Wise Provider Network Commercial |
$118.46
|
|
|
SURGIFOAM SPONGE 8X12.5X2
|
Facility
|
IP
|
$124.70
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$124.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$122.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.71
|
| Rate for Payer: Altius Commercial |
$119.71
|
| Rate for Payer: Beech Street Commercial |
$122.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.38
|
| Rate for Payer: Cash Price |
$87.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.96
|
| Rate for Payer: Cigna of WY Commercial |
$122.21
|
| Rate for Payer: Entrust Commercial |
$118.46
|
| Rate for Payer: First Choice Health Commercial |
$118.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$118.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.30
|
| Rate for Payer: HealthUtah PPO |
$124.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.96
|
| Rate for Payer: Multiplan Medicare/VA |
$78.19
|
| Rate for Payer: One Health Plan of WY PPO |
$122.21
|
| Rate for Payer: PacificSource Commercial |
$112.23
|
| Rate for Payer: PHCS PPO |
$122.21
|
| Rate for Payer: Three Rivers PPO |
$93.52
|
| Rate for Payer: TriWest Veterans Administration |
$82.30
|
| Rate for Payer: United Healthcare Commercial |
$108.49
|
| Rate for Payer: United Healthcare Medicare |
$82.30
|
| Rate for Payer: WINHealth Partners Commercial |
$118.46
|
| Rate for Payer: Wise Provider Network Commercial |
$118.46
|
|
|
SURGIFOAM SPONGE 8X6.25X10
|
Facility
|
OP
|
$84.31
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.62
|
| Rate for Payer: Aetna of WY Medicare |
$55.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.94
|
| Rate for Payer: Altius Commercial |
$80.94
|
| Rate for Payer: Beech Street Commercial |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.22
|
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.78
|
| Rate for Payer: Cigna of WY Commercial |
$82.62
|
| Rate for Payer: Entrust Commercial |
$80.09
|
| Rate for Payer: First Choice Health Commercial |
$80.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.90
|
| Rate for Payer: HealthUtah PPO |
$84.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.78
|
| Rate for Payer: Multiplan Medicare/VA |
$46.45
|
| Rate for Payer: One Health Plan of WY PPO |
$82.62
|
| Rate for Payer: PacificSource Commercial |
$75.88
|
| Rate for Payer: PHCS PPO |
$82.62
|
| Rate for Payer: Three Rivers PPO |
$63.23
|
| Rate for Payer: TriWest Veterans Administration |
$48.90
|
| Rate for Payer: United Healthcare Commercial |
$73.35
|
| Rate for Payer: United Healthcare Medicare |
$48.90
|
| Rate for Payer: WINHealth Partners Commercial |
$82.62
|
| Rate for Payer: Wise Provider Network Commercial |
$80.09
|
|
|
SURGIFOAM SPONGE 8X6.25X10
|
Facility
|
IP
|
$84.31
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$84.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.94
|
| Rate for Payer: Altius Commercial |
$80.94
|
| Rate for Payer: Beech Street Commercial |
$82.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.22
|
| Rate for Payer: Cash Price |
$59.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.78
|
| Rate for Payer: Cigna of WY Commercial |
$82.62
|
| Rate for Payer: Entrust Commercial |
$80.09
|
| Rate for Payer: First Choice Health Commercial |
$80.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.64
|
| Rate for Payer: HealthUtah PPO |
$84.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.78
|
| Rate for Payer: Multiplan Medicare/VA |
$52.86
|
| Rate for Payer: One Health Plan of WY PPO |
$82.62
|
| Rate for Payer: PacificSource Commercial |
$75.88
|
| Rate for Payer: PHCS PPO |
$82.62
|
| Rate for Payer: Three Rivers PPO |
$63.23
|
| Rate for Payer: TriWest Veterans Administration |
$55.64
|
| Rate for Payer: United Healthcare Commercial |
$73.35
|
| Rate for Payer: United Healthcare Medicare |
$55.64
|
| Rate for Payer: WINHealth Partners Commercial |
$80.09
|
| Rate for Payer: Wise Provider Network Commercial |
$80.09
|
|
|
SURGIPHOR ANTIMICROBIAL IRRIGATION KIT
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$143.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.86
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$119.57
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$125.86
|
| Rate for Payer: WINHealth Partners Commercial |
$212.66
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
SURGIPHOR ANTIMICROBIAL IRRIGATION KIT
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.06 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.22
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$136.06
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.22
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$143.22
|
| Rate for Payer: WINHealth Partners Commercial |
$206.15
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
