|
CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION [11330]
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
HCPCS J9060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.32
|
| Rate for Payer: Aetna of WY Medicare |
$10.99
|
| Rate for Payer: Altius Commercial |
$15.98
|
| Rate for Payer: Beech Street Commercial |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.15
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.15
|
| Rate for Payer: Cigna of WY Commercial |
$16.32
|
| Rate for Payer: Entrust Commercial |
$15.82
|
| Rate for Payer: First Choice Health Commercial |
$15.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$16.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.15
|
| Rate for Payer: Multiplan Medicare/VA |
$9.02
|
| Rate for Payer: One Health Plan of WY PPO |
$16.32
|
| Rate for Payer: PacificSource Commercial |
$14.98
|
| Rate for Payer: PHCS PPO |
$16.32
|
| Rate for Payer: Three Rivers PPO |
$12.49
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$15.90
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$16.32
|
| Rate for Payer: Wise Provider Network Commercial |
$15.82
|
|
|
CLARIFIX CRYOTHERAPY DEVICE
|
Facility
|
IP
|
$5,465.18
|
|
| Hospital Charge Code |
3004780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,167.07 |
| Max. Negotiated Rate |
$5,465.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,355.88
|
| Rate for Payer: Aetna of WY Medicare |
$3,497.72
|
| Rate for Payer: Altius Commercial |
$5,246.57
|
| Rate for Payer: Beech Street Commercial |
$5,355.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,301.22
|
| Rate for Payer: Cash Price |
$3,825.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,301.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,355.88
|
| Rate for Payer: Entrust Commercial |
$5,191.92
|
| Rate for Payer: First Choice Health Commercial |
$5,191.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,191.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,333.76
|
| Rate for Payer: HealthUtah PPO |
$5,465.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,301.22
|
| Rate for Payer: Multiplan Medicare/VA |
$3,167.07
|
| Rate for Payer: One Health Plan of WY PPO |
$5,355.88
|
| Rate for Payer: PacificSource Commercial |
$4,918.66
|
| Rate for Payer: PHCS PPO |
$5,355.88
|
| Rate for Payer: Three Rivers PPO |
$4,098.88
|
| Rate for Payer: TriWest Veterans Administration |
$3,333.76
|
| Rate for Payer: United Healthcare Commercial |
$5,219.25
|
| Rate for Payer: United Healthcare Medicare |
$3,333.76
|
| Rate for Payer: WINHealth Partners Commercial |
$5,191.92
|
| Rate for Payer: Wise Provider Network Commercial |
$5,191.92
|
|
|
CLARIFIX CRYOTHERAPY DEVICE
|
Facility
|
OP
|
$5,465.18
|
|
| Hospital Charge Code |
3004780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,959.39 |
| Max. Negotiated Rate |
$5,465.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,355.88
|
| Rate for Payer: Aetna of WY Medicare |
$3,607.02
|
| Rate for Payer: Altius Commercial |
$5,246.57
|
| Rate for Payer: Beech Street Commercial |
$5,355.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,301.22
|
| Rate for Payer: Cash Price |
$3,825.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,301.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,355.88
|
| Rate for Payer: Entrust Commercial |
$5,191.92
|
| Rate for Payer: First Choice Health Commercial |
$5,191.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,191.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,115.15
|
| Rate for Payer: HealthUtah PPO |
$5,465.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,301.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,959.39
|
| Rate for Payer: One Health Plan of WY PPO |
$5,355.88
|
| Rate for Payer: PacificSource Commercial |
$4,918.66
|
| Rate for Payer: PHCS PPO |
$5,355.88
|
| Rate for Payer: Three Rivers PPO |
$4,098.88
|
| Rate for Payer: TriWest Veterans Administration |
$3,115.15
|
| Rate for Payer: United Healthcare Commercial |
$5,219.25
|
| Rate for Payer: United Healthcare Medicare |
$3,115.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,355.88
|
| Rate for Payer: Wise Provider Network Commercial |
$5,191.92
|
|
|
CLARITHROMYCIN 500 MG TABLET [3801]
|
Facility
|
IP
|
$18.91
|
|
|
Service Code
|
NDC 0781196260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.53
|
| Rate for Payer: Aetna of WY Medicare |
$12.10
|
| Rate for Payer: Altius Commercial |
$18.15
|
| Rate for Payer: Beech Street Commercial |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.34
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.34
|
| Rate for Payer: Cigna of WY Commercial |
$18.53
|
| Rate for Payer: Entrust Commercial |
$17.96
|
| Rate for Payer: First Choice Health Commercial |
$17.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.54
|
| Rate for Payer: HealthUtah PPO |
$18.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.34
|
| Rate for Payer: Multiplan Medicare/VA |
$10.96
|
| Rate for Payer: One Health Plan of WY PPO |
$18.53
|
| Rate for Payer: PacificSource Commercial |
$17.02
|
| Rate for Payer: PHCS PPO |
$18.53
|
| Rate for Payer: Three Rivers PPO |
$14.18
|
| Rate for Payer: TriWest Veterans Administration |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$18.06
|
| Rate for Payer: United Healthcare Medicare |
$11.54
|
| Rate for Payer: WINHealth Partners Commercial |
$17.96
|
| Rate for Payer: Wise Provider Network Commercial |
$17.96
|
|
|
CLARITHROMYCIN 500 MG TABLET [3801]
|
Facility
|
OP
|
$18.91
|
|
|
Service Code
|
NDC 0781196260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$18.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.53
|
| Rate for Payer: Aetna of WY Medicare |
$12.48
|
| Rate for Payer: Altius Commercial |
$18.15
|
| Rate for Payer: Beech Street Commercial |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.34
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.34
|
| Rate for Payer: Cigna of WY Commercial |
$18.53
|
| Rate for Payer: Entrust Commercial |
$17.96
|
| Rate for Payer: First Choice Health Commercial |
$17.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.78
|
| Rate for Payer: HealthUtah PPO |
$18.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.34
|
| Rate for Payer: Multiplan Medicare/VA |
$10.24
|
| Rate for Payer: One Health Plan of WY PPO |
$18.53
|
| Rate for Payer: PacificSource Commercial |
$17.02
|
| Rate for Payer: PHCS PPO |
$18.53
|
| Rate for Payer: Three Rivers PPO |
$14.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$18.06
|
| Rate for Payer: United Healthcare Medicare |
$10.78
|
| Rate for Payer: WINHealth Partners Commercial |
$18.53
|
| Rate for Payer: Wise Provider Network Commercial |
$17.96
|
|
|
CLAVICAL SPLINT LRG
|
Facility
|
IP
|
$21.94
|
|
| Hospital Charge Code |
2200012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.04
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.38
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.71
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$13.38
|
| Rate for Payer: United Healthcare Commercial |
$20.95
|
| Rate for Payer: United Healthcare Medicare |
$13.38
|
| Rate for Payer: WINHealth Partners Commercial |
$20.84
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT LRG
|
Facility
|
OP
|
$21.94
|
|
| Hospital Charge Code |
2200012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.48
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.51
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$11.88
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$12.51
|
| Rate for Payer: United Healthcare Commercial |
$20.95
|
| Rate for Payer: United Healthcare Medicare |
$12.51
|
| Rate for Payer: WINHealth Partners Commercial |
$21.50
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT MED VP10123-03
|
Facility
|
OP
|
$21.94
|
|
| Hospital Charge Code |
2200013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.48
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.51
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$11.88
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$12.51
|
| Rate for Payer: United Healthcare Commercial |
$20.95
|
| Rate for Payer: United Healthcare Medicare |
$12.51
|
| Rate for Payer: WINHealth Partners Commercial |
$21.50
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT MED VP10123-03
|
Facility
|
IP
|
$21.94
|
|
| Hospital Charge Code |
2200013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.04
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.38
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.71
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$13.38
|
| Rate for Payer: United Healthcare Commercial |
$20.95
|
| Rate for Payer: United Healthcare Medicare |
$13.38
|
| Rate for Payer: WINHealth Partners Commercial |
$20.84
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT SM VP10123-020
|
Facility
|
IP
|
$21.94
|
|
| Hospital Charge Code |
2200355
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.04
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.38
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$12.71
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$13.38
|
| Rate for Payer: United Healthcare Commercial |
$20.95
|
| Rate for Payer: United Healthcare Medicare |
$13.38
|
| Rate for Payer: WINHealth Partners Commercial |
$20.84
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT SM VP10123-020
|
Facility
|
OP
|
$21.94
|
|
| Hospital Charge Code |
2200355
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$21.94 |
| Rate for Payer: United Healthcare Commercial |
$20.95
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.50
|
| Rate for Payer: Aetna of WY Medicare |
$14.48
|
| Rate for Payer: Altius Commercial |
$21.06
|
| Rate for Payer: Beech Street Commercial |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.28
|
| Rate for Payer: Cigna of WY Commercial |
$21.50
|
| Rate for Payer: Entrust Commercial |
$20.84
|
| Rate for Payer: First Choice Health Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.51
|
| Rate for Payer: HealthUtah PPO |
$21.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.28
|
| Rate for Payer: Multiplan Medicare/VA |
$11.88
|
| Rate for Payer: One Health Plan of WY PPO |
$21.50
|
| Rate for Payer: PacificSource Commercial |
$19.75
|
| Rate for Payer: PHCS PPO |
$21.50
|
| Rate for Payer: Three Rivers PPO |
$16.46
|
| Rate for Payer: TriWest Veterans Administration |
$12.51
|
| Rate for Payer: United Healthcare Medicare |
$12.51
|
| Rate for Payer: WINHealth Partners Commercial |
$21.50
|
| Rate for Payer: Wise Provider Network Commercial |
$20.84
|
|
|
CLAVICAL SPLINT XL
|
Facility
|
IP
|
$17.64
|
|
| Hospital Charge Code |
2200358
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.29
|
| Rate for Payer: Aetna of WY Medicare |
$11.29
|
| Rate for Payer: Altius Commercial |
$16.93
|
| Rate for Payer: Beech Street Commercial |
$17.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.11
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.11
|
| Rate for Payer: Cigna of WY Commercial |
$17.29
|
| Rate for Payer: Entrust Commercial |
$16.76
|
| Rate for Payer: First Choice Health Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.76
|
| Rate for Payer: HealthUtah PPO |
$17.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.11
|
| Rate for Payer: Multiplan Medicare/VA |
$10.22
|
| Rate for Payer: One Health Plan of WY PPO |
$17.29
|
| Rate for Payer: PacificSource Commercial |
$15.88
|
| Rate for Payer: PHCS PPO |
$17.29
|
| Rate for Payer: Three Rivers PPO |
$13.23
|
| Rate for Payer: TriWest Veterans Administration |
$10.76
|
| Rate for Payer: United Healthcare Commercial |
$16.85
|
| Rate for Payer: United Healthcare Medicare |
$10.76
|
| Rate for Payer: WINHealth Partners Commercial |
$16.76
|
| Rate for Payer: Wise Provider Network Commercial |
$16.76
|
|
|
CLAVICAL SPLINT XL
|
Facility
|
OP
|
$17.64
|
|
| Hospital Charge Code |
2200358
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.29
|
| Rate for Payer: Aetna of WY Medicare |
$11.64
|
| Rate for Payer: Altius Commercial |
$16.93
|
| Rate for Payer: Beech Street Commercial |
$17.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.11
|
| Rate for Payer: Cash Price |
$12.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.11
|
| Rate for Payer: Cigna of WY Commercial |
$17.29
|
| Rate for Payer: Entrust Commercial |
$16.76
|
| Rate for Payer: First Choice Health Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$17.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.11
|
| Rate for Payer: Multiplan Medicare/VA |
$9.55
|
| Rate for Payer: One Health Plan of WY PPO |
$17.29
|
| Rate for Payer: PacificSource Commercial |
$15.88
|
| Rate for Payer: PHCS PPO |
$17.29
|
| Rate for Payer: Three Rivers PPO |
$13.23
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$16.85
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$17.29
|
| Rate for Payer: Wise Provider Network Commercial |
$16.76
|
|
|
CLAVICAL SPLINT XSM 79-85002
|
Facility
|
IP
|
$15.89
|
|
| Hospital Charge Code |
2200016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.57
|
| Rate for Payer: Aetna of WY Medicare |
$10.17
|
| Rate for Payer: Altius Commercial |
$15.25
|
| Rate for Payer: Beech Street Commercial |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.41
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.41
|
| Rate for Payer: Cigna of WY Commercial |
$15.57
|
| Rate for Payer: Entrust Commercial |
$15.10
|
| Rate for Payer: First Choice Health Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.69
|
| Rate for Payer: HealthUtah PPO |
$15.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.41
|
| Rate for Payer: Multiplan Medicare/VA |
$9.21
|
| Rate for Payer: One Health Plan of WY PPO |
$15.57
|
| Rate for Payer: PacificSource Commercial |
$14.30
|
| Rate for Payer: PHCS PPO |
$15.57
|
| Rate for Payer: Three Rivers PPO |
$11.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.69
|
| Rate for Payer: United Healthcare Commercial |
$15.17
|
| Rate for Payer: United Healthcare Medicare |
$9.69
|
| Rate for Payer: WINHealth Partners Commercial |
$15.10
|
| Rate for Payer: Wise Provider Network Commercial |
$15.10
|
|
|
CLAVICAL SPLINT XSM 79-85002
|
Facility
|
OP
|
$15.89
|
|
| Hospital Charge Code |
2200016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.57
|
| Rate for Payer: Aetna of WY Medicare |
$10.49
|
| Rate for Payer: Altius Commercial |
$15.25
|
| Rate for Payer: Beech Street Commercial |
$15.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.41
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.41
|
| Rate for Payer: Cigna of WY Commercial |
$15.57
|
| Rate for Payer: Entrust Commercial |
$15.10
|
| Rate for Payer: First Choice Health Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.06
|
| Rate for Payer: HealthUtah PPO |
$15.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.41
|
| Rate for Payer: Multiplan Medicare/VA |
$8.60
|
| Rate for Payer: One Health Plan of WY PPO |
$15.57
|
| Rate for Payer: PacificSource Commercial |
$14.30
|
| Rate for Payer: PHCS PPO |
$15.57
|
| Rate for Payer: Three Rivers PPO |
$11.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.06
|
| Rate for Payer: United Healthcare Commercial |
$15.17
|
| Rate for Payer: United Healthcare Medicare |
$9.06
|
| Rate for Payer: WINHealth Partners Commercial |
$15.57
|
| Rate for Payer: Wise Provider Network Commercial |
$15.10
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 23120 AS
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,563.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,511.74
|
| Rate for Payer: Beech Street Commercial |
$2,434.85
|
| Rate for Payer: Cash Price |
$1,794.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,486.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,511.74
|
| Rate for Payer: First Choice Health Commercial |
$2,306.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,434.85
|
| Rate for Payer: HealthUtah PPO |
$2,563.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,486.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,511.74
|
| Rate for Payer: PacificSource Commercial |
$2,306.70
|
| Rate for Payer: PHCS PPO |
$2,434.85
|
| Rate for Payer: Three Rivers PPO |
$1,922.25
|
| Rate for Payer: United Healthcare Commercial |
$2,434.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,178.55
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 23120 80
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,563.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,511.74
|
| Rate for Payer: Beech Street Commercial |
$2,434.85
|
| Rate for Payer: Cash Price |
$1,794.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,486.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,511.74
|
| Rate for Payer: First Choice Health Commercial |
$2,306.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,434.85
|
| Rate for Payer: HealthUtah PPO |
$2,563.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,486.11
|
| Rate for Payer: One Health Plan of WY PPO |
$2,511.74
|
| Rate for Payer: PacificSource Commercial |
$2,306.70
|
| Rate for Payer: PHCS PPO |
$2,434.85
|
| Rate for Payer: Three Rivers PPO |
$1,922.25
|
| Rate for Payer: United Healthcare Commercial |
$2,434.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,178.55
|
|
|
CLAVICULECTOMY PARTIAL
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 23120
|
| Min. Negotiated Rate |
$490.02 |
| Max. Negotiated Rate |
$2,563.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,511.74
|
| Rate for Payer: Aetna of WY Medicare |
$576.49
|
| Rate for Payer: Beech Street Commercial |
$2,434.85
|
| Rate for Payer: Cash Price |
$1,794.10
|
| Rate for Payer: Cash Price |
$1,794.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,486.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,511.74
|
| Rate for Payer: First Choice Health Commercial |
$2,306.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,434.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$576.49
|
| Rate for Payer: HealthUtah PPO |
$2,563.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,486.11
|
| Rate for Payer: Multiplan Medicare/VA |
$490.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,511.74
|
| Rate for Payer: PacificSource Commercial |
$2,306.70
|
| Rate for Payer: PHCS PPO |
$2,434.85
|
| Rate for Payer: Three Rivers PPO |
$1,922.25
|
| Rate for Payer: TriWest Veterans Administration |
$576.49
|
| Rate for Payer: United Healthcare Commercial |
$2,434.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,178.55
|
|
|
CLEARVIEW UTERINE MANIPULATOR 7CM
|
Facility
|
OP
|
$302.09
|
|
| Hospital Charge Code |
3005577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$302.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.05
|
| Rate for Payer: Aetna of WY Medicare |
$199.38
|
| Rate for Payer: Altius Commercial |
$290.01
|
| Rate for Payer: Beech Street Commercial |
$296.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.03
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.03
|
| Rate for Payer: Cigna of WY Commercial |
$296.05
|
| Rate for Payer: Entrust Commercial |
$286.99
|
| Rate for Payer: First Choice Health Commercial |
$286.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.19
|
| Rate for Payer: HealthUtah PPO |
$302.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.03
|
| Rate for Payer: Multiplan Medicare/VA |
$163.58
|
| Rate for Payer: One Health Plan of WY PPO |
$296.05
|
| Rate for Payer: PacificSource Commercial |
$271.88
|
| Rate for Payer: PHCS PPO |
$296.05
|
| Rate for Payer: Three Rivers PPO |
$226.57
|
| Rate for Payer: TriWest Veterans Administration |
$172.19
|
| Rate for Payer: United Healthcare Commercial |
$288.50
|
| Rate for Payer: United Healthcare Medicare |
$172.19
|
| Rate for Payer: WINHealth Partners Commercial |
$296.05
|
| Rate for Payer: Wise Provider Network Commercial |
$286.99
|
|
|
CLEARVIEW UTERINE MANIPULATOR 7CM
|
Facility
|
IP
|
$302.09
|
|
| Hospital Charge Code |
3005577
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$302.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$296.05
|
| Rate for Payer: Aetna of WY Medicare |
$193.34
|
| Rate for Payer: Altius Commercial |
$290.01
|
| Rate for Payer: Beech Street Commercial |
$296.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$293.03
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$293.03
|
| Rate for Payer: Cigna of WY Commercial |
$296.05
|
| Rate for Payer: Entrust Commercial |
$286.99
|
| Rate for Payer: First Choice Health Commercial |
$286.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$286.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.27
|
| Rate for Payer: HealthUtah PPO |
$302.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$293.03
|
| Rate for Payer: Multiplan Medicare/VA |
$175.06
|
| Rate for Payer: One Health Plan of WY PPO |
$296.05
|
| Rate for Payer: PacificSource Commercial |
$271.88
|
| Rate for Payer: PHCS PPO |
$296.05
|
| Rate for Payer: Three Rivers PPO |
$226.57
|
| Rate for Payer: TriWest Veterans Administration |
$184.27
|
| Rate for Payer: United Healthcare Commercial |
$288.50
|
| Rate for Payer: United Healthcare Medicare |
$184.27
|
| Rate for Payer: WINHealth Partners Commercial |
$286.99
|
| Rate for Payer: Wise Provider Network Commercial |
$286.99
|
|
|
CLIK ANCHOR SC-4316
|
Facility
|
IP
|
$1,312.50
|
|
| Hospital Charge Code |
2800183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$760.59 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,286.25
|
| Rate for Payer: Aetna of WY Medicare |
$840.00
|
| Rate for Payer: Altius Commercial |
$1,260.00
|
| Rate for Payer: Beech Street Commercial |
$1,286.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,273.12
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,273.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,286.25
|
| Rate for Payer: Entrust Commercial |
$1,246.88
|
| Rate for Payer: First Choice Health Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$800.62
|
| Rate for Payer: HealthUtah PPO |
$1,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,273.12
|
| Rate for Payer: Multiplan Medicare/VA |
$760.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,286.25
|
| Rate for Payer: PacificSource Commercial |
$1,181.25
|
| Rate for Payer: PHCS PPO |
$1,286.25
|
| Rate for Payer: Three Rivers PPO |
$984.38
|
| Rate for Payer: TriWest Veterans Administration |
$800.62
|
| Rate for Payer: United Healthcare Commercial |
$1,253.44
|
| Rate for Payer: United Healthcare Medicare |
$800.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,246.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,246.88
|
|
|
CLIK ANCHOR SC-4316
|
Facility
|
OP
|
$1,312.50
|
|
| Hospital Charge Code |
2800183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.72 |
| Max. Negotiated Rate |
$1,312.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,286.25
|
| Rate for Payer: Aetna of WY Medicare |
$866.25
|
| Rate for Payer: Altius Commercial |
$1,260.00
|
| Rate for Payer: Beech Street Commercial |
$1,286.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,273.12
|
| Rate for Payer: Cash Price |
$918.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,273.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,286.25
|
| Rate for Payer: Entrust Commercial |
$1,246.88
|
| Rate for Payer: First Choice Health Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,246.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$748.12
|
| Rate for Payer: HealthUtah PPO |
$1,312.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,273.12
|
| Rate for Payer: Multiplan Medicare/VA |
$710.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,286.25
|
| Rate for Payer: PacificSource Commercial |
$1,181.25
|
| Rate for Payer: PHCS PPO |
$1,286.25
|
| Rate for Payer: Three Rivers PPO |
$984.38
|
| Rate for Payer: TriWest Veterans Administration |
$748.12
|
| Rate for Payer: United Healthcare Commercial |
$1,253.44
|
| Rate for Payer: United Healthcare Medicare |
$748.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,286.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,246.88
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [20513]
|
Facility
|
OP
|
$15.95
|
|
|
Service Code
|
NDC 0781328991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.63
|
| Rate for Payer: Entrust Commercial |
$15.15
|
| Rate for Payer: First Choice Health Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.63
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.63
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$15.23
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.15
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [20513]
|
Facility
|
OP
|
$15.95
|
|
|
Service Code
|
NDC 0781328909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.53
|
| Rate for Payer: Altius Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.63
|
| Rate for Payer: Entrust Commercial |
$15.15
|
| Rate for Payer: First Choice Health Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.64
|
| Rate for Payer: One Health Plan of WY PPO |
$15.63
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.63
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$15.23
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.63
|
| Rate for Payer: Wise Provider Network Commercial |
$15.15
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [20513]
|
Facility
|
IP
|
$15.95
|
|
|
Service Code
|
NDC 0781328991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.63
|
| Rate for Payer: Aetna of WY Medicare |
$10.21
|
| Rate for Payer: Altius Commercial |
$15.31
|
| Rate for Payer: Beech Street Commercial |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.47
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.47
|
| Rate for Payer: Cigna of WY Commercial |
$15.63
|
| Rate for Payer: Entrust Commercial |
$15.15
|
| Rate for Payer: First Choice Health Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.73
|
| Rate for Payer: HealthUtah PPO |
$15.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.47
|
| Rate for Payer: Multiplan Medicare/VA |
$9.24
|
| Rate for Payer: One Health Plan of WY PPO |
$15.63
|
| Rate for Payer: PacificSource Commercial |
$14.36
|
| Rate for Payer: PHCS PPO |
$15.63
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.73
|
| Rate for Payer: United Healthcare Commercial |
$15.23
|
| Rate for Payer: United Healthcare Medicare |
$9.73
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$15.15
|
|
