|
ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 93005
|
| Hospital Charge Code |
93005
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$135.85
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: First Choice Health Commercial |
$128.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.14
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$5.22
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$135.85
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare |
$6.14
|
| Rate for Payer: WINHealth Partners Commercial |
$135.85
|
|
|
ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 93306 26
|
| Hospital Charge Code |
93306
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.22
|
| Rate for Payer: Aetna of WY Medicare |
$65.72
|
| Rate for Payer: Beech Street Commercial |
$227.05
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$231.83
|
| Rate for Payer: Cigna of WY Commercial |
$234.22
|
| Rate for Payer: First Choice Health Commercial |
$215.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.72
|
| Rate for Payer: HealthUtah PPO |
$239.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$231.83
|
| Rate for Payer: Multiplan Medicare/VA |
$55.86
|
| Rate for Payer: One Health Plan of WY PPO |
$234.22
|
| Rate for Payer: PacificSource Commercial |
$215.10
|
| Rate for Payer: PHCS PPO |
$227.05
|
| Rate for Payer: Three Rivers PPO |
$179.25
|
| Rate for Payer: TriWest Veterans Administration |
$65.72
|
| Rate for Payer: United Healthcare Commercial |
$207.93
|
| Rate for Payer: United Healthcare Medicare |
$65.72
|
| Rate for Payer: WINHealth Partners Commercial |
$227.05
|
|
|
EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN [182823]
|
Facility
|
OP
|
$2,816.61
|
|
|
Service Code
|
HCPCS J9334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,551.95 |
| Max. Negotiated Rate |
$2,816.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,760.28
|
| Rate for Payer: Aetna of WY Medicare |
$1,858.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,703.95
|
| Rate for Payer: Altius Commercial |
$2,703.95
|
| Rate for Payer: Beech Street Commercial |
$2,760.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,312.44
|
| Rate for Payer: Cash Price |
$1,971.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,732.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,760.28
|
| Rate for Payer: Entrust Commercial |
$2,675.78
|
| Rate for Payer: First Choice Health Commercial |
$2,675.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,675.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,633.63
|
| Rate for Payer: HealthUtah PPO |
$2,816.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,732.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,551.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,760.28
|
| Rate for Payer: PacificSource Commercial |
$2,534.95
|
| Rate for Payer: PHCS PPO |
$2,760.28
|
| Rate for Payer: Three Rivers PPO |
$2,112.46
|
| Rate for Payer: TriWest Veterans Administration |
$1,633.63
|
| Rate for Payer: United Healthcare Commercial |
$2,450.45
|
| Rate for Payer: United Healthcare Medicare |
$1,633.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,760.28
|
| Rate for Payer: Wise Provider Network Commercial |
$2,675.78
|
|
|
EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN [182823]
|
Facility
|
IP
|
$2,816.61
|
|
|
Service Code
|
HCPCS J9334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,766.01 |
| Max. Negotiated Rate |
$2,816.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,760.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,703.95
|
| Rate for Payer: Altius Commercial |
$2,703.95
|
| Rate for Payer: Beech Street Commercial |
$2,760.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,312.44
|
| Rate for Payer: Cash Price |
$1,971.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,732.11
|
| Rate for Payer: Cigna of WY Commercial |
$2,760.28
|
| Rate for Payer: Entrust Commercial |
$2,675.78
|
| Rate for Payer: First Choice Health Commercial |
$2,675.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,675.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,858.96
|
| Rate for Payer: HealthUtah PPO |
$2,816.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,732.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,766.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,760.28
|
| Rate for Payer: PacificSource Commercial |
$2,534.95
|
| Rate for Payer: PHCS PPO |
$2,760.28
|
| Rate for Payer: Three Rivers PPO |
$2,112.46
|
| Rate for Payer: TriWest Veterans Administration |
$1,858.96
|
| Rate for Payer: United Healthcare Commercial |
$2,450.45
|
| Rate for Payer: United Healthcare Medicare |
$1,858.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,675.78
|
| Rate for Payer: Wise Provider Network Commercial |
$2,675.78
|
|
|
EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$3,733.00
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
43249
|
| Min. Negotiated Rate |
$123.89 |
| Max. Negotiated Rate |
$3,733.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,658.34
|
| Rate for Payer: Aetna of WY Medicare |
$145.75
|
| Rate for Payer: Beech Street Commercial |
$3,546.35
|
| Rate for Payer: Cash Price |
$2,613.10
|
| Rate for Payer: Cash Price |
$2,613.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,621.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,658.34
|
| Rate for Payer: First Choice Health Commercial |
$3,359.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,546.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.75
|
| Rate for Payer: HealthUtah PPO |
$3,733.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,621.01
|
| Rate for Payer: Multiplan Medicare/VA |
$123.89
|
| Rate for Payer: One Health Plan of WY PPO |
$3,658.34
|
| Rate for Payer: PacificSource Commercial |
$3,359.70
|
| Rate for Payer: PHCS PPO |
$3,546.35
|
| Rate for Payer: Three Rivers PPO |
$2,799.75
|
| Rate for Payer: TriWest Veterans Administration |
$145.75
|
| Rate for Payer: United Healthcare Commercial |
$3,247.71
|
| Rate for Payer: United Healthcare Medicare |
$145.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,173.05
|
|
|
EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
43245
|
| Min. Negotiated Rate |
$141.25 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,015.86
|
| Rate for Payer: Aetna of WY Medicare |
$166.18
|
| Rate for Payer: Beech Street Commercial |
$1,954.15
|
| Rate for Payer: Cash Price |
$1,439.90
|
| Rate for Payer: Cash Price |
$1,439.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,995.29
|
| Rate for Payer: Cigna of WY Commercial |
$2,015.86
|
| Rate for Payer: First Choice Health Commercial |
$1,851.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,954.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.18
|
| Rate for Payer: HealthUtah PPO |
$2,057.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,995.29
|
| Rate for Payer: Multiplan Medicare/VA |
$141.25
|
| Rate for Payer: One Health Plan of WY PPO |
$2,015.86
|
| Rate for Payer: PacificSource Commercial |
$1,851.30
|
| Rate for Payer: PHCS PPO |
$1,954.15
|
| Rate for Payer: Three Rivers PPO |
$1,542.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.18
|
| Rate for Payer: United Healthcare Commercial |
$1,789.59
|
| Rate for Payer: United Healthcare Medicare |
$166.18
|
| Rate for Payer: WINHealth Partners Commercial |
$1,748.45
|
|
|
EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER
|
Professional
|
Both
|
$4,272.00
|
|
|
Service Code
|
HCPCS 43233
|
| Hospital Charge Code |
43233
|
| Min. Negotiated Rate |
$183.85 |
| Max. Negotiated Rate |
$4,272.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,186.56
|
| Rate for Payer: Aetna of WY Medicare |
$216.29
|
| Rate for Payer: Beech Street Commercial |
$4,058.40
|
| Rate for Payer: Cash Price |
$2,990.40
|
| Rate for Payer: Cash Price |
$2,990.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,143.84
|
| Rate for Payer: Cigna of WY Commercial |
$4,186.56
|
| Rate for Payer: First Choice Health Commercial |
$3,844.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,058.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$216.29
|
| Rate for Payer: HealthUtah PPO |
$4,272.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,143.84
|
| Rate for Payer: Multiplan Medicare/VA |
$183.85
|
| Rate for Payer: One Health Plan of WY PPO |
$4,186.56
|
| Rate for Payer: PacificSource Commercial |
$3,844.80
|
| Rate for Payer: PHCS PPO |
$4,058.40
|
| Rate for Payer: Three Rivers PPO |
$3,204.00
|
| Rate for Payer: TriWest Veterans Administration |
$216.29
|
| Rate for Payer: United Healthcare Commercial |
$3,716.64
|
| Rate for Payer: United Healthcare Medicare |
$216.29
|
| Rate for Payer: WINHealth Partners Commercial |
$3,631.20
|
|
|
EGD FIXED WIRE BALLOON 11-13MM
|
Facility
|
OP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.25 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Aetna of WY Medicare |
$334.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.94
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.25
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$293.94
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$293.94
|
| Rate for Payer: WINHealth Partners Commercial |
$496.66
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 11-13MM
|
Facility
|
IP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.49
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$317.76
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$334.49
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$334.49
|
| Rate for Payer: WINHealth Partners Commercial |
$481.46
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 13.5-15.5MM
|
Facility
|
OP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.25 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Aetna of WY Medicare |
$334.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.94
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.25
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$293.94
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$293.94
|
| Rate for Payer: WINHealth Partners Commercial |
$496.66
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 13.5-15.5MM
|
Facility
|
IP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.49
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$317.76
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$334.49
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$334.49
|
| Rate for Payer: WINHealth Partners Commercial |
$481.46
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 16-18MM
|
Facility
|
OP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.25 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Aetna of WY Medicare |
$334.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.94
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.25
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$293.94
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$293.94
|
| Rate for Payer: WINHealth Partners Commercial |
$496.66
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 16-18MM
|
Facility
|
IP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.49
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$317.76
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$334.49
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$334.49
|
| Rate for Payer: WINHealth Partners Commercial |
$481.46
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 18-20MM
|
Facility
|
OP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.25 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Aetna of WY Medicare |
$334.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.94
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.25
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$293.94
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$293.94
|
| Rate for Payer: WINHealth Partners Commercial |
$496.66
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 18-20MM
|
Facility
|
IP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.49
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$317.76
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$334.49
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$334.49
|
| Rate for Payer: WINHealth Partners Commercial |
$481.46
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 8.5-10.5MM
|
Facility
|
OP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.25 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Aetna of WY Medicare |
$334.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.94
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.25
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$293.94
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$293.94
|
| Rate for Payer: WINHealth Partners Commercial |
$496.66
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FIXED WIRE BALLOON 8.5-10.5MM
|
Facility
|
IP
|
$506.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$506.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$496.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$486.53
|
| Rate for Payer: Altius Commercial |
$486.53
|
| Rate for Payer: Beech Street Commercial |
$496.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$416.08
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$491.60
|
| Rate for Payer: Cigna of WY Commercial |
$496.66
|
| Rate for Payer: Entrust Commercial |
$481.46
|
| Rate for Payer: First Choice Health Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$481.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$334.49
|
| Rate for Payer: HealthUtah PPO |
$506.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$491.60
|
| Rate for Payer: Multiplan Medicare/VA |
$317.76
|
| Rate for Payer: One Health Plan of WY PPO |
$496.66
|
| Rate for Payer: PacificSource Commercial |
$456.12
|
| Rate for Payer: PHCS PPO |
$496.66
|
| Rate for Payer: Three Rivers PPO |
$380.10
|
| Rate for Payer: TriWest Veterans Administration |
$334.49
|
| Rate for Payer: United Healthcare Commercial |
$440.92
|
| Rate for Payer: United Healthcare Medicare |
$334.49
|
| Rate for Payer: WINHealth Partners Commercial |
$481.46
|
| Rate for Payer: Wise Provider Network Commercial |
$481.46
|
|
|
EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
43247
|
| Min. Negotiated Rate |
$142.38 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,303.40
|
| Rate for Payer: Aetna of WY Medicare |
$167.51
|
| Rate for Payer: Beech Street Commercial |
$1,263.50
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: Cash Price |
$931.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,290.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,303.40
|
| Rate for Payer: First Choice Health Commercial |
$1,197.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,263.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.51
|
| Rate for Payer: HealthUtah PPO |
$1,330.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,290.10
|
| Rate for Payer: Multiplan Medicare/VA |
$142.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,303.40
|
| Rate for Payer: PacificSource Commercial |
$1,197.00
|
| Rate for Payer: PHCS PPO |
$1,263.50
|
| Rate for Payer: Three Rivers PPO |
$997.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.51
|
| Rate for Payer: United Healthcare Commercial |
$1,157.10
|
| Rate for Payer: United Healthcare Medicare |
$167.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
|
|
EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$1,558.00
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
43250
|
| Min. Negotiated Rate |
$136.88 |
| Max. Negotiated Rate |
$1,558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,526.84
|
| Rate for Payer: Aetna of WY Medicare |
$161.03
|
| Rate for Payer: Beech Street Commercial |
$1,480.10
|
| Rate for Payer: Cash Price |
$1,090.60
|
| Rate for Payer: Cash Price |
$1,090.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,511.26
|
| Rate for Payer: Cigna of WY Commercial |
$1,526.84
|
| Rate for Payer: First Choice Health Commercial |
$1,402.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,480.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.03
|
| Rate for Payer: HealthUtah PPO |
$1,558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,511.26
|
| Rate for Payer: Multiplan Medicare/VA |
$136.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,526.84
|
| Rate for Payer: PacificSource Commercial |
$1,402.20
|
| Rate for Payer: PHCS PPO |
$1,480.10
|
| Rate for Payer: Three Rivers PPO |
$1,168.50
|
| Rate for Payer: TriWest Veterans Administration |
$161.03
|
| Rate for Payer: United Healthcare Commercial |
$1,355.46
|
| Rate for Payer: United Healthcare Medicare |
$161.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1,324.30
|
|
|
EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
43248
|
| Min. Negotiated Rate |
$134.04 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,407.28
|
| Rate for Payer: Aetna of WY Medicare |
$157.70
|
| Rate for Payer: Beech Street Commercial |
$1,364.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: Cash Price |
$1,005.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,392.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,407.28
|
| Rate for Payer: First Choice Health Commercial |
$1,292.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,364.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.70
|
| Rate for Payer: HealthUtah PPO |
$1,436.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,392.92
|
| Rate for Payer: Multiplan Medicare/VA |
$134.04
|
| Rate for Payer: One Health Plan of WY PPO |
$1,407.28
|
| Rate for Payer: PacificSource Commercial |
$1,292.40
|
| Rate for Payer: PHCS PPO |
$1,364.20
|
| Rate for Payer: Three Rivers PPO |
$1,077.00
|
| Rate for Payer: TriWest Veterans Administration |
$157.70
|
| Rate for Payer: United Healthcare Commercial |
$1,249.32
|
| Rate for Payer: United Healthcare Medicare |
$157.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,220.60
|
|
|
EGD INTRALUMINAL TUBE/CATHETER INSERTION
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 43241
|
| Hospital Charge Code |
43241
|
| Min. Negotiated Rate |
$114.78 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.30
|
| Rate for Payer: Aetna of WY Medicare |
$135.03
|
| Rate for Payer: Beech Street Commercial |
$698.25
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$712.95
|
| Rate for Payer: Cigna of WY Commercial |
$720.30
|
| Rate for Payer: First Choice Health Commercial |
$661.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.03
|
| Rate for Payer: HealthUtah PPO |
$735.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$712.95
|
| Rate for Payer: Multiplan Medicare/VA |
$114.78
|
| Rate for Payer: One Health Plan of WY PPO |
$720.30
|
| Rate for Payer: PacificSource Commercial |
$661.50
|
| Rate for Payer: PHCS PPO |
$698.25
|
| Rate for Payer: Three Rivers PPO |
$551.25
|
| Rate for Payer: TriWest Veterans Administration |
$135.03
|
| Rate for Payer: United Healthcare Commercial |
$639.45
|
| Rate for Payer: United Healthcare Medicare |
$135.03
|
| Rate for Payer: WINHealth Partners Commercial |
$624.75
|
|
|
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 43246 AS
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,017.24
|
| Rate for Payer: Aetna of WY Medicare |
$189.15
|
| Rate for Payer: Beech Street Commercial |
$986.10
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,006.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,017.24
|
| Rate for Payer: First Choice Health Commercial |
$934.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$986.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.15
|
| Rate for Payer: HealthUtah PPO |
$1,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,006.86
|
| Rate for Payer: Multiplan Medicare/VA |
$160.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,017.24
|
| Rate for Payer: PacificSource Commercial |
$934.20
|
| Rate for Payer: PHCS PPO |
$986.10
|
| Rate for Payer: Three Rivers PPO |
$778.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.15
|
| Rate for Payer: United Healthcare Commercial |
$903.06
|
| Rate for Payer: United Healthcare Medicare |
$189.15
|
| Rate for Payer: WINHealth Partners Commercial |
$882.30
|
|
|
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 43246 80
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,017.24
|
| Rate for Payer: Aetna of WY Medicare |
$189.15
|
| Rate for Payer: Beech Street Commercial |
$986.10
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,006.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,017.24
|
| Rate for Payer: First Choice Health Commercial |
$934.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$986.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.15
|
| Rate for Payer: HealthUtah PPO |
$1,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,006.86
|
| Rate for Payer: Multiplan Medicare/VA |
$160.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,017.24
|
| Rate for Payer: PacificSource Commercial |
$934.20
|
| Rate for Payer: PHCS PPO |
$986.10
|
| Rate for Payer: Three Rivers PPO |
$778.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.15
|
| Rate for Payer: United Healthcare Commercial |
$903.06
|
| Rate for Payer: United Healthcare Medicare |
$189.15
|
| Rate for Payer: WINHealth Partners Commercial |
$882.30
|
|
|
EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
43246
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,017.24
|
| Rate for Payer: Aetna of WY Medicare |
$189.15
|
| Rate for Payer: Beech Street Commercial |
$986.10
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: Cash Price |
$726.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,006.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,017.24
|
| Rate for Payer: First Choice Health Commercial |
$934.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$986.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.15
|
| Rate for Payer: HealthUtah PPO |
$1,038.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,006.86
|
| Rate for Payer: Multiplan Medicare/VA |
$160.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1,017.24
|
| Rate for Payer: PacificSource Commercial |
$934.20
|
| Rate for Payer: PHCS PPO |
$986.10
|
| Rate for Payer: Three Rivers PPO |
$778.50
|
| Rate for Payer: TriWest Veterans Administration |
$189.15
|
| Rate for Payer: United Healthcare Commercial |
$903.06
|
| Rate for Payer: United Healthcare Medicare |
$189.15
|
| Rate for Payer: WINHealth Partners Commercial |
$882.30
|
|
|
EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
43251
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,680.70
|
| Rate for Payer: Aetna of WY Medicare |
$185.67
|
| Rate for Payer: Beech Street Commercial |
$1,629.25
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: Cash Price |
$1,200.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,663.55
|
| Rate for Payer: Cigna of WY Commercial |
$1,680.70
|
| Rate for Payer: First Choice Health Commercial |
$1,543.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,629.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.67
|
| Rate for Payer: HealthUtah PPO |
$1,715.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,663.55
|
| Rate for Payer: Multiplan Medicare/VA |
$157.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,680.70
|
| Rate for Payer: PacificSource Commercial |
$1,543.50
|
| Rate for Payer: PHCS PPO |
$1,629.25
|
| Rate for Payer: Three Rivers PPO |
$1,286.25
|
| Rate for Payer: TriWest Veterans Administration |
$185.67
|
| Rate for Payer: United Healthcare Commercial |
$1,492.05
|
| Rate for Payer: United Healthcare Medicare |
$185.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,457.75
|
|
