|
CRUSH CANCELLOUS + CHIPS 15CC
|
Facility
|
OP
|
$1,134.00
|
|
| Hospital Charge Code |
3004244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,111.32
|
| Rate for Payer: Aetna of WY Medicare |
$748.44
|
| Rate for Payer: Altius Commercial |
$1,088.64
|
| Rate for Payer: Beech Street Commercial |
$1,111.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,099.98
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,099.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,111.32
|
| Rate for Payer: Entrust Commercial |
$1,077.30
|
| Rate for Payer: First Choice Health Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$646.38
|
| Rate for Payer: HealthUtah PPO |
$1,134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,099.98
|
| Rate for Payer: Multiplan Medicare/VA |
$614.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,111.32
|
| Rate for Payer: PacificSource Commercial |
$1,020.60
|
| Rate for Payer: PHCS PPO |
$1,111.32
|
| Rate for Payer: Three Rivers PPO |
$850.50
|
| Rate for Payer: TriWest Veterans Administration |
$646.38
|
| Rate for Payer: United Healthcare Commercial |
$1,082.97
|
| Rate for Payer: United Healthcare Medicare |
$646.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,111.32
|
| Rate for Payer: Wise Provider Network Commercial |
$1,077.30
|
|
|
CRUSH CANCELLOUS + CHIPS 15CC
|
Facility
|
IP
|
$1,134.00
|
|
| Hospital Charge Code |
3004244
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.15 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,111.32
|
| Rate for Payer: Aetna of WY Medicare |
$725.76
|
| Rate for Payer: Altius Commercial |
$1,088.64
|
| Rate for Payer: Beech Street Commercial |
$1,111.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,099.98
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,099.98
|
| Rate for Payer: Cigna of WY Commercial |
$1,111.32
|
| Rate for Payer: Entrust Commercial |
$1,077.30
|
| Rate for Payer: First Choice Health Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,077.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$691.74
|
| Rate for Payer: HealthUtah PPO |
$1,134.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,099.98
|
| Rate for Payer: Multiplan Medicare/VA |
$657.15
|
| Rate for Payer: One Health Plan of WY PPO |
$1,111.32
|
| Rate for Payer: PacificSource Commercial |
$1,020.60
|
| Rate for Payer: PHCS PPO |
$1,111.32
|
| Rate for Payer: Three Rivers PPO |
$850.50
|
| Rate for Payer: TriWest Veterans Administration |
$691.74
|
| Rate for Payer: United Healthcare Commercial |
$1,082.97
|
| Rate for Payer: United Healthcare Medicare |
$691.74
|
| Rate for Payer: WINHealth Partners Commercial |
$1,077.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,077.30
|
|
|
CRUSH CANCELLOUS + CHIPS 30CC
|
Facility
|
IP
|
$1,837.50
|
|
| Hospital Charge Code |
3004245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.83 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,800.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,176.00
|
| Rate for Payer: Altius Commercial |
$1,764.00
|
| Rate for Payer: Beech Street Commercial |
$1,800.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,782.38
|
| Rate for Payer: Cash Price |
$1,286.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,782.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,800.75
|
| Rate for Payer: Entrust Commercial |
$1,745.62
|
| Rate for Payer: First Choice Health Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,120.88
|
| Rate for Payer: HealthUtah PPO |
$1,837.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,782.38
|
| Rate for Payer: Multiplan Medicare/VA |
$1,064.83
|
| Rate for Payer: One Health Plan of WY PPO |
$1,800.75
|
| Rate for Payer: PacificSource Commercial |
$1,653.75
|
| Rate for Payer: PHCS PPO |
$1,800.75
|
| Rate for Payer: Three Rivers PPO |
$1,378.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,120.88
|
| Rate for Payer: United Healthcare Commercial |
$1,754.81
|
| Rate for Payer: United Healthcare Medicare |
$1,120.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,745.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,745.62
|
|
|
CRUSH CANCELLOUS + CHIPS 30CC
|
Facility
|
OP
|
$1,837.50
|
|
| Hospital Charge Code |
3004245
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$995.01 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,800.75
|
| Rate for Payer: Aetna of WY Medicare |
$1,212.75
|
| Rate for Payer: Altius Commercial |
$1,764.00
|
| Rate for Payer: Beech Street Commercial |
$1,800.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,782.38
|
| Rate for Payer: Cash Price |
$1,286.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,782.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,800.75
|
| Rate for Payer: Entrust Commercial |
$1,745.62
|
| Rate for Payer: First Choice Health Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,745.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,047.38
|
| Rate for Payer: HealthUtah PPO |
$1,837.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,782.38
|
| Rate for Payer: Multiplan Medicare/VA |
$995.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,800.75
|
| Rate for Payer: PacificSource Commercial |
$1,653.75
|
| Rate for Payer: PHCS PPO |
$1,800.75
|
| Rate for Payer: Three Rivers PPO |
$1,378.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,047.38
|
| Rate for Payer: United Healthcare Commercial |
$1,754.81
|
| Rate for Payer: United Healthcare Medicare |
$1,047.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,800.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,745.62
|
|
|
CRUTCH FOREARM PAIR
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS E0110
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Beech Street Commercial |
$23.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: First Choice Health Commercial |
$22.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$23.75
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: United Healthcare Commercial |
$23.75
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
|
|
CRUTCH MEDIUM 5'2"-5'10"
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
3000154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.74
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.94
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$22.74
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$23.94
|
| Rate for Payer: United Healthcare Commercial |
$40.11
|
| Rate for Payer: United Healthcare Medicare |
$23.94
|
| Rate for Payer: WINHealth Partners Commercial |
$41.16
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
CRUTCH MEDIUM 5'2"-5'10"
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
3000154
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Aetna of WY Medicare |
$26.88
|
| Rate for Payer: Altius Commercial |
$40.32
|
| Rate for Payer: Beech Street Commercial |
$41.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.74
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: Entrust Commercial |
$39.90
|
| Rate for Payer: First Choice Health Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.62
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: Multiplan Medicare/VA |
$24.34
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$41.16
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.62
|
| Rate for Payer: United Healthcare Commercial |
$40.11
|
| Rate for Payer: United Healthcare Medicare |
$25.62
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.90
|
|
|
CRUTCH TALL 5'10"-6'6"
|
Facility
|
IP
|
$47.25
|
|
| Hospital Charge Code |
3000155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.30
|
| Rate for Payer: Aetna of WY Medicare |
$30.24
|
| Rate for Payer: Altius Commercial |
$45.36
|
| Rate for Payer: Beech Street Commercial |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.83
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.83
|
| Rate for Payer: Cigna of WY Commercial |
$46.30
|
| Rate for Payer: Entrust Commercial |
$44.89
|
| Rate for Payer: First Choice Health Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.82
|
| Rate for Payer: HealthUtah PPO |
$47.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.83
|
| Rate for Payer: Multiplan Medicare/VA |
$27.38
|
| Rate for Payer: One Health Plan of WY PPO |
$46.30
|
| Rate for Payer: PacificSource Commercial |
$42.52
|
| Rate for Payer: PHCS PPO |
$46.30
|
| Rate for Payer: Three Rivers PPO |
$35.44
|
| Rate for Payer: TriWest Veterans Administration |
$28.82
|
| Rate for Payer: United Healthcare Commercial |
$45.12
|
| Rate for Payer: United Healthcare Medicare |
$28.82
|
| Rate for Payer: WINHealth Partners Commercial |
$44.89
|
| Rate for Payer: Wise Provider Network Commercial |
$44.89
|
|
|
CRUTCH TALL 5'10"-6'6"
|
Facility
|
OP
|
$47.25
|
|
| Hospital Charge Code |
3000155
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.59 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.30
|
| Rate for Payer: Aetna of WY Medicare |
$31.18
|
| Rate for Payer: Altius Commercial |
$45.36
|
| Rate for Payer: Beech Street Commercial |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.83
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.83
|
| Rate for Payer: Cigna of WY Commercial |
$46.30
|
| Rate for Payer: Entrust Commercial |
$44.89
|
| Rate for Payer: First Choice Health Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.93
|
| Rate for Payer: HealthUtah PPO |
$47.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.83
|
| Rate for Payer: Multiplan Medicare/VA |
$25.59
|
| Rate for Payer: One Health Plan of WY PPO |
$46.30
|
| Rate for Payer: PacificSource Commercial |
$42.52
|
| Rate for Payer: PHCS PPO |
$46.30
|
| Rate for Payer: Three Rivers PPO |
$35.44
|
| Rate for Payer: TriWest Veterans Administration |
$26.93
|
| Rate for Payer: United Healthcare Commercial |
$45.12
|
| Rate for Payer: United Healthcare Medicare |
$26.93
|
| Rate for Payer: WINHealth Partners Commercial |
$46.30
|
| Rate for Payer: Wise Provider Network Commercial |
$44.89
|
|
|
CRUTCH TIP REPLACEMENTS
|
Facility
|
OP
|
$5.61
|
|
| Hospital Charge Code |
3000157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.50
|
| Rate for Payer: Aetna of WY Medicare |
$3.70
|
| Rate for Payer: Altius Commercial |
$5.39
|
| Rate for Payer: Beech Street Commercial |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.44
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.44
|
| Rate for Payer: Cigna of WY Commercial |
$5.50
|
| Rate for Payer: Entrust Commercial |
$5.33
|
| Rate for Payer: First Choice Health Commercial |
$5.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.20
|
| Rate for Payer: HealthUtah PPO |
$5.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.44
|
| Rate for Payer: Multiplan Medicare/VA |
$3.04
|
| Rate for Payer: One Health Plan of WY PPO |
$5.50
|
| Rate for Payer: PacificSource Commercial |
$5.05
|
| Rate for Payer: PHCS PPO |
$5.50
|
| Rate for Payer: Three Rivers PPO |
$4.21
|
| Rate for Payer: TriWest Veterans Administration |
$3.20
|
| Rate for Payer: United Healthcare Commercial |
$5.36
|
| Rate for Payer: United Healthcare Medicare |
$3.20
|
| Rate for Payer: WINHealth Partners Commercial |
$5.50
|
| Rate for Payer: Wise Provider Network Commercial |
$5.33
|
|
|
CRUTCH TIP REPLACEMENTS
|
Facility
|
IP
|
$5.61
|
|
| Hospital Charge Code |
3000157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.50
|
| Rate for Payer: Aetna of WY Medicare |
$3.59
|
| Rate for Payer: Altius Commercial |
$5.39
|
| Rate for Payer: Beech Street Commercial |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.44
|
| Rate for Payer: Cash Price |
$3.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.44
|
| Rate for Payer: Cigna of WY Commercial |
$5.50
|
| Rate for Payer: Entrust Commercial |
$5.33
|
| Rate for Payer: First Choice Health Commercial |
$5.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.42
|
| Rate for Payer: HealthUtah PPO |
$5.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.44
|
| Rate for Payer: Multiplan Medicare/VA |
$3.25
|
| Rate for Payer: One Health Plan of WY PPO |
$5.50
|
| Rate for Payer: PacificSource Commercial |
$5.05
|
| Rate for Payer: PHCS PPO |
$5.50
|
| Rate for Payer: Three Rivers PPO |
$4.21
|
| Rate for Payer: TriWest Veterans Administration |
$3.42
|
| Rate for Payer: United Healthcare Commercial |
$5.36
|
| Rate for Payer: United Healthcare Medicare |
$3.42
|
| Rate for Payer: WINHealth Partners Commercial |
$5.33
|
| Rate for Payer: Wise Provider Network Commercial |
$5.33
|
|
|
CRUTCH YOUTH 4'6"-5'2"
|
Facility
|
OP
|
$31.92
|
|
| Hospital Charge Code |
3000156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.28
|
| Rate for Payer: Aetna of WY Medicare |
$21.07
|
| Rate for Payer: Altius Commercial |
$30.64
|
| Rate for Payer: Beech Street Commercial |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.96
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.96
|
| Rate for Payer: Cigna of WY Commercial |
$31.28
|
| Rate for Payer: Entrust Commercial |
$30.32
|
| Rate for Payer: First Choice Health Commercial |
$30.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.19
|
| Rate for Payer: HealthUtah PPO |
$31.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.96
|
| Rate for Payer: Multiplan Medicare/VA |
$17.28
|
| Rate for Payer: One Health Plan of WY PPO |
$31.28
|
| Rate for Payer: PacificSource Commercial |
$28.73
|
| Rate for Payer: PHCS PPO |
$31.28
|
| Rate for Payer: Three Rivers PPO |
$23.94
|
| Rate for Payer: TriWest Veterans Administration |
$18.19
|
| Rate for Payer: United Healthcare Commercial |
$30.48
|
| Rate for Payer: United Healthcare Medicare |
$18.19
|
| Rate for Payer: WINHealth Partners Commercial |
$31.28
|
| Rate for Payer: Wise Provider Network Commercial |
$30.32
|
|
|
CRUTCH YOUTH 4'6"-5'2"
|
Facility
|
IP
|
$31.92
|
|
| Hospital Charge Code |
3000156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$31.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.28
|
| Rate for Payer: Aetna of WY Medicare |
$20.43
|
| Rate for Payer: Altius Commercial |
$30.64
|
| Rate for Payer: Beech Street Commercial |
$31.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.96
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.96
|
| Rate for Payer: Cigna of WY Commercial |
$31.28
|
| Rate for Payer: Entrust Commercial |
$30.32
|
| Rate for Payer: First Choice Health Commercial |
$30.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.47
|
| Rate for Payer: HealthUtah PPO |
$31.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.96
|
| Rate for Payer: Multiplan Medicare/VA |
$18.50
|
| Rate for Payer: One Health Plan of WY PPO |
$31.28
|
| Rate for Payer: PacificSource Commercial |
$28.73
|
| Rate for Payer: PHCS PPO |
$31.28
|
| Rate for Payer: Three Rivers PPO |
$23.94
|
| Rate for Payer: TriWest Veterans Administration |
$19.47
|
| Rate for Payer: United Healthcare Commercial |
$30.48
|
| Rate for Payer: United Healthcare Medicare |
$19.47
|
| Rate for Payer: WINHealth Partners Commercial |
$30.32
|
| Rate for Payer: Wise Provider Network Commercial |
$30.32
|
|
|
CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 17340
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$47.36
|
| Rate for Payer: Beech Street Commercial |
$199.50
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: First Choice Health Commercial |
$189.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.36
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$40.26
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$199.50
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$47.36
|
| Rate for Payer: United Healthcare Commercial |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$178.50
|
|
|
C-SECTION PACK
|
Facility
|
IP
|
$339.19
|
|
| Hospital Charge Code |
2650222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$339.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$332.41
|
| Rate for Payer: Aetna of WY Medicare |
$217.08
|
| Rate for Payer: Altius Commercial |
$325.62
|
| Rate for Payer: Beech Street Commercial |
$332.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$329.01
|
| Rate for Payer: Cash Price |
$237.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.01
|
| Rate for Payer: Cigna of WY Commercial |
$332.41
|
| Rate for Payer: Entrust Commercial |
$322.23
|
| Rate for Payer: First Choice Health Commercial |
$322.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$322.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.91
|
| Rate for Payer: HealthUtah PPO |
$339.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.01
|
| Rate for Payer: Multiplan Medicare/VA |
$196.56
|
| Rate for Payer: One Health Plan of WY PPO |
$332.41
|
| Rate for Payer: PacificSource Commercial |
$305.27
|
| Rate for Payer: PHCS PPO |
$332.41
|
| Rate for Payer: Three Rivers PPO |
$254.39
|
| Rate for Payer: TriWest Veterans Administration |
$206.91
|
| Rate for Payer: United Healthcare Commercial |
$323.93
|
| Rate for Payer: United Healthcare Medicare |
$206.91
|
| Rate for Payer: WINHealth Partners Commercial |
$322.23
|
| Rate for Payer: Wise Provider Network Commercial |
$322.23
|
|
|
C-SECTION PACK
|
Facility
|
OP
|
$339.19
|
|
| Hospital Charge Code |
2650222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.67 |
| Max. Negotiated Rate |
$339.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$332.41
|
| Rate for Payer: Aetna of WY Medicare |
$223.87
|
| Rate for Payer: Altius Commercial |
$325.62
|
| Rate for Payer: Beech Street Commercial |
$332.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$329.01
|
| Rate for Payer: Cash Price |
$237.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$329.01
|
| Rate for Payer: Cigna of WY Commercial |
$332.41
|
| Rate for Payer: Entrust Commercial |
$322.23
|
| Rate for Payer: First Choice Health Commercial |
$322.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$322.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.34
|
| Rate for Payer: HealthUtah PPO |
$339.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$329.01
|
| Rate for Payer: Multiplan Medicare/VA |
$183.67
|
| Rate for Payer: One Health Plan of WY PPO |
$332.41
|
| Rate for Payer: PacificSource Commercial |
$305.27
|
| Rate for Payer: PHCS PPO |
$332.41
|
| Rate for Payer: Three Rivers PPO |
$254.39
|
| Rate for Payer: TriWest Veterans Administration |
$193.34
|
| Rate for Payer: United Healthcare Commercial |
$323.93
|
| Rate for Payer: United Healthcare Medicare |
$193.34
|
| Rate for Payer: WINHealth Partners Commercial |
$332.41
|
| Rate for Payer: Wise Provider Network Commercial |
$322.23
|
|
|
CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 75571 26
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.74
|
| Rate for Payer: Aetna of WY Medicare |
$26.27
|
| Rate for Payer: Beech Street Commercial |
$297.35
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.61
|
| Rate for Payer: Cigna of WY Commercial |
$306.74
|
| Rate for Payer: First Choice Health Commercial |
$281.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$297.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.27
|
| Rate for Payer: HealthUtah PPO |
$313.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.61
|
| Rate for Payer: Multiplan Medicare/VA |
$22.33
|
| Rate for Payer: One Health Plan of WY PPO |
$306.74
|
| Rate for Payer: PacificSource Commercial |
$281.70
|
| Rate for Payer: PHCS PPO |
$297.35
|
| Rate for Payer: Three Rivers PPO |
$234.75
|
| Rate for Payer: TriWest Veterans Administration |
$26.27
|
| Rate for Payer: United Healthcare Commercial |
$297.35
|
| Rate for Payer: WINHealth Partners Commercial |
$297.35
|
|
|
CTM FLOW CONNECTIVE TISSUE IMPLANT 2.0 CC
|
Facility
|
OP
|
$20,965.00
|
|
| Hospital Charge Code |
3004746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,352.55 |
| Max. Negotiated Rate |
$20,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20,545.70
|
| Rate for Payer: Aetna of WY Medicare |
$13,836.90
|
| Rate for Payer: Altius Commercial |
$20,126.40
|
| Rate for Payer: Beech Street Commercial |
$20,545.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20,336.05
|
| Rate for Payer: Cash Price |
$14,675.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$20,336.05
|
| Rate for Payer: Cigna of WY Commercial |
$20,545.70
|
| Rate for Payer: Entrust Commercial |
$19,916.75
|
| Rate for Payer: First Choice Health Commercial |
$19,916.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19,916.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11,950.05
|
| Rate for Payer: HealthUtah PPO |
$20,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20,336.05
|
| Rate for Payer: Multiplan Medicare/VA |
$11,352.55
|
| Rate for Payer: One Health Plan of WY PPO |
$20,545.70
|
| Rate for Payer: PacificSource Commercial |
$18,868.50
|
| Rate for Payer: PHCS PPO |
$20,545.70
|
| Rate for Payer: Three Rivers PPO |
$15,723.75
|
| Rate for Payer: TriWest Veterans Administration |
$11,950.05
|
| Rate for Payer: United Healthcare Commercial |
$20,021.58
|
| Rate for Payer: United Healthcare Medicare |
$11,950.05
|
| Rate for Payer: WINHealth Partners Commercial |
$20,545.70
|
| Rate for Payer: Wise Provider Network Commercial |
$19,916.75
|
|
|
CTM FLOW CONNECTIVE TISSUE IMPLANT 2.0 CC
|
Facility
|
IP
|
$20,965.00
|
|
| Hospital Charge Code |
3004746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,149.22 |
| Max. Negotiated Rate |
$20,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20,545.70
|
| Rate for Payer: Aetna of WY Medicare |
$13,417.60
|
| Rate for Payer: Altius Commercial |
$20,126.40
|
| Rate for Payer: Beech Street Commercial |
$20,545.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20,336.05
|
| Rate for Payer: Cash Price |
$14,675.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$20,336.05
|
| Rate for Payer: Cigna of WY Commercial |
$20,545.70
|
| Rate for Payer: Entrust Commercial |
$19,916.75
|
| Rate for Payer: First Choice Health Commercial |
$19,916.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19,916.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12,788.65
|
| Rate for Payer: HealthUtah PPO |
$20,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20,336.05
|
| Rate for Payer: Multiplan Medicare/VA |
$12,149.22
|
| Rate for Payer: One Health Plan of WY PPO |
$20,545.70
|
| Rate for Payer: PacificSource Commercial |
$18,868.50
|
| Rate for Payer: PHCS PPO |
$20,545.70
|
| Rate for Payer: Three Rivers PPO |
$15,723.75
|
| Rate for Payer: TriWest Veterans Administration |
$12,788.65
|
| Rate for Payer: United Healthcare Commercial |
$20,021.58
|
| Rate for Payer: United Healthcare Medicare |
$12,788.65
|
| Rate for Payer: WINHealth Partners Commercial |
$19,916.75
|
| Rate for Payer: Wise Provider Network Commercial |
$19,916.75
|
|
|
CTM FLOW CONNECTIVE TISSUE IMPLANT 4.0 CC
|
Facility
|
OP
|
$27,965.00
|
|
| Hospital Charge Code |
3004754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,143.05 |
| Max. Negotiated Rate |
$27,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27,405.70
|
| Rate for Payer: Aetna of WY Medicare |
$18,456.90
|
| Rate for Payer: Altius Commercial |
$26,846.40
|
| Rate for Payer: Beech Street Commercial |
$27,405.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27,126.05
|
| Rate for Payer: Cash Price |
$19,575.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$27,126.05
|
| Rate for Payer: Cigna of WY Commercial |
$27,405.70
|
| Rate for Payer: Entrust Commercial |
$26,566.75
|
| Rate for Payer: First Choice Health Commercial |
$26,566.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26,566.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15,940.05
|
| Rate for Payer: HealthUtah PPO |
$27,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27,126.05
|
| Rate for Payer: Multiplan Medicare/VA |
$15,143.05
|
| Rate for Payer: One Health Plan of WY PPO |
$27,405.70
|
| Rate for Payer: PacificSource Commercial |
$25,168.50
|
| Rate for Payer: PHCS PPO |
$27,405.70
|
| Rate for Payer: Three Rivers PPO |
$20,973.75
|
| Rate for Payer: TriWest Veterans Administration |
$15,940.05
|
| Rate for Payer: United Healthcare Commercial |
$26,706.58
|
| Rate for Payer: United Healthcare Medicare |
$15,940.05
|
| Rate for Payer: WINHealth Partners Commercial |
$27,405.70
|
| Rate for Payer: Wise Provider Network Commercial |
$26,566.75
|
|
|
CTM FLOW CONNECTIVE TISSUE IMPLANT 4.0 CC
|
Facility
|
IP
|
$27,965.00
|
|
| Hospital Charge Code |
3004754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,205.72 |
| Max. Negotiated Rate |
$27,965.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27,405.70
|
| Rate for Payer: Aetna of WY Medicare |
$17,897.60
|
| Rate for Payer: Altius Commercial |
$26,846.40
|
| Rate for Payer: Beech Street Commercial |
$27,405.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27,126.05
|
| Rate for Payer: Cash Price |
$19,575.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$27,126.05
|
| Rate for Payer: Cigna of WY Commercial |
$27,405.70
|
| Rate for Payer: Entrust Commercial |
$26,566.75
|
| Rate for Payer: First Choice Health Commercial |
$26,566.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26,566.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17,058.65
|
| Rate for Payer: HealthUtah PPO |
$27,965.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27,126.05
|
| Rate for Payer: Multiplan Medicare/VA |
$16,205.72
|
| Rate for Payer: One Health Plan of WY PPO |
$27,405.70
|
| Rate for Payer: PacificSource Commercial |
$25,168.50
|
| Rate for Payer: PHCS PPO |
$27,405.70
|
| Rate for Payer: Three Rivers PPO |
$20,973.75
|
| Rate for Payer: TriWest Veterans Administration |
$17,058.65
|
| Rate for Payer: United Healthcare Commercial |
$26,706.58
|
| Rate for Payer: United Healthcare Medicare |
$17,058.65
|
| Rate for Payer: WINHealth Partners Commercial |
$26,566.75
|
| Rate for Payer: Wise Provider Network Commercial |
$26,566.75
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 30906
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$599.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$587.02
|
| Rate for Payer: Aetna of WY Medicare |
$126.25
|
| Rate for Payer: Beech Street Commercial |
$569.05
|
| Rate for Payer: Cash Price |
$419.30
|
| Rate for Payer: Cash Price |
$419.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$581.03
|
| Rate for Payer: Cigna of WY Commercial |
$587.02
|
| Rate for Payer: First Choice Health Commercial |
$539.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$569.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.25
|
| Rate for Payer: HealthUtah PPO |
$599.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$581.03
|
| Rate for Payer: Multiplan Medicare/VA |
$107.31
|
| Rate for Payer: One Health Plan of WY PPO |
$587.02
|
| Rate for Payer: PacificSource Commercial |
$539.10
|
| Rate for Payer: PHCS PPO |
$569.05
|
| Rate for Payer: Three Rivers PPO |
$449.25
|
| Rate for Payer: TriWest Veterans Administration |
$126.25
|
| Rate for Payer: United Healthcare Commercial |
$569.05
|
| Rate for Payer: WINHealth Partners Commercial |
$509.15
|
|
|
CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$2,254.00
|
|
|
Service Code
|
HCPCS 42962
|
| Min. Negotiated Rate |
$427.94 |
| Max. Negotiated Rate |
$2,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,208.92
|
| Rate for Payer: Aetna of WY Medicare |
$503.46
|
| Rate for Payer: Beech Street Commercial |
$2,141.30
|
| Rate for Payer: Cash Price |
$1,577.80
|
| Rate for Payer: Cash Price |
$1,577.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,186.38
|
| Rate for Payer: Cigna of WY Commercial |
$2,208.92
|
| Rate for Payer: First Choice Health Commercial |
$2,028.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,141.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$503.46
|
| Rate for Payer: HealthUtah PPO |
$2,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,186.38
|
| Rate for Payer: Multiplan Medicare/VA |
$427.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,208.92
|
| Rate for Payer: PacificSource Commercial |
$2,028.60
|
| Rate for Payer: PHCS PPO |
$2,141.30
|
| Rate for Payer: Three Rivers PPO |
$1,690.50
|
| Rate for Payer: TriWest Veterans Administration |
$503.46
|
| Rate for Payer: United Healthcare Commercial |
$2,141.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,915.90
|
|
|
CUBITAL TUNNEL SPLINT M/L
|
Facility
|
OP
|
$209.12
|
|
| Hospital Charge Code |
2200240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$113.24 |
| Max. Negotiated Rate |
$209.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.94
|
| Rate for Payer: Aetna of WY Medicare |
$138.02
|
| Rate for Payer: Altius Commercial |
$200.76
|
| Rate for Payer: Beech Street Commercial |
$204.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.85
|
| Rate for Payer: Cash Price |
$146.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.85
|
| Rate for Payer: Cigna of WY Commercial |
$204.94
|
| Rate for Payer: Entrust Commercial |
$198.66
|
| Rate for Payer: First Choice Health Commercial |
$198.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$198.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.20
|
| Rate for Payer: HealthUtah PPO |
$209.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.85
|
| Rate for Payer: Multiplan Medicare/VA |
$113.24
|
| Rate for Payer: One Health Plan of WY PPO |
$204.94
|
| Rate for Payer: PacificSource Commercial |
$188.21
|
| Rate for Payer: PHCS PPO |
$204.94
|
| Rate for Payer: Three Rivers PPO |
$156.84
|
| Rate for Payer: TriWest Veterans Administration |
$119.20
|
| Rate for Payer: United Healthcare Commercial |
$199.71
|
| Rate for Payer: United Healthcare Medicare |
$119.20
|
| Rate for Payer: WINHealth Partners Commercial |
$204.94
|
| Rate for Payer: Wise Provider Network Commercial |
$198.66
|
|
|
CUBITAL TUNNEL SPLINT M/L
|
Facility
|
IP
|
$209.12
|
|
| Hospital Charge Code |
2200240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.19 |
| Max. Negotiated Rate |
$209.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.94
|
| Rate for Payer: Aetna of WY Medicare |
$133.84
|
| Rate for Payer: Altius Commercial |
$200.76
|
| Rate for Payer: Beech Street Commercial |
$204.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.85
|
| Rate for Payer: Cash Price |
$146.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.85
|
| Rate for Payer: Cigna of WY Commercial |
$204.94
|
| Rate for Payer: Entrust Commercial |
$198.66
|
| Rate for Payer: First Choice Health Commercial |
$198.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$198.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.56
|
| Rate for Payer: HealthUtah PPO |
$209.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.85
|
| Rate for Payer: Multiplan Medicare/VA |
$121.19
|
| Rate for Payer: One Health Plan of WY PPO |
$204.94
|
| Rate for Payer: PacificSource Commercial |
$188.21
|
| Rate for Payer: PHCS PPO |
$204.94
|
| Rate for Payer: Three Rivers PPO |
$156.84
|
| Rate for Payer: TriWest Veterans Administration |
$127.56
|
| Rate for Payer: United Healthcare Commercial |
$199.71
|
| Rate for Payer: United Healthcare Medicare |
$127.56
|
| Rate for Payer: WINHealth Partners Commercial |
$198.66
|
| Rate for Payer: Wise Provider Network Commercial |
$198.66
|
|
