|
AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,457.00
|
|
|
Service Code
|
HCPCS 28810 AS
|
| Hospital Charge Code |
28810
|
| Min. Negotiated Rate |
$347.40 |
| Max. Negotiated Rate |
$1,457.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,427.86
|
| Rate for Payer: Aetna of WY Medicare |
$408.70
|
| Rate for Payer: Beech Street Commercial |
$1,384.15
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: Cash Price |
$1,019.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,413.29
|
| Rate for Payer: Cigna of WY Commercial |
$1,427.86
|
| Rate for Payer: First Choice Health Commercial |
$1,311.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,384.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.70
|
| Rate for Payer: HealthUtah PPO |
$1,457.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,413.29
|
| Rate for Payer: Multiplan Medicare/VA |
$347.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,427.86
|
| Rate for Payer: PacificSource Commercial |
$1,311.30
|
| Rate for Payer: PHCS PPO |
$1,384.15
|
| Rate for Payer: Three Rivers PPO |
$1,092.75
|
| Rate for Payer: TriWest Veterans Administration |
$408.70
|
| Rate for Payer: United Healthcare Commercial |
$1,267.59
|
| Rate for Payer: United Healthcare Medicare |
$408.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,238.45
|
|
|
AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 28825 AS
|
| Hospital Charge Code |
28825
|
| Min. Negotiated Rate |
$140.99 |
| Max. Negotiated Rate |
$1,011.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$990.78
|
| Rate for Payer: Aetna of WY Medicare |
$165.87
|
| Rate for Payer: Beech Street Commercial |
$960.45
|
| Rate for Payer: Cash Price |
$707.70
|
| Rate for Payer: Cash Price |
$707.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$980.67
|
| Rate for Payer: Cigna of WY Commercial |
$990.78
|
| Rate for Payer: First Choice Health Commercial |
$909.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$960.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.87
|
| Rate for Payer: HealthUtah PPO |
$1,011.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$980.67
|
| Rate for Payer: Multiplan Medicare/VA |
$140.99
|
| Rate for Payer: One Health Plan of WY PPO |
$990.78
|
| Rate for Payer: PacificSource Commercial |
$909.90
|
| Rate for Payer: PHCS PPO |
$960.45
|
| Rate for Payer: Three Rivers PPO |
$758.25
|
| Rate for Payer: TriWest Veterans Administration |
$165.87
|
| Rate for Payer: United Healthcare Commercial |
$879.57
|
| Rate for Payer: United Healthcare Medicare |
$165.87
|
| Rate for Payer: WINHealth Partners Commercial |
$859.35
|
|
|
AMPUTATION TOE INTERPHALANGEAL JOINT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 28825
|
| Hospital Charge Code |
28825
|
| Min. Negotiated Rate |
$140.99 |
| Max. Negotiated Rate |
$1,011.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$990.78
|
| Rate for Payer: Aetna of WY Medicare |
$165.87
|
| Rate for Payer: Beech Street Commercial |
$960.45
|
| Rate for Payer: Cash Price |
$707.70
|
| Rate for Payer: Cash Price |
$707.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$980.67
|
| Rate for Payer: Cigna of WY Commercial |
$990.78
|
| Rate for Payer: First Choice Health Commercial |
$909.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$960.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.87
|
| Rate for Payer: HealthUtah PPO |
$1,011.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$980.67
|
| Rate for Payer: Multiplan Medicare/VA |
$140.99
|
| Rate for Payer: One Health Plan of WY PPO |
$990.78
|
| Rate for Payer: PacificSource Commercial |
$909.90
|
| Rate for Payer: PHCS PPO |
$960.45
|
| Rate for Payer: Three Rivers PPO |
$758.25
|
| Rate for Payer: TriWest Veterans Administration |
$165.87
|
| Rate for Payer: United Healthcare Commercial |
$879.57
|
| Rate for Payer: United Healthcare Medicare |
$165.87
|
| Rate for Payer: WINHealth Partners Commercial |
$859.35
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 28820 80
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$144.53 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,989.40
|
| Rate for Payer: Aetna of WY Medicare |
$170.04
|
| Rate for Payer: Beech Street Commercial |
$1,928.50
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,969.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,989.40
|
| Rate for Payer: First Choice Health Commercial |
$1,827.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,928.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.04
|
| Rate for Payer: HealthUtah PPO |
$2,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,969.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,989.40
|
| Rate for Payer: PacificSource Commercial |
$1,827.00
|
| Rate for Payer: PHCS PPO |
$1,928.50
|
| Rate for Payer: Three Rivers PPO |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration |
$170.04
|
| Rate for Payer: United Healthcare Commercial |
$1,766.10
|
| Rate for Payer: United Healthcare Medicare |
$170.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,725.50
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 28820 AS
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$144.53 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,989.40
|
| Rate for Payer: Aetna of WY Medicare |
$170.04
|
| Rate for Payer: Beech Street Commercial |
$1,928.50
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,969.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,989.40
|
| Rate for Payer: First Choice Health Commercial |
$1,827.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,928.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.04
|
| Rate for Payer: HealthUtah PPO |
$2,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,969.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,989.40
|
| Rate for Payer: PacificSource Commercial |
$1,827.00
|
| Rate for Payer: PHCS PPO |
$1,928.50
|
| Rate for Payer: Three Rivers PPO |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration |
$170.04
|
| Rate for Payer: United Healthcare Commercial |
$1,766.10
|
| Rate for Payer: United Healthcare Medicare |
$170.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,725.50
|
|
|
AMPUTATION TOE METATARSOPHALANGEAL JOINT
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
28820
|
| Min. Negotiated Rate |
$144.53 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,989.40
|
| Rate for Payer: Aetna of WY Medicare |
$170.04
|
| Rate for Payer: Beech Street Commercial |
$1,928.50
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: Cash Price |
$1,421.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,969.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,989.40
|
| Rate for Payer: First Choice Health Commercial |
$1,827.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,928.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.04
|
| Rate for Payer: HealthUtah PPO |
$2,030.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,969.10
|
| Rate for Payer: Multiplan Medicare/VA |
$144.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,989.40
|
| Rate for Payer: PacificSource Commercial |
$1,827.00
|
| Rate for Payer: PHCS PPO |
$1,928.50
|
| Rate for Payer: Three Rivers PPO |
$1,522.50
|
| Rate for Payer: TriWest Veterans Administration |
$170.04
|
| Rate for Payer: United Healthcare Commercial |
$1,766.10
|
| Rate for Payer: United Healthcare Medicare |
$170.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,725.50
|
|
|
ANATOMICAL NASAL PACK Q770406
|
Facility
|
OP
|
$19.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.70
|
| Rate for Payer: Aetna of WY Medicare |
$12.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.32
|
| Rate for Payer: Altius Commercial |
$18.32
|
| Rate for Payer: Beech Street Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.66
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.51
|
| Rate for Payer: Cigna of WY Commercial |
$18.70
|
| Rate for Payer: Entrust Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.07
|
| Rate for Payer: HealthUtah PPO |
$19.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.51
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$18.70
|
| Rate for Payer: PacificSource Commercial |
$17.17
|
| Rate for Payer: PHCS PPO |
$18.70
|
| Rate for Payer: Three Rivers PPO |
$14.31
|
| Rate for Payer: TriWest Veterans Administration |
$11.07
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Medicare |
$11.07
|
| Rate for Payer: WINHealth Partners Commercial |
$18.70
|
| Rate for Payer: Wise Provider Network Commercial |
$18.13
|
|
|
ANATOMICAL NASAL PACK Q770406
|
Facility
|
IP
|
$19.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.32
|
| Rate for Payer: Altius Commercial |
$18.32
|
| Rate for Payer: Beech Street Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.66
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.51
|
| Rate for Payer: Cigna of WY Commercial |
$18.70
|
| Rate for Payer: Entrust Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.59
|
| Rate for Payer: HealthUtah PPO |
$19.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.51
|
| Rate for Payer: Multiplan Medicare/VA |
$11.96
|
| Rate for Payer: One Health Plan of WY PPO |
$18.70
|
| Rate for Payer: PacificSource Commercial |
$17.17
|
| Rate for Payer: PHCS PPO |
$18.70
|
| Rate for Payer: Three Rivers PPO |
$14.31
|
| Rate for Payer: TriWest Veterans Administration |
$12.59
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Medicare |
$12.59
|
| Rate for Payer: WINHealth Partners Commercial |
$18.13
|
| Rate for Payer: Wise Provider Network Commercial |
$18.13
|
|
|
ANCHOR BONE 3 ALL IN ONE TRAY
|
Facility
|
OP
|
$3,747.42
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.83 |
| Max. Negotiated Rate |
$3,747.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,672.47
|
| Rate for Payer: Aetna of WY Medicare |
$2,473.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,597.52
|
| Rate for Payer: Altius Commercial |
$3,597.52
|
| Rate for Payer: Beech Street Commercial |
$3,672.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,076.63
|
| Rate for Payer: Cash Price |
$2,623.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,672.47
|
| Rate for Payer: Entrust Commercial |
$3,560.05
|
| Rate for Payer: First Choice Health Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,173.50
|
| Rate for Payer: HealthUtah PPO |
$3,747.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,064.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,672.47
|
| Rate for Payer: PacificSource Commercial |
$3,372.68
|
| Rate for Payer: PHCS PPO |
$3,672.47
|
| Rate for Payer: Three Rivers PPO |
$2,810.56
|
| Rate for Payer: TriWest Veterans Administration |
$2,173.50
|
| Rate for Payer: United Healthcare Commercial |
$3,260.26
|
| Rate for Payer: United Healthcare Medicare |
$2,173.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,672.47
|
| Rate for Payer: Wise Provider Network Commercial |
$3,560.05
|
|
|
ANCHOR BONE 3 ALL IN ONE TRAY
|
Facility
|
IP
|
$3,747.42
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,349.63 |
| Max. Negotiated Rate |
$3,747.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,672.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3,597.52
|
| Rate for Payer: Altius Commercial |
$3,597.52
|
| Rate for Payer: Beech Street Commercial |
$3,672.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,076.63
|
| Rate for Payer: Cash Price |
$2,623.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,635.00
|
| Rate for Payer: Cigna of WY Commercial |
$3,672.47
|
| Rate for Payer: Entrust Commercial |
$3,560.05
|
| Rate for Payer: First Choice Health Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,560.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,473.30
|
| Rate for Payer: HealthUtah PPO |
$3,747.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,635.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,349.63
|
| Rate for Payer: One Health Plan of WY PPO |
$3,672.47
|
| Rate for Payer: PacificSource Commercial |
$3,372.68
|
| Rate for Payer: PHCS PPO |
$3,672.47
|
| Rate for Payer: Three Rivers PPO |
$2,810.56
|
| Rate for Payer: TriWest Veterans Administration |
$2,473.30
|
| Rate for Payer: United Healthcare Commercial |
$3,260.26
|
| Rate for Payer: United Healthcare Medicare |
$2,473.30
|
| Rate for Payer: WINHealth Partners Commercial |
$3,560.05
|
| Rate for Payer: Wise Provider Network Commercial |
$3,560.05
|
|
|
ANCHOR PEEK SWIVELOCK 4.75X19
|
Facility
|
OP
|
$2,963.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.05 |
| Max. Negotiated Rate |
$2,963.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,904.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,956.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,845.25
|
| Rate for Payer: Altius Commercial |
$2,845.25
|
| Rate for Payer: Beech Street Commercial |
$2,904.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,433.28
|
| Rate for Payer: Cash Price |
$2,074.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,874.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,904.52
|
| Rate for Payer: Entrust Commercial |
$2,815.61
|
| Rate for Payer: First Choice Health Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,719.00
|
| Rate for Payer: HealthUtah PPO |
$2,963.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,874.89
|
| Rate for Payer: Multiplan Medicare/VA |
$1,633.05
|
| Rate for Payer: One Health Plan of WY PPO |
$2,904.52
|
| Rate for Payer: PacificSource Commercial |
$2,667.42
|
| Rate for Payer: PHCS PPO |
$2,904.52
|
| Rate for Payer: Three Rivers PPO |
$2,222.85
|
| Rate for Payer: TriWest Veterans Administration |
$1,719.00
|
| Rate for Payer: United Healthcare Commercial |
$2,578.51
|
| Rate for Payer: United Healthcare Medicare |
$1,719.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,904.52
|
| Rate for Payer: Wise Provider Network Commercial |
$2,815.61
|
|
|
ANCHOR PEEK SWIVELOCK 4.75X19
|
Facility
|
IP
|
$2,963.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,858.30 |
| Max. Negotiated Rate |
$2,963.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,904.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,845.25
|
| Rate for Payer: Altius Commercial |
$2,845.25
|
| Rate for Payer: Beech Street Commercial |
$2,904.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,433.28
|
| Rate for Payer: Cash Price |
$2,074.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,874.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,904.52
|
| Rate for Payer: Entrust Commercial |
$2,815.61
|
| Rate for Payer: First Choice Health Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,815.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,956.11
|
| Rate for Payer: HealthUtah PPO |
$2,963.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,874.89
|
| Rate for Payer: Multiplan Medicare/VA |
$1,858.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2,904.52
|
| Rate for Payer: PacificSource Commercial |
$2,667.42
|
| Rate for Payer: PHCS PPO |
$2,904.52
|
| Rate for Payer: Three Rivers PPO |
$2,222.85
|
| Rate for Payer: TriWest Veterans Administration |
$1,956.11
|
| Rate for Payer: United Healthcare Commercial |
$2,578.51
|
| Rate for Payer: United Healthcare Medicare |
$1,956.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,815.61
|
| Rate for Payer: Wise Provider Network Commercial |
$2,815.61
|
|
|
ANCHOR PUSHLOK 2.9X12.5
|
Facility
|
OP
|
$1,471.68
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$810.90 |
| Max. Negotiated Rate |
$1,471.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.25
|
| Rate for Payer: Aetna of WY Medicare |
$971.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,412.81
|
| Rate for Payer: Altius Commercial |
$1,412.81
|
| Rate for Payer: Beech Street Commercial |
$1,442.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,208.25
|
| Rate for Payer: Cash Price |
$1,030.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.25
|
| Rate for Payer: Entrust Commercial |
$1,398.10
|
| Rate for Payer: First Choice Health Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$853.57
|
| Rate for Payer: HealthUtah PPO |
$1,471.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.53
|
| Rate for Payer: Multiplan Medicare/VA |
$810.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.25
|
| Rate for Payer: PacificSource Commercial |
$1,324.51
|
| Rate for Payer: PHCS PPO |
$1,442.25
|
| Rate for Payer: Three Rivers PPO |
$1,103.76
|
| Rate for Payer: TriWest Veterans Administration |
$853.57
|
| Rate for Payer: United Healthcare Commercial |
$1,280.36
|
| Rate for Payer: United Healthcare Medicare |
$853.57
|
| Rate for Payer: WINHealth Partners Commercial |
$1,442.25
|
| Rate for Payer: Wise Provider Network Commercial |
$1,398.10
|
|
|
ANCHOR PUSHLOK 2.9X12.5
|
Facility
|
IP
|
$1,471.68
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.74 |
| Max. Negotiated Rate |
$1,471.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,442.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,412.81
|
| Rate for Payer: Altius Commercial |
$1,412.81
|
| Rate for Payer: Beech Street Commercial |
$1,442.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,208.25
|
| Rate for Payer: Cash Price |
$1,030.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,427.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,442.25
|
| Rate for Payer: Entrust Commercial |
$1,398.10
|
| Rate for Payer: First Choice Health Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,398.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$971.31
|
| Rate for Payer: HealthUtah PPO |
$1,471.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,427.53
|
| Rate for Payer: Multiplan Medicare/VA |
$922.74
|
| Rate for Payer: One Health Plan of WY PPO |
$1,442.25
|
| Rate for Payer: PacificSource Commercial |
$1,324.51
|
| Rate for Payer: PHCS PPO |
$1,442.25
|
| Rate for Payer: Three Rivers PPO |
$1,103.76
|
| Rate for Payer: TriWest Veterans Administration |
$971.31
|
| Rate for Payer: United Healthcare Commercial |
$1,280.36
|
| Rate for Payer: United Healthcare Medicare |
$971.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,398.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,398.10
|
|
|
ANCHORS TENDON 8
|
Facility
|
OP
|
$2,573.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.83 |
| Max. Negotiated Rate |
$2,573.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,521.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,698.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,470.27
|
| Rate for Payer: Altius Commercial |
$2,470.27
|
| Rate for Payer: Beech Street Commercial |
$2,521.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,112.60
|
| Rate for Payer: Cash Price |
$1,801.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,496.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,521.74
|
| Rate for Payer: Entrust Commercial |
$2,444.54
|
| Rate for Payer: First Choice Health Commercial |
$2,444.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,444.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,492.46
|
| Rate for Payer: HealthUtah PPO |
$2,573.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,496.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,417.83
|
| Rate for Payer: One Health Plan of WY PPO |
$2,521.74
|
| Rate for Payer: PacificSource Commercial |
$2,315.88
|
| Rate for Payer: PHCS PPO |
$2,521.74
|
| Rate for Payer: Three Rivers PPO |
$1,929.90
|
| Rate for Payer: TriWest Veterans Administration |
$1,492.46
|
| Rate for Payer: United Healthcare Commercial |
$2,238.68
|
| Rate for Payer: United Healthcare Medicare |
$1,492.46
|
| Rate for Payer: WINHealth Partners Commercial |
$2,521.74
|
| Rate for Payer: Wise Provider Network Commercial |
$2,444.54
|
|
|
ANCHORS TENDON 8
|
Facility
|
IP
|
$2,573.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,613.40 |
| Max. Negotiated Rate |
$2,573.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,521.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,470.27
|
| Rate for Payer: Altius Commercial |
$2,470.27
|
| Rate for Payer: Beech Street Commercial |
$2,521.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,112.60
|
| Rate for Payer: Cash Price |
$1,801.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,496.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,521.74
|
| Rate for Payer: Entrust Commercial |
$2,444.54
|
| Rate for Payer: First Choice Health Commercial |
$2,444.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,444.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,698.31
|
| Rate for Payer: HealthUtah PPO |
$2,573.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,496.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,613.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,521.74
|
| Rate for Payer: PacificSource Commercial |
$2,315.88
|
| Rate for Payer: PHCS PPO |
$2,521.74
|
| Rate for Payer: Three Rivers PPO |
$1,929.90
|
| Rate for Payer: TriWest Veterans Administration |
$1,698.31
|
| Rate for Payer: United Healthcare Commercial |
$2,238.68
|
| Rate for Payer: United Healthcare Medicare |
$1,698.31
|
| Rate for Payer: WINHealth Partners Commercial |
$2,444.54
|
| Rate for Payer: Wise Provider Network Commercial |
$2,444.54
|
|
|
ANES COMP BY EMERGENCY CONDITIONS SPECIFY
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 99140
|
| Hospital Charge Code |
99140
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Beech Street Commercial |
$230.85
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: First Choice Health Commercial |
$218.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$230.85
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: United Healthcare Commercial |
$211.41
|
| Rate for Payer: WINHealth Partners Commercial |
$230.85
|
|
|
ANESTHESIA EXTREME AGE PATIENT<1 YR&>70
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
99100
|
| Min. Negotiated Rate |
$182.25 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$238.14
|
| Rate for Payer: Beech Street Commercial |
$230.85
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$235.71
|
| Rate for Payer: Cigna of WY Commercial |
$238.14
|
| Rate for Payer: First Choice Health Commercial |
$218.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.85
|
| Rate for Payer: HealthUtah PPO |
$243.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$235.71
|
| Rate for Payer: One Health Plan of WY PPO |
$238.14
|
| Rate for Payer: PacificSource Commercial |
$218.70
|
| Rate for Payer: PHCS PPO |
$230.85
|
| Rate for Payer: Three Rivers PPO |
$182.25
|
| Rate for Payer: United Healthcare Commercial |
$211.41
|
| Rate for Payer: WINHealth Partners Commercial |
$230.85
|
|
|
ANGIO PACK CATH III PLUS
|
Facility
|
OP
|
$280.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.59 |
| Max. Negotiated Rate |
$280.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.96
|
| Rate for Payer: Aetna of WY Medicare |
$185.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$269.35
|
| Rate for Payer: Altius Commercial |
$269.35
|
| Rate for Payer: Beech Street Commercial |
$274.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$230.35
|
| Rate for Payer: Cash Price |
$196.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$272.15
|
| Rate for Payer: Cigna of WY Commercial |
$274.96
|
| Rate for Payer: Entrust Commercial |
$266.54
|
| Rate for Payer: First Choice Health Commercial |
$266.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$162.73
|
| Rate for Payer: HealthUtah PPO |
$280.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.15
|
| Rate for Payer: Multiplan Medicare/VA |
$154.59
|
| Rate for Payer: One Health Plan of WY PPO |
$274.96
|
| Rate for Payer: PacificSource Commercial |
$252.51
|
| Rate for Payer: PHCS PPO |
$274.96
|
| Rate for Payer: Three Rivers PPO |
$210.43
|
| Rate for Payer: TriWest Veterans Administration |
$162.73
|
| Rate for Payer: United Healthcare Commercial |
$244.10
|
| Rate for Payer: United Healthcare Medicare |
$162.73
|
| Rate for Payer: WINHealth Partners Commercial |
$274.96
|
| Rate for Payer: Wise Provider Network Commercial |
$266.54
|
|
|
ANGIO PACK CATH III PLUS
|
Facility
|
IP
|
$280.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.92 |
| Max. Negotiated Rate |
$280.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$269.35
|
| Rate for Payer: Altius Commercial |
$269.35
|
| Rate for Payer: Beech Street Commercial |
$274.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$230.35
|
| Rate for Payer: Cash Price |
$196.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$272.15
|
| Rate for Payer: Cigna of WY Commercial |
$274.96
|
| Rate for Payer: Entrust Commercial |
$266.54
|
| Rate for Payer: First Choice Health Commercial |
$266.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.18
|
| Rate for Payer: HealthUtah PPO |
$280.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.15
|
| Rate for Payer: Multiplan Medicare/VA |
$175.92
|
| Rate for Payer: One Health Plan of WY PPO |
$274.96
|
| Rate for Payer: PacificSource Commercial |
$252.51
|
| Rate for Payer: PHCS PPO |
$274.96
|
| Rate for Payer: Three Rivers PPO |
$210.43
|
| Rate for Payer: TriWest Veterans Administration |
$185.18
|
| Rate for Payer: United Healthcare Commercial |
$244.10
|
| Rate for Payer: United Healthcare Medicare |
$185.18
|
| Rate for Payer: WINHealth Partners Commercial |
$266.54
|
| Rate for Payer: Wise Provider Network Commercial |
$266.54
|
|
|
ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION [162889]
|
Facility
|
IP
|
$2,681.98
|
|
|
Service Code
|
HCPCS J0491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,681.60 |
| Max. Negotiated Rate |
$2,681.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,628.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,574.70
|
| Rate for Payer: Altius Commercial |
$2,574.70
|
| Rate for Payer: Beech Street Commercial |
$2,628.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,201.91
|
| Rate for Payer: Cash Price |
$1,877.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,601.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,628.34
|
| Rate for Payer: Entrust Commercial |
$2,547.88
|
| Rate for Payer: First Choice Health Commercial |
$2,547.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,547.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,770.11
|
| Rate for Payer: HealthUtah PPO |
$2,681.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,601.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,681.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,628.34
|
| Rate for Payer: PacificSource Commercial |
$2,413.78
|
| Rate for Payer: PHCS PPO |
$2,628.34
|
| Rate for Payer: Three Rivers PPO |
$2,011.48
|
| Rate for Payer: TriWest Veterans Administration |
$1,770.11
|
| Rate for Payer: United Healthcare Commercial |
$2,333.32
|
| Rate for Payer: United Healthcare Medicare |
$1,770.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,547.88
|
| Rate for Payer: Wise Provider Network Commercial |
$2,547.88
|
|
|
ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION [162889]
|
Facility
|
OP
|
$2,681.98
|
|
|
Service Code
|
HCPCS J0491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,477.77 |
| Max. Negotiated Rate |
$2,681.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,628.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,770.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,574.70
|
| Rate for Payer: Altius Commercial |
$2,574.70
|
| Rate for Payer: Beech Street Commercial |
$2,628.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,201.91
|
| Rate for Payer: Cash Price |
$1,877.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,601.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,628.34
|
| Rate for Payer: Entrust Commercial |
$2,547.88
|
| Rate for Payer: First Choice Health Commercial |
$2,547.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,547.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,555.55
|
| Rate for Payer: HealthUtah PPO |
$2,681.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,601.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,477.77
|
| Rate for Payer: One Health Plan of WY PPO |
$2,628.34
|
| Rate for Payer: PacificSource Commercial |
$2,413.78
|
| Rate for Payer: PHCS PPO |
$2,628.34
|
| Rate for Payer: Three Rivers PPO |
$2,011.48
|
| Rate for Payer: TriWest Veterans Administration |
$1,555.55
|
| Rate for Payer: United Healthcare Commercial |
$2,333.32
|
| Rate for Payer: United Healthcare Medicare |
$1,555.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,628.34
|
| Rate for Payer: Wise Provider Network Commercial |
$2,547.88
|
|
|
ANKLE CONTROL ORTHO PRE OTS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
L4350
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
ANKLE DISTRACTOR AR-1712
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$151.20
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.31
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.95
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$98.75
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$103.95
|
| Rate for Payer: United Healthcare Commercial |
$137.02
|
| Rate for Payer: United Healthcare Medicare |
$103.95
|
| Rate for Payer: WINHealth Partners Commercial |
$149.62
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
ANKLE DISTRACTOR AR-1712
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.78 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$103.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$151.20
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.31
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.35
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$86.78
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$91.35
|
| Rate for Payer: United Healthcare Commercial |
$137.02
|
| Rate for Payer: United Healthcare Medicare |
$91.35
|
| Rate for Payer: WINHealth Partners Commercial |
$154.35
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
