|
GADOBUTROL 2 MMOL/2 ML (1 MMOL/ML) INTRAVENOUS SOLUTION [135580]
|
Facility
|
IP
|
$47.37
|
|
|
Service Code
|
HCPCS A9585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.48
|
| Rate for Payer: Altius Commercial |
$45.48
|
| Rate for Payer: Beech Street Commercial |
$46.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$33.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.95
|
| Rate for Payer: Cigna of WY Commercial |
$46.42
|
| Rate for Payer: Entrust Commercial |
$45.00
|
| Rate for Payer: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.26
|
| Rate for Payer: HealthUtah PPO |
$47.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.95
|
| Rate for Payer: Multiplan Medicare/VA |
$29.70
|
| Rate for Payer: One Health Plan of WY PPO |
$46.42
|
| Rate for Payer: PacificSource Commercial |
$42.63
|
| Rate for Payer: PHCS PPO |
$46.42
|
| Rate for Payer: Three Rivers PPO |
$35.53
|
| Rate for Payer: TriWest Veterans Administration |
$31.26
|
| Rate for Payer: United Healthcare Commercial |
$41.21
|
| Rate for Payer: United Healthcare Medicare |
$31.26
|
| Rate for Payer: WINHealth Partners Commercial |
$45.00
|
| Rate for Payer: Wise Provider Network Commercial |
$45.00
|
|
|
GADOBUTROL 2 MMOL/2 ML (1 MMOL/ML) INTRAVENOUS SOLUTION [135580]
|
Facility
|
OP
|
$47.37
|
|
|
Service Code
|
HCPCS A9585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.42
|
| Rate for Payer: Aetna of WY Medicare |
$31.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.48
|
| Rate for Payer: Altius Commercial |
$45.48
|
| Rate for Payer: Beech Street Commercial |
$46.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$33.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.95
|
| Rate for Payer: Cigna of WY Commercial |
$46.42
|
| Rate for Payer: Entrust Commercial |
$45.00
|
| Rate for Payer: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.47
|
| Rate for Payer: HealthUtah PPO |
$47.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.95
|
| Rate for Payer: Multiplan Medicare/VA |
$26.10
|
| Rate for Payer: One Health Plan of WY PPO |
$46.42
|
| Rate for Payer: PacificSource Commercial |
$42.63
|
| Rate for Payer: PHCS PPO |
$46.42
|
| Rate for Payer: Three Rivers PPO |
$35.53
|
| Rate for Payer: TriWest Veterans Administration |
$27.47
|
| Rate for Payer: United Healthcare Commercial |
$41.21
|
| Rate for Payer: United Healthcare Medicare |
$27.47
|
| Rate for Payer: WINHealth Partners Commercial |
$46.42
|
| Rate for Payer: Wise Provider Network Commercial |
$45.00
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [130431]
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
HCPCS A9575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.48
|
| Rate for Payer: Altius Commercial |
$24.48
|
| Rate for Payer: Beech Street Commercial |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.74
|
| Rate for Payer: Cigna of WY Commercial |
$24.99
|
| Rate for Payer: Entrust Commercial |
$24.22
|
| Rate for Payer: First Choice Health Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.83
|
| Rate for Payer: HealthUtah PPO |
$25.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.74
|
| Rate for Payer: Multiplan Medicare/VA |
$15.99
|
| Rate for Payer: One Health Plan of WY PPO |
$24.99
|
| Rate for Payer: PacificSource Commercial |
$22.95
|
| Rate for Payer: PHCS PPO |
$24.99
|
| Rate for Payer: Three Rivers PPO |
$19.12
|
| Rate for Payer: TriWest Veterans Administration |
$16.83
|
| Rate for Payer: United Healthcare Commercial |
$22.18
|
| Rate for Payer: United Healthcare Medicare |
$16.83
|
| Rate for Payer: WINHealth Partners Commercial |
$24.22
|
| Rate for Payer: Wise Provider Network Commercial |
$24.22
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [130431]
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
HCPCS A9575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.99
|
| Rate for Payer: Aetna of WY Medicare |
$16.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.48
|
| Rate for Payer: Altius Commercial |
$24.48
|
| Rate for Payer: Beech Street Commercial |
$24.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.74
|
| Rate for Payer: Cigna of WY Commercial |
$24.99
|
| Rate for Payer: Entrust Commercial |
$24.22
|
| Rate for Payer: First Choice Health Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.79
|
| Rate for Payer: HealthUtah PPO |
$25.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.74
|
| Rate for Payer: Multiplan Medicare/VA |
$14.05
|
| Rate for Payer: One Health Plan of WY PPO |
$24.99
|
| Rate for Payer: PacificSource Commercial |
$22.95
|
| Rate for Payer: PHCS PPO |
$24.99
|
| Rate for Payer: Three Rivers PPO |
$19.12
|
| Rate for Payer: TriWest Veterans Administration |
$14.79
|
| Rate for Payer: United Healthcare Commercial |
$22.18
|
| Rate for Payer: United Healthcare Medicare |
$14.79
|
| Rate for Payer: WINHealth Partners Commercial |
$24.99
|
| Rate for Payer: Wise Provider Network Commercial |
$24.22
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML INTRAVENOUS SYRINGE [130493]
|
Facility
|
OP
|
$34.25
|
|
|
Service Code
|
HCPCS A9575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$34.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
| Rate for Payer: Aetna of WY Medicare |
$22.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
| Rate for Payer: Altius Commercial |
$32.88
|
| Rate for Payer: Beech Street Commercial |
$33.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
| Rate for Payer: Cigna of WY Commercial |
$33.56
|
| Rate for Payer: Entrust Commercial |
$32.54
|
| Rate for Payer: First Choice Health Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.86
|
| Rate for Payer: HealthUtah PPO |
$34.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
| Rate for Payer: Multiplan Medicare/VA |
$18.87
|
| Rate for Payer: One Health Plan of WY PPO |
$33.56
|
| Rate for Payer: PacificSource Commercial |
$30.82
|
| Rate for Payer: PHCS PPO |
$33.56
|
| Rate for Payer: Three Rivers PPO |
$25.69
|
| Rate for Payer: TriWest Veterans Administration |
$19.86
|
| Rate for Payer: United Healthcare Commercial |
$29.80
|
| Rate for Payer: United Healthcare Medicare |
$19.86
|
| Rate for Payer: WINHealth Partners Commercial |
$33.56
|
| Rate for Payer: Wise Provider Network Commercial |
$32.54
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML INTRAVENOUS SYRINGE [130493]
|
Facility
|
IP
|
$34.25
|
|
|
Service Code
|
HCPCS A9575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$34.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.88
|
| Rate for Payer: Altius Commercial |
$32.88
|
| Rate for Payer: Beech Street Commercial |
$33.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.22
|
| Rate for Payer: Cigna of WY Commercial |
$33.56
|
| Rate for Payer: Entrust Commercial |
$32.54
|
| Rate for Payer: First Choice Health Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.60
|
| Rate for Payer: HealthUtah PPO |
$34.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.22
|
| Rate for Payer: Multiplan Medicare/VA |
$21.47
|
| Rate for Payer: One Health Plan of WY PPO |
$33.56
|
| Rate for Payer: PacificSource Commercial |
$30.82
|
| Rate for Payer: PHCS PPO |
$33.56
|
| Rate for Payer: Three Rivers PPO |
$25.69
|
| Rate for Payer: TriWest Veterans Administration |
$22.60
|
| Rate for Payer: United Healthcare Commercial |
$29.80
|
| Rate for Payer: United Healthcare Medicare |
$22.60
|
| Rate for Payer: WINHealth Partners Commercial |
$32.54
|
| Rate for Payer: Wise Provider Network Commercial |
$32.54
|
|
|
GAIT BELT 60"
|
Facility
|
IP
|
$10.46
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.04
|
| Rate for Payer: Altius Commercial |
$10.04
|
| Rate for Payer: Beech Street Commercial |
$10.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.15
|
| Rate for Payer: Cigna of WY Commercial |
$10.25
|
| Rate for Payer: Entrust Commercial |
$9.94
|
| Rate for Payer: First Choice Health Commercial |
$9.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.90
|
| Rate for Payer: HealthUtah PPO |
$10.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.15
|
| Rate for Payer: Multiplan Medicare/VA |
$6.56
|
| Rate for Payer: One Health Plan of WY PPO |
$10.25
|
| Rate for Payer: PacificSource Commercial |
$9.41
|
| Rate for Payer: PHCS PPO |
$10.25
|
| Rate for Payer: Three Rivers PPO |
$7.84
|
| Rate for Payer: TriWest Veterans Administration |
$6.90
|
| Rate for Payer: United Healthcare Commercial |
$9.10
|
| Rate for Payer: United Healthcare Medicare |
$6.90
|
| Rate for Payer: WINHealth Partners Commercial |
$9.94
|
| Rate for Payer: Wise Provider Network Commercial |
$9.94
|
|
|
GAIT BELT 60"
|
Facility
|
OP
|
$10.46
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.25
|
| Rate for Payer: Aetna of WY Medicare |
$6.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.04
|
| Rate for Payer: Altius Commercial |
$10.04
|
| Rate for Payer: Beech Street Commercial |
$10.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.15
|
| Rate for Payer: Cigna of WY Commercial |
$10.25
|
| Rate for Payer: Entrust Commercial |
$9.94
|
| Rate for Payer: First Choice Health Commercial |
$9.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.07
|
| Rate for Payer: HealthUtah PPO |
$10.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.15
|
| Rate for Payer: Multiplan Medicare/VA |
$5.76
|
| Rate for Payer: One Health Plan of WY PPO |
$10.25
|
| Rate for Payer: PacificSource Commercial |
$9.41
|
| Rate for Payer: PHCS PPO |
$10.25
|
| Rate for Payer: Three Rivers PPO |
$7.84
|
| Rate for Payer: TriWest Veterans Administration |
$6.07
|
| Rate for Payer: United Healthcare Commercial |
$9.10
|
| Rate for Payer: United Healthcare Medicare |
$6.07
|
| Rate for Payer: WINHealth Partners Commercial |
$10.25
|
| Rate for Payer: Wise Provider Network Commercial |
$9.94
|
|
|
GAIT BELT 72" HEAVY DUTYIN
|
Facility
|
IP
|
$16.91
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.23
|
| Rate for Payer: Altius Commercial |
$16.23
|
| Rate for Payer: Beech Street Commercial |
$16.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.88
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.40
|
| Rate for Payer: Cigna of WY Commercial |
$16.57
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.16
|
| Rate for Payer: HealthUtah PPO |
$16.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.40
|
| Rate for Payer: Multiplan Medicare/VA |
$10.60
|
| Rate for Payer: One Health Plan of WY PPO |
$16.57
|
| Rate for Payer: PacificSource Commercial |
$15.22
|
| Rate for Payer: PHCS PPO |
$16.57
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$11.16
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$11.16
|
| Rate for Payer: WINHealth Partners Commercial |
$16.06
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
|
GAIT BELT 72" HEAVY DUTYIN
|
Facility
|
OP
|
$16.91
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.57
|
| Rate for Payer: Aetna of WY Medicare |
$11.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.23
|
| Rate for Payer: Altius Commercial |
$16.23
|
| Rate for Payer: Beech Street Commercial |
$16.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.88
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.40
|
| Rate for Payer: Cigna of WY Commercial |
$16.57
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
| Rate for Payer: HealthUtah PPO |
$16.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.32
|
| Rate for Payer: One Health Plan of WY PPO |
$16.57
|
| Rate for Payer: PacificSource Commercial |
$15.22
|
| Rate for Payer: PHCS PPO |
$16.57
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$9.81
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$9.81
|
| Rate for Payer: WINHealth Partners Commercial |
$16.57
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
|
GAMMAGARD LIQUID 10 % INJECTION SOLUTION [38825]
|
Facility
|
OP
|
$58.65
|
|
|
Service Code
|
HCPCS J1569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.48
|
| Rate for Payer: Aetna of WY Medicare |
$38.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.30
|
| Rate for Payer: Altius Commercial |
$56.30
|
| Rate for Payer: Beech Street Commercial |
$57.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.15
|
| Rate for Payer: Cash Price |
$41.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.89
|
| Rate for Payer: Cigna of WY Commercial |
$57.48
|
| Rate for Payer: Entrust Commercial |
$55.72
|
| Rate for Payer: First Choice Health Commercial |
$55.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.02
|
| Rate for Payer: HealthUtah PPO |
$58.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.89
|
| Rate for Payer: Multiplan Medicare/VA |
$32.32
|
| Rate for Payer: One Health Plan of WY PPO |
$57.48
|
| Rate for Payer: PacificSource Commercial |
$52.78
|
| Rate for Payer: PHCS PPO |
$57.48
|
| Rate for Payer: Three Rivers PPO |
$43.99
|
| Rate for Payer: TriWest Veterans Administration |
$34.02
|
| Rate for Payer: United Healthcare Commercial |
$51.03
|
| Rate for Payer: United Healthcare Medicare |
$34.02
|
| Rate for Payer: WINHealth Partners Commercial |
$57.48
|
| Rate for Payer: Wise Provider Network Commercial |
$55.72
|
|
|
GAMMAGARD LIQUID 10 % INJECTION SOLUTION [38825]
|
Facility
|
IP
|
$58.65
|
|
|
Service Code
|
HCPCS J1569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$56.30
|
| Rate for Payer: Altius Commercial |
$56.30
|
| Rate for Payer: Beech Street Commercial |
$57.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.15
|
| Rate for Payer: Cash Price |
$41.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.89
|
| Rate for Payer: Cigna of WY Commercial |
$57.48
|
| Rate for Payer: Entrust Commercial |
$55.72
|
| Rate for Payer: First Choice Health Commercial |
$55.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.71
|
| Rate for Payer: HealthUtah PPO |
$58.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.89
|
| Rate for Payer: Multiplan Medicare/VA |
$36.77
|
| Rate for Payer: One Health Plan of WY PPO |
$57.48
|
| Rate for Payer: PacificSource Commercial |
$52.78
|
| Rate for Payer: PHCS PPO |
$57.48
|
| Rate for Payer: Three Rivers PPO |
$43.99
|
| Rate for Payer: TriWest Veterans Administration |
$38.71
|
| Rate for Payer: United Healthcare Commercial |
$51.03
|
| Rate for Payer: United Healthcare Medicare |
$38.71
|
| Rate for Payer: WINHealth Partners Commercial |
$55.72
|
| Rate for Payer: Wise Provider Network Commercial |
$55.72
|
|
|
GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 94727 26
|
| Hospital Charge Code |
94727
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: First Choice Health Commercial |
$75.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$79.80
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$11.38
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
|
|
GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 43755 80
|
| Hospital Charge Code |
43755
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$57.34
|
| Rate for Payer: Beech Street Commercial |
$289.75
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: First Choice Health Commercial |
$274.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.34
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$48.74
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$289.75
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$57.34
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$57.34
|
| Rate for Payer: WINHealth Partners Commercial |
$259.25
|
|
|
GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 43755
|
| Hospital Charge Code |
43755
|
| Min. Negotiated Rate |
$48.74 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$298.90
|
| Rate for Payer: Aetna of WY Medicare |
$57.34
|
| Rate for Payer: Beech Street Commercial |
$289.75
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$295.85
|
| Rate for Payer: Cigna of WY Commercial |
$298.90
|
| Rate for Payer: First Choice Health Commercial |
$274.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$289.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.34
|
| Rate for Payer: HealthUtah PPO |
$305.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$295.85
|
| Rate for Payer: Multiplan Medicare/VA |
$48.74
|
| Rate for Payer: One Health Plan of WY PPO |
$298.90
|
| Rate for Payer: PacificSource Commercial |
$274.50
|
| Rate for Payer: PHCS PPO |
$289.75
|
| Rate for Payer: Three Rivers PPO |
$228.75
|
| Rate for Payer: TriWest Veterans Administration |
$57.34
|
| Rate for Payer: United Healthcare Commercial |
$265.35
|
| Rate for Payer: United Healthcare Medicare |
$57.34
|
| Rate for Payer: WINHealth Partners Commercial |
$259.25
|
|
|
GASTRIC INTUBATION TREATMENT
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 91105
|
| Hospital Charge Code |
91105
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
|
|
GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
43753
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$112.70
|
| Rate for Payer: Aetna of WY Medicare |
$20.27
|
| Rate for Payer: Beech Street Commercial |
$109.25
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$111.55
|
| Rate for Payer: Cigna of WY Commercial |
$112.70
|
| Rate for Payer: First Choice Health Commercial |
$103.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.27
|
| Rate for Payer: HealthUtah PPO |
$115.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$111.55
|
| Rate for Payer: Multiplan Medicare/VA |
$17.23
|
| Rate for Payer: One Health Plan of WY PPO |
$112.70
|
| Rate for Payer: PacificSource Commercial |
$103.50
|
| Rate for Payer: PHCS PPO |
$109.25
|
| Rate for Payer: Three Rivers PPO |
$86.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.27
|
| Rate for Payer: United Healthcare Commercial |
$100.05
|
| Rate for Payer: United Healthcare Medicare |
$20.27
|
| Rate for Payer: WINHealth Partners Commercial |
$97.75
|
|
|
GASTRIC LAVAGE SYSTEM
|
Facility
|
OP
|
$31.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$31.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.53
|
| Rate for Payer: Aetna of WY Medicare |
$20.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.90
|
| Rate for Payer: Altius Commercial |
$29.90
|
| Rate for Payer: Beech Street Commercial |
$30.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.57
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.22
|
| Rate for Payer: Cigna of WY Commercial |
$30.53
|
| Rate for Payer: Entrust Commercial |
$29.59
|
| Rate for Payer: First Choice Health Commercial |
$29.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.07
|
| Rate for Payer: HealthUtah PPO |
$31.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.22
|
| Rate for Payer: Multiplan Medicare/VA |
$17.16
|
| Rate for Payer: One Health Plan of WY PPO |
$30.53
|
| Rate for Payer: PacificSource Commercial |
$28.04
|
| Rate for Payer: PHCS PPO |
$30.53
|
| Rate for Payer: Three Rivers PPO |
$23.36
|
| Rate for Payer: TriWest Veterans Administration |
$18.07
|
| Rate for Payer: United Healthcare Commercial |
$27.10
|
| Rate for Payer: United Healthcare Medicare |
$18.07
|
| Rate for Payer: WINHealth Partners Commercial |
$30.53
|
| Rate for Payer: Wise Provider Network Commercial |
$29.59
|
|
|
GASTRIC LAVAGE SYSTEM
|
Facility
|
IP
|
$31.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$31.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.90
|
| Rate for Payer: Altius Commercial |
$29.90
|
| Rate for Payer: Beech Street Commercial |
$30.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.57
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.22
|
| Rate for Payer: Cigna of WY Commercial |
$30.53
|
| Rate for Payer: Entrust Commercial |
$29.59
|
| Rate for Payer: First Choice Health Commercial |
$29.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.56
|
| Rate for Payer: HealthUtah PPO |
$31.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.22
|
| Rate for Payer: Multiplan Medicare/VA |
$19.53
|
| Rate for Payer: One Health Plan of WY PPO |
$30.53
|
| Rate for Payer: PacificSource Commercial |
$28.04
|
| Rate for Payer: PHCS PPO |
$30.53
|
| Rate for Payer: Three Rivers PPO |
$23.36
|
| Rate for Payer: TriWest Veterans Administration |
$20.56
|
| Rate for Payer: United Healthcare Commercial |
$27.10
|
| Rate for Payer: United Healthcare Medicare |
$20.56
|
| Rate for Payer: WINHealth Partners Commercial |
$29.59
|
| Rate for Payer: Wise Provider Network Commercial |
$29.59
|
|
|
GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$6,790.00
|
|
|
Service Code
|
HCPCS 43825
|
| Hospital Charge Code |
43825
|
| Min. Negotiated Rate |
$1,055.57 |
| Max. Negotiated Rate |
$6,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,654.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,241.85
|
| Rate for Payer: Beech Street Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,753.00
|
| Rate for Payer: Cash Price |
$4,753.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,586.30
|
| Rate for Payer: Cigna of WY Commercial |
$6,654.20
|
| Rate for Payer: First Choice Health Commercial |
$6,111.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,450.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,241.85
|
| Rate for Payer: HealthUtah PPO |
$6,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,586.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,055.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,654.20
|
| Rate for Payer: PacificSource Commercial |
$6,111.00
|
| Rate for Payer: PHCS PPO |
$6,450.50
|
| Rate for Payer: Three Rivers PPO |
$5,092.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,241.85
|
| Rate for Payer: United Healthcare Commercial |
$5,907.30
|
| Rate for Payer: United Healthcare Medicare |
$1,241.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,771.50
|
|
|
GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$6,790.00
|
|
|
Service Code
|
HCPCS 43825 80
|
| Hospital Charge Code |
43825
|
| Min. Negotiated Rate |
$1,055.57 |
| Max. Negotiated Rate |
$6,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,654.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,241.85
|
| Rate for Payer: Beech Street Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,753.00
|
| Rate for Payer: Cash Price |
$4,753.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,586.30
|
| Rate for Payer: Cigna of WY Commercial |
$6,654.20
|
| Rate for Payer: First Choice Health Commercial |
$6,111.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,450.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,241.85
|
| Rate for Payer: HealthUtah PPO |
$6,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,586.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,055.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,654.20
|
| Rate for Payer: PacificSource Commercial |
$6,111.00
|
| Rate for Payer: PHCS PPO |
$6,450.50
|
| Rate for Payer: Three Rivers PPO |
$5,092.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,241.85
|
| Rate for Payer: United Healthcare Commercial |
$5,907.30
|
| Rate for Payer: United Healthcare Medicare |
$1,241.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,771.50
|
|
|
GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$6,790.00
|
|
|
Service Code
|
HCPCS 43825 AS
|
| Hospital Charge Code |
43825
|
| Min. Negotiated Rate |
$1,055.57 |
| Max. Negotiated Rate |
$6,790.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,654.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,241.85
|
| Rate for Payer: Beech Street Commercial |
$6,450.50
|
| Rate for Payer: Cash Price |
$4,753.00
|
| Rate for Payer: Cash Price |
$4,753.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,586.30
|
| Rate for Payer: Cigna of WY Commercial |
$6,654.20
|
| Rate for Payer: First Choice Health Commercial |
$6,111.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,450.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,241.85
|
| Rate for Payer: HealthUtah PPO |
$6,790.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,586.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,055.57
|
| Rate for Payer: One Health Plan of WY PPO |
$6,654.20
|
| Rate for Payer: PacificSource Commercial |
$6,111.00
|
| Rate for Payer: PHCS PPO |
$6,450.50
|
| Rate for Payer: Three Rivers PPO |
$5,092.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,241.85
|
| Rate for Payer: United Healthcare Commercial |
$5,907.30
|
| Rate for Payer: United Healthcare Medicare |
$1,241.85
|
| Rate for Payer: WINHealth Partners Commercial |
$5,771.50
|
|
|
GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$6,372.00
|
|
|
Service Code
|
HCPCS 43840 80
|
| Hospital Charge Code |
43840
|
| Min. Negotiated Rate |
$1,094.38 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,244.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,287.51
|
| Rate for Payer: Beech Street Commercial |
$6,053.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,180.84
|
| Rate for Payer: Cigna of WY Commercial |
$6,244.56
|
| Rate for Payer: First Choice Health Commercial |
$5,734.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,053.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,287.51
|
| Rate for Payer: HealthUtah PPO |
$6,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,180.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1,094.38
|
| Rate for Payer: One Health Plan of WY PPO |
$6,244.56
|
| Rate for Payer: PacificSource Commercial |
$5,734.80
|
| Rate for Payer: PHCS PPO |
$6,053.40
|
| Rate for Payer: Three Rivers PPO |
$4,779.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,287.51
|
| Rate for Payer: United Healthcare Commercial |
$5,543.64
|
| Rate for Payer: United Healthcare Medicare |
$1,287.51
|
| Rate for Payer: WINHealth Partners Commercial |
$5,416.20
|
|
|
GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$6,372.00
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
43840
|
| Min. Negotiated Rate |
$1,094.38 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,244.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,287.51
|
| Rate for Payer: Beech Street Commercial |
$6,053.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,180.84
|
| Rate for Payer: Cigna of WY Commercial |
$6,244.56
|
| Rate for Payer: First Choice Health Commercial |
$5,734.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,053.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,287.51
|
| Rate for Payer: HealthUtah PPO |
$6,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,180.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1,094.38
|
| Rate for Payer: One Health Plan of WY PPO |
$6,244.56
|
| Rate for Payer: PacificSource Commercial |
$5,734.80
|
| Rate for Payer: PHCS PPO |
$6,053.40
|
| Rate for Payer: Three Rivers PPO |
$4,779.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,287.51
|
| Rate for Payer: United Healthcare Commercial |
$5,543.64
|
| Rate for Payer: United Healthcare Medicare |
$1,287.51
|
| Rate for Payer: WINHealth Partners Commercial |
$5,416.20
|
|
|
GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$6,372.00
|
|
|
Service Code
|
HCPCS 43840 AS
|
| Hospital Charge Code |
43840
|
| Min. Negotiated Rate |
$1,094.38 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,244.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,287.51
|
| Rate for Payer: Beech Street Commercial |
$6,053.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: Cash Price |
$4,460.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,180.84
|
| Rate for Payer: Cigna of WY Commercial |
$6,244.56
|
| Rate for Payer: First Choice Health Commercial |
$5,734.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,053.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,287.51
|
| Rate for Payer: HealthUtah PPO |
$6,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,180.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1,094.38
|
| Rate for Payer: One Health Plan of WY PPO |
$6,244.56
|
| Rate for Payer: PacificSource Commercial |
$5,734.80
|
| Rate for Payer: PHCS PPO |
$6,053.40
|
| Rate for Payer: Three Rivers PPO |
$4,779.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,287.51
|
| Rate for Payer: United Healthcare Commercial |
$5,543.64
|
| Rate for Payer: United Healthcare Medicare |
$1,287.51
|
| Rate for Payer: WINHealth Partners Commercial |
$5,416.20
|
|
