|
ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$4,180.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$189.64 |
| Max. Negotiated Rate |
$4,180.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,096.40
|
| Rate for Payer: Aetna of WY Medicare |
$223.10
|
| Rate for Payer: Beech Street Commercial |
$3,971.00
|
| Rate for Payer: Cash Price |
$2,926.00
|
| Rate for Payer: Cash Price |
$2,926.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,054.60
|
| Rate for Payer: Cigna of WY Commercial |
$4,096.40
|
| Rate for Payer: First Choice Health Commercial |
$3,762.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,971.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.10
|
| Rate for Payer: HealthUtah PPO |
$4,180.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,054.60
|
| Rate for Payer: Multiplan Medicare/VA |
$189.64
|
| Rate for Payer: One Health Plan of WY PPO |
$4,096.40
|
| Rate for Payer: PacificSource Commercial |
$3,762.00
|
| Rate for Payer: PHCS PPO |
$3,971.00
|
| Rate for Payer: Three Rivers PPO |
$3,135.00
|
| Rate for Payer: TriWest Veterans Administration |
$223.10
|
| Rate for Payer: United Healthcare Commercial |
$3,971.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,553.00
|
|
|
ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.46
|
| Rate for Payer: Aetna of WY Medicare |
$38.18
|
| Rate for Payer: Beech Street Commercial |
$168.15
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.69
|
| Rate for Payer: Cigna of WY Commercial |
$173.46
|
| Rate for Payer: First Choice Health Commercial |
$159.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.18
|
| Rate for Payer: HealthUtah PPO |
$177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.69
|
| Rate for Payer: Multiplan Medicare/VA |
$32.45
|
| Rate for Payer: One Health Plan of WY PPO |
$173.46
|
| Rate for Payer: PacificSource Commercial |
$159.30
|
| Rate for Payer: PHCS PPO |
$168.15
|
| Rate for Payer: Three Rivers PPO |
$132.75
|
| Rate for Payer: TriWest Veterans Administration |
$38.18
|
| Rate for Payer: United Healthcare Commercial |
$168.15
|
| Rate for Payer: WINHealth Partners Commercial |
$150.45
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.48
|
| Rate for Payer: Aetna of WY Medicare |
$60.18
|
| Rate for Payer: Beech Street Commercial |
$262.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.72
|
| Rate for Payer: Cigna of WY Commercial |
$270.48
|
| Rate for Payer: First Choice Health Commercial |
$248.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.18
|
| Rate for Payer: HealthUtah PPO |
$276.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.72
|
| Rate for Payer: Multiplan Medicare/VA |
$51.15
|
| Rate for Payer: One Health Plan of WY PPO |
$270.48
|
| Rate for Payer: PacificSource Commercial |
$248.40
|
| Rate for Payer: PHCS PPO |
$262.20
|
| Rate for Payer: Three Rivers PPO |
$207.00
|
| Rate for Payer: TriWest Veterans Administration |
$60.18
|
| Rate for Payer: United Healthcare Commercial |
$262.20
|
| Rate for Payer: WINHealth Partners Commercial |
$234.60
|
|
|
ENDOPATH 5MM CURVED
|
Facility
|
IP
|
$137.41
|
|
| Hospital Charge Code |
2650012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.63 |
| Max. Negotiated Rate |
$137.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.66
|
| Rate for Payer: Aetna of WY Medicare |
$87.94
|
| Rate for Payer: Altius Commercial |
$131.91
|
| Rate for Payer: Beech Street Commercial |
$134.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.29
|
| Rate for Payer: Cash Price |
$96.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.29
|
| Rate for Payer: Cigna of WY Commercial |
$134.66
|
| Rate for Payer: Entrust Commercial |
$130.54
|
| Rate for Payer: First Choice Health Commercial |
$130.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.82
|
| Rate for Payer: HealthUtah PPO |
$137.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.29
|
| Rate for Payer: Multiplan Medicare/VA |
$79.63
|
| Rate for Payer: One Health Plan of WY PPO |
$134.66
|
| Rate for Payer: PacificSource Commercial |
$123.67
|
| Rate for Payer: PHCS PPO |
$134.66
|
| Rate for Payer: Three Rivers PPO |
$103.06
|
| Rate for Payer: TriWest Veterans Administration |
$83.82
|
| Rate for Payer: United Healthcare Commercial |
$131.23
|
| Rate for Payer: United Healthcare Medicare |
$83.82
|
| Rate for Payer: WINHealth Partners Commercial |
$130.54
|
| Rate for Payer: Wise Provider Network Commercial |
$130.54
|
|
|
ENDOPATH 5MM CURVED
|
Facility
|
OP
|
$137.41
|
|
| Hospital Charge Code |
2650012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.41 |
| Max. Negotiated Rate |
$137.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$134.66
|
| Rate for Payer: Aetna of WY Medicare |
$90.69
|
| Rate for Payer: Altius Commercial |
$131.91
|
| Rate for Payer: Beech Street Commercial |
$134.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.29
|
| Rate for Payer: Cash Price |
$96.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$133.29
|
| Rate for Payer: Cigna of WY Commercial |
$134.66
|
| Rate for Payer: Entrust Commercial |
$130.54
|
| Rate for Payer: First Choice Health Commercial |
$130.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$130.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.32
|
| Rate for Payer: HealthUtah PPO |
$137.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$133.29
|
| Rate for Payer: Multiplan Medicare/VA |
$74.41
|
| Rate for Payer: One Health Plan of WY PPO |
$134.66
|
| Rate for Payer: PacificSource Commercial |
$123.67
|
| Rate for Payer: PHCS PPO |
$134.66
|
| Rate for Payer: Three Rivers PPO |
$103.06
|
| Rate for Payer: TriWest Veterans Administration |
$78.32
|
| Rate for Payer: United Healthcare Commercial |
$131.23
|
| Rate for Payer: United Healthcare Medicare |
$78.32
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$130.54
|
|
|
ENDOSCOPE VALVE SET DISP 3PC
|
Facility
|
IP
|
$26.25
|
|
| Hospital Charge Code |
2650917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
| Rate for Payer: Aetna of WY Medicare |
$16.80
|
| Rate for Payer: Altius Commercial |
$25.20
|
| Rate for Payer: Beech Street Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.46
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
| Rate for Payer: Cigna of WY Commercial |
$25.72
|
| Rate for Payer: Entrust Commercial |
$24.94
|
| Rate for Payer: First Choice Health Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.01
|
| Rate for Payer: HealthUtah PPO |
$26.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
| Rate for Payer: Multiplan Medicare/VA |
$15.21
|
| Rate for Payer: One Health Plan of WY PPO |
$25.72
|
| Rate for Payer: PacificSource Commercial |
$23.62
|
| Rate for Payer: PHCS PPO |
$25.72
|
| Rate for Payer: Three Rivers PPO |
$19.69
|
| Rate for Payer: TriWest Veterans Administration |
$16.01
|
| Rate for Payer: United Healthcare Commercial |
$25.07
|
| Rate for Payer: United Healthcare Medicare |
$16.01
|
| Rate for Payer: WINHealth Partners Commercial |
$24.94
|
| Rate for Payer: Wise Provider Network Commercial |
$24.94
|
|
|
ENDOSCOPE VALVE SET DISP 3PC
|
Facility
|
OP
|
$26.25
|
|
| Hospital Charge Code |
2650917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.72
|
| Rate for Payer: Aetna of WY Medicare |
$17.32
|
| Rate for Payer: Altius Commercial |
$25.20
|
| Rate for Payer: Beech Street Commercial |
$25.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.46
|
| Rate for Payer: Cash Price |
$18.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.46
|
| Rate for Payer: Cigna of WY Commercial |
$25.72
|
| Rate for Payer: Entrust Commercial |
$24.94
|
| Rate for Payer: First Choice Health Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.96
|
| Rate for Payer: HealthUtah PPO |
$26.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.46
|
| Rate for Payer: Multiplan Medicare/VA |
$14.21
|
| Rate for Payer: One Health Plan of WY PPO |
$25.72
|
| Rate for Payer: PacificSource Commercial |
$23.62
|
| Rate for Payer: PHCS PPO |
$25.72
|
| Rate for Payer: Three Rivers PPO |
$19.69
|
| Rate for Payer: TriWest Veterans Administration |
$14.96
|
| Rate for Payer: United Healthcare Commercial |
$25.07
|
| Rate for Payer: United Healthcare Medicare |
$14.96
|
| Rate for Payer: WINHealth Partners Commercial |
$25.72
|
| Rate for Payer: Wise Provider Network Commercial |
$24.94
|
|
|
ENDO SCRUB TUBING
|
Facility
|
OP
|
$154.19
|
|
| Hospital Charge Code |
2700004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$154.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.11
|
| Rate for Payer: Aetna of WY Medicare |
$101.77
|
| Rate for Payer: Altius Commercial |
$148.02
|
| Rate for Payer: Beech Street Commercial |
$151.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.56
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.56
|
| Rate for Payer: Cigna of WY Commercial |
$151.11
|
| Rate for Payer: Entrust Commercial |
$146.48
|
| Rate for Payer: First Choice Health Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.89
|
| Rate for Payer: HealthUtah PPO |
$154.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.56
|
| Rate for Payer: Multiplan Medicare/VA |
$83.49
|
| Rate for Payer: One Health Plan of WY PPO |
$151.11
|
| Rate for Payer: PacificSource Commercial |
$138.77
|
| Rate for Payer: PHCS PPO |
$151.11
|
| Rate for Payer: Three Rivers PPO |
$115.64
|
| Rate for Payer: TriWest Veterans Administration |
$87.89
|
| Rate for Payer: United Healthcare Commercial |
$147.25
|
| Rate for Payer: United Healthcare Medicare |
$87.89
|
| Rate for Payer: WINHealth Partners Commercial |
$151.11
|
| Rate for Payer: Wise Provider Network Commercial |
$146.48
|
|
|
ENDO SCRUB TUBING
|
Facility
|
IP
|
$154.19
|
|
| Hospital Charge Code |
2700004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.35 |
| Max. Negotiated Rate |
$154.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.11
|
| Rate for Payer: Aetna of WY Medicare |
$98.68
|
| Rate for Payer: Altius Commercial |
$148.02
|
| Rate for Payer: Beech Street Commercial |
$151.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$149.56
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.56
|
| Rate for Payer: Cigna of WY Commercial |
$151.11
|
| Rate for Payer: Entrust Commercial |
$146.48
|
| Rate for Payer: First Choice Health Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.06
|
| Rate for Payer: HealthUtah PPO |
$154.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.56
|
| Rate for Payer: Multiplan Medicare/VA |
$89.35
|
| Rate for Payer: One Health Plan of WY PPO |
$151.11
|
| Rate for Payer: PacificSource Commercial |
$138.77
|
| Rate for Payer: PHCS PPO |
$151.11
|
| Rate for Payer: Three Rivers PPO |
$115.64
|
| Rate for Payer: TriWest Veterans Administration |
$94.06
|
| Rate for Payer: United Healthcare Commercial |
$147.25
|
| Rate for Payer: United Healthcare Medicare |
$94.06
|
| Rate for Payer: WINHealth Partners Commercial |
$146.48
|
| Rate for Payer: Wise Provider Network Commercial |
$146.48
|
|
|
ENDO SHEAR
|
Facility
|
OP
|
$89.36
|
|
| Hospital Charge Code |
2650131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.39 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.57
|
| Rate for Payer: Aetna of WY Medicare |
$58.98
|
| Rate for Payer: Altius Commercial |
$85.79
|
| Rate for Payer: Beech Street Commercial |
$87.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.68
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.68
|
| Rate for Payer: Cigna of WY Commercial |
$87.57
|
| Rate for Payer: Entrust Commercial |
$84.89
|
| Rate for Payer: First Choice Health Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.94
|
| Rate for Payer: HealthUtah PPO |
$89.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.68
|
| Rate for Payer: Multiplan Medicare/VA |
$48.39
|
| Rate for Payer: One Health Plan of WY PPO |
$87.57
|
| Rate for Payer: PacificSource Commercial |
$80.42
|
| Rate for Payer: PHCS PPO |
$87.57
|
| Rate for Payer: Three Rivers PPO |
$67.02
|
| Rate for Payer: TriWest Veterans Administration |
$50.94
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$50.94
|
| Rate for Payer: WINHealth Partners Commercial |
$87.57
|
| Rate for Payer: Wise Provider Network Commercial |
$84.89
|
|
|
ENDO SHEAR
|
Facility
|
IP
|
$89.36
|
|
| Hospital Charge Code |
2650131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.78 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.57
|
| Rate for Payer: Aetna of WY Medicare |
$57.19
|
| Rate for Payer: Altius Commercial |
$85.79
|
| Rate for Payer: Beech Street Commercial |
$87.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.68
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.68
|
| Rate for Payer: Cigna of WY Commercial |
$87.57
|
| Rate for Payer: Entrust Commercial |
$84.89
|
| Rate for Payer: First Choice Health Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.51
|
| Rate for Payer: HealthUtah PPO |
$89.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.68
|
| Rate for Payer: Multiplan Medicare/VA |
$51.78
|
| Rate for Payer: One Health Plan of WY PPO |
$87.57
|
| Rate for Payer: PacificSource Commercial |
$80.42
|
| Rate for Payer: PHCS PPO |
$87.57
|
| Rate for Payer: Three Rivers PPO |
$67.02
|
| Rate for Payer: TriWest Veterans Administration |
$54.51
|
| Rate for Payer: United Healthcare Commercial |
$85.34
|
| Rate for Payer: United Healthcare Medicare |
$54.51
|
| Rate for Payer: WINHealth Partners Commercial |
$84.89
|
| Rate for Payer: Wise Provider Network Commercial |
$84.89
|
|
|
ENDOSTCH POLYSORB 0 ES9 170056
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2150090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.72 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.70
|
| 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: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$113.72
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$200.55
|
| Rate for Payer: United Healthcare Medicare |
$119.70
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ENDOSTCH POLYSORB 0 ES9 170056
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2150090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.70 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$134.40
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.70
|
| 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: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.10
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$121.70
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$128.10
|
| Rate for Payer: United Healthcare Commercial |
$200.55
|
| Rate for Payer: United Healthcare Medicare |
$128.10
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ENDOSTCH POLYSORB 30 170073
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2150105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.72 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.70
|
| 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: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$113.72
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$200.55
|
| Rate for Payer: United Healthcare Medicare |
$119.70
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ENDOSTCH POLYSORB 30 170073
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2150105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.70 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$134.40
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.70
|
| 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: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.10
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$121.70
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$128.10
|
| Rate for Payer: United Healthcare Commercial |
$200.55
|
| Rate for Payer: United Healthcare Medicare |
$128.10
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ENDOSTCH SURGIDAC 0 ES9 173024
|
Facility
|
OP
|
$231.20
|
|
| Hospital Charge Code |
2150148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.19 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$226.58
|
| Rate for Payer: Aetna of WY Medicare |
$152.59
|
| Rate for Payer: Altius Commercial |
$221.95
|
| Rate for Payer: Beech Street Commercial |
$226.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.26
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$224.26
|
| Rate for Payer: Cigna of WY Commercial |
$226.58
|
| Rate for Payer: Entrust Commercial |
$219.64
|
| Rate for Payer: First Choice Health Commercial |
$219.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$219.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.78
|
| Rate for Payer: HealthUtah PPO |
$231.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$224.26
|
| Rate for Payer: Multiplan Medicare/VA |
$125.19
|
| Rate for Payer: One Health Plan of WY PPO |
$226.58
|
| Rate for Payer: PacificSource Commercial |
$208.08
|
| Rate for Payer: PHCS PPO |
$226.58
|
| Rate for Payer: Three Rivers PPO |
$173.40
|
| Rate for Payer: TriWest Veterans Administration |
$131.78
|
| Rate for Payer: United Healthcare Commercial |
$220.80
|
| Rate for Payer: United Healthcare Medicare |
$131.78
|
| Rate for Payer: WINHealth Partners Commercial |
$226.58
|
| Rate for Payer: Wise Provider Network Commercial |
$219.64
|
|
|
ENDOSTCH SURGIDAC 0 ES9 173024
|
Facility
|
IP
|
$231.20
|
|
| Hospital Charge Code |
2150148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$226.58
|
| Rate for Payer: Aetna of WY Medicare |
$147.97
|
| Rate for Payer: Altius Commercial |
$221.95
|
| Rate for Payer: Beech Street Commercial |
$226.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$224.26
|
| Rate for Payer: Cash Price |
$161.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$224.26
|
| Rate for Payer: Cigna of WY Commercial |
$226.58
|
| Rate for Payer: Entrust Commercial |
$219.64
|
| Rate for Payer: First Choice Health Commercial |
$219.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$219.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$141.03
|
| Rate for Payer: HealthUtah PPO |
$231.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$224.26
|
| Rate for Payer: Multiplan Medicare/VA |
$133.98
|
| Rate for Payer: One Health Plan of WY PPO |
$226.58
|
| Rate for Payer: PacificSource Commercial |
$208.08
|
| Rate for Payer: PHCS PPO |
$226.58
|
| Rate for Payer: Three Rivers PPO |
$173.40
|
| Rate for Payer: TriWest Veterans Administration |
$141.03
|
| Rate for Payer: United Healthcare Commercial |
$220.80
|
| Rate for Payer: United Healthcare Medicare |
$141.03
|
| Rate for Payer: WINHealth Partners Commercial |
$219.64
|
| Rate for Payer: Wise Provider Network Commercial |
$219.64
|
|
|
ENDOSTITCH 10MM SUTUR DEV
|
Facility
|
OP
|
$665.00
|
|
| Hospital Charge Code |
2150053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.10 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$645.05
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.05
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$360.10
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$379.05
|
| Rate for Payer: United Healthcare Commercial |
$635.08
|
| Rate for Payer: United Healthcare Medicare |
$379.05
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
ENDOSTITCH 10MM SUTUR DEV
|
Facility
|
IP
|
$665.00
|
|
| Hospital Charge Code |
2150053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.37 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$425.60
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$645.05
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.65
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$385.37
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$405.65
|
| Rate for Payer: United Healthcare Commercial |
$635.08
|
| Rate for Payer: United Healthcare Medicare |
$405.65
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
ENDOTRACH EVAC 7.5 CUFF
|
Facility
|
IP
|
$47.62
|
|
| Hospital Charge Code |
2500018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.67
|
| Rate for Payer: Aetna of WY Medicare |
$30.48
|
| Rate for Payer: Altius Commercial |
$45.72
|
| Rate for Payer: Beech Street Commercial |
$46.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.19
|
| Rate for Payer: Cash Price |
$33.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.19
|
| Rate for Payer: Cigna of WY Commercial |
$46.67
|
| Rate for Payer: Entrust Commercial |
$45.24
|
| Rate for Payer: First Choice Health Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.05
|
| Rate for Payer: HealthUtah PPO |
$47.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.19
|
| Rate for Payer: Multiplan Medicare/VA |
$27.60
|
| Rate for Payer: One Health Plan of WY PPO |
$46.67
|
| Rate for Payer: PacificSource Commercial |
$42.86
|
| Rate for Payer: PHCS PPO |
$46.67
|
| Rate for Payer: Three Rivers PPO |
$35.72
|
| Rate for Payer: TriWest Veterans Administration |
$29.05
|
| Rate for Payer: United Healthcare Commercial |
$45.48
|
| Rate for Payer: United Healthcare Medicare |
$29.05
|
| Rate for Payer: WINHealth Partners Commercial |
$45.24
|
| Rate for Payer: Wise Provider Network Commercial |
$45.24
|
|
|
ENDOTRACH EVAC 7.5 CUFF
|
Facility
|
OP
|
$47.62
|
|
| Hospital Charge Code |
2500018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.67
|
| Rate for Payer: Aetna of WY Medicare |
$31.43
|
| Rate for Payer: Altius Commercial |
$45.72
|
| Rate for Payer: Beech Street Commercial |
$46.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.19
|
| Rate for Payer: Cash Price |
$33.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.19
|
| Rate for Payer: Cigna of WY Commercial |
$46.67
|
| Rate for Payer: Entrust Commercial |
$45.24
|
| Rate for Payer: First Choice Health Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.14
|
| Rate for Payer: HealthUtah PPO |
$47.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.19
|
| Rate for Payer: Multiplan Medicare/VA |
$25.79
|
| Rate for Payer: One Health Plan of WY PPO |
$46.67
|
| Rate for Payer: PacificSource Commercial |
$42.86
|
| Rate for Payer: PHCS PPO |
$46.67
|
| Rate for Payer: Three Rivers PPO |
$35.72
|
| Rate for Payer: TriWest Veterans Administration |
$27.14
|
| Rate for Payer: United Healthcare Commercial |
$45.48
|
| Rate for Payer: United Healthcare Medicare |
$27.14
|
| Rate for Payer: WINHealth Partners Commercial |
$46.67
|
| Rate for Payer: Wise Provider Network Commercial |
$45.24
|
|
|
ENDOTRACH EVAC 8.0 CUFF
|
Facility
|
IP
|
$47.62
|
|
| Hospital Charge Code |
2500019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.67
|
| Rate for Payer: Aetna of WY Medicare |
$30.48
|
| Rate for Payer: Altius Commercial |
$45.72
|
| Rate for Payer: Beech Street Commercial |
$46.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.19
|
| Rate for Payer: Cash Price |
$33.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.19
|
| Rate for Payer: Cigna of WY Commercial |
$46.67
|
| Rate for Payer: Entrust Commercial |
$45.24
|
| Rate for Payer: First Choice Health Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.05
|
| Rate for Payer: HealthUtah PPO |
$47.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.19
|
| Rate for Payer: Multiplan Medicare/VA |
$27.60
|
| Rate for Payer: One Health Plan of WY PPO |
$46.67
|
| Rate for Payer: PacificSource Commercial |
$42.86
|
| Rate for Payer: PHCS PPO |
$46.67
|
| Rate for Payer: Three Rivers PPO |
$35.72
|
| Rate for Payer: TriWest Veterans Administration |
$29.05
|
| Rate for Payer: United Healthcare Commercial |
$45.48
|
| Rate for Payer: United Healthcare Medicare |
$29.05
|
| Rate for Payer: WINHealth Partners Commercial |
$45.24
|
| Rate for Payer: Wise Provider Network Commercial |
$45.24
|
|
|
ENDOTRACH EVAC 8.0 CUFF
|
Facility
|
OP
|
$47.62
|
|
| Hospital Charge Code |
2500019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.79 |
| Max. Negotiated Rate |
$47.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.67
|
| Rate for Payer: Aetna of WY Medicare |
$31.43
|
| Rate for Payer: Altius Commercial |
$45.72
|
| Rate for Payer: Beech Street Commercial |
$46.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.19
|
| Rate for Payer: Cash Price |
$33.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.19
|
| Rate for Payer: Cigna of WY Commercial |
$46.67
|
| Rate for Payer: Entrust Commercial |
$45.24
|
| Rate for Payer: First Choice Health Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.14
|
| Rate for Payer: HealthUtah PPO |
$47.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.19
|
| Rate for Payer: Multiplan Medicare/VA |
$25.79
|
| Rate for Payer: One Health Plan of WY PPO |
$46.67
|
| Rate for Payer: PacificSource Commercial |
$42.86
|
| Rate for Payer: PHCS PPO |
$46.67
|
| Rate for Payer: Three Rivers PPO |
$35.72
|
| Rate for Payer: TriWest Veterans Administration |
$27.14
|
| Rate for Payer: United Healthcare Commercial |
$45.48
|
| Rate for Payer: United Healthcare Medicare |
$27.14
|
| Rate for Payer: WINHealth Partners Commercial |
$46.67
|
| Rate for Payer: Wise Provider Network Commercial |
$45.24
|
|
|
ENDOTRACH ORAL RAE 5.5 CUFFED
|
Facility
|
OP
|
$13.86
|
|
| Hospital Charge Code |
2500073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.58
|
| Rate for Payer: Aetna of WY Medicare |
$9.15
|
| Rate for Payer: Altius Commercial |
$13.31
|
| Rate for Payer: Beech Street Commercial |
$13.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.44
|
| Rate for Payer: Cigna of WY Commercial |
$13.58
|
| Rate for Payer: Entrust Commercial |
$13.17
|
| Rate for Payer: First Choice Health Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.90
|
| Rate for Payer: HealthUtah PPO |
$13.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.44
|
| Rate for Payer: Multiplan Medicare/VA |
$7.51
|
| Rate for Payer: One Health Plan of WY PPO |
$13.58
|
| Rate for Payer: PacificSource Commercial |
$12.47
|
| Rate for Payer: PHCS PPO |
$13.58
|
| Rate for Payer: Three Rivers PPO |
$10.40
|
| Rate for Payer: TriWest Veterans Administration |
$7.90
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Medicare |
$7.90
|
| Rate for Payer: WINHealth Partners Commercial |
$13.58
|
| Rate for Payer: Wise Provider Network Commercial |
$13.17
|
|
|
ENDOTRACH ORAL RAE 5.5 CUFFED
|
Facility
|
IP
|
$13.86
|
|
| Hospital Charge Code |
2500073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.58
|
| Rate for Payer: Aetna of WY Medicare |
$8.87
|
| Rate for Payer: Altius Commercial |
$13.31
|
| Rate for Payer: Beech Street Commercial |
$13.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.44
|
| Rate for Payer: Cigna of WY Commercial |
$13.58
|
| Rate for Payer: Entrust Commercial |
$13.17
|
| Rate for Payer: First Choice Health Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.45
|
| Rate for Payer: HealthUtah PPO |
$13.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.44
|
| Rate for Payer: Multiplan Medicare/VA |
$8.03
|
| Rate for Payer: One Health Plan of WY PPO |
$13.58
|
| Rate for Payer: PacificSource Commercial |
$12.47
|
| Rate for Payer: PHCS PPO |
$13.58
|
| Rate for Payer: Three Rivers PPO |
$10.40
|
| Rate for Payer: TriWest Veterans Administration |
$8.45
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Medicare |
$8.45
|
| Rate for Payer: WINHealth Partners Commercial |
$13.17
|
| Rate for Payer: Wise Provider Network Commercial |
$13.17
|
|
