|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
OP
|
$16.80
|
|
|
Service Code
|
NDC 6332373911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$11.09
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.58
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.10
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$9.58
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$9.58
|
| Rate for Payer: WINHealth Partners Commercial |
$16.46
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6332373911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$10.75
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION [157895]
|
Facility
|
OP
|
$2,549.82
|
|
|
Service Code
|
HCPCS J9358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,380.73 |
| Max. Negotiated Rate |
$2,549.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,498.82
|
| Rate for Payer: Aetna of WY Medicare |
$1,682.88
|
| Rate for Payer: Altius Commercial |
$2,447.83
|
| Rate for Payer: Beech Street Commercial |
$2,498.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,473.33
|
| Rate for Payer: Cash Price |
$1,784.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,473.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,498.82
|
| Rate for Payer: Entrust Commercial |
$2,422.33
|
| Rate for Payer: First Choice Health Commercial |
$2,422.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,422.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,453.40
|
| Rate for Payer: HealthUtah PPO |
$2,549.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,380.73
|
| Rate for Payer: One Health Plan of WY PPO |
$2,498.82
|
| Rate for Payer: PacificSource Commercial |
$2,294.84
|
| Rate for Payer: PHCS PPO |
$2,498.82
|
| Rate for Payer: Three Rivers PPO |
$1,912.36
|
| Rate for Payer: TriWest Veterans Administration |
$1,453.40
|
| Rate for Payer: United Healthcare Commercial |
$2,435.08
|
| Rate for Payer: United Healthcare Medicare |
$1,453.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,498.82
|
| Rate for Payer: Wise Provider Network Commercial |
$2,422.33
|
|
|
FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION [157895]
|
Facility
|
IP
|
$2,549.82
|
|
|
Service Code
|
HCPCS J9358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,477.62 |
| Max. Negotiated Rate |
$2,549.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,498.82
|
| Rate for Payer: Aetna of WY Medicare |
$1,631.88
|
| Rate for Payer: Altius Commercial |
$2,447.83
|
| Rate for Payer: Beech Street Commercial |
$2,498.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,473.33
|
| Rate for Payer: Cash Price |
$1,784.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,473.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,498.82
|
| Rate for Payer: Entrust Commercial |
$2,422.33
|
| Rate for Payer: First Choice Health Commercial |
$2,422.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,422.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,555.39
|
| Rate for Payer: HealthUtah PPO |
$2,549.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Medicare/VA |
$1,477.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2,498.82
|
| Rate for Payer: PacificSource Commercial |
$2,294.84
|
| Rate for Payer: PHCS PPO |
$2,498.82
|
| Rate for Payer: Three Rivers PPO |
$1,912.36
|
| Rate for Payer: TriWest Veterans Administration |
$1,555.39
|
| Rate for Payer: United Healthcare Commercial |
$2,435.08
|
| Rate for Payer: United Healthcare Medicare |
$1,555.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,422.33
|
| Rate for Payer: Wise Provider Network Commercial |
$2,422.33
|
|
|
FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 28060
|
| Min. Negotiated Rate |
$299.72 |
| Max. Negotiated Rate |
$1,590.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,558.20
|
| Rate for Payer: Aetna of WY Medicare |
$352.61
|
| Rate for Payer: Beech Street Commercial |
$1,510.50
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: Cash Price |
$1,113.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,542.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,558.20
|
| Rate for Payer: First Choice Health Commercial |
$1,431.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,510.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$352.61
|
| Rate for Payer: HealthUtah PPO |
$1,590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,542.30
|
| Rate for Payer: Multiplan Medicare/VA |
$299.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,558.20
|
| Rate for Payer: PacificSource Commercial |
$1,431.00
|
| Rate for Payer: PHCS PPO |
$1,510.50
|
| Rate for Payer: Three Rivers PPO |
$1,192.50
|
| Rate for Payer: TriWest Veterans Administration |
$352.61
|
| Rate for Payer: United Healthcare Commercial |
$1,510.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,351.50
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$395.64 |
| Max. Negotiated Rate |
$2,075.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,033.50
|
| Rate for Payer: Aetna of WY Medicare |
$465.46
|
| Rate for Payer: Beech Street Commercial |
$1,971.25
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,012.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,033.50
|
| Rate for Payer: First Choice Health Commercial |
$1,867.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,971.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.46
|
| Rate for Payer: HealthUtah PPO |
$2,075.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,012.75
|
| Rate for Payer: Multiplan Medicare/VA |
$395.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,033.50
|
| Rate for Payer: PacificSource Commercial |
$1,867.50
|
| Rate for Payer: PHCS PPO |
$1,971.25
|
| Rate for Payer: Three Rivers PPO |
$1,556.25
|
| Rate for Payer: TriWest Veterans Administration |
$465.46
|
| Rate for Payer: United Healthcare Commercial |
$1,971.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,763.75
|
|
|
FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$6,499.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$695.95 |
| Max. Negotiated Rate |
$6,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,369.02
|
| Rate for Payer: Aetna of WY Medicare |
$818.77
|
| Rate for Payer: Beech Street Commercial |
$6,174.05
|
| Rate for Payer: Cash Price |
$4,549.30
|
| Rate for Payer: Cash Price |
$4,549.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,304.03
|
| Rate for Payer: Cigna of WY Commercial |
$6,369.02
|
| Rate for Payer: First Choice Health Commercial |
$5,849.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,174.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$818.77
|
| Rate for Payer: HealthUtah PPO |
$6,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,304.03
|
| Rate for Payer: Multiplan Medicare/VA |
$695.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,369.02
|
| Rate for Payer: PacificSource Commercial |
$5,849.10
|
| Rate for Payer: PHCS PPO |
$6,174.05
|
| Rate for Payer: Three Rivers PPO |
$4,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$818.77
|
| Rate for Payer: United Healthcare Commercial |
$6,174.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,524.15
|
|
|
FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$216.34 |
| Max. Negotiated Rate |
$3,089.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,027.22
|
| Rate for Payer: Aetna of WY Medicare |
$254.52
|
| Rate for Payer: Beech Street Commercial |
$2,934.55
|
| Rate for Payer: Cash Price |
$2,162.30
|
| Rate for Payer: Cash Price |
$2,162.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,996.33
|
| Rate for Payer: Cigna of WY Commercial |
$3,027.22
|
| Rate for Payer: First Choice Health Commercial |
$2,780.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,934.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.52
|
| Rate for Payer: HealthUtah PPO |
$3,089.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,996.33
|
| Rate for Payer: Multiplan Medicare/VA |
$216.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,027.22
|
| Rate for Payer: PacificSource Commercial |
$2,780.10
|
| Rate for Payer: PHCS PPO |
$2,934.55
|
| Rate for Payer: Three Rivers PPO |
$2,316.75
|
| Rate for Payer: TriWest Veterans Administration |
$254.52
|
| Rate for Payer: United Healthcare Commercial |
$2,934.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,625.65
|
|
|
FAT EMULSION 20 % INTRAVENOUS [2318]
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
NDC 0264446030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.10
|
| Rate for Payer: Aetna of WY Medicare |
$10.17
|
| Rate for Payer: Altius Commercial |
$14.79
|
| Rate for Payer: Beech Street Commercial |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.95
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.10
|
| Rate for Payer: Entrust Commercial |
$14.64
|
| Rate for Payer: First Choice Health Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.78
|
| Rate for Payer: HealthUtah PPO |
$15.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.95
|
| Rate for Payer: Multiplan Medicare/VA |
$8.34
|
| Rate for Payer: One Health Plan of WY PPO |
$15.10
|
| Rate for Payer: PacificSource Commercial |
$13.87
|
| Rate for Payer: PHCS PPO |
$15.10
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.10
|
| Rate for Payer: Wise Provider Network Commercial |
$14.64
|
|
|
FAT EMULSION 20 % INTRAVENOUS [2318]
|
Facility
|
IP
|
$15.41
|
|
|
Service Code
|
NDC 0264446030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.10
|
| Rate for Payer: Aetna of WY Medicare |
$9.86
|
| Rate for Payer: Altius Commercial |
$14.79
|
| Rate for Payer: Beech Street Commercial |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.95
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.10
|
| Rate for Payer: Entrust Commercial |
$14.64
|
| Rate for Payer: First Choice Health Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.40
|
| Rate for Payer: HealthUtah PPO |
$15.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.95
|
| Rate for Payer: Multiplan Medicare/VA |
$8.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.10
|
| Rate for Payer: PacificSource Commercial |
$13.87
|
| Rate for Payer: PHCS PPO |
$15.10
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
| Rate for Payer: WINHealth Partners Commercial |
$14.64
|
| Rate for Payer: Wise Provider Network Commercial |
$14.64
|
|
|
FAT EMULSION (NUTRILIPID OR INTRALIPID) BOLUS FROM BAG [4090000077]
|
Facility
|
OP
|
$15.41
|
|
|
Service Code
|
NDC 0264446030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.10
|
| Rate for Payer: Aetna of WY Medicare |
$10.17
|
| Rate for Payer: Altius Commercial |
$14.79
|
| Rate for Payer: Beech Street Commercial |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.95
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.10
|
| Rate for Payer: Entrust Commercial |
$14.64
|
| Rate for Payer: First Choice Health Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.78
|
| Rate for Payer: HealthUtah PPO |
$15.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.95
|
| Rate for Payer: Multiplan Medicare/VA |
$8.34
|
| Rate for Payer: One Health Plan of WY PPO |
$15.10
|
| Rate for Payer: PacificSource Commercial |
$13.87
|
| Rate for Payer: PHCS PPO |
$15.10
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.10
|
| Rate for Payer: Wise Provider Network Commercial |
$14.64
|
|
|
FAT EMULSION (NUTRILIPID OR INTRALIPID) BOLUS FROM BAG [4090000077]
|
Facility
|
IP
|
$15.41
|
|
|
Service Code
|
NDC 0264446030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.10
|
| Rate for Payer: Aetna of WY Medicare |
$9.86
|
| Rate for Payer: Altius Commercial |
$14.79
|
| Rate for Payer: Beech Street Commercial |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.95
|
| Rate for Payer: Cash Price |
$10.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.95
|
| Rate for Payer: Cigna of WY Commercial |
$15.10
|
| Rate for Payer: Entrust Commercial |
$14.64
|
| Rate for Payer: First Choice Health Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.40
|
| Rate for Payer: HealthUtah PPO |
$15.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.95
|
| Rate for Payer: Multiplan Medicare/VA |
$8.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.10
|
| Rate for Payer: PacificSource Commercial |
$13.87
|
| Rate for Payer: PHCS PPO |
$15.10
|
| Rate for Payer: Three Rivers PPO |
$11.56
|
| Rate for Payer: TriWest Veterans Administration |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
| Rate for Payer: WINHealth Partners Commercial |
$14.64
|
| Rate for Payer: Wise Provider Network Commercial |
$14.64
|
|
|
FECAL BLOOD SCRN IMMUNOASSAY
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS G0328
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$18.05
|
| Rate for Payer: Beech Street Commercial |
$115.90
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: First Choice Health Commercial |
$109.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.05
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$15.34
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$115.90
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$18.05
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
|
|
FECAL GLOBIN BY IMMUNOCHEMISTRY (FIT)
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 82274
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$119.56
|
| Rate for Payer: Aetna of WY Medicare |
$15.92
|
| Rate for Payer: Beech Street Commercial |
$115.90
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: Cash Price |
$85.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.34
|
| Rate for Payer: Cigna of WY Commercial |
$119.56
|
| Rate for Payer: First Choice Health Commercial |
$109.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$115.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.92
|
| Rate for Payer: HealthUtah PPO |
$122.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.34
|
| Rate for Payer: Multiplan Medicare/VA |
$13.53
|
| Rate for Payer: One Health Plan of WY PPO |
$119.56
|
| Rate for Payer: PacificSource Commercial |
$109.80
|
| Rate for Payer: PHCS PPO |
$115.90
|
| Rate for Payer: Three Rivers PPO |
$91.50
|
| Rate for Payer: TriWest Veterans Administration |
$15.92
|
| Rate for Payer: United Healthcare Commercial |
$115.90
|
| Rate for Payer: WINHealth Partners Commercial |
$115.90
|
|
|
FEEDING TUBE 10FR 43" DOBBHOFF
|
Facility
|
OP
|
$33.48
|
|
| Hospital Charge Code |
2400201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.81
|
| Rate for Payer: Aetna of WY Medicare |
$22.10
|
| Rate for Payer: Altius Commercial |
$32.14
|
| Rate for Payer: Beech Street Commercial |
$32.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.48
|
| Rate for Payer: Cash Price |
$23.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.48
|
| Rate for Payer: Cigna of WY Commercial |
$32.81
|
| Rate for Payer: Entrust Commercial |
$31.81
|
| Rate for Payer: First Choice Health Commercial |
$31.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.08
|
| Rate for Payer: HealthUtah PPO |
$33.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.48
|
| Rate for Payer: Multiplan Medicare/VA |
$18.13
|
| Rate for Payer: One Health Plan of WY PPO |
$32.81
|
| Rate for Payer: PacificSource Commercial |
$30.13
|
| Rate for Payer: PHCS PPO |
$32.81
|
| Rate for Payer: Three Rivers PPO |
$25.11
|
| Rate for Payer: TriWest Veterans Administration |
$19.08
|
| Rate for Payer: United Healthcare Commercial |
$31.97
|
| Rate for Payer: United Healthcare Medicare |
$19.08
|
| Rate for Payer: WINHealth Partners Commercial |
$32.81
|
| Rate for Payer: Wise Provider Network Commercial |
$31.81
|
|
|
FEEDING TUBE 10FR 43" DOBBHOFF
|
Facility
|
IP
|
$33.48
|
|
| Hospital Charge Code |
2400201
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$33.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.81
|
| Rate for Payer: Aetna of WY Medicare |
$21.43
|
| Rate for Payer: Altius Commercial |
$32.14
|
| Rate for Payer: Beech Street Commercial |
$32.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.48
|
| Rate for Payer: Cash Price |
$23.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.48
|
| Rate for Payer: Cigna of WY Commercial |
$32.81
|
| Rate for Payer: Entrust Commercial |
$31.81
|
| Rate for Payer: First Choice Health Commercial |
$31.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.42
|
| Rate for Payer: HealthUtah PPO |
$33.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.48
|
| Rate for Payer: Multiplan Medicare/VA |
$19.40
|
| Rate for Payer: One Health Plan of WY PPO |
$32.81
|
| Rate for Payer: PacificSource Commercial |
$30.13
|
| Rate for Payer: PHCS PPO |
$32.81
|
| Rate for Payer: Three Rivers PPO |
$25.11
|
| Rate for Payer: TriWest Veterans Administration |
$20.42
|
| Rate for Payer: United Healthcare Commercial |
$31.97
|
| Rate for Payer: United Healthcare Medicare |
$20.42
|
| Rate for Payer: WINHealth Partners Commercial |
$31.81
|
| Rate for Payer: Wise Provider Network Commercial |
$31.81
|
|
|
FEEDING TUBE 8FR 55" DOBBHOFF
|
Facility
|
OP
|
$30.12
|
|
| Hospital Charge Code |
2400202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.52
|
| Rate for Payer: Aetna of WY Medicare |
$19.88
|
| Rate for Payer: Altius Commercial |
$28.92
|
| Rate for Payer: Beech Street Commercial |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.22
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.22
|
| Rate for Payer: Cigna of WY Commercial |
$29.52
|
| Rate for Payer: Entrust Commercial |
$28.61
|
| Rate for Payer: First Choice Health Commercial |
$28.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.17
|
| Rate for Payer: HealthUtah PPO |
$30.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.22
|
| Rate for Payer: Multiplan Medicare/VA |
$16.31
|
| Rate for Payer: One Health Plan of WY PPO |
$29.52
|
| Rate for Payer: PacificSource Commercial |
$27.11
|
| Rate for Payer: PHCS PPO |
$29.52
|
| Rate for Payer: Three Rivers PPO |
$22.59
|
| Rate for Payer: TriWest Veterans Administration |
$17.17
|
| Rate for Payer: United Healthcare Commercial |
$28.76
|
| Rate for Payer: United Healthcare Medicare |
$17.17
|
| Rate for Payer: WINHealth Partners Commercial |
$29.52
|
| Rate for Payer: Wise Provider Network Commercial |
$28.61
|
|
|
FEEDING TUBE 8FR 55" DOBBHOFF
|
Facility
|
IP
|
$30.12
|
|
| Hospital Charge Code |
2400202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.52
|
| Rate for Payer: Aetna of WY Medicare |
$19.28
|
| Rate for Payer: Altius Commercial |
$28.92
|
| Rate for Payer: Beech Street Commercial |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.22
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.22
|
| Rate for Payer: Cigna of WY Commercial |
$29.52
|
| Rate for Payer: Entrust Commercial |
$28.61
|
| Rate for Payer: First Choice Health Commercial |
$28.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.37
|
| Rate for Payer: HealthUtah PPO |
$30.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.22
|
| Rate for Payer: Multiplan Medicare/VA |
$17.45
|
| Rate for Payer: One Health Plan of WY PPO |
$29.52
|
| Rate for Payer: PacificSource Commercial |
$27.11
|
| Rate for Payer: PHCS PPO |
$29.52
|
| Rate for Payer: Three Rivers PPO |
$22.59
|
| Rate for Payer: TriWest Veterans Administration |
$18.37
|
| Rate for Payer: United Healthcare Commercial |
$28.76
|
| Rate for Payer: United Healthcare Medicare |
$18.37
|
| Rate for Payer: WINHealth Partners Commercial |
$28.61
|
| Rate for Payer: Wise Provider Network Commercial |
$28.61
|
|
|
FEEDING TUBE ARGYLE 5 FR 16"
|
Facility
|
OP
|
$2.28
|
|
| Hospital Charge Code |
2400049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Aetna of WY Medicare |
$1.50
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.30
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$2.18
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2.23
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
FEEDING TUBE ARGYLE 5 FR 16"
|
Facility
|
IP
|
$2.28
|
|
| Hospital Charge Code |
2400049
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Aetna of WY Medicare |
$1.46
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$2.18
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.17
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
FEEDING TUBE ARGYLE 8 FR 16"
|
Facility
|
IP
|
$2.28
|
|
| Hospital Charge Code |
2400048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Aetna of WY Medicare |
$1.46
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$2.18
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.17
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
FEEDING TUBE ARGYLE 8 FR 16"
|
Facility
|
OP
|
$2.28
|
|
| Hospital Charge Code |
2400048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Aetna of WY Medicare |
$1.50
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.30
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$2.18
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2.23
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
FELT ORTHOPEDIC 2 X 2
|
Facility
|
IP
|
$8.73
|
|
| Hospital Charge Code |
2250142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.56
|
| Rate for Payer: Aetna of WY Medicare |
$5.59
|
| Rate for Payer: Altius Commercial |
$8.38
|
| Rate for Payer: Beech Street Commercial |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.47
|
| Rate for Payer: Cigna of WY Commercial |
$8.56
|
| Rate for Payer: Entrust Commercial |
$8.29
|
| Rate for Payer: First Choice Health Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.33
|
| Rate for Payer: HealthUtah PPO |
$8.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.47
|
| Rate for Payer: Multiplan Medicare/VA |
$5.06
|
| Rate for Payer: One Health Plan of WY PPO |
$8.56
|
| Rate for Payer: PacificSource Commercial |
$7.86
|
| Rate for Payer: PHCS PPO |
$8.56
|
| Rate for Payer: Three Rivers PPO |
$6.55
|
| Rate for Payer: TriWest Veterans Administration |
$5.33
|
| Rate for Payer: United Healthcare Commercial |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$5.33
|
| Rate for Payer: WINHealth Partners Commercial |
$8.29
|
| Rate for Payer: Wise Provider Network Commercial |
$8.29
|
|
|
FELT ORTHOPEDIC 2 X 2
|
Facility
|
OP
|
$8.73
|
|
| Hospital Charge Code |
2250142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.56
|
| Rate for Payer: Aetna of WY Medicare |
$5.76
|
| Rate for Payer: Altius Commercial |
$8.38
|
| Rate for Payer: Beech Street Commercial |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.47
|
| Rate for Payer: Cigna of WY Commercial |
$8.56
|
| Rate for Payer: Entrust Commercial |
$8.29
|
| Rate for Payer: First Choice Health Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.98
|
| Rate for Payer: HealthUtah PPO |
$8.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.47
|
| Rate for Payer: Multiplan Medicare/VA |
$4.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8.56
|
| Rate for Payer: PacificSource Commercial |
$7.86
|
| Rate for Payer: PHCS PPO |
$8.56
|
| Rate for Payer: Three Rivers PPO |
$6.55
|
| Rate for Payer: TriWest Veterans Administration |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$8.34
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
| Rate for Payer: WINHealth Partners Commercial |
$8.56
|
| Rate for Payer: Wise Provider Network Commercial |
$8.29
|
|
|
FEMOR NAIL 09X280MM 1825-0928S
|
Facility
|
IP
|
$3,879.61
|
|
| Hospital Charge Code |
3100610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,248.23 |
| Max. Negotiated Rate |
$3,879.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,802.02
|
| Rate for Payer: Aetna of WY Medicare |
$2,482.95
|
| Rate for Payer: Altius Commercial |
$3,724.43
|
| Rate for Payer: Beech Street Commercial |
$3,802.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,763.22
|
| Rate for Payer: Cash Price |
$2,715.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,763.22
|
| Rate for Payer: Cigna of WY Commercial |
$3,802.02
|
| Rate for Payer: Entrust Commercial |
$3,685.63
|
| Rate for Payer: First Choice Health Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,685.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,366.56
|
| Rate for Payer: HealthUtah PPO |
$3,879.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,763.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2,248.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,802.02
|
| Rate for Payer: PacificSource Commercial |
$3,491.65
|
| Rate for Payer: PHCS PPO |
$3,802.02
|
| Rate for Payer: Three Rivers PPO |
$2,909.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,366.56
|
| Rate for Payer: United Healthcare Commercial |
$3,705.03
|
| Rate for Payer: United Healthcare Medicare |
$2,366.56
|
| Rate for Payer: WINHealth Partners Commercial |
$3,685.63
|
| Rate for Payer: Wise Provider Network Commercial |
$3,685.63
|
|
