|
HC PRO ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY - ESOPHAGOSCOPY
|
Professional
|
Both
|
$1,361.00
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
9834321501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$113.86 |
| Max. Negotiated Rate |
$1,361.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,333.78
|
| Rate for Payer: Aetna of WY Medicare |
$133.95
|
| Rate for Payer: Beech Street Commercial |
$1,292.95
|
| Rate for Payer: Cash Price |
$952.70
|
| Rate for Payer: Cash Price |
$952.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,320.17
|
| Rate for Payer: Cigna of WY Commercial |
$1,333.78
|
| Rate for Payer: First Choice Health Commercial |
$1,224.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,292.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.95
|
| Rate for Payer: HealthUtah PPO |
$1,361.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,320.17
|
| Rate for Payer: Multiplan Medicare/VA |
$113.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,333.78
|
| Rate for Payer: PacificSource Commercial |
$1,224.90
|
| Rate for Payer: PHCS PPO |
$1,292.95
|
| Rate for Payer: Three Rivers PPO |
$1,020.75
|
| Rate for Payer: TriWest Veterans Administration |
$133.95
|
| Rate for Payer: United Healthcare Commercial |
$1,184.07
|
| Rate for Payer: United Healthcare Medicare |
$133.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,156.85
|
|
|
HC PRO ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC - ESOPHAGOSCOPY
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
9834320001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$1,829.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,792.42
|
| Rate for Payer: Aetna of WY Medicare |
$83.91
|
| Rate for Payer: Beech Street Commercial |
$1,737.55
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: Cash Price |
$1,280.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,774.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,792.42
|
| Rate for Payer: First Choice Health Commercial |
$1,646.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,737.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.91
|
| Rate for Payer: HealthUtah PPO |
$1,829.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,774.13
|
| Rate for Payer: Multiplan Medicare/VA |
$71.32
|
| Rate for Payer: One Health Plan of WY PPO |
$1,792.42
|
| Rate for Payer: PacificSource Commercial |
$1,646.10
|
| Rate for Payer: PHCS PPO |
$1,737.55
|
| Rate for Payer: Three Rivers PPO |
$1,371.75
|
| Rate for Payer: TriWest Veterans Administration |
$83.91
|
| Rate for Payer: United Healthcare Commercial |
$1,591.23
|
| Rate for Payer: United Healthcare Medicare |
$83.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1,554.65
|
|
|
HC PRO ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$1,447.00
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
9834320201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,418.06
|
| Rate for Payer: Aetna of WY Medicare |
$98.23
|
| Rate for Payer: Beech Street Commercial |
$1,374.65
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,403.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,418.06
|
| Rate for Payer: First Choice Health Commercial |
$1,302.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,374.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.23
|
| Rate for Payer: HealthUtah PPO |
$1,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,403.59
|
| Rate for Payer: Multiplan Medicare/VA |
$83.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,418.06
|
| Rate for Payer: PacificSource Commercial |
$1,302.30
|
| Rate for Payer: PHCS PPO |
$1,374.65
|
| Rate for Payer: Three Rivers PPO |
$1,085.25
|
| Rate for Payer: TriWest Veterans Administration |
$98.23
|
| Rate for Payer: United Healthcare Commercial |
$1,258.89
|
| Rate for Payer: United Healthcare Medicare |
$98.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,229.95
|
|
|
HC PRO ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 43191
|
| Hospital Charge Code |
9834319101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$542.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$531.16
|
| Rate for Payer: Aetna of WY Medicare |
$149.34
|
| Rate for Payer: Beech Street Commercial |
$514.90
|
| Rate for Payer: Cash Price |
$379.40
|
| Rate for Payer: Cash Price |
$379.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$525.74
|
| Rate for Payer: Cigna of WY Commercial |
$531.16
|
| Rate for Payer: First Choice Health Commercial |
$487.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$514.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.34
|
| Rate for Payer: HealthUtah PPO |
$542.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$525.74
|
| Rate for Payer: Multiplan Medicare/VA |
$126.94
|
| Rate for Payer: One Health Plan of WY PPO |
$531.16
|
| Rate for Payer: PacificSource Commercial |
$487.80
|
| Rate for Payer: PHCS PPO |
$514.90
|
| Rate for Payer: Three Rivers PPO |
$406.50
|
| Rate for Payer: TriWest Veterans Administration |
$149.34
|
| Rate for Payer: United Healthcare Commercial |
$471.54
|
| Rate for Payer: United Healthcare Medicare |
$149.34
|
| Rate for Payer: WINHealth Partners Commercial |
$460.70
|
|
|
HC PRO EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 11740 NONPBBPAYER
|
| Hospital Charge Code |
9831174001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$31.51
|
| Rate for Payer: Beech Street Commercial |
$150.10
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: First Choice Health Commercial |
$142.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.51
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$26.78
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$150.10
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.51
|
| Rate for Payer: United Healthcare Commercial |
$137.46
|
| Rate for Payer: United Healthcare Medicare |
$31.51
|
| Rate for Payer: WINHealth Partners Commercial |
$134.30
|
|
|
HC PRO EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 11740
|
| Hospital Charge Code |
9831174001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$123.48
|
| Rate for Payer: Aetna of WY Medicare |
$31.51
|
| Rate for Payer: Aetna of WY Medicare |
$31.51
|
| Rate for Payer: Beech Street Commercial |
$119.70
|
| Rate for Payer: Beech Street Commercial |
$182.40
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$122.22
|
| Rate for Payer: Cigna of WY Commercial |
$123.48
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: First Choice Health Commercial |
$113.40
|
| Rate for Payer: First Choice Health Commercial |
$172.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$119.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.51
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: HealthUtah PPO |
$126.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$122.22
|
| Rate for Payer: Multiplan Medicare/VA |
$26.78
|
| Rate for Payer: Multiplan Medicare/VA |
$26.78
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: One Health Plan of WY PPO |
$123.48
|
| Rate for Payer: PacificSource Commercial |
$113.40
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$182.40
|
| Rate for Payer: PHCS PPO |
$119.70
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: Three Rivers PPO |
$94.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.51
|
| Rate for Payer: TriWest Veterans Administration |
$31.51
|
| Rate for Payer: United Healthcare Commercial |
$109.62
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: United Healthcare Medicare |
$31.51
|
| Rate for Payer: United Healthcare Medicare |
$31.51
|
| Rate for Payer: WINHealth Partners Commercial |
$163.20
|
| Rate for Payer: WINHealth Partners Commercial |
$107.10
|
|
|
HC PRO EVAL OF BRONCHOSPASM - SPIROMETRY WITH BRONCHODILATOR
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 94060 26
|
| Hospital Charge Code |
9839406001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| 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 |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| 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 |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$9.74
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
|
|
HC PRO EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
9831142601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$219.75 |
| Max. Negotiated Rate |
$1,098.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,076.04
|
| Rate for Payer: Aetna of WY Medicare |
$258.53
|
| Rate for Payer: Beech Street Commercial |
$1,043.10
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,065.06
|
| Rate for Payer: Cigna of WY Commercial |
$1,076.04
|
| Rate for Payer: First Choice Health Commercial |
$988.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,043.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.53
|
| Rate for Payer: HealthUtah PPO |
$1,098.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,065.06
|
| Rate for Payer: Multiplan Medicare/VA |
$219.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,076.04
|
| Rate for Payer: PacificSource Commercial |
$988.20
|
| Rate for Payer: PHCS PPO |
$1,043.10
|
| Rate for Payer: Three Rivers PPO |
$823.50
|
| Rate for Payer: TriWest Veterans Administration |
$258.53
|
| Rate for Payer: United Healthcare Commercial |
$955.26
|
| Rate for Payer: United Healthcare Medicare |
$258.53
|
| Rate for Payer: WINHealth Partners Commercial |
$933.30
|
|
|
HC PRO EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 11426 NONPBBPAYER
|
| Hospital Charge Code |
9831142601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$219.75 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,344.56
|
| Rate for Payer: Aetna of WY Medicare |
$258.53
|
| Rate for Payer: Beech Street Commercial |
$1,303.40
|
| Rate for Payer: Cash Price |
$960.40
|
| Rate for Payer: Cash Price |
$960.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,330.84
|
| Rate for Payer: Cigna of WY Commercial |
$1,344.56
|
| Rate for Payer: First Choice Health Commercial |
$1,234.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,303.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$258.53
|
| Rate for Payer: HealthUtah PPO |
$1,372.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,330.84
|
| Rate for Payer: Multiplan Medicare/VA |
$219.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,344.56
|
| Rate for Payer: PacificSource Commercial |
$1,234.80
|
| Rate for Payer: PHCS PPO |
$1,303.40
|
| Rate for Payer: Three Rivers PPO |
$1,029.00
|
| Rate for Payer: TriWest Veterans Administration |
$258.53
|
| Rate for Payer: United Healthcare Commercial |
$1,193.64
|
| Rate for Payer: United Healthcare Medicare |
$258.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,166.20
|
|
|
HC PRO EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
9831144301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$695.80
|
| Rate for Payer: Aetna of WY Medicare |
$174.08
|
| Rate for Payer: Beech Street Commercial |
$674.50
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$688.70
|
| Rate for Payer: Cigna of WY Commercial |
$695.80
|
| Rate for Payer: First Choice Health Commercial |
$639.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$674.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.08
|
| Rate for Payer: HealthUtah PPO |
$710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$688.70
|
| Rate for Payer: Multiplan Medicare/VA |
$147.97
|
| Rate for Payer: One Health Plan of WY PPO |
$695.80
|
| Rate for Payer: PacificSource Commercial |
$639.00
|
| Rate for Payer: PHCS PPO |
$674.50
|
| Rate for Payer: Three Rivers PPO |
$532.50
|
| Rate for Payer: TriWest Veterans Administration |
$174.08
|
| Rate for Payer: United Healthcare Commercial |
$617.70
|
| Rate for Payer: United Healthcare Medicare |
$174.08
|
| Rate for Payer: WINHealth Partners Commercial |
$603.50
|
|
|
HC PRO EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 11443 NONPBBPAYER
|
| Hospital Charge Code |
9831144301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$869.26
|
| Rate for Payer: Aetna of WY Medicare |
$174.08
|
| Rate for Payer: Beech Street Commercial |
$842.65
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: Cash Price |
$620.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$860.39
|
| Rate for Payer: Cigna of WY Commercial |
$869.26
|
| Rate for Payer: First Choice Health Commercial |
$798.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$842.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$174.08
|
| Rate for Payer: HealthUtah PPO |
$887.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$860.39
|
| Rate for Payer: Multiplan Medicare/VA |
$147.97
|
| Rate for Payer: One Health Plan of WY PPO |
$869.26
|
| Rate for Payer: PacificSource Commercial |
$798.30
|
| Rate for Payer: PHCS PPO |
$842.65
|
| Rate for Payer: Three Rivers PPO |
$665.25
|
| Rate for Payer: TriWest Veterans Administration |
$174.08
|
| Rate for Payer: United Healthcare Commercial |
$771.69
|
| Rate for Payer: United Healthcare Medicare |
$174.08
|
| Rate for Payer: WINHealth Partners Commercial |
$753.95
|
|
|
HC PRO EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$4,496.00
|
|
|
Service Code
|
HCPCS 56740
|
| Hospital Charge Code |
9835674001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$258.94 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,406.08
|
| Rate for Payer: Aetna of WY Medicare |
$304.63
|
| Rate for Payer: Beech Street Commercial |
$4,271.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: Cash Price |
$3,147.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,361.12
|
| Rate for Payer: Cigna of WY Commercial |
$4,406.08
|
| Rate for Payer: First Choice Health Commercial |
$4,046.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,271.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$304.63
|
| Rate for Payer: HealthUtah PPO |
$4,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,361.12
|
| Rate for Payer: Multiplan Medicare/VA |
$258.94
|
| Rate for Payer: One Health Plan of WY PPO |
$4,406.08
|
| Rate for Payer: PacificSource Commercial |
$4,046.40
|
| Rate for Payer: PHCS PPO |
$4,271.20
|
| Rate for Payer: Three Rivers PPO |
$3,372.00
|
| Rate for Payer: TriWest Veterans Administration |
$304.63
|
| Rate for Payer: United Healthcare Commercial |
$3,911.52
|
| Rate for Payer: United Healthcare Medicare |
$304.63
|
| Rate for Payer: WINHealth Partners Commercial |
$3,821.60
|
|
|
HC PRO EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
HCPCS 42815
|
| Hospital Charge Code |
9834281501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$445.33 |
| Max. Negotiated Rate |
$2,804.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,747.92
|
| Rate for Payer: Aetna of WY Medicare |
$523.92
|
| Rate for Payer: Beech Street Commercial |
$2,663.80
|
| Rate for Payer: Cash Price |
$1,962.80
|
| Rate for Payer: Cash Price |
$1,962.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,719.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,747.92
|
| Rate for Payer: First Choice Health Commercial |
$2,523.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,663.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$523.92
|
| Rate for Payer: HealthUtah PPO |
$2,804.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,719.88
|
| Rate for Payer: Multiplan Medicare/VA |
$445.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2,747.92
|
| Rate for Payer: PacificSource Commercial |
$2,523.60
|
| Rate for Payer: PHCS PPO |
$2,663.80
|
| Rate for Payer: Three Rivers PPO |
$2,103.00
|
| Rate for Payer: TriWest Veterans Administration |
$523.92
|
| Rate for Payer: United Healthcare Commercial |
$2,439.48
|
| Rate for Payer: United Healthcare Medicare |
$523.92
|
| Rate for Payer: WINHealth Partners Commercial |
$2,383.40
|
|
|
HC PRO EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 19125 50
|
| Hospital Charge Code |
9831912501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$377.38 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,615.80
|
| Rate for Payer: Aetna of WY Medicare |
$443.98
|
| Rate for Payer: Beech Street Commercial |
$4,474.50
|
| Rate for Payer: Cash Price |
$3,297.00
|
| Rate for Payer: Cash Price |
$3,297.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,568.70
|
| Rate for Payer: Cigna of WY Commercial |
$4,615.80
|
| Rate for Payer: First Choice Health Commercial |
$4,239.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,474.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.98
|
| Rate for Payer: HealthUtah PPO |
$4,710.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,568.70
|
| Rate for Payer: Multiplan Medicare/VA |
$377.38
|
| Rate for Payer: One Health Plan of WY PPO |
$4,615.80
|
| Rate for Payer: PacificSource Commercial |
$4,239.00
|
| Rate for Payer: PHCS PPO |
$4,474.50
|
| Rate for Payer: Three Rivers PPO |
$3,532.50
|
| Rate for Payer: TriWest Veterans Administration |
$443.98
|
| Rate for Payer: United Healthcare Commercial |
$4,097.70
|
| Rate for Payer: United Healthcare Medicare |
$443.98
|
| Rate for Payer: WINHealth Partners Commercial |
$4,003.50
|
|
|
HC PRO EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$2,355.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
9831912501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$377.38 |
| Max. Negotiated Rate |
$2,355.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,307.90
|
| Rate for Payer: Aetna of WY Medicare |
$443.98
|
| Rate for Payer: Beech Street Commercial |
$2,237.25
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: Cash Price |
$1,648.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,284.35
|
| Rate for Payer: Cigna of WY Commercial |
$2,307.90
|
| Rate for Payer: First Choice Health Commercial |
$2,119.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,237.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.98
|
| Rate for Payer: HealthUtah PPO |
$2,355.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,284.35
|
| Rate for Payer: Multiplan Medicare/VA |
$377.38
|
| Rate for Payer: One Health Plan of WY PPO |
$2,307.90
|
| Rate for Payer: PacificSource Commercial |
$2,119.50
|
| Rate for Payer: PHCS PPO |
$2,237.25
|
| Rate for Payer: Three Rivers PPO |
$1,766.25
|
| Rate for Payer: TriWest Veterans Administration |
$443.98
|
| Rate for Payer: United Healthcare Commercial |
$2,048.85
|
| Rate for Payer: United Healthcare Medicare |
$443.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,001.75
|
|
|
HC PRO EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
9832412001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$444.14 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,827.70
|
| Rate for Payer: Aetna of WY Medicare |
$522.52
|
| Rate for Payer: Beech Street Commercial |
$1,771.75
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: Cash Price |
$1,305.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,809.05
|
| Rate for Payer: Cigna of WY Commercial |
$1,827.70
|
| Rate for Payer: First Choice Health Commercial |
$1,678.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,771.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$522.52
|
| Rate for Payer: HealthUtah PPO |
$1,865.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,809.05
|
| Rate for Payer: Multiplan Medicare/VA |
$444.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,827.70
|
| Rate for Payer: PacificSource Commercial |
$1,678.50
|
| Rate for Payer: PHCS PPO |
$1,771.75
|
| Rate for Payer: Three Rivers PPO |
$1,398.75
|
| Rate for Payer: TriWest Veterans Administration |
$522.52
|
| Rate for Payer: United Healthcare Commercial |
$1,622.55
|
| Rate for Payer: United Healthcare Medicare |
$522.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,585.25
|
|
|
HC PRO EXC/CUT, TARS/METATARS BONE CY
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
9832810401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,788.50
|
| Rate for Payer: Aetna of WY Medicare |
$346.70
|
| Rate for Payer: Beech Street Commercial |
$1,733.75
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,770.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,788.50
|
| Rate for Payer: First Choice Health Commercial |
$1,642.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,733.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.70
|
| Rate for Payer: HealthUtah PPO |
$1,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,770.25
|
| Rate for Payer: Multiplan Medicare/VA |
$294.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,788.50
|
| Rate for Payer: PacificSource Commercial |
$1,642.50
|
| Rate for Payer: PHCS PPO |
$1,733.75
|
| Rate for Payer: Three Rivers PPO |
$1,368.75
|
| Rate for Payer: TriWest Veterans Administration |
$346.70
|
| Rate for Payer: United Healthcare Commercial |
$1,587.75
|
| Rate for Payer: United Healthcare Medicare |
$346.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,551.25
|
|
|
HC PRO EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$1,094.00
|
|
|
Service Code
|
HCPCS 40819 NONPBBPAYER
|
| Hospital Charge Code |
9834081901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$1,094.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,072.12
|
| Rate for Payer: Aetna of WY Medicare |
$194.74
|
| Rate for Payer: Beech Street Commercial |
$1,039.30
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: Cash Price |
$765.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,061.18
|
| Rate for Payer: Cigna of WY Commercial |
$1,072.12
|
| Rate for Payer: First Choice Health Commercial |
$984.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,039.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.74
|
| Rate for Payer: HealthUtah PPO |
$1,094.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,061.18
|
| Rate for Payer: Multiplan Medicare/VA |
$165.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,072.12
|
| Rate for Payer: PacificSource Commercial |
$984.60
|
| Rate for Payer: PHCS PPO |
$1,039.30
|
| Rate for Payer: Three Rivers PPO |
$820.50
|
| Rate for Payer: TriWest Veterans Administration |
$194.74
|
| Rate for Payer: United Healthcare Commercial |
$951.78
|
| Rate for Payer: United Healthcare Medicare |
$194.74
|
| Rate for Payer: WINHealth Partners Commercial |
$929.90
|
|
|
HC PRO EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
9834081901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$194.74
|
| Rate for Payer: Beech Street Commercial |
$831.25
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: First Choice Health Commercial |
$787.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.74
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$165.53
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$831.25
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.74
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$194.74
|
| Rate for Payer: WINHealth Partners Commercial |
$743.75
|
|
|
HC PRO EXCISE BREAST CYST/FIBROADENOMA/TUM/LES 1 OR MORE
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
9831912001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,081.52
|
| Rate for Payer: Aetna of WY Medicare |
$401.98
|
| Rate for Payer: Beech Street Commercial |
$2,017.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,060.28
|
| Rate for Payer: Cigna of WY Commercial |
$2,081.52
|
| Rate for Payer: First Choice Health Commercial |
$1,911.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,017.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.98
|
| Rate for Payer: HealthUtah PPO |
$2,124.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,060.28
|
| Rate for Payer: Multiplan Medicare/VA |
$341.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,081.52
|
| Rate for Payer: PacificSource Commercial |
$1,911.60
|
| Rate for Payer: PHCS PPO |
$2,017.80
|
| Rate for Payer: Three Rivers PPO |
$1,593.00
|
| Rate for Payer: TriWest Veterans Administration |
$401.98
|
| Rate for Payer: United Healthcare Commercial |
$1,847.88
|
| Rate for Payer: United Healthcare Medicare |
$401.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.40
|
|
|
HC PRO EXCISE BREAST CYST/FIBROADENOMA/TUM/LES 1 OR MORE
|
Professional
|
Both
|
$4,247.00
|
|
|
Service Code
|
HCPCS 19120 50
|
| Hospital Charge Code |
9831912001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$4,247.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,162.06
|
| Rate for Payer: Aetna of WY Medicare |
$401.98
|
| Rate for Payer: Beech Street Commercial |
$4,034.65
|
| Rate for Payer: Cash Price |
$2,972.90
|
| Rate for Payer: Cash Price |
$2,972.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,119.59
|
| Rate for Payer: Cigna of WY Commercial |
$4,162.06
|
| Rate for Payer: First Choice Health Commercial |
$3,822.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,034.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$401.98
|
| Rate for Payer: HealthUtah PPO |
$4,247.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,119.59
|
| Rate for Payer: Multiplan Medicare/VA |
$341.68
|
| Rate for Payer: One Health Plan of WY PPO |
$4,162.06
|
| Rate for Payer: PacificSource Commercial |
$3,822.30
|
| Rate for Payer: PHCS PPO |
$4,034.65
|
| Rate for Payer: Three Rivers PPO |
$3,185.25
|
| Rate for Payer: TriWest Veterans Administration |
$401.98
|
| Rate for Payer: United Healthcare Commercial |
$3,694.89
|
| Rate for Payer: United Healthcare Medicare |
$401.98
|
| Rate for Payer: WINHealth Partners Commercial |
$3,609.95
|
|
|
HC PRO EXCISE CUTANEOUS NEUROMA
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
9836477401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$353.68 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,071.72
|
| Rate for Payer: Aetna of WY Medicare |
$416.09
|
| Rate for Payer: Beech Street Commercial |
$2,008.30
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: Cash Price |
$1,479.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,050.58
|
| Rate for Payer: Cigna of WY Commercial |
$2,071.72
|
| Rate for Payer: First Choice Health Commercial |
$1,902.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,008.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.09
|
| Rate for Payer: HealthUtah PPO |
$2,114.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,050.58
|
| Rate for Payer: Multiplan Medicare/VA |
$353.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,071.72
|
| Rate for Payer: PacificSource Commercial |
$1,902.60
|
| Rate for Payer: PHCS PPO |
$2,008.30
|
| Rate for Payer: Three Rivers PPO |
$1,585.50
|
| Rate for Payer: TriWest Veterans Administration |
$416.09
|
| Rate for Payer: United Healthcare Commercial |
$1,839.18
|
| Rate for Payer: United Healthcare Medicare |
$416.09
|
| Rate for Payer: WINHealth Partners Commercial |
$1,796.90
|
|
|
HC PRO EXCISE LES,PALATE/UVULA SIMPLE PRIMARY CLOSE
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 42106
|
| Hospital Charge Code |
9834210601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$757.54
|
| Rate for Payer: Aetna of WY Medicare |
$156.10
|
| Rate for Payer: Beech Street Commercial |
$734.35
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$749.81
|
| Rate for Payer: Cigna of WY Commercial |
$757.54
|
| Rate for Payer: First Choice Health Commercial |
$695.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$734.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.10
|
| Rate for Payer: HealthUtah PPO |
$773.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$749.81
|
| Rate for Payer: Multiplan Medicare/VA |
$132.68
|
| Rate for Payer: One Health Plan of WY PPO |
$757.54
|
| Rate for Payer: PacificSource Commercial |
$695.70
|
| Rate for Payer: PHCS PPO |
$734.35
|
| Rate for Payer: Three Rivers PPO |
$579.75
|
| Rate for Payer: TriWest Veterans Administration |
$156.10
|
| Rate for Payer: United Healthcare Commercial |
$672.51
|
| Rate for Payer: United Healthcare Medicare |
$156.10
|
| Rate for Payer: WINHealth Partners Commercial |
$657.05
|
|
|
HC PRO EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 25130
|
| Hospital Charge Code |
9832513001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$378.62 |
| 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 |
$445.44
|
| 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 |
$445.44
|
| Rate for Payer: HealthUtah PPO |
$1,590.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,542.30
|
| Rate for Payer: Multiplan Medicare/VA |
$378.62
|
| 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 |
$445.44
|
| Rate for Payer: United Healthcare Commercial |
$1,383.30
|
| Rate for Payer: United Healthcare Medicare |
$445.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,351.50
|
|
|
HC PRO EXCISION/CURETTAGE CYST/TUMOR METACARPAL
|
Professional
|
Both
|
$5,625.00
|
|
|
Service Code
|
HCPCS 26200
|
| Hospital Charge Code |
9832620001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$377.36 |
| Max. Negotiated Rate |
$5,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,512.50
|
| Rate for Payer: Aetna of WY Medicare |
$443.95
|
| Rate for Payer: Beech Street Commercial |
$5,343.75
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: Cash Price |
$3,937.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,456.25
|
| Rate for Payer: Cigna of WY Commercial |
$5,512.50
|
| Rate for Payer: First Choice Health Commercial |
$5,062.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,343.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$443.95
|
| Rate for Payer: HealthUtah PPO |
$5,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,456.25
|
| Rate for Payer: Multiplan Medicare/VA |
$377.36
|
| Rate for Payer: One Health Plan of WY PPO |
$5,512.50
|
| Rate for Payer: PacificSource Commercial |
$5,062.50
|
| Rate for Payer: PHCS PPO |
$5,343.75
|
| Rate for Payer: Three Rivers PPO |
$4,218.75
|
| Rate for Payer: TriWest Veterans Administration |
$443.95
|
| Rate for Payer: United Healthcare Commercial |
$4,893.75
|
| Rate for Payer: United Healthcare Medicare |
$443.95
|
| Rate for Payer: WINHealth Partners Commercial |
$4,781.25
|
|
