|
HC PRO EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
HCPCS 11626 NONPBBPAYER
|
| Hospital Charge Code |
9831162601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$236.27 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,438.64
|
| Rate for Payer: Aetna of WY Medicare |
$277.97
|
| Rate for Payer: Beech Street Commercial |
$1,394.60
|
| Rate for Payer: Cash Price |
$1,027.60
|
| Rate for Payer: Cash Price |
$1,027.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,423.96
|
| Rate for Payer: Cigna of WY Commercial |
$1,438.64
|
| Rate for Payer: First Choice Health Commercial |
$1,321.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,394.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.97
|
| Rate for Payer: HealthUtah PPO |
$1,468.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,423.96
|
| Rate for Payer: Multiplan Medicare/VA |
$236.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,438.64
|
| Rate for Payer: PacificSource Commercial |
$1,321.20
|
| Rate for Payer: PHCS PPO |
$1,394.60
|
| Rate for Payer: Three Rivers PPO |
$1,101.00
|
| Rate for Payer: TriWest Veterans Administration |
$277.97
|
| Rate for Payer: United Healthcare Commercial |
$1,277.16
|
| Rate for Payer: United Healthcare Medicare |
$277.97
|
| Rate for Payer: WINHealth Partners Commercial |
$1,247.80
|
|
|
HC PRO EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
9831162601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$236.27 |
| Max. Negotiated Rate |
$1,174.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,150.52
|
| Rate for Payer: Aetna of WY Medicare |
$277.97
|
| Rate for Payer: Beech Street Commercial |
$1,115.30
|
| Rate for Payer: Cash Price |
$821.80
|
| Rate for Payer: Cash Price |
$821.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,138.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,150.52
|
| Rate for Payer: First Choice Health Commercial |
$1,056.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,115.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.97
|
| Rate for Payer: HealthUtah PPO |
$1,174.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,138.78
|
| Rate for Payer: Multiplan Medicare/VA |
$236.27
|
| Rate for Payer: One Health Plan of WY PPO |
$1,150.52
|
| Rate for Payer: PacificSource Commercial |
$1,056.60
|
| Rate for Payer: PHCS PPO |
$1,115.30
|
| Rate for Payer: Three Rivers PPO |
$880.50
|
| Rate for Payer: TriWest Veterans Administration |
$277.97
|
| Rate for Payer: United Healthcare Commercial |
$1,021.38
|
| Rate for Payer: United Healthcare Medicare |
$277.97
|
| Rate for Payer: WINHealth Partners Commercial |
$997.90
|
|
|
HC PRO EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
|
Professional
|
Both
|
$3,498.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
9834623001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$142.43 |
| Max. Negotiated Rate |
$3,498.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,428.04
|
| Rate for Payer: Aetna of WY Medicare |
$167.56
|
| Rate for Payer: Beech Street Commercial |
$3,323.10
|
| Rate for Payer: Cash Price |
$2,448.60
|
| Rate for Payer: Cash Price |
$2,448.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,393.06
|
| Rate for Payer: Cigna of WY Commercial |
$3,428.04
|
| Rate for Payer: First Choice Health Commercial |
$3,148.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,323.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.56
|
| Rate for Payer: HealthUtah PPO |
$3,498.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,393.06
|
| Rate for Payer: Multiplan Medicare/VA |
$142.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,428.04
|
| Rate for Payer: PacificSource Commercial |
$3,148.20
|
| Rate for Payer: PHCS PPO |
$3,323.10
|
| Rate for Payer: Three Rivers PPO |
$2,623.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.56
|
| Rate for Payer: United Healthcare Commercial |
$3,043.26
|
| Rate for Payer: United Healthcare Medicare |
$167.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,973.30
|
|
|
HC PRO EXCISION NAIL MATRIX PRT/CMPL PERMANENT REMOVAL
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
9831175001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$84.23 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$834.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$398.86
|
| Rate for Payer: Aetna of WY Medicare |
$99.09
|
| Rate for Payer: Aetna of WY Medicare |
$99.09
|
| Rate for Payer: Beech Street Commercial |
$386.65
|
| Rate for Payer: Beech Street Commercial |
$809.40
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$284.90
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$826.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$394.79
|
| Rate for Payer: Cigna of WY Commercial |
$398.86
|
| Rate for Payer: Cigna of WY Commercial |
$834.96
|
| Rate for Payer: First Choice Health Commercial |
$366.30
|
| Rate for Payer: First Choice Health Commercial |
$766.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$809.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$386.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.09
|
| Rate for Payer: HealthUtah PPO |
$852.00
|
| Rate for Payer: HealthUtah PPO |
$407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$826.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$394.79
|
| Rate for Payer: Multiplan Medicare/VA |
$84.23
|
| Rate for Payer: Multiplan Medicare/VA |
$84.23
|
| Rate for Payer: One Health Plan of WY PPO |
$834.96
|
| Rate for Payer: One Health Plan of WY PPO |
$398.86
|
| Rate for Payer: PacificSource Commercial |
$366.30
|
| Rate for Payer: PacificSource Commercial |
$766.80
|
| Rate for Payer: PHCS PPO |
$809.40
|
| Rate for Payer: PHCS PPO |
$386.65
|
| Rate for Payer: Three Rivers PPO |
$639.00
|
| Rate for Payer: Three Rivers PPO |
$305.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.09
|
| Rate for Payer: TriWest Veterans Administration |
$99.09
|
| Rate for Payer: United Healthcare Commercial |
$354.09
|
| Rate for Payer: United Healthcare Commercial |
$741.24
|
| Rate for Payer: United Healthcare Medicare |
$99.09
|
| Rate for Payer: United Healthcare Medicare |
$99.09
|
| Rate for Payer: WINHealth Partners Commercial |
$724.20
|
| Rate for Payer: WINHealth Partners Commercial |
$345.95
|
|
|
HC PRO EXCISION NAIL MATRIX PRT/CMPL PERMANENT REMOVAL
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 11750 NONPBBPAYER
|
| Hospital Charge Code |
9831175001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$84.23 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$498.82
|
| Rate for Payer: Aetna of WY Medicare |
$99.09
|
| Rate for Payer: Beech Street Commercial |
$483.55
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: Cash Price |
$356.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$493.73
|
| Rate for Payer: Cigna of WY Commercial |
$498.82
|
| Rate for Payer: First Choice Health Commercial |
$458.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$483.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.09
|
| Rate for Payer: HealthUtah PPO |
$509.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$493.73
|
| Rate for Payer: Multiplan Medicare/VA |
$84.23
|
| Rate for Payer: One Health Plan of WY PPO |
$498.82
|
| Rate for Payer: PacificSource Commercial |
$458.10
|
| Rate for Payer: PHCS PPO |
$483.55
|
| Rate for Payer: Three Rivers PPO |
$381.75
|
| Rate for Payer: TriWest Veterans Administration |
$99.09
|
| Rate for Payer: United Healthcare Commercial |
$442.83
|
| Rate for Payer: United Healthcare Medicare |
$99.09
|
| Rate for Payer: WINHealth Partners Commercial |
$432.65
|
|
|
HC PRO EXCISION NASAL POLYP EXTENSIVE
|
Professional
|
Both
|
$1,629.00
|
|
|
Service Code
|
HCPCS 30115
|
| Hospital Charge Code |
9833011501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$388.07 |
| Max. Negotiated Rate |
$1,629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,596.42
|
| Rate for Payer: Aetna of WY Medicare |
$456.55
|
| Rate for Payer: Beech Street Commercial |
$1,547.55
|
| Rate for Payer: Cash Price |
$1,140.30
|
| Rate for Payer: Cash Price |
$1,140.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,580.13
|
| Rate for Payer: Cigna of WY Commercial |
$1,596.42
|
| Rate for Payer: First Choice Health Commercial |
$1,466.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,547.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$456.55
|
| Rate for Payer: HealthUtah PPO |
$1,629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,580.13
|
| Rate for Payer: Multiplan Medicare/VA |
$388.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,596.42
|
| Rate for Payer: PacificSource Commercial |
$1,466.10
|
| Rate for Payer: PHCS PPO |
$1,547.55
|
| Rate for Payer: Three Rivers PPO |
$1,221.75
|
| Rate for Payer: TriWest Veterans Administration |
$456.55
|
| Rate for Payer: United Healthcare Commercial |
$1,417.23
|
| Rate for Payer: United Healthcare Medicare |
$456.55
|
| Rate for Payer: WINHealth Partners Commercial |
$1,384.65
|
|
|
HC PRO EXCISION NASAL POLYP EXTENSIVE
|
Professional
|
Both
|
$3,257.00
|
|
|
Service Code
|
HCPCS 30115 50
|
| Hospital Charge Code |
9833011501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$388.07 |
| Max. Negotiated Rate |
$3,257.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,191.86
|
| Rate for Payer: Aetna of WY Medicare |
$456.55
|
| Rate for Payer: Beech Street Commercial |
$3,094.15
|
| Rate for Payer: Cash Price |
$2,279.90
|
| Rate for Payer: Cash Price |
$2,279.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,159.29
|
| Rate for Payer: Cigna of WY Commercial |
$3,191.86
|
| Rate for Payer: First Choice Health Commercial |
$2,931.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,094.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$456.55
|
| Rate for Payer: HealthUtah PPO |
$3,257.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,159.29
|
| Rate for Payer: Multiplan Medicare/VA |
$388.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,191.86
|
| Rate for Payer: PacificSource Commercial |
$2,931.30
|
| Rate for Payer: PHCS PPO |
$3,094.15
|
| Rate for Payer: Three Rivers PPO |
$2,442.75
|
| Rate for Payer: TriWest Veterans Administration |
$456.55
|
| Rate for Payer: United Healthcare Commercial |
$2,833.59
|
| Rate for Payer: United Healthcare Medicare |
$456.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,768.45
|
|
|
HC PRO EXCISION NASAL POLYP SIMPLE
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 30110
|
| Hospital Charge Code |
9833011001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$110.42 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$854.56
|
| Rate for Payer: Aetna of WY Medicare |
$129.91
|
| Rate for Payer: Beech Street Commercial |
$828.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: Cash Price |
$610.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$845.84
|
| Rate for Payer: Cigna of WY Commercial |
$854.56
|
| Rate for Payer: First Choice Health Commercial |
$784.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$828.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.91
|
| Rate for Payer: HealthUtah PPO |
$872.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$845.84
|
| Rate for Payer: Multiplan Medicare/VA |
$110.42
|
| Rate for Payer: One Health Plan of WY PPO |
$854.56
|
| Rate for Payer: PacificSource Commercial |
$784.80
|
| Rate for Payer: PHCS PPO |
$828.40
|
| Rate for Payer: Three Rivers PPO |
$654.00
|
| Rate for Payer: TriWest Veterans Administration |
$129.91
|
| Rate for Payer: United Healthcare Commercial |
$758.64
|
| Rate for Payer: United Healthcare Medicare |
$129.91
|
| Rate for Payer: WINHealth Partners Commercial |
$741.20
|
|
|
HC PRO EXCISION OF UVULA
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
9834214001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$136.03 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,066.24
|
| Rate for Payer: Aetna of WY Medicare |
$160.03
|
| Rate for Payer: Beech Street Commercial |
$1,033.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,055.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,066.24
|
| Rate for Payer: First Choice Health Commercial |
$979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,033.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.03
|
| Rate for Payer: HealthUtah PPO |
$1,088.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,055.36
|
| Rate for Payer: Multiplan Medicare/VA |
$136.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,066.24
|
| Rate for Payer: PacificSource Commercial |
$979.20
|
| Rate for Payer: PHCS PPO |
$1,033.60
|
| Rate for Payer: Three Rivers PPO |
$816.00
|
| Rate for Payer: TriWest Veterans Administration |
$160.03
|
| Rate for Payer: United Healthcare Commercial |
$946.56
|
| Rate for Payer: United Healthcare Medicare |
$160.03
|
| Rate for Payer: WINHealth Partners Commercial |
$924.80
|
|
|
HC PRO EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$1,826.00
|
|
|
Service Code
|
HCPCS 24105
|
| Hospital Charge Code |
9832410501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$304.05 |
| Max. Negotiated Rate |
$1,826.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,789.48
|
| Rate for Payer: Aetna of WY Medicare |
$357.71
|
| Rate for Payer: Beech Street Commercial |
$1,734.70
|
| Rate for Payer: Cash Price |
$1,278.20
|
| Rate for Payer: Cash Price |
$1,278.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,771.22
|
| Rate for Payer: Cigna of WY Commercial |
$1,789.48
|
| Rate for Payer: First Choice Health Commercial |
$1,643.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,734.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$357.71
|
| Rate for Payer: HealthUtah PPO |
$1,826.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,771.22
|
| Rate for Payer: Multiplan Medicare/VA |
$304.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,789.48
|
| Rate for Payer: PacificSource Commercial |
$1,643.40
|
| Rate for Payer: PHCS PPO |
$1,734.70
|
| Rate for Payer: Three Rivers PPO |
$1,369.50
|
| Rate for Payer: TriWest Veterans Administration |
$357.71
|
| Rate for Payer: United Healthcare Commercial |
$1,588.62
|
| Rate for Payer: United Healthcare Medicare |
$357.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,552.10
|
|
|
HC PRO EXCISION OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
9833851001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$340.76 |
| Max. Negotiated Rate |
$2,159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,115.82
|
| Rate for Payer: Aetna of WY Medicare |
$400.90
|
| Rate for Payer: Beech Street Commercial |
$2,051.05
|
| Rate for Payer: Cash Price |
$1,511.30
|
| Rate for Payer: Cash Price |
$1,511.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,094.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,115.82
|
| Rate for Payer: First Choice Health Commercial |
$1,943.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,051.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.90
|
| Rate for Payer: HealthUtah PPO |
$2,159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,094.23
|
| Rate for Payer: Multiplan Medicare/VA |
$340.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,115.82
|
| Rate for Payer: PacificSource Commercial |
$1,943.10
|
| Rate for Payer: PHCS PPO |
$2,051.05
|
| Rate for Payer: Three Rivers PPO |
$1,619.25
|
| Rate for Payer: TriWest Veterans Administration |
$400.90
|
| Rate for Payer: United Healthcare Commercial |
$1,878.33
|
| Rate for Payer: United Healthcare Medicare |
$400.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,835.15
|
|
|
HC PRO EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 11770 NONPBBPAYER
|
| Hospital Charge Code |
9831177001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$906.50
|
| Rate for Payer: Aetna of WY Medicare |
$178.24
|
| Rate for Payer: Beech Street Commercial |
$878.75
|
| Rate for Payer: Cash Price |
$647.50
|
| Rate for Payer: Cash Price |
$647.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$897.25
|
| Rate for Payer: Cigna of WY Commercial |
$906.50
|
| Rate for Payer: First Choice Health Commercial |
$832.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$878.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.24
|
| Rate for Payer: HealthUtah PPO |
$925.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$897.25
|
| Rate for Payer: Multiplan Medicare/VA |
$151.50
|
| Rate for Payer: One Health Plan of WY PPO |
$906.50
|
| Rate for Payer: PacificSource Commercial |
$832.50
|
| Rate for Payer: PHCS PPO |
$878.75
|
| Rate for Payer: Three Rivers PPO |
$693.75
|
| Rate for Payer: TriWest Veterans Administration |
$178.24
|
| Rate for Payer: United Healthcare Commercial |
$804.75
|
| Rate for Payer: United Healthcare Medicare |
$178.24
|
| Rate for Payer: WINHealth Partners Commercial |
$786.25
|
|
|
HC PRO EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 11770
|
| Hospital Charge Code |
9831177001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$740.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$725.20
|
| Rate for Payer: Aetna of WY Medicare |
$178.24
|
| Rate for Payer: Beech Street Commercial |
$703.00
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$717.80
|
| Rate for Payer: Cigna of WY Commercial |
$725.20
|
| Rate for Payer: First Choice Health Commercial |
$666.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$703.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$178.24
|
| Rate for Payer: HealthUtah PPO |
$740.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$717.80
|
| Rate for Payer: Multiplan Medicare/VA |
$151.50
|
| Rate for Payer: One Health Plan of WY PPO |
$725.20
|
| Rate for Payer: PacificSource Commercial |
$666.00
|
| Rate for Payer: PHCS PPO |
$703.00
|
| Rate for Payer: Three Rivers PPO |
$555.00
|
| Rate for Payer: TriWest Veterans Administration |
$178.24
|
| Rate for Payer: United Healthcare Commercial |
$643.80
|
| Rate for Payer: United Healthcare Medicare |
$178.24
|
| Rate for Payer: WINHealth Partners Commercial |
$629.00
|
|
|
HC PRO EXCISION; SHOULDER LESION, LESS THAN 5CM
|
Professional
|
Both
|
$5,543.00
|
|
|
Service Code
|
HCPCS 23076 NONPBBPAYER
|
| Hospital Charge Code |
9832307601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$5,543.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,432.14
|
| Rate for Payer: Aetna of WY Medicare |
$526.59
|
| Rate for Payer: Beech Street Commercial |
$5,265.85
|
| Rate for Payer: Cash Price |
$3,880.10
|
| Rate for Payer: Cash Price |
$3,880.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,376.71
|
| Rate for Payer: Cigna of WY Commercial |
$5,432.14
|
| Rate for Payer: First Choice Health Commercial |
$4,988.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,265.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.59
|
| Rate for Payer: HealthUtah PPO |
$5,543.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,376.71
|
| Rate for Payer: Multiplan Medicare/VA |
$447.60
|
| Rate for Payer: One Health Plan of WY PPO |
$5,432.14
|
| Rate for Payer: PacificSource Commercial |
$4,988.70
|
| Rate for Payer: PHCS PPO |
$5,265.85
|
| Rate for Payer: Three Rivers PPO |
$4,157.25
|
| Rate for Payer: TriWest Veterans Administration |
$526.59
|
| Rate for Payer: United Healthcare Commercial |
$4,822.41
|
| Rate for Payer: United Healthcare Medicare |
$526.59
|
| Rate for Payer: WINHealth Partners Commercial |
$4,711.55
|
|
|
HC PRO EXCISION; SHOULDER LESION, LESS THAN 5CM
|
Professional
|
Both
|
$4,434.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
9832307601
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$4,434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,345.32
|
| Rate for Payer: Aetna of WY Medicare |
$526.59
|
| Rate for Payer: Beech Street Commercial |
$4,212.30
|
| Rate for Payer: Cash Price |
$3,103.80
|
| Rate for Payer: Cash Price |
$3,103.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,300.98
|
| Rate for Payer: Cigna of WY Commercial |
$4,345.32
|
| Rate for Payer: First Choice Health Commercial |
$3,990.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,212.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.59
|
| Rate for Payer: HealthUtah PPO |
$4,434.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,300.98
|
| Rate for Payer: Multiplan Medicare/VA |
$447.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4,345.32
|
| Rate for Payer: PacificSource Commercial |
$3,990.60
|
| Rate for Payer: PHCS PPO |
$4,212.30
|
| Rate for Payer: Three Rivers PPO |
$3,325.50
|
| Rate for Payer: TriWest Veterans Administration |
$526.59
|
| Rate for Payer: United Healthcare Commercial |
$3,857.58
|
| Rate for Payer: United Healthcare Medicare |
$526.59
|
| Rate for Payer: WINHealth Partners Commercial |
$3,768.90
|
|
|
HC PRO EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Professional
|
Both
|
$3,908.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
9834622001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$3,908.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,829.84
|
| Rate for Payer: Aetna of WY Medicare |
$117.93
|
| Rate for Payer: Beech Street Commercial |
$3,712.60
|
| Rate for Payer: Cash Price |
$2,735.60
|
| Rate for Payer: Cash Price |
$2,735.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,790.76
|
| Rate for Payer: Cigna of WY Commercial |
$3,829.84
|
| Rate for Payer: First Choice Health Commercial |
$3,517.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,712.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.93
|
| Rate for Payer: HealthUtah PPO |
$3,908.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,790.76
|
| Rate for Payer: Multiplan Medicare/VA |
$100.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,829.84
|
| Rate for Payer: PacificSource Commercial |
$3,517.20
|
| Rate for Payer: PHCS PPO |
$3,712.60
|
| Rate for Payer: Three Rivers PPO |
$2,931.00
|
| Rate for Payer: TriWest Veterans Administration |
$117.93
|
| Rate for Payer: United Healthcare Commercial |
$3,399.96
|
| Rate for Payer: United Healthcare Medicare |
$117.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3,321.80
|
|
|
HC PRO EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Professional
|
Both
|
$6,311.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
9835484001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$6,311.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,184.78
|
| Rate for Payer: Aetna of WY Medicare |
$312.15
|
| Rate for Payer: Beech Street Commercial |
$5,995.45
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: Cash Price |
$4,417.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,121.67
|
| Rate for Payer: Cigna of WY Commercial |
$6,184.78
|
| Rate for Payer: First Choice Health Commercial |
$5,679.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,995.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$312.15
|
| Rate for Payer: HealthUtah PPO |
$6,311.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,121.67
|
| Rate for Payer: Multiplan Medicare/VA |
$265.33
|
| Rate for Payer: One Health Plan of WY PPO |
$6,184.78
|
| Rate for Payer: PacificSource Commercial |
$5,679.90
|
| Rate for Payer: PHCS PPO |
$5,995.45
|
| Rate for Payer: Three Rivers PPO |
$4,733.25
|
| Rate for Payer: TriWest Veterans Administration |
$312.15
|
| Rate for Payer: United Healthcare Commercial |
$5,490.57
|
| Rate for Payer: United Healthcare Medicare |
$312.15
|
| Rate for Payer: WINHealth Partners Commercial |
$5,364.35
|
|
|
HC PRO EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 42440
|
| Hospital Charge Code |
9834244001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$1,445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,416.10
|
| Rate for Payer: Aetna of WY Medicare |
$405.04
|
| Rate for Payer: Beech Street Commercial |
$1,372.75
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: Cash Price |
$1,011.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,401.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,416.10
|
| Rate for Payer: First Choice Health Commercial |
$1,300.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,372.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.04
|
| Rate for Payer: HealthUtah PPO |
$1,445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,401.65
|
| Rate for Payer: Multiplan Medicare/VA |
$344.28
|
| Rate for Payer: One Health Plan of WY PPO |
$1,416.10
|
| Rate for Payer: PacificSource Commercial |
$1,300.50
|
| Rate for Payer: PHCS PPO |
$1,372.75
|
| Rate for Payer: Three Rivers PPO |
$1,083.75
|
| Rate for Payer: TriWest Veterans Administration |
$405.04
|
| Rate for Payer: United Healthcare Commercial |
$1,257.15
|
| Rate for Payer: United Healthcare Medicare |
$405.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,228.25
|
|
|
HC PRO EXCISION, TENDON/SHEATH, CAPSULE FOOT
|
Professional
|
Both
|
$1,622.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
9832809001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$257.10 |
| Max. Negotiated Rate |
$1,622.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,589.56
|
| Rate for Payer: Aetna of WY Medicare |
$302.47
|
| Rate for Payer: Beech Street Commercial |
$1,540.90
|
| Rate for Payer: Cash Price |
$1,135.40
|
| Rate for Payer: Cash Price |
$1,135.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,573.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,589.56
|
| Rate for Payer: First Choice Health Commercial |
$1,459.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,540.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.47
|
| Rate for Payer: HealthUtah PPO |
$1,622.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,573.34
|
| Rate for Payer: Multiplan Medicare/VA |
$257.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,589.56
|
| Rate for Payer: PacificSource Commercial |
$1,459.80
|
| Rate for Payer: PHCS PPO |
$1,540.90
|
| Rate for Payer: Three Rivers PPO |
$1,216.50
|
| Rate for Payer: TriWest Veterans Administration |
$302.47
|
| Rate for Payer: United Healthcare Commercial |
$1,411.14
|
| Rate for Payer: United Healthcare Medicare |
$302.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,378.70
|
|
|
HC PRO EXCISION THROMBOSED HEMORRHOID, EXTERNAL
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
9834632001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$336.14
|
| Rate for Payer: Aetna of WY Medicare |
$109.83
|
| Rate for Payer: Beech Street Commercial |
$325.85
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: Cash Price |
$240.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$332.71
|
| Rate for Payer: Cigna of WY Commercial |
$336.14
|
| Rate for Payer: First Choice Health Commercial |
$308.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$325.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.83
|
| Rate for Payer: HealthUtah PPO |
$343.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$332.71
|
| Rate for Payer: Multiplan Medicare/VA |
$93.36
|
| Rate for Payer: One Health Plan of WY PPO |
$336.14
|
| Rate for Payer: PacificSource Commercial |
$308.70
|
| Rate for Payer: PHCS PPO |
$325.85
|
| Rate for Payer: Three Rivers PPO |
$257.25
|
| Rate for Payer: TriWest Veterans Administration |
$109.83
|
| Rate for Payer: United Healthcare Commercial |
$298.41
|
| Rate for Payer: United Healthcare Medicare |
$109.83
|
| Rate for Payer: WINHealth Partners Commercial |
$291.55
|
|
|
HC PRO EXCISION TROCHANTERIC BURSA/CALCIFICATION
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
9832706201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$378.45 |
| Max. Negotiated Rate |
$1,589.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,557.22
|
| Rate for Payer: Aetna of WY Medicare |
$445.23
|
| Rate for Payer: Beech Street Commercial |
$1,509.55
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: Cash Price |
$1,112.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,541.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,557.22
|
| Rate for Payer: First Choice Health Commercial |
$1,430.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,509.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$445.23
|
| Rate for Payer: HealthUtah PPO |
$1,589.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,541.33
|
| Rate for Payer: Multiplan Medicare/VA |
$378.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,557.22
|
| Rate for Payer: PacificSource Commercial |
$1,430.10
|
| Rate for Payer: PHCS PPO |
$1,509.55
|
| Rate for Payer: Three Rivers PPO |
$1,191.75
|
| Rate for Payer: TriWest Veterans Administration |
$445.23
|
| Rate for Payer: United Healthcare Commercial |
$1,382.43
|
| Rate for Payer: United Healthcare Medicare |
$445.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,350.65
|
|
|
HC PRO EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>
|
Professional
|
Both
|
$1,784.00
|
|
|
Service Code
|
HCPCS 28039
|
| Hospital Charge Code |
9832803901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$1,784.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,748.32
|
| Rate for Payer: Aetna of WY Medicare |
$329.76
|
| Rate for Payer: Beech Street Commercial |
$1,694.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: Cash Price |
$1,248.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,730.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,748.32
|
| Rate for Payer: First Choice Health Commercial |
$1,605.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,694.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.76
|
| Rate for Payer: HealthUtah PPO |
$1,784.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,730.48
|
| Rate for Payer: Multiplan Medicare/VA |
$280.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,748.32
|
| Rate for Payer: PacificSource Commercial |
$1,605.60
|
| Rate for Payer: PHCS PPO |
$1,694.80
|
| Rate for Payer: Three Rivers PPO |
$1,338.00
|
| Rate for Payer: TriWest Veterans Administration |
$329.76
|
| Rate for Payer: United Healthcare Commercial |
$1,552.08
|
| Rate for Payer: United Healthcare Medicare |
$329.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,516.40
|
|
|
HC PRO EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>
|
Professional
|
Both
|
$3,569.00
|
|
|
Service Code
|
HCPCS 28039 50
|
| Hospital Charge Code |
9832803901
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$280.30 |
| Max. Negotiated Rate |
$3,569.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,497.62
|
| Rate for Payer: Aetna of WY Medicare |
$329.76
|
| Rate for Payer: Beech Street Commercial |
$3,390.55
|
| Rate for Payer: Cash Price |
$2,498.30
|
| Rate for Payer: Cash Price |
$2,498.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,461.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,497.62
|
| Rate for Payer: First Choice Health Commercial |
$3,212.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,390.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.76
|
| Rate for Payer: HealthUtah PPO |
$3,569.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,461.93
|
| Rate for Payer: Multiplan Medicare/VA |
$280.30
|
| Rate for Payer: One Health Plan of WY PPO |
$3,497.62
|
| Rate for Payer: PacificSource Commercial |
$3,212.10
|
| Rate for Payer: PHCS PPO |
$3,390.55
|
| Rate for Payer: Three Rivers PPO |
$2,676.75
|
| Rate for Payer: TriWest Veterans Administration |
$329.76
|
| Rate for Payer: United Healthcare Commercial |
$3,105.03
|
| Rate for Payer: United Healthcare Medicare |
$329.76
|
| Rate for Payer: WINHealth Partners Commercial |
$3,033.65
|
|
|
HC PRO EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>
|
Professional
|
Both
|
$3,480.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
9822101201
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$279.79 |
| Max. Negotiated Rate |
$3,480.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,410.40
|
| Rate for Payer: Aetna of WY Medicare |
$329.16
|
| Rate for Payer: Beech Street Commercial |
$3,306.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,375.60
|
| Rate for Payer: Cigna of WY Commercial |
$3,410.40
|
| Rate for Payer: First Choice Health Commercial |
$3,132.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,306.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.16
|
| Rate for Payer: HealthUtah PPO |
$3,480.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,375.60
|
| Rate for Payer: Multiplan Medicare/VA |
$279.79
|
| Rate for Payer: One Health Plan of WY PPO |
$3,410.40
|
| Rate for Payer: PacificSource Commercial |
$3,132.00
|
| Rate for Payer: PHCS PPO |
$3,306.00
|
| Rate for Payer: Three Rivers PPO |
$2,610.00
|
| Rate for Payer: TriWest Veterans Administration |
$329.16
|
| Rate for Payer: United Healthcare Commercial |
$3,027.60
|
| Rate for Payer: United Healthcare Medicare |
$329.16
|
| Rate for Payer: WINHealth Partners Commercial |
$2,958.00
|
|
|
HC PRO EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
9832101101
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$216.45 |
| Max. Negotiated Rate |
$1,322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,295.56
|
| Rate for Payer: Aetna of WY Medicare |
$254.65
|
| Rate for Payer: Beech Street Commercial |
$1,255.90
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: Cash Price |
$925.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,282.34
|
| Rate for Payer: Cigna of WY Commercial |
$1,295.56
|
| Rate for Payer: First Choice Health Commercial |
$1,189.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,255.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.65
|
| Rate for Payer: HealthUtah PPO |
$1,322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,282.34
|
| Rate for Payer: Multiplan Medicare/VA |
$216.45
|
| Rate for Payer: One Health Plan of WY PPO |
$1,295.56
|
| Rate for Payer: PacificSource Commercial |
$1,189.80
|
| Rate for Payer: PHCS PPO |
$1,255.90
|
| Rate for Payer: Three Rivers PPO |
$991.50
|
| Rate for Payer: TriWest Veterans Administration |
$254.65
|
| Rate for Payer: United Healthcare Commercial |
$1,150.14
|
| Rate for Payer: United Healthcare Medicare |
$254.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,123.70
|
|
