|
HC PRO PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$2,518.00
|
|
|
Service Code
|
HCPCS 25651
|
| Hospital Charge Code |
9822565101
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$412.27 |
| Max. Negotiated Rate |
$2,518.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,467.64
|
| Rate for Payer: Aetna of WY Medicare |
$485.02
|
| Rate for Payer: Beech Street Commercial |
$2,392.10
|
| Rate for Payer: Cash Price |
$1,762.60
|
| Rate for Payer: Cash Price |
$1,762.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,442.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,467.64
|
| Rate for Payer: First Choice Health Commercial |
$2,266.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,392.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$485.02
|
| Rate for Payer: HealthUtah PPO |
$2,518.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,442.46
|
| Rate for Payer: Multiplan Medicare/VA |
$412.27
|
| Rate for Payer: One Health Plan of WY PPO |
$2,467.64
|
| Rate for Payer: PacificSource Commercial |
$2,266.20
|
| Rate for Payer: PHCS PPO |
$2,392.10
|
| Rate for Payer: Three Rivers PPO |
$1,888.50
|
| Rate for Payer: TriWest Veterans Administration |
$485.02
|
| Rate for Payer: United Healthcare Commercial |
$2,190.66
|
| Rate for Payer: United Healthcare Medicare |
$485.02
|
| Rate for Payer: WINHealth Partners Commercial |
$2,140.30
|
|
|
HC PRO PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT
|
Professional
|
Both
|
$2,608.00
|
|
|
Service Code
|
HCPCS 26676
|
| Hospital Charge Code |
9822667601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$429.19 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,555.84
|
| Rate for Payer: Aetna of WY Medicare |
$504.93
|
| Rate for Payer: Beech Street Commercial |
$2,477.60
|
| Rate for Payer: Cash Price |
$1,825.60
|
| Rate for Payer: Cash Price |
$1,825.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,529.76
|
| Rate for Payer: Cigna of WY Commercial |
$2,555.84
|
| Rate for Payer: First Choice Health Commercial |
$2,347.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,477.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$504.93
|
| Rate for Payer: HealthUtah PPO |
$2,608.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,529.76
|
| Rate for Payer: Multiplan Medicare/VA |
$429.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,555.84
|
| Rate for Payer: PacificSource Commercial |
$2,347.20
|
| Rate for Payer: PHCS PPO |
$2,477.60
|
| Rate for Payer: Three Rivers PPO |
$1,956.00
|
| Rate for Payer: TriWest Veterans Administration |
$504.93
|
| Rate for Payer: United Healthcare Commercial |
$2,268.96
|
| Rate for Payer: United Healthcare Medicare |
$504.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,216.80
|
|
|
HC PRO PRQ SKEL FIXJ FEMORAL FX PROX END NECK
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
9832723501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$744.27 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,062.50
|
| Rate for Payer: Aetna of WY Medicare |
$875.61
|
| Rate for Payer: Beech Street Commercial |
$2,968.75
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: Cash Price |
$2,187.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,031.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,062.50
|
| Rate for Payer: First Choice Health Commercial |
$2,812.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,968.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$875.61
|
| Rate for Payer: HealthUtah PPO |
$3,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,031.25
|
| Rate for Payer: Multiplan Medicare/VA |
$744.27
|
| Rate for Payer: One Health Plan of WY PPO |
$3,062.50
|
| Rate for Payer: PacificSource Commercial |
$2,812.50
|
| Rate for Payer: PHCS PPO |
$2,968.75
|
| Rate for Payer: Three Rivers PPO |
$2,343.75
|
| Rate for Payer: TriWest Veterans Administration |
$875.61
|
| Rate for Payer: United Healthcare Commercial |
$2,718.75
|
| Rate for Payer: United Healthcare Medicare |
$875.61
|
| Rate for Payer: WINHealth Partners Commercial |
$2,656.25
|
|
|
HC PRO PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$4,287.00
|
|
|
Service Code
|
HCPCS 27360
|
| Hospital Charge Code |
9832736001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$745.13 |
| Max. Negotiated Rate |
$4,287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,201.26
|
| Rate for Payer: Aetna of WY Medicare |
$876.62
|
| Rate for Payer: Beech Street Commercial |
$4,072.65
|
| Rate for Payer: Cash Price |
$3,000.90
|
| Rate for Payer: Cash Price |
$3,000.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,158.39
|
| Rate for Payer: Cigna of WY Commercial |
$4,201.26
|
| Rate for Payer: First Choice Health Commercial |
$3,858.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,072.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$876.62
|
| Rate for Payer: HealthUtah PPO |
$4,287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,158.39
|
| Rate for Payer: Multiplan Medicare/VA |
$745.13
|
| Rate for Payer: One Health Plan of WY PPO |
$4,201.26
|
| Rate for Payer: PacificSource Commercial |
$3,858.30
|
| Rate for Payer: PHCS PPO |
$4,072.65
|
| Rate for Payer: Three Rivers PPO |
$3,215.25
|
| Rate for Payer: TriWest Veterans Administration |
$876.62
|
| Rate for Payer: United Healthcare Commercial |
$3,729.69
|
| Rate for Payer: United Healthcare Medicare |
$876.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,643.95
|
|
|
HC PRO PRTL HYMENECTOMY/REVJ HYMENAL RING
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
9835670001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$167.76 |
| Max. Negotiated Rate |
$1,697.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,663.06
|
| Rate for Payer: Aetna of WY Medicare |
$197.36
|
| Rate for Payer: Beech Street Commercial |
$1,612.15
|
| Rate for Payer: Cash Price |
$1,187.90
|
| Rate for Payer: Cash Price |
$1,187.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,646.09
|
| Rate for Payer: Cigna of WY Commercial |
$1,663.06
|
| Rate for Payer: First Choice Health Commercial |
$1,527.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,612.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.36
|
| Rate for Payer: HealthUtah PPO |
$1,697.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,646.09
|
| Rate for Payer: Multiplan Medicare/VA |
$167.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,663.06
|
| Rate for Payer: PacificSource Commercial |
$1,527.30
|
| Rate for Payer: PHCS PPO |
$1,612.15
|
| Rate for Payer: Three Rivers PPO |
$1,272.75
|
| Rate for Payer: TriWest Veterans Administration |
$197.36
|
| Rate for Payer: United Healthcare Commercial |
$1,476.39
|
| Rate for Payer: United Healthcare Medicare |
$197.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,442.45
|
|
|
HC PRO PUNCH BIOPSY SKIN LESION EACH ADDITIONAL
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
9831110501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$24.37
|
| Rate for Payer: Beech Street Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: First Choice Health Commercial |
$97.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.37
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$20.71
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$102.60
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$93.96
|
| Rate for Payer: United Healthcare Medicare |
$24.37
|
| Rate for Payer: WINHealth Partners Commercial |
$91.80
|
|
|
HC PRO PUNCH BIOPSY SKIN LESION EACH ADDITIONAL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 11105 NONPBBPAYER
|
| Hospital Charge Code |
9831110501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.30
|
| Rate for Payer: Aetna of WY Medicare |
$24.37
|
| Rate for Payer: Beech Street Commercial |
$128.25
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.95
|
| Rate for Payer: Cigna of WY Commercial |
$132.30
|
| Rate for Payer: First Choice Health Commercial |
$121.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.37
|
| Rate for Payer: HealthUtah PPO |
$135.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.95
|
| Rate for Payer: Multiplan Medicare/VA |
$20.71
|
| Rate for Payer: One Health Plan of WY PPO |
$132.30
|
| Rate for Payer: PacificSource Commercial |
$121.50
|
| Rate for Payer: PHCS PPO |
$128.25
|
| Rate for Payer: Three Rivers PPO |
$101.25
|
| Rate for Payer: TriWest Veterans Administration |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$117.45
|
| Rate for Payer: United Healthcare Medicare |
$24.37
|
| Rate for Payer: WINHealth Partners Commercial |
$114.75
|
|
|
HC PRO PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 11104 NONPBBPAYER
|
| Hospital Charge Code |
9831110401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.10
|
| Rate for Payer: Aetna of WY Medicare |
$44.66
|
| Rate for Payer: Beech Street Commercial |
$232.75
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.65
|
| Rate for Payer: Cigna of WY Commercial |
$240.10
|
| Rate for Payer: First Choice Health Commercial |
$220.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.66
|
| Rate for Payer: HealthUtah PPO |
$245.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.65
|
| Rate for Payer: Multiplan Medicare/VA |
$37.96
|
| Rate for Payer: One Health Plan of WY PPO |
$240.10
|
| Rate for Payer: PacificSource Commercial |
$220.50
|
| Rate for Payer: PHCS PPO |
$232.75
|
| Rate for Payer: Three Rivers PPO |
$183.75
|
| Rate for Payer: TriWest Veterans Administration |
$44.66
|
| Rate for Payer: United Healthcare Commercial |
$213.15
|
| Rate for Payer: United Healthcare Medicare |
$44.66
|
| Rate for Payer: WINHealth Partners Commercial |
$208.25
|
|
|
HC PRO PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
9831110401
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$192.08
|
| Rate for Payer: Aetna of WY Medicare |
$44.66
|
| Rate for Payer: Beech Street Commercial |
$186.20
|
| Rate for Payer: Cash Price |
$137.20
|
| Rate for Payer: Cash Price |
$137.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$190.12
|
| Rate for Payer: Cigna of WY Commercial |
$192.08
|
| Rate for Payer: First Choice Health Commercial |
$176.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$186.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.66
|
| Rate for Payer: HealthUtah PPO |
$196.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$190.12
|
| Rate for Payer: Multiplan Medicare/VA |
$37.96
|
| Rate for Payer: One Health Plan of WY PPO |
$192.08
|
| Rate for Payer: PacificSource Commercial |
$176.40
|
| Rate for Payer: PHCS PPO |
$186.20
|
| Rate for Payer: Three Rivers PPO |
$147.00
|
| Rate for Payer: TriWest Veterans Administration |
$44.66
|
| Rate for Payer: United Healthcare Commercial |
$170.52
|
| Rate for Payer: United Healthcare Medicare |
$44.66
|
| Rate for Payer: WINHealth Partners Commercial |
$166.60
|
|
|
HC PRO PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
9831016001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$519.40
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.42
|
| Rate for Payer: Aetna of WY Medicare |
$93.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.92
|
| Rate for Payer: Beech Street Commercial |
$360.05
|
| Rate for Payer: Beech Street Commercial |
$503.50
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$514.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.63
|
| Rate for Payer: Cigna of WY Commercial |
$371.42
|
| Rate for Payer: Cigna of WY Commercial |
$519.40
|
| Rate for Payer: First Choice Health Commercial |
$341.10
|
| Rate for Payer: First Choice Health Commercial |
$477.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$503.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.92
|
| Rate for Payer: HealthUtah PPO |
$530.00
|
| Rate for Payer: HealthUtah PPO |
$379.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$514.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.63
|
| Rate for Payer: Multiplan Medicare/VA |
$79.83
|
| Rate for Payer: Multiplan Medicare/VA |
$79.83
|
| Rate for Payer: One Health Plan of WY PPO |
$519.40
|
| Rate for Payer: One Health Plan of WY PPO |
$371.42
|
| Rate for Payer: PacificSource Commercial |
$341.10
|
| Rate for Payer: PacificSource Commercial |
$477.00
|
| Rate for Payer: PHCS PPO |
$503.50
|
| Rate for Payer: PHCS PPO |
$360.05
|
| Rate for Payer: Three Rivers PPO |
$397.50
|
| Rate for Payer: Three Rivers PPO |
$284.25
|
| Rate for Payer: TriWest Veterans Administration |
$93.92
|
| Rate for Payer: TriWest Veterans Administration |
$93.92
|
| Rate for Payer: United Healthcare Commercial |
$329.73
|
| Rate for Payer: United Healthcare Commercial |
$461.10
|
| Rate for Payer: United Healthcare Medicare |
$93.92
|
| Rate for Payer: United Healthcare Medicare |
$93.92
|
| Rate for Payer: WINHealth Partners Commercial |
$450.50
|
| Rate for Payer: WINHealth Partners Commercial |
$322.15
|
|
|
HC PRO PUNCTURE/ASPIRATE ABSCESS/HEMATOMA/BULLA/CYST
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 10160 NONPBBPAYER
|
| Hospital Charge Code |
9831016001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$464.52
|
| Rate for Payer: Aetna of WY Medicare |
$93.92
|
| Rate for Payer: Beech Street Commercial |
$450.30
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$459.78
|
| Rate for Payer: Cigna of WY Commercial |
$464.52
|
| Rate for Payer: First Choice Health Commercial |
$426.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$450.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.92
|
| Rate for Payer: HealthUtah PPO |
$474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$459.78
|
| Rate for Payer: Multiplan Medicare/VA |
$79.83
|
| Rate for Payer: One Health Plan of WY PPO |
$464.52
|
| Rate for Payer: PacificSource Commercial |
$426.60
|
| Rate for Payer: PHCS PPO |
$450.30
|
| Rate for Payer: Three Rivers PPO |
$355.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.92
|
| Rate for Payer: United Healthcare Commercial |
$412.38
|
| Rate for Payer: United Healthcare Medicare |
$93.92
|
| Rate for Payer: WINHealth Partners Commercial |
$402.90
|
|
|
HC PRO PVB THORACIC SINGLE INJECTION SITE W/IMG GID
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 64461 50
|
| Hospital Charge Code |
9646446101
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$63.13 |
| Max. Negotiated Rate |
$928.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$909.44
|
| Rate for Payer: Aetna of WY Medicare |
$74.27
|
| Rate for Payer: Beech Street Commercial |
$881.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: Cash Price |
$649.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$900.16
|
| Rate for Payer: Cigna of WY Commercial |
$909.44
|
| Rate for Payer: First Choice Health Commercial |
$835.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$881.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.27
|
| Rate for Payer: HealthUtah PPO |
$928.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$900.16
|
| Rate for Payer: Multiplan Medicare/VA |
$63.13
|
| Rate for Payer: One Health Plan of WY PPO |
$909.44
|
| Rate for Payer: PacificSource Commercial |
$835.20
|
| Rate for Payer: PHCS PPO |
$881.60
|
| Rate for Payer: Three Rivers PPO |
$696.00
|
| Rate for Payer: TriWest Veterans Administration |
$74.27
|
| Rate for Payer: United Healthcare Commercial |
$807.36
|
| Rate for Payer: United Healthcare Medicare |
$74.27
|
| Rate for Payer: WINHealth Partners Commercial |
$788.80
|
|
|
HC PRO PVB THORACIC SINGLE INJECTION SITE W/IMG GID
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 64461
|
| Hospital Charge Code |
9646446101
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$63.13 |
| Max. Negotiated Rate |
$464.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$454.72
|
| Rate for Payer: Aetna of WY Medicare |
$74.27
|
| Rate for Payer: Beech Street Commercial |
$440.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$450.08
|
| Rate for Payer: Cigna of WY Commercial |
$454.72
|
| Rate for Payer: First Choice Health Commercial |
$417.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$440.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.27
|
| Rate for Payer: HealthUtah PPO |
$464.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$450.08
|
| Rate for Payer: Multiplan Medicare/VA |
$63.13
|
| Rate for Payer: One Health Plan of WY PPO |
$454.72
|
| Rate for Payer: PacificSource Commercial |
$417.60
|
| Rate for Payer: PHCS PPO |
$440.80
|
| Rate for Payer: Three Rivers PPO |
$348.00
|
| Rate for Payer: TriWest Veterans Administration |
$74.27
|
| Rate for Payer: United Healthcare Commercial |
$403.68
|
| Rate for Payer: United Healthcare Medicare |
$74.27
|
| Rate for Payer: WINHealth Partners Commercial |
$394.40
|
|
|
HC PRO/QHP TELEPHONE EVALUATION 11-20 MIN
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 99442
|
| Hospital Charge Code |
9839944201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$63.08
|
| Rate for Payer: Beech Street Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: First Choice Health Commercial |
$80.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.08
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$53.62
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$84.55
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.08
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$63.08
|
| Rate for Payer: WINHealth Partners Commercial |
$84.55
|
|
|
HC PRO/QHP TELEPHONE EVALUATION 21-30 MIN
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 99443
|
| Hospital Charge Code |
9839944301
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$93.43
|
| Rate for Payer: Beech Street Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: First Choice Health Commercial |
$118.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.43
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$79.42
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$125.40
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$93.43
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$93.43
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
|
|
HC PRO/QHP TELEPHONE EVALUATION 21-30 MIN
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 99443
|
| Hospital Charge Code |
9009944301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Aetna of WY Medicare |
$93.43
|
| Rate for Payer: Beech Street Commercial |
$408.50
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$417.10
|
| Rate for Payer: Cigna of WY Commercial |
$421.40
|
| Rate for Payer: First Choice Health Commercial |
$387.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.43
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$79.42
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$408.50
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$93.43
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$93.43
|
| Rate for Payer: WINHealth Partners Commercial |
$408.50
|
|
|
HC PRO RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 25115
|
| Hospital Charge Code |
9832511501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$628.01 |
| Max. Negotiated Rate |
$2,637.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,584.26
|
| Rate for Payer: Aetna of WY Medicare |
$738.84
|
| Rate for Payer: Beech Street Commercial |
$2,505.15
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: Cash Price |
$1,845.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,557.89
|
| Rate for Payer: Cigna of WY Commercial |
$2,584.26
|
| Rate for Payer: First Choice Health Commercial |
$2,373.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,505.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$738.84
|
| Rate for Payer: HealthUtah PPO |
$2,637.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,557.89
|
| Rate for Payer: Multiplan Medicare/VA |
$628.01
|
| Rate for Payer: One Health Plan of WY PPO |
$2,584.26
|
| Rate for Payer: PacificSource Commercial |
$2,373.30
|
| Rate for Payer: PHCS PPO |
$2,505.15
|
| Rate for Payer: Three Rivers PPO |
$1,977.75
|
| Rate for Payer: TriWest Veterans Administration |
$738.84
|
| Rate for Payer: United Healthcare Commercial |
$2,294.19
|
| Rate for Payer: United Healthcare Medicare |
$738.84
|
| Rate for Payer: WINHealth Partners Commercial |
$2,241.45
|
|
|
HC PRO RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,119.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
9822511601
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$504.79 |
| Max. Negotiated Rate |
$2,119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,076.62
|
| Rate for Payer: Aetna of WY Medicare |
$593.87
|
| Rate for Payer: Beech Street Commercial |
$2,013.05
|
| Rate for Payer: Cash Price |
$1,483.30
|
| Rate for Payer: Cash Price |
$1,483.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,055.43
|
| Rate for Payer: Cigna of WY Commercial |
$2,076.62
|
| Rate for Payer: First Choice Health Commercial |
$1,907.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,013.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$593.87
|
| Rate for Payer: HealthUtah PPO |
$2,119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,055.43
|
| Rate for Payer: Multiplan Medicare/VA |
$504.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,076.62
|
| Rate for Payer: PacificSource Commercial |
$1,907.10
|
| Rate for Payer: PHCS PPO |
$2,013.05
|
| Rate for Payer: Three Rivers PPO |
$1,589.25
|
| Rate for Payer: TriWest Veterans Administration |
$593.87
|
| Rate for Payer: United Healthcare Commercial |
$1,843.53
|
| Rate for Payer: United Healthcare Medicare |
$593.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,801.15
|
|
|
HC PRO RADICAL STYLOIDECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 25230
|
| Hospital Charge Code |
9832523001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$363.04 |
| Max. Negotiated Rate |
$3,371.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,303.58
|
| Rate for Payer: Aetna of WY Medicare |
$427.11
|
| Rate for Payer: Beech Street Commercial |
$3,202.45
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: Cash Price |
$2,359.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,269.87
|
| Rate for Payer: Cigna of WY Commercial |
$3,303.58
|
| Rate for Payer: First Choice Health Commercial |
$3,033.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,202.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$427.11
|
| Rate for Payer: HealthUtah PPO |
$3,371.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,269.87
|
| Rate for Payer: Multiplan Medicare/VA |
$363.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3,303.58
|
| Rate for Payer: PacificSource Commercial |
$3,033.90
|
| Rate for Payer: PHCS PPO |
$3,202.45
|
| Rate for Payer: Three Rivers PPO |
$2,528.25
|
| Rate for Payer: TriWest Veterans Administration |
$427.11
|
| Rate for Payer: United Healthcare Commercial |
$2,932.77
|
| Rate for Payer: United Healthcare Medicare |
$427.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,865.35
|
|
|
HC PRO RADIOACTIVE TRACER IDENTIFY SENTINEL NODE
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
9833879201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,799.28
|
| Rate for Payer: Aetna of WY Medicare |
$30.42
|
| Rate for Payer: Beech Street Commercial |
$1,744.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,780.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,799.28
|
| Rate for Payer: First Choice Health Commercial |
$1,652.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,744.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.42
|
| Rate for Payer: HealthUtah PPO |
$1,836.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,780.92
|
| Rate for Payer: Multiplan Medicare/VA |
$25.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,799.28
|
| Rate for Payer: PacificSource Commercial |
$1,652.40
|
| Rate for Payer: PHCS PPO |
$1,744.20
|
| Rate for Payer: Three Rivers PPO |
$1,377.00
|
| Rate for Payer: TriWest Veterans Administration |
$30.42
|
| Rate for Payer: United Healthcare Commercial |
$1,597.32
|
| Rate for Payer: United Healthcare Medicare |
$30.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,560.60
|
|
|
HC PRO RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$2,538.00
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
9836462501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$160.22 |
| Max. Negotiated Rate |
$2,538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,487.24
|
| Rate for Payer: Aetna of WY Medicare |
$188.49
|
| Rate for Payer: Beech Street Commercial |
$2,411.10
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: Cash Price |
$1,776.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,461.86
|
| Rate for Payer: Cigna of WY Commercial |
$2,487.24
|
| Rate for Payer: First Choice Health Commercial |
$2,284.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,411.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.49
|
| Rate for Payer: HealthUtah PPO |
$2,538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,461.86
|
| Rate for Payer: Multiplan Medicare/VA |
$160.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,487.24
|
| Rate for Payer: PacificSource Commercial |
$2,284.20
|
| Rate for Payer: PHCS PPO |
$2,411.10
|
| Rate for Payer: Three Rivers PPO |
$1,903.50
|
| Rate for Payer: TriWest Veterans Administration |
$188.49
|
| Rate for Payer: United Healthcare Commercial |
$2,208.06
|
| Rate for Payer: United Healthcare Medicare |
$188.49
|
| Rate for Payer: WINHealth Partners Commercial |
$2,157.30
|
|
|
HC PRO RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$5,076.00
|
|
|
Service Code
|
HCPCS 64625 50
|
| Hospital Charge Code |
9836462501
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$160.22 |
| Max. Negotiated Rate |
$5,076.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,974.48
|
| Rate for Payer: Aetna of WY Medicare |
$188.49
|
| Rate for Payer: Beech Street Commercial |
$4,822.20
|
| Rate for Payer: Cash Price |
$3,553.20
|
| Rate for Payer: Cash Price |
$3,553.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,923.72
|
| Rate for Payer: Cigna of WY Commercial |
$4,974.48
|
| Rate for Payer: First Choice Health Commercial |
$4,568.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,822.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.49
|
| Rate for Payer: HealthUtah PPO |
$5,076.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,923.72
|
| Rate for Payer: Multiplan Medicare/VA |
$160.22
|
| Rate for Payer: One Health Plan of WY PPO |
$4,974.48
|
| Rate for Payer: PacificSource Commercial |
$4,568.40
|
| Rate for Payer: PHCS PPO |
$4,822.20
|
| Rate for Payer: Three Rivers PPO |
$3,807.00
|
| Rate for Payer: TriWest Veterans Administration |
$188.49
|
| Rate for Payer: United Healthcare Commercial |
$4,416.12
|
| Rate for Payer: United Healthcare Medicare |
$188.49
|
| Rate for Payer: WINHealth Partners Commercial |
$4,314.60
|
|
|
HC PRO RADIOLOGIC EXAM CHEST 2 VIEWS - XR CHEST 2 VIEWS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 71046 TC
|
| Hospital Charge Code |
9727104601
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$275.38
|
| Rate for Payer: Aetna of WY Medicare |
$22.84
|
| Rate for Payer: Beech Street Commercial |
$266.95
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: Cash Price |
$196.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$272.57
|
| Rate for Payer: Cigna of WY Commercial |
$275.38
|
| Rate for Payer: First Choice Health Commercial |
$252.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.84
|
| Rate for Payer: HealthUtah PPO |
$281.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$272.57
|
| Rate for Payer: Multiplan Medicare/VA |
$19.41
|
| Rate for Payer: One Health Plan of WY PPO |
$275.38
|
| Rate for Payer: PacificSource Commercial |
$252.90
|
| Rate for Payer: PHCS PPO |
$266.95
|
| Rate for Payer: Three Rivers PPO |
$210.75
|
| Rate for Payer: TriWest Veterans Administration |
$22.84
|
| Rate for Payer: United Healthcare Commercial |
$244.47
|
| Rate for Payer: United Healthcare Medicare |
$22.84
|
| Rate for Payer: WINHealth Partners Commercial |
$266.95
|
|
|
HC PRO RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
9832742201
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$612.94 |
| Max. Negotiated Rate |
$2,574.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,522.52
|
| Rate for Payer: Aetna of WY Medicare |
$721.10
|
| Rate for Payer: Beech Street Commercial |
$2,445.30
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: Cash Price |
$1,801.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,496.78
|
| Rate for Payer: Cigna of WY Commercial |
$2,522.52
|
| Rate for Payer: First Choice Health Commercial |
$2,316.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,445.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$721.10
|
| Rate for Payer: HealthUtah PPO |
$2,574.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,496.78
|
| Rate for Payer: Multiplan Medicare/VA |
$612.94
|
| Rate for Payer: One Health Plan of WY PPO |
$2,522.52
|
| Rate for Payer: PacificSource Commercial |
$2,316.60
|
| Rate for Payer: PHCS PPO |
$2,445.30
|
| Rate for Payer: Three Rivers PPO |
$1,930.50
|
| Rate for Payer: TriWest Veterans Administration |
$721.10
|
| Rate for Payer: United Healthcare Commercial |
$2,239.38
|
| Rate for Payer: United Healthcare Medicare |
$721.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,187.90
|
|
|
HC PRO RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27420
|
| Hospital Charge Code |
9832742001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$619.74 |
| Max. Negotiated Rate |
$2,602.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,549.96
|
| Rate for Payer: Aetna of WY Medicare |
$729.10
|
| Rate for Payer: Beech Street Commercial |
$2,471.90
|
| Rate for Payer: Cash Price |
$1,821.40
|
| Rate for Payer: Cash Price |
$1,821.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,523.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,549.96
|
| Rate for Payer: First Choice Health Commercial |
$2,341.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,471.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$729.10
|
| Rate for Payer: HealthUtah PPO |
$2,602.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,523.94
|
| Rate for Payer: Multiplan Medicare/VA |
$619.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,549.96
|
| Rate for Payer: PacificSource Commercial |
$2,341.80
|
| Rate for Payer: PHCS PPO |
$2,471.90
|
| Rate for Payer: Three Rivers PPO |
$1,951.50
|
| Rate for Payer: TriWest Veterans Administration |
$729.10
|
| Rate for Payer: United Healthcare Commercial |
$2,263.74
|
| Rate for Payer: United Healthcare Medicare |
$729.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,211.70
|
|
