|
HC X-RAY URETHROCYSTOGRAM+VOIDING - FL VOIDING CYSTOURETHROGRAM
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 74455
|
| Hospital Charge Code |
3207445501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$702.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$739.20
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$702.24
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$739.20
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$739.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,064.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC X-RAY URETHROCYSTOGRAM+VOIDING - FL VOIDING CYSTOURETHROGRAM
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 74455
|
| Hospital Charge Code |
3207445501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$617.12 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,097.60
|
| Rate for Payer: Aetna of WY Medicare |
$739.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,075.20
|
| Rate for Payer: Altius Commercial |
$1,075.20
|
| Rate for Payer: Beech Street Commercial |
$1,097.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$919.52
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,086.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,097.60
|
| Rate for Payer: Entrust Commercial |
$1,064.00
|
| Rate for Payer: First Choice Health Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,064.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$649.60
|
| Rate for Payer: HealthUtah PPO |
$1,120.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,086.40
|
| Rate for Payer: Multiplan Medicare/VA |
$617.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,097.60
|
| Rate for Payer: PacificSource Commercial |
$1,008.00
|
| Rate for Payer: PHCS PPO |
$1,097.60
|
| Rate for Payer: Three Rivers PPO |
$840.00
|
| Rate for Payer: TriWest Veterans Administration |
$649.60
|
| Rate for Payer: United Healthcare Commercial |
$974.40
|
| Rate for Payer: United Healthcare Medicare |
$649.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.60
|
| Rate for Payer: Wise Provider Network Commercial |
$1,064.00
|
|
|
HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
3207310003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Aetna of WY Medicare |
$283.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| 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: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.40
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$236.93
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.40
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$249.40
|
| Rate for Payer: WINHealth Partners Commercial |
$421.40
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
3207310003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.61 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$421.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$412.80
|
| Rate for Payer: Altius Commercial |
$412.80
|
| Rate for Payer: Beech Street Commercial |
$421.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.03
|
| 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: Entrust Commercial |
$408.50
|
| Rate for Payer: First Choice Health Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$408.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$283.80
|
| Rate for Payer: HealthUtah PPO |
$430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$417.10
|
| Rate for Payer: Multiplan Medicare/VA |
$269.61
|
| Rate for Payer: One Health Plan of WY PPO |
$421.40
|
| Rate for Payer: PacificSource Commercial |
$387.00
|
| Rate for Payer: PHCS PPO |
$421.40
|
| Rate for Payer: Three Rivers PPO |
$322.50
|
| Rate for Payer: TriWest Veterans Administration |
$283.80
|
| Rate for Payer: United Healthcare Commercial |
$374.10
|
| Rate for Payer: United Healthcare Medicare |
$283.80
|
| Rate for Payer: WINHealth Partners Commercial |
$408.50
|
| Rate for Payer: Wise Provider Network Commercial |
$408.50
|
|
|
HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS LEFT
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
3207310001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Aetna of WY Medicare |
$306.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$269.70
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$256.22
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$269.70
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$269.70
|
| Rate for Payer: WINHealth Partners Commercial |
$455.70
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS LEFT
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
3207310001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.90
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$291.56
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.90
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$306.90
|
| Rate for Payer: WINHealth Partners Commercial |
$441.75
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS RIGHT
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
3207310002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.22 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Aetna of WY Medicare |
$306.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$269.70
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$256.22
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$269.70
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$269.70
|
| Rate for Payer: WINHealth Partners Commercial |
$455.70
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS RIGHT
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
HCPCS 73100
|
| Hospital Charge Code |
3207310002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.56 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$455.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$446.40
|
| Rate for Payer: Altius Commercial |
$446.40
|
| Rate for Payer: Beech Street Commercial |
$455.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$381.76
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$451.05
|
| Rate for Payer: Cigna of WY Commercial |
$455.70
|
| Rate for Payer: Entrust Commercial |
$441.75
|
| Rate for Payer: First Choice Health Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$441.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$306.90
|
| Rate for Payer: HealthUtah PPO |
$465.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$451.05
|
| Rate for Payer: Multiplan Medicare/VA |
$291.56
|
| Rate for Payer: One Health Plan of WY PPO |
$455.70
|
| Rate for Payer: PacificSource Commercial |
$418.50
|
| Rate for Payer: PHCS PPO |
$455.70
|
| Rate for Payer: Three Rivers PPO |
$348.75
|
| Rate for Payer: TriWest Veterans Administration |
$306.90
|
| Rate for Payer: United Healthcare Commercial |
$404.55
|
| Rate for Payer: United Healthcare Medicare |
$306.90
|
| Rate for Payer: WINHealth Partners Commercial |
$441.75
|
| Rate for Payer: Wise Provider Network Commercial |
$441.75
|
|
|
HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
3207311003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
3207311003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS LEFT
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
3207311001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS LEFT
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
3207311001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS RIGHT
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
3207311002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Aetna of WY Medicare |
$356.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.20
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$297.54
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$313.20
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$313.20
|
| Rate for Payer: WINHealth Partners Commercial |
$529.20
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS RIGHT
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
HCPCS 73110
|
| Hospital Charge Code |
3207311002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$529.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$518.40
|
| Rate for Payer: Altius Commercial |
$518.40
|
| Rate for Payer: Beech Street Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$443.34
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$523.80
|
| Rate for Payer: Cigna of WY Commercial |
$529.20
|
| Rate for Payer: Entrust Commercial |
$513.00
|
| Rate for Payer: First Choice Health Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.40
|
| Rate for Payer: HealthUtah PPO |
$540.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$523.80
|
| Rate for Payer: Multiplan Medicare/VA |
$338.58
|
| Rate for Payer: One Health Plan of WY PPO |
$529.20
|
| Rate for Payer: PacificSource Commercial |
$486.00
|
| Rate for Payer: PHCS PPO |
$529.20
|
| Rate for Payer: Three Rivers PPO |
$405.00
|
| Rate for Payer: TriWest Veterans Administration |
$356.40
|
| Rate for Payer: United Healthcare Commercial |
$469.80
|
| Rate for Payer: United Healthcare Medicare |
$356.40
|
| Rate for Payer: WINHealth Partners Commercial |
$513.00
|
| Rate for Payer: Wise Provider Network Commercial |
$513.00
|
|
|
HC XR SCREENI DIGITAL BREAST TOMOSYNTHESIS
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
4037706304
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$68.97 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.60
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$68.97
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.60
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$72.60
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HC XR SCREENI DIGITAL BREAST TOMOSYNTHESIS
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
4037706304
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$50.82 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$72.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$105.60
|
| Rate for Payer: Altius Commercial |
$105.60
|
| Rate for Payer: Beech Street Commercial |
$107.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$90.31
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: Entrust Commercial |
$104.50
|
| Rate for Payer: First Choice Health Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$60.61
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$107.80
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$50.82
|
| Rate for Payer: WINHealth Partners Commercial |
$107.80
|
| Rate for Payer: Wise Provider Network Commercial |
$104.50
|
|
|
HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 96156
|
| Hospital Charge Code |
96156
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.88
|
| Rate for Payer: Aetna of WY Medicare |
$85.52
|
| Rate for Payer: Beech Street Commercial |
$243.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.32
|
| Rate for Payer: Cigna of WY Commercial |
$250.88
|
| Rate for Payer: First Choice Health Commercial |
$230.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.52
|
| Rate for Payer: HealthUtah PPO |
$256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.32
|
| Rate for Payer: Multiplan Medicare/VA |
$72.69
|
| Rate for Payer: One Health Plan of WY PPO |
$250.88
|
| Rate for Payer: PacificSource Commercial |
$230.40
|
| Rate for Payer: PHCS PPO |
$243.20
|
| Rate for Payer: Three Rivers PPO |
$192.00
|
| Rate for Payer: TriWest Veterans Administration |
$85.52
|
| Rate for Payer: United Healthcare Commercial |
$222.72
|
| Rate for Payer: United Healthcare Medicare |
$85.52
|
| Rate for Payer: WINHealth Partners Commercial |
$243.20
|
|
|
HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 96170
|
| Hospital Charge Code |
96170
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 96171
|
| Hospital Charge Code |
96171
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Beech Street Commercial |
$74.10
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: First Choice Health Commercial |
$70.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$74.10
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$67.86
|
| Rate for Payer: WINHealth Partners Commercial |
$74.10
|
|
|
HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 96167
|
| Hospital Charge Code |
96167
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$60.56
|
| Rate for Payer: Beech Street Commercial |
$76.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: First Choice Health Commercial |
$72.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.56
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$51.48
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$76.95
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.56
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$60.56
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
|
|
HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 96164
|
| Hospital Charge Code |
96164
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$79.38
|
| Rate for Payer: Aetna of WY Medicare |
$9.08
|
| Rate for Payer: Beech Street Commercial |
$76.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.57
|
| Rate for Payer: Cigna of WY Commercial |
$79.38
|
| Rate for Payer: First Choice Health Commercial |
$72.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.08
|
| Rate for Payer: HealthUtah PPO |
$81.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.57
|
| Rate for Payer: Multiplan Medicare/VA |
$7.72
|
| Rate for Payer: One Health Plan of WY PPO |
$79.38
|
| Rate for Payer: PacificSource Commercial |
$72.90
|
| Rate for Payer: PHCS PPO |
$76.95
|
| Rate for Payer: Three Rivers PPO |
$60.75
|
| Rate for Payer: TriWest Veterans Administration |
$9.08
|
| Rate for Payer: United Healthcare Commercial |
$70.47
|
| Rate for Payer: United Healthcare Medicare |
$9.08
|
| Rate for Payer: WINHealth Partners Commercial |
$76.95
|
|
|
HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 96165
|
| Hospital Charge Code |
96165
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Aetna of WY Medicare |
$3.93
|
| Rate for Payer: Beech Street Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: First Choice Health Commercial |
$12.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.93
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: Multiplan Medicare/VA |
$3.34
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.30
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: TriWest Veterans Administration |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$12.18
|
| Rate for Payer: United Healthcare Medicare |
$3.93
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
|
|
HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 96158
|
| Hospital Charge Code |
96158
|
| Min. Negotiated Rate |
$48.70 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$57.29
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.29
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$48.70
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$57.29
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$57.29
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
|
|
HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 96159
|
| Hospital Charge Code |
96159
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$19.23
|
| Rate for Payer: Beech Street Commercial |
$59.85
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: First Choice Health Commercial |
$56.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.23
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$16.35
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$59.85
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$19.23
|
| Rate for Payer: United Healthcare Commercial |
$54.81
|
| Rate for Payer: United Healthcare Medicare |
$19.23
|
| Rate for Payer: WINHealth Partners Commercial |
$59.85
|
|
|
HEARING AID EXAMINATION & SELECTION BINAURAL
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 92591
|
| Hospital Charge Code |
92591
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.96
|
| Rate for Payer: Beech Street Commercial |
$49.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.44
|
| Rate for Payer: Cigna of WY Commercial |
$50.96
|
| Rate for Payer: First Choice Health Commercial |
$46.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.40
|
| Rate for Payer: HealthUtah PPO |
$52.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.44
|
| Rate for Payer: One Health Plan of WY PPO |
$50.96
|
| Rate for Payer: PacificSource Commercial |
$46.80
|
| Rate for Payer: PHCS PPO |
$49.40
|
| Rate for Payer: Three Rivers PPO |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$45.24
|
| Rate for Payer: WINHealth Partners Commercial |
$49.40
|
|
