|
CANNULA TWISTIN GREEN AR-6535
|
Facility
|
OP
|
$102.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Aetna of WY Medicare |
$67.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.11
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.91
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.28
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$56.31
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$59.28
|
| Rate for Payer: United Healthcare Commercial |
$88.91
|
| Rate for Payer: United Healthcare Medicare |
$59.28
|
| Rate for Payer: WINHealth Partners Commercial |
$100.16
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
CANNULA TWISTIN PURPLE AR-6570
|
Facility
|
OP
|
$102.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Aetna of WY Medicare |
$67.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.11
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.91
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.28
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$56.31
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$59.28
|
| Rate for Payer: United Healthcare Commercial |
$88.91
|
| Rate for Payer: United Healthcare Medicare |
$59.28
|
| Rate for Payer: WINHealth Partners Commercial |
$100.16
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
CANNULA TWISTIN PURPLE AR-6570
|
Facility
|
IP
|
$102.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.08 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.11
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.91
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.45
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$64.08
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$67.45
|
| Rate for Payer: United Healthcare Commercial |
$88.91
|
| Rate for Payer: United Healthcare Medicare |
$67.45
|
| Rate for Payer: WINHealth Partners Commercial |
$97.09
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
CAPIO SLIM SUTURE CAPTURING DEVICE
|
Facility
|
OP
|
$2,109.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,162.23 |
| Max. Negotiated Rate |
$2,109.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,067.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,392.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,024.94
|
| Rate for Payer: Altius Commercial |
$2,024.94
|
| Rate for Payer: Beech Street Commercial |
$2,067.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,731.74
|
| Rate for Payer: Cash Price |
$1,476.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,046.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,067.12
|
| Rate for Payer: Entrust Commercial |
$2,003.84
|
| Rate for Payer: First Choice Health Commercial |
$2,003.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,003.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,223.40
|
| Rate for Payer: HealthUtah PPO |
$2,109.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,046.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,162.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2,067.12
|
| Rate for Payer: PacificSource Commercial |
$1,898.38
|
| Rate for Payer: PHCS PPO |
$2,067.12
|
| Rate for Payer: Three Rivers PPO |
$1,581.98
|
| Rate for Payer: TriWest Veterans Administration |
$1,223.40
|
| Rate for Payer: United Healthcare Commercial |
$1,835.10
|
| Rate for Payer: United Healthcare Medicare |
$1,223.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,067.12
|
| Rate for Payer: Wise Provider Network Commercial |
$2,003.84
|
|
|
CAPIO SLIM SUTURE CAPTURING DEVICE
|
Facility
|
IP
|
$2,109.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,322.54 |
| Max. Negotiated Rate |
$2,109.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,067.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,024.94
|
| Rate for Payer: Altius Commercial |
$2,024.94
|
| Rate for Payer: Beech Street Commercial |
$2,067.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,731.74
|
| Rate for Payer: Cash Price |
$1,476.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,046.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,067.12
|
| Rate for Payer: Entrust Commercial |
$2,003.84
|
| Rate for Payer: First Choice Health Commercial |
$2,003.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,003.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,392.14
|
| Rate for Payer: HealthUtah PPO |
$2,109.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,046.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,322.54
|
| Rate for Payer: One Health Plan of WY PPO |
$2,067.12
|
| Rate for Payer: PacificSource Commercial |
$1,898.38
|
| Rate for Payer: PHCS PPO |
$2,067.12
|
| Rate for Payer: Three Rivers PPO |
$1,581.98
|
| Rate for Payer: TriWest Veterans Administration |
$1,392.14
|
| Rate for Payer: United Healthcare Commercial |
$1,835.10
|
| Rate for Payer: United Healthcare Medicare |
$1,392.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,003.84
|
| Rate for Payer: Wise Provider Network Commercial |
$2,003.84
|
|
|
CAPIO SUTURE NA BRAID 26MM 1/2 TAPER 36"
|
Facility
|
OP
|
$152.74
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.16 |
| Max. Negotiated Rate |
$152.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.69
|
| Rate for Payer: Aetna of WY Medicare |
$100.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$146.63
|
| Rate for Payer: Altius Commercial |
$146.63
|
| Rate for Payer: Beech Street Commercial |
$149.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$106.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.16
|
| Rate for Payer: Cigna of WY Commercial |
$149.69
|
| Rate for Payer: Entrust Commercial |
$145.10
|
| Rate for Payer: First Choice Health Commercial |
$145.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.59
|
| Rate for Payer: HealthUtah PPO |
$152.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.16
|
| Rate for Payer: Multiplan Medicare/VA |
$84.16
|
| Rate for Payer: One Health Plan of WY PPO |
$149.69
|
| Rate for Payer: PacificSource Commercial |
$137.47
|
| Rate for Payer: PHCS PPO |
$149.69
|
| Rate for Payer: Three Rivers PPO |
$114.56
|
| Rate for Payer: TriWest Veterans Administration |
$88.59
|
| Rate for Payer: United Healthcare Commercial |
$132.88
|
| Rate for Payer: United Healthcare Medicare |
$88.59
|
| Rate for Payer: WINHealth Partners Commercial |
$149.69
|
| Rate for Payer: Wise Provider Network Commercial |
$145.10
|
|
|
CAPIO SUTURE NA BRAID 26MM 1/2 TAPER 36"
|
Facility
|
IP
|
$152.74
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.77 |
| Max. Negotiated Rate |
$152.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$146.63
|
| Rate for Payer: Altius Commercial |
$146.63
|
| Rate for Payer: Beech Street Commercial |
$149.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$106.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$148.16
|
| Rate for Payer: Cigna of WY Commercial |
$149.69
|
| Rate for Payer: Entrust Commercial |
$145.10
|
| Rate for Payer: First Choice Health Commercial |
$145.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.81
|
| Rate for Payer: HealthUtah PPO |
$152.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$148.16
|
| Rate for Payer: Multiplan Medicare/VA |
$95.77
|
| Rate for Payer: One Health Plan of WY PPO |
$149.69
|
| Rate for Payer: PacificSource Commercial |
$137.47
|
| Rate for Payer: PHCS PPO |
$149.69
|
| Rate for Payer: Three Rivers PPO |
$114.56
|
| Rate for Payer: TriWest Veterans Administration |
$100.81
|
| Rate for Payer: United Healthcare Commercial |
$132.88
|
| Rate for Payer: United Healthcare Medicare |
$100.81
|
| Rate for Payer: WINHealth Partners Commercial |
$145.10
|
| Rate for Payer: Wise Provider Network Commercial |
$145.10
|
|
|
CAPNOLINE CO2/O2 TUBING ADULT
|
Facility
|
OP
|
$30.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.76
|
| Rate for Payer: Aetna of WY Medicare |
$20.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.16
|
| Rate for Payer: Altius Commercial |
$29.16
|
| Rate for Payer: Beech Street Commercial |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.93
|
| Rate for Payer: Cash Price |
$21.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.46
|
| Rate for Payer: Cigna of WY Commercial |
$29.76
|
| Rate for Payer: Entrust Commercial |
$28.85
|
| Rate for Payer: First Choice Health Commercial |
$28.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.61
|
| Rate for Payer: HealthUtah PPO |
$30.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.46
|
| Rate for Payer: Multiplan Medicare/VA |
$16.73
|
| Rate for Payer: One Health Plan of WY PPO |
$29.76
|
| Rate for Payer: PacificSource Commercial |
$27.33
|
| Rate for Payer: PHCS PPO |
$29.76
|
| Rate for Payer: Three Rivers PPO |
$22.78
|
| Rate for Payer: TriWest Veterans Administration |
$17.61
|
| Rate for Payer: United Healthcare Commercial |
$26.42
|
| Rate for Payer: United Healthcare Medicare |
$17.61
|
| Rate for Payer: WINHealth Partners Commercial |
$29.76
|
| Rate for Payer: Wise Provider Network Commercial |
$28.85
|
|
|
CAPNOLINE CO2/O2 TUBING ADULT
|
Facility
|
IP
|
$30.37
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.04 |
| Max. Negotiated Rate |
$30.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.16
|
| Rate for Payer: Altius Commercial |
$29.16
|
| Rate for Payer: Beech Street Commercial |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.93
|
| Rate for Payer: Cash Price |
$21.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.46
|
| Rate for Payer: Cigna of WY Commercial |
$29.76
|
| Rate for Payer: Entrust Commercial |
$28.85
|
| Rate for Payer: First Choice Health Commercial |
$28.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.04
|
| Rate for Payer: HealthUtah PPO |
$30.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.46
|
| Rate for Payer: Multiplan Medicare/VA |
$19.04
|
| Rate for Payer: One Health Plan of WY PPO |
$29.76
|
| Rate for Payer: PacificSource Commercial |
$27.33
|
| Rate for Payer: PHCS PPO |
$29.76
|
| Rate for Payer: Three Rivers PPO |
$22.78
|
| Rate for Payer: TriWest Veterans Administration |
$20.04
|
| Rate for Payer: United Healthcare Commercial |
$26.42
|
| Rate for Payer: United Healthcare Medicare |
$20.04
|
| Rate for Payer: WINHealth Partners Commercial |
$28.85
|
| Rate for Payer: Wise Provider Network Commercial |
$28.85
|
|
|
CAPNOLINE CO2/O2 TUBING PEDS
|
Facility
|
OP
|
$36.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.11
|
| Rate for Payer: Aetna of WY Medicare |
$24.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.38
|
| Rate for Payer: Altius Commercial |
$35.38
|
| Rate for Payer: Beech Street Commercial |
$36.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.74
|
| Rate for Payer: Cigna of WY Commercial |
$36.11
|
| Rate for Payer: Entrust Commercial |
$35.01
|
| Rate for Payer: First Choice Health Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.37
|
| Rate for Payer: HealthUtah PPO |
$36.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.74
|
| Rate for Payer: Multiplan Medicare/VA |
$20.30
|
| Rate for Payer: One Health Plan of WY PPO |
$36.11
|
| Rate for Payer: PacificSource Commercial |
$33.16
|
| Rate for Payer: PHCS PPO |
$36.11
|
| Rate for Payer: Three Rivers PPO |
$27.64
|
| Rate for Payer: TriWest Veterans Administration |
$21.37
|
| Rate for Payer: United Healthcare Commercial |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$21.37
|
| Rate for Payer: WINHealth Partners Commercial |
$36.11
|
| Rate for Payer: Wise Provider Network Commercial |
$35.01
|
|
|
CAPNOLINE CO2/O2 TUBING PEDS
|
Facility
|
IP
|
$36.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.38
|
| Rate for Payer: Altius Commercial |
$35.38
|
| Rate for Payer: Beech Street Commercial |
$36.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.25
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.74
|
| Rate for Payer: Cigna of WY Commercial |
$36.11
|
| Rate for Payer: Entrust Commercial |
$35.01
|
| Rate for Payer: First Choice Health Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.32
|
| Rate for Payer: HealthUtah PPO |
$36.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.74
|
| Rate for Payer: Multiplan Medicare/VA |
$23.10
|
| Rate for Payer: One Health Plan of WY PPO |
$36.11
|
| Rate for Payer: PacificSource Commercial |
$33.16
|
| Rate for Payer: PHCS PPO |
$36.11
|
| Rate for Payer: Three Rivers PPO |
$27.64
|
| Rate for Payer: TriWest Veterans Administration |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$24.32
|
| Rate for Payer: WINHealth Partners Commercial |
$35.01
|
| Rate for Payer: Wise Provider Network Commercial |
$35.01
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$6,894.00
|
|
|
Service Code
|
HCPCS 25320 50
|
| Hospital Charge Code |
25320
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$6,894.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,756.12
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$6,549.30
|
| Rate for Payer: Cash Price |
$4,825.80
|
| Rate for Payer: Cash Price |
$4,825.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,687.18
|
| Rate for Payer: Cigna of WY Commercial |
$6,756.12
|
| Rate for Payer: First Choice Health Commercial |
$6,204.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,549.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$6,894.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,687.18
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$6,756.12
|
| Rate for Payer: PacificSource Commercial |
$6,204.60
|
| Rate for Payer: PHCS PPO |
$6,549.30
|
| Rate for Payer: Three Rivers PPO |
$5,170.50
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$5,997.78
|
| Rate for Payer: United Healthcare Medicare |
$965.90
|
| Rate for Payer: WINHealth Partners Commercial |
$5,859.90
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$3,447.00
|
|
|
Service Code
|
HCPCS 25320 80
|
| Hospital Charge Code |
25320
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$3,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,378.06
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$3,274.65
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,343.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,378.06
|
| Rate for Payer: First Choice Health Commercial |
$3,102.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,274.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$3,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,343.59
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,378.06
|
| Rate for Payer: PacificSource Commercial |
$3,102.30
|
| Rate for Payer: PHCS PPO |
$3,274.65
|
| Rate for Payer: Three Rivers PPO |
$2,585.25
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$2,998.89
|
| Rate for Payer: United Healthcare Medicare |
$965.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,929.95
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$3,447.00
|
|
|
Service Code
|
HCPCS 25320
|
| Hospital Charge Code |
25320
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$3,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,378.06
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$3,274.65
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,343.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,378.06
|
| Rate for Payer: First Choice Health Commercial |
$3,102.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,274.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$3,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,343.59
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,378.06
|
| Rate for Payer: PacificSource Commercial |
$3,102.30
|
| Rate for Payer: PHCS PPO |
$3,274.65
|
| Rate for Payer: Three Rivers PPO |
$2,585.25
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$2,998.89
|
| Rate for Payer: United Healthcare Medicare |
$965.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,929.95
|
|
|
CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS
|
Professional
|
Both
|
$3,447.00
|
|
|
Service Code
|
HCPCS 25320 AS
|
| Hospital Charge Code |
25320
|
| Min. Negotiated Rate |
$821.02 |
| Max. Negotiated Rate |
$3,447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,378.06
|
| Rate for Payer: Aetna of WY Medicare |
$965.90
|
| Rate for Payer: Beech Street Commercial |
$3,274.65
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: Cash Price |
$2,412.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,343.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,378.06
|
| Rate for Payer: First Choice Health Commercial |
$3,102.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,274.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$965.90
|
| Rate for Payer: HealthUtah PPO |
$3,447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,343.59
|
| Rate for Payer: Multiplan Medicare/VA |
$821.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3,378.06
|
| Rate for Payer: PacificSource Commercial |
$3,102.30
|
| Rate for Payer: PHCS PPO |
$3,274.65
|
| Rate for Payer: Three Rivers PPO |
$2,585.25
|
| Rate for Payer: TriWest Veterans Administration |
$965.90
|
| Rate for Payer: United Healthcare Commercial |
$2,998.89
|
| Rate for Payer: United Healthcare Medicare |
$965.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,929.95
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 23020 AS
|
| Hospital Charge Code |
23020
|
| Min. Negotiated Rate |
$570.83 |
| Max. Negotiated Rate |
$3,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,188.92
|
| Rate for Payer: Aetna of WY Medicare |
$671.56
|
| Rate for Payer: Beech Street Commercial |
$3,091.30
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,156.38
|
| Rate for Payer: Cigna of WY Commercial |
$3,188.92
|
| Rate for Payer: First Choice Health Commercial |
$2,928.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,091.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.56
|
| Rate for Payer: HealthUtah PPO |
$3,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,156.38
|
| Rate for Payer: Multiplan Medicare/VA |
$570.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,188.92
|
| Rate for Payer: PacificSource Commercial |
$2,928.60
|
| Rate for Payer: PHCS PPO |
$3,091.30
|
| Rate for Payer: Three Rivers PPO |
$2,440.50
|
| Rate for Payer: TriWest Veterans Administration |
$671.56
|
| Rate for Payer: United Healthcare Commercial |
$2,830.98
|
| Rate for Payer: United Healthcare Medicare |
$671.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,765.90
|
|
|
CAPSULAR CONTRACTURE RELEASE
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 23020
|
| Hospital Charge Code |
23020
|
| Min. Negotiated Rate |
$570.83 |
| Max. Negotiated Rate |
$3,254.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,188.92
|
| Rate for Payer: Aetna of WY Medicare |
$671.56
|
| Rate for Payer: Beech Street Commercial |
$3,091.30
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: Cash Price |
$2,277.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,156.38
|
| Rate for Payer: Cigna of WY Commercial |
$3,188.92
|
| Rate for Payer: First Choice Health Commercial |
$2,928.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,091.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$671.56
|
| Rate for Payer: HealthUtah PPO |
$3,254.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,156.38
|
| Rate for Payer: Multiplan Medicare/VA |
$570.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,188.92
|
| Rate for Payer: PacificSource Commercial |
$2,928.60
|
| Rate for Payer: PHCS PPO |
$3,091.30
|
| Rate for Payer: Three Rivers PPO |
$2,440.50
|
| Rate for Payer: TriWest Veterans Administration |
$671.56
|
| Rate for Payer: United Healthcare Commercial |
$2,830.98
|
| Rate for Payer: United Healthcare Medicare |
$671.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,765.90
|
|
|
CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH
|
Professional
|
Both
|
$4,168.00
|
|
|
Service Code
|
HCPCS 26525
|
| Hospital Charge Code |
26525
|
| Min. Negotiated Rate |
$572.61 |
| Max. Negotiated Rate |
$4,168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,084.64
|
| Rate for Payer: Aetna of WY Medicare |
$673.66
|
| Rate for Payer: Beech Street Commercial |
$3,959.60
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,042.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,084.64
|
| Rate for Payer: First Choice Health Commercial |
$3,751.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,959.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$673.66
|
| Rate for Payer: HealthUtah PPO |
$4,168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,042.96
|
| Rate for Payer: Multiplan Medicare/VA |
$572.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4,084.64
|
| Rate for Payer: PacificSource Commercial |
$3,751.20
|
| Rate for Payer: PHCS PPO |
$3,959.60
|
| Rate for Payer: Three Rivers PPO |
$3,126.00
|
| Rate for Payer: TriWest Veterans Administration |
$673.66
|
| Rate for Payer: United Healthcare Commercial |
$3,626.16
|
| Rate for Payer: United Healthcare Medicare |
$673.66
|
| Rate for Payer: WINHealth Partners Commercial |
$3,542.80
|
|
|
CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH
|
Professional
|
Both
|
$4,168.00
|
|
|
Service Code
|
HCPCS 26525 80
|
| Hospital Charge Code |
26525
|
| Min. Negotiated Rate |
$572.61 |
| Max. Negotiated Rate |
$4,168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,084.64
|
| Rate for Payer: Aetna of WY Medicare |
$673.66
|
| Rate for Payer: Beech Street Commercial |
$3,959.60
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,042.96
|
| Rate for Payer: Cigna of WY Commercial |
$4,084.64
|
| Rate for Payer: First Choice Health Commercial |
$3,751.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,959.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$673.66
|
| Rate for Payer: HealthUtah PPO |
$4,168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,042.96
|
| Rate for Payer: Multiplan Medicare/VA |
$572.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4,084.64
|
| Rate for Payer: PacificSource Commercial |
$3,751.20
|
| Rate for Payer: PHCS PPO |
$3,959.60
|
| Rate for Payer: Three Rivers PPO |
$3,126.00
|
| Rate for Payer: TriWest Veterans Administration |
$673.66
|
| Rate for Payer: United Healthcare Commercial |
$3,626.16
|
| Rate for Payer: United Healthcare Medicare |
$673.66
|
| Rate for Payer: WINHealth Partners Commercial |
$3,542.80
|
|
|
CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$3,407.00
|
|
|
Service Code
|
HCPCS 26520
|
| Hospital Charge Code |
26520
|
| Min. Negotiated Rate |
$569.42 |
| Max. Negotiated Rate |
$3,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,338.86
|
| Rate for Payer: Aetna of WY Medicare |
$669.90
|
| Rate for Payer: Beech Street Commercial |
$3,236.65
|
| Rate for Payer: Cash Price |
$2,384.90
|
| Rate for Payer: Cash Price |
$2,384.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,304.79
|
| Rate for Payer: Cigna of WY Commercial |
$3,338.86
|
| Rate for Payer: First Choice Health Commercial |
$3,066.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,236.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$3,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,304.79
|
| Rate for Payer: Multiplan Medicare/VA |
$569.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,338.86
|
| Rate for Payer: PacificSource Commercial |
$3,066.30
|
| Rate for Payer: PHCS PPO |
$3,236.65
|
| Rate for Payer: Three Rivers PPO |
$2,555.25
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$2,964.09
|
| Rate for Payer: United Healthcare Medicare |
$669.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,895.95
|
|
|
CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$3,407.00
|
|
|
Service Code
|
HCPCS 26520 80
|
| Hospital Charge Code |
26520
|
| Min. Negotiated Rate |
$569.42 |
| Max. Negotiated Rate |
$3,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,338.86
|
| Rate for Payer: Aetna of WY Medicare |
$669.90
|
| Rate for Payer: Beech Street Commercial |
$3,236.65
|
| Rate for Payer: Cash Price |
$2,384.90
|
| Rate for Payer: Cash Price |
$2,384.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,304.79
|
| Rate for Payer: Cigna of WY Commercial |
$3,338.86
|
| Rate for Payer: First Choice Health Commercial |
$3,066.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,236.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$669.90
|
| Rate for Payer: HealthUtah PPO |
$3,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,304.79
|
| Rate for Payer: Multiplan Medicare/VA |
$569.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,338.86
|
| Rate for Payer: PacificSource Commercial |
$3,066.30
|
| Rate for Payer: PHCS PPO |
$3,236.65
|
| Rate for Payer: Three Rivers PPO |
$2,555.25
|
| Rate for Payer: TriWest Veterans Administration |
$669.90
|
| Rate for Payer: United Healthcare Commercial |
$2,964.09
|
| Rate for Payer: United Healthcare Medicare |
$669.90
|
| Rate for Payer: WINHealth Partners Commercial |
$2,895.95
|
|
|
CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
HCPCS 26516 AS
|
| Hospital Charge Code |
26516
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$4,576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,484.48
|
| Rate for Payer: Aetna of WY Medicare |
$728.47
|
| Rate for Payer: Beech Street Commercial |
$4,347.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,438.72
|
| Rate for Payer: Cigna of WY Commercial |
$4,484.48
|
| Rate for Payer: First Choice Health Commercial |
$4,118.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,347.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.47
|
| Rate for Payer: HealthUtah PPO |
$4,576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,438.72
|
| Rate for Payer: Multiplan Medicare/VA |
$619.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,484.48
|
| Rate for Payer: PacificSource Commercial |
$4,118.40
|
| Rate for Payer: PHCS PPO |
$4,347.20
|
| Rate for Payer: Three Rivers PPO |
$3,432.00
|
| Rate for Payer: TriWest Veterans Administration |
$728.47
|
| Rate for Payer: United Healthcare Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare Medicare |
$728.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,889.60
|
|
|
CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
HCPCS 26516
|
| Hospital Charge Code |
26516
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$4,576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,484.48
|
| Rate for Payer: Aetna of WY Medicare |
$728.47
|
| Rate for Payer: Beech Street Commercial |
$4,347.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: Cash Price |
$3,203.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,438.72
|
| Rate for Payer: Cigna of WY Commercial |
$4,484.48
|
| Rate for Payer: First Choice Health Commercial |
$4,118.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,347.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$728.47
|
| Rate for Payer: HealthUtah PPO |
$4,576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,438.72
|
| Rate for Payer: Multiplan Medicare/VA |
$619.20
|
| Rate for Payer: One Health Plan of WY PPO |
$4,484.48
|
| Rate for Payer: PacificSource Commercial |
$4,118.40
|
| Rate for Payer: PHCS PPO |
$4,347.20
|
| Rate for Payer: Three Rivers PPO |
$3,432.00
|
| Rate for Payer: TriWest Veterans Administration |
$728.47
|
| Rate for Payer: United Healthcare Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare Medicare |
$728.47
|
| Rate for Payer: WINHealth Partners Commercial |
$3,889.60
|
|
|
CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$5,474.00
|
|
|
Service Code
|
HCPCS 23462
|
| Hospital Charge Code |
23462
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$5,474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,364.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,027.90
|
| Rate for Payer: Beech Street Commercial |
$5,200.30
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,309.78
|
| Rate for Payer: Cigna of WY Commercial |
$5,364.52
|
| Rate for Payer: First Choice Health Commercial |
$4,926.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,200.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,027.90
|
| Rate for Payer: HealthUtah PPO |
$5,474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,309.78
|
| Rate for Payer: Multiplan Medicare/VA |
$873.72
|
| Rate for Payer: One Health Plan of WY PPO |
$5,364.52
|
| Rate for Payer: PacificSource Commercial |
$4,926.60
|
| Rate for Payer: PHCS PPO |
$5,200.30
|
| Rate for Payer: Three Rivers PPO |
$4,105.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,027.90
|
| Rate for Payer: United Healthcare Commercial |
$4,762.38
|
| Rate for Payer: United Healthcare Medicare |
$1,027.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,652.90
|
|
|
CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$5,474.00
|
|
|
Service Code
|
HCPCS 23462 AS
|
| Hospital Charge Code |
23462
|
| Min. Negotiated Rate |
$873.72 |
| Max. Negotiated Rate |
$5,474.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,364.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,027.90
|
| Rate for Payer: Beech Street Commercial |
$5,200.30
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: Cash Price |
$3,831.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,309.78
|
| Rate for Payer: Cigna of WY Commercial |
$5,364.52
|
| Rate for Payer: First Choice Health Commercial |
$4,926.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,200.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,027.90
|
| Rate for Payer: HealthUtah PPO |
$5,474.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,309.78
|
| Rate for Payer: Multiplan Medicare/VA |
$873.72
|
| Rate for Payer: One Health Plan of WY PPO |
$5,364.52
|
| Rate for Payer: PacificSource Commercial |
$4,926.60
|
| Rate for Payer: PHCS PPO |
$5,200.30
|
| Rate for Payer: Three Rivers PPO |
$4,105.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,027.90
|
| Rate for Payer: United Healthcare Commercial |
$4,762.38
|
| Rate for Payer: United Healthcare Medicare |
$1,027.90
|
| Rate for Payer: WINHealth Partners Commercial |
$4,652.90
|
|
