|
RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS
|
Professional
|
Both
|
$4,083.00
|
|
|
Service Code
|
HCPCS 24149 80
|
| Hospital Charge Code |
24149
|
| Min. Negotiated Rate |
$972.67 |
| Max. Negotiated Rate |
$4,083.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,001.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,144.32
|
| Rate for Payer: Beech Street Commercial |
$3,878.85
|
| Rate for Payer: Cash Price |
$2,858.10
|
| Rate for Payer: Cash Price |
$2,858.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,960.51
|
| Rate for Payer: Cigna of WY Commercial |
$4,001.34
|
| Rate for Payer: First Choice Health Commercial |
$3,674.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,878.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,144.32
|
| Rate for Payer: HealthUtah PPO |
$4,083.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,960.51
|
| Rate for Payer: Multiplan Medicare/VA |
$972.67
|
| Rate for Payer: One Health Plan of WY PPO |
$4,001.34
|
| Rate for Payer: PacificSource Commercial |
$3,674.70
|
| Rate for Payer: PHCS PPO |
$3,878.85
|
| Rate for Payer: Three Rivers PPO |
$3,062.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,144.32
|
| Rate for Payer: United Healthcare Commercial |
$3,552.21
|
| Rate for Payer: United Healthcare Medicare |
$1,144.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,470.55
|
|
|
RALTEGRAVIR 25 MG CHEWABLE TABLET [100298]
|
Facility
|
OP
|
$8.68
|
|
|
Service Code
|
NDC 0006047361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.51
|
| Rate for Payer: Aetna of WY Medicare |
$5.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.33
|
| Rate for Payer: Altius Commercial |
$8.33
|
| Rate for Payer: Beech Street Commercial |
$8.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.42
|
| Rate for Payer: Cigna of WY Commercial |
$8.51
|
| Rate for Payer: Entrust Commercial |
$8.25
|
| Rate for Payer: First Choice Health Commercial |
$8.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.03
|
| Rate for Payer: HealthUtah PPO |
$8.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.42
|
| Rate for Payer: Multiplan Medicare/VA |
$4.78
|
| Rate for Payer: One Health Plan of WY PPO |
$8.51
|
| Rate for Payer: PacificSource Commercial |
$7.81
|
| Rate for Payer: PHCS PPO |
$8.51
|
| Rate for Payer: Three Rivers PPO |
$6.51
|
| Rate for Payer: TriWest Veterans Administration |
$5.03
|
| Rate for Payer: United Healthcare Commercial |
$7.55
|
| Rate for Payer: United Healthcare Medicare |
$5.03
|
| Rate for Payer: WINHealth Partners Commercial |
$8.51
|
| Rate for Payer: Wise Provider Network Commercial |
$8.25
|
|
|
RALTEGRAVIR 25 MG CHEWABLE TABLET [100298]
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
NDC 0006047361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.33
|
| Rate for Payer: Altius Commercial |
$8.33
|
| Rate for Payer: Beech Street Commercial |
$8.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.42
|
| Rate for Payer: Cigna of WY Commercial |
$8.51
|
| Rate for Payer: Entrust Commercial |
$8.25
|
| Rate for Payer: First Choice Health Commercial |
$8.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.73
|
| Rate for Payer: HealthUtah PPO |
$8.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.42
|
| Rate for Payer: Multiplan Medicare/VA |
$5.44
|
| Rate for Payer: One Health Plan of WY PPO |
$8.51
|
| Rate for Payer: PacificSource Commercial |
$7.81
|
| Rate for Payer: PHCS PPO |
$8.51
|
| Rate for Payer: Three Rivers PPO |
$6.51
|
| Rate for Payer: TriWest Veterans Administration |
$5.73
|
| Rate for Payer: United Healthcare Commercial |
$7.55
|
| Rate for Payer: United Healthcare Medicare |
$5.73
|
| Rate for Payer: WINHealth Partners Commercial |
$8.25
|
| Rate for Payer: Wise Provider Network Commercial |
$8.25
|
|
|
RAMIPRIL 5 MG CAPSULE [19556]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 6800143000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Aetna of WY Medicare |
$0.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.46
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.44
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.46
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.46
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
RAMIPRIL 5 MG CAPSULE [19556]
|
Facility
|
IP
|
$0.80
|
|
|
Service Code
|
NDC 6800143000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
| Rate for Payer: Altius Commercial |
$0.77
|
| Rate for Payer: Beech Street Commercial |
$0.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
| Rate for Payer: Cash Price |
$0.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
| Rate for Payer: Cigna of WY Commercial |
$0.78
|
| Rate for Payer: Entrust Commercial |
$0.76
|
| Rate for Payer: First Choice Health Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
| Rate for Payer: HealthUtah PPO |
$0.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.78
|
| Rate for Payer: PacificSource Commercial |
$0.72
|
| Rate for Payer: PHCS PPO |
$0.78
|
| Rate for Payer: Three Rivers PPO |
$0.60
|
| Rate for Payer: TriWest Veterans Administration |
$0.53
|
| Rate for Payer: United Healthcare Commercial |
$0.70
|
| Rate for Payer: United Healthcare Medicare |
$0.53
|
| Rate for Payer: WINHealth Partners Commercial |
$0.76
|
| Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
|
RAPID RHINO 4.5 CM ANTER RR450
|
Facility
|
OP
|
$149.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.10 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.42
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$82.10
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.42
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$86.42
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
RAPID RHINO 4.5 CM ANTER RR450
|
Facility
|
IP
|
$149.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.34
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$93.42
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.34
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
RAPID RHINO 5.5 CM ANTER RR550
|
Facility
|
IP
|
$149.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.34
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$93.42
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.34
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$98.34
|
| Rate for Payer: WINHealth Partners Commercial |
$141.55
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
RAPID RHINO 5.5 CM ANTER RR550
|
Facility
|
OP
|
$149.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.10 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$146.02
|
| Rate for Payer: Aetna of WY Medicare |
$98.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$143.04
|
| Rate for Payer: Altius Commercial |
$143.04
|
| Rate for Payer: Beech Street Commercial |
$146.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.33
|
| Rate for Payer: Cash Price |
$104.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.53
|
| Rate for Payer: Cigna of WY Commercial |
$146.02
|
| Rate for Payer: Entrust Commercial |
$141.55
|
| Rate for Payer: First Choice Health Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.42
|
| Rate for Payer: HealthUtah PPO |
$149.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.53
|
| Rate for Payer: Multiplan Medicare/VA |
$82.10
|
| Rate for Payer: One Health Plan of WY PPO |
$146.02
|
| Rate for Payer: PacificSource Commercial |
$134.10
|
| Rate for Payer: PHCS PPO |
$146.02
|
| Rate for Payer: Three Rivers PPO |
$111.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.42
|
| Rate for Payer: United Healthcare Commercial |
$129.63
|
| Rate for Payer: United Healthcare Medicare |
$86.42
|
| Rate for Payer: WINHealth Partners Commercial |
$146.02
|
| Rate for Payer: Wise Provider Network Commercial |
$141.55
|
|
|
RAPID RHINO 7.5 CM RR750
|
Facility
|
OP
|
$153.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.64 |
| Max. Negotiated Rate |
$153.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.55
|
| Rate for Payer: Aetna of WY Medicare |
$101.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$147.48
|
| Rate for Payer: Altius Commercial |
$147.48
|
| Rate for Payer: Beech Street Commercial |
$150.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.12
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.01
|
| Rate for Payer: Cigna of WY Commercial |
$150.55
|
| Rate for Payer: Entrust Commercial |
$145.94
|
| Rate for Payer: First Choice Health Commercial |
$145.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.10
|
| Rate for Payer: HealthUtah PPO |
$153.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.01
|
| Rate for Payer: Multiplan Medicare/VA |
$84.64
|
| Rate for Payer: One Health Plan of WY PPO |
$150.55
|
| Rate for Payer: PacificSource Commercial |
$138.26
|
| Rate for Payer: PHCS PPO |
$150.55
|
| Rate for Payer: Three Rivers PPO |
$115.22
|
| Rate for Payer: TriWest Veterans Administration |
$89.10
|
| Rate for Payer: United Healthcare Commercial |
$133.65
|
| Rate for Payer: United Healthcare Medicare |
$89.10
|
| Rate for Payer: WINHealth Partners Commercial |
$150.55
|
| Rate for Payer: Wise Provider Network Commercial |
$145.94
|
|
|
RAPID RHINO 7.5 CM RR750
|
Facility
|
IP
|
$153.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$153.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$147.48
|
| Rate for Payer: Altius Commercial |
$147.48
|
| Rate for Payer: Beech Street Commercial |
$150.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.12
|
| Rate for Payer: Cash Price |
$107.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.01
|
| Rate for Payer: Cigna of WY Commercial |
$150.55
|
| Rate for Payer: Entrust Commercial |
$145.94
|
| Rate for Payer: First Choice Health Commercial |
$145.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$145.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.39
|
| Rate for Payer: HealthUtah PPO |
$153.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.01
|
| Rate for Payer: Multiplan Medicare/VA |
$96.32
|
| Rate for Payer: One Health Plan of WY PPO |
$150.55
|
| Rate for Payer: PacificSource Commercial |
$138.26
|
| Rate for Payer: PHCS PPO |
$150.55
|
| Rate for Payer: Three Rivers PPO |
$115.22
|
| Rate for Payer: TriWest Veterans Administration |
$101.39
|
| Rate for Payer: United Healthcare Commercial |
$133.65
|
| Rate for Payer: United Healthcare Medicare |
$101.39
|
| Rate for Payer: WINHealth Partners Commercial |
$145.94
|
| Rate for Payer: Wise Provider Network Commercial |
$145.94
|
|
|
RASP STRYK 5100-37-113
|
Facility
|
OP
|
$298.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.69 |
| Max. Negotiated Rate |
$298.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$292.92
|
| Rate for Payer: Aetna of WY Medicare |
$197.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$286.94
|
| Rate for Payer: Altius Commercial |
$286.94
|
| Rate for Payer: Beech Street Commercial |
$292.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$245.40
|
| Rate for Payer: Cash Price |
$209.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$289.93
|
| Rate for Payer: Cigna of WY Commercial |
$292.92
|
| Rate for Payer: Entrust Commercial |
$283.96
|
| Rate for Payer: First Choice Health Commercial |
$283.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$283.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$173.36
|
| Rate for Payer: HealthUtah PPO |
$298.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$289.93
|
| Rate for Payer: Multiplan Medicare/VA |
$164.69
|
| Rate for Payer: One Health Plan of WY PPO |
$292.92
|
| Rate for Payer: PacificSource Commercial |
$269.01
|
| Rate for Payer: PHCS PPO |
$292.92
|
| Rate for Payer: Three Rivers PPO |
$224.18
|
| Rate for Payer: TriWest Veterans Administration |
$173.36
|
| Rate for Payer: United Healthcare Commercial |
$260.04
|
| Rate for Payer: United Healthcare Medicare |
$173.36
|
| Rate for Payer: WINHealth Partners Commercial |
$292.92
|
| Rate for Payer: Wise Provider Network Commercial |
$283.96
|
|
|
RASP STRYK 5100-37-113
|
Facility
|
IP
|
$298.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.41 |
| Max. Negotiated Rate |
$298.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$292.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$286.94
|
| Rate for Payer: Altius Commercial |
$286.94
|
| Rate for Payer: Beech Street Commercial |
$292.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$245.40
|
| Rate for Payer: Cash Price |
$209.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$289.93
|
| Rate for Payer: Cigna of WY Commercial |
$292.92
|
| Rate for Payer: Entrust Commercial |
$283.96
|
| Rate for Payer: First Choice Health Commercial |
$283.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$283.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.27
|
| Rate for Payer: HealthUtah PPO |
$298.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$289.93
|
| Rate for Payer: Multiplan Medicare/VA |
$187.41
|
| Rate for Payer: One Health Plan of WY PPO |
$292.92
|
| Rate for Payer: PacificSource Commercial |
$269.01
|
| Rate for Payer: PHCS PPO |
$292.92
|
| Rate for Payer: Three Rivers PPO |
$224.18
|
| Rate for Payer: TriWest Veterans Administration |
$197.27
|
| Rate for Payer: United Healthcare Commercial |
$260.04
|
| Rate for Payer: United Healthcare Medicare |
$197.27
|
| Rate for Payer: WINHealth Partners Commercial |
$283.96
|
| Rate for Payer: Wise Provider Network Commercial |
$283.96
|
|
|
RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$6,567.00
|
|
|
Service Code
|
HCPCS 26541 AS
|
| Hospital Charge Code |
26541
|
| Min. Negotiated Rate |
$694.54 |
| Max. Negotiated Rate |
$6,567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,435.66
|
| Rate for Payer: Aetna of WY Medicare |
$817.10
|
| Rate for Payer: Beech Street Commercial |
$6,238.65
|
| Rate for Payer: Cash Price |
$4,596.90
|
| Rate for Payer: Cash Price |
$4,596.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,369.99
|
| Rate for Payer: Cigna of WY Commercial |
$6,435.66
|
| Rate for Payer: First Choice Health Commercial |
$5,910.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,238.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$817.10
|
| Rate for Payer: HealthUtah PPO |
$6,567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,369.99
|
| Rate for Payer: Multiplan Medicare/VA |
$694.54
|
| Rate for Payer: One Health Plan of WY PPO |
$6,435.66
|
| Rate for Payer: PacificSource Commercial |
$5,910.30
|
| Rate for Payer: PHCS PPO |
$6,238.65
|
| Rate for Payer: Three Rivers PPO |
$4,925.25
|
| Rate for Payer: TriWest Veterans Administration |
$817.10
|
| Rate for Payer: United Healthcare Commercial |
$5,713.29
|
| Rate for Payer: United Healthcare Medicare |
$817.10
|
| Rate for Payer: WINHealth Partners Commercial |
$5,581.95
|
|
|
RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$6,567.00
|
|
|
Service Code
|
HCPCS 26541
|
| Hospital Charge Code |
26541
|
| Min. Negotiated Rate |
$694.54 |
| Max. Negotiated Rate |
$6,567.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,435.66
|
| Rate for Payer: Aetna of WY Medicare |
$817.10
|
| Rate for Payer: Beech Street Commercial |
$6,238.65
|
| Rate for Payer: Cash Price |
$4,596.90
|
| Rate for Payer: Cash Price |
$4,596.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,369.99
|
| Rate for Payer: Cigna of WY Commercial |
$6,435.66
|
| Rate for Payer: First Choice Health Commercial |
$5,910.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,238.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$817.10
|
| Rate for Payer: HealthUtah PPO |
$6,567.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,369.99
|
| Rate for Payer: Multiplan Medicare/VA |
$694.54
|
| Rate for Payer: One Health Plan of WY PPO |
$6,435.66
|
| Rate for Payer: PacificSource Commercial |
$5,910.30
|
| Rate for Payer: PHCS PPO |
$6,238.65
|
| Rate for Payer: Three Rivers PPO |
$4,925.25
|
| Rate for Payer: TriWest Veterans Administration |
$817.10
|
| Rate for Payer: United Healthcare Commercial |
$5,713.29
|
| Rate for Payer: United Healthcare Medicare |
$817.10
|
| Rate for Payer: WINHealth Partners Commercial |
$5,581.95
|
|
|
RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 27422 AS
|
| Hospital Charge Code |
27422
|
| 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
|
|
|
RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 27422 80
|
| Hospital Charge Code |
27422
|
| 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
|
|
|
RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
27422
|
| 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
|
|
|
RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27420 AS
|
| Hospital Charge Code |
27420
|
| 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
|
|
|
RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27420
|
| Hospital Charge Code |
27420
|
| 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
|
|
|
RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,602.00
|
|
|
Service Code
|
HCPCS 27420 80
|
| Hospital Charge Code |
27420
|
| 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
|
|
|
RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$3,818.00
|
|
|
Service Code
|
HCPCS 24344
|
| Hospital Charge Code |
24344
|
| Min. Negotiated Rate |
$909.23 |
| Max. Negotiated Rate |
$3,818.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,741.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.68
|
| Rate for Payer: Beech Street Commercial |
$3,627.10
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: Cash Price |
$2,672.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,703.46
|
| Rate for Payer: Cigna of WY Commercial |
$3,741.64
|
| Rate for Payer: First Choice Health Commercial |
$3,436.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,627.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.68
|
| Rate for Payer: HealthUtah PPO |
$3,818.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,703.46
|
| Rate for Payer: Multiplan Medicare/VA |
$909.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,741.64
|
| Rate for Payer: PacificSource Commercial |
$3,436.20
|
| Rate for Payer: PHCS PPO |
$3,627.10
|
| Rate for Payer: Three Rivers PPO |
$2,863.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.68
|
| Rate for Payer: United Healthcare Commercial |
$3,321.66
|
| Rate for Payer: United Healthcare Medicare |
$1,069.68
|
| Rate for Payer: WINHealth Partners Commercial |
$3,245.30
|
|
|
RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$5,507.00
|
|
|
Service Code
|
HCPCS 24346 AS
|
| Hospital Charge Code |
24346
|
| Min. Negotiated Rate |
$909.23 |
| Max. Negotiated Rate |
$5,507.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,396.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.68
|
| Rate for Payer: Beech Street Commercial |
$5,231.65
|
| Rate for Payer: Cash Price |
$3,854.90
|
| Rate for Payer: Cash Price |
$3,854.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,341.79
|
| Rate for Payer: Cigna of WY Commercial |
$5,396.86
|
| Rate for Payer: First Choice Health Commercial |
$4,956.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,231.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.68
|
| Rate for Payer: HealthUtah PPO |
$5,507.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,341.79
|
| Rate for Payer: Multiplan Medicare/VA |
$909.23
|
| Rate for Payer: One Health Plan of WY PPO |
$5,396.86
|
| Rate for Payer: PacificSource Commercial |
$4,956.30
|
| Rate for Payer: PHCS PPO |
$5,231.65
|
| Rate for Payer: Three Rivers PPO |
$4,130.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.68
|
| Rate for Payer: United Healthcare Commercial |
$4,791.09
|
| Rate for Payer: United Healthcare Medicare |
$1,069.68
|
| Rate for Payer: WINHealth Partners Commercial |
$4,680.95
|
|
|
RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$5,507.00
|
|
|
Service Code
|
HCPCS 24346
|
| Hospital Charge Code |
24346
|
| Min. Negotiated Rate |
$909.23 |
| Max. Negotiated Rate |
$5,507.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,396.86
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.68
|
| Rate for Payer: Beech Street Commercial |
$5,231.65
|
| Rate for Payer: Cash Price |
$3,854.90
|
| Rate for Payer: Cash Price |
$3,854.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,341.79
|
| Rate for Payer: Cigna of WY Commercial |
$5,396.86
|
| Rate for Payer: First Choice Health Commercial |
$4,956.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,231.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.68
|
| Rate for Payer: HealthUtah PPO |
$5,507.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,341.79
|
| Rate for Payer: Multiplan Medicare/VA |
$909.23
|
| Rate for Payer: One Health Plan of WY PPO |
$5,396.86
|
| Rate for Payer: PacificSource Commercial |
$4,956.30
|
| Rate for Payer: PHCS PPO |
$5,231.65
|
| Rate for Payer: Three Rivers PPO |
$4,130.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.68
|
| Rate for Payer: United Healthcare Commercial |
$4,791.09
|
| Rate for Payer: United Healthcare Medicare |
$1,069.68
|
| Rate for Payer: WINHealth Partners Commercial |
$4,680.95
|
|
|
RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR
|
Professional
|
Both
|
$2,510.00
|
|
|
Service Code
|
HCPCS 28238 AS
|
| Hospital Charge Code |
28238
|
| Min. Negotiated Rate |
$405.03 |
| Max. Negotiated Rate |
$2,510.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,459.80
|
| Rate for Payer: Aetna of WY Medicare |
$476.51
|
| Rate for Payer: Beech Street Commercial |
$2,384.50
|
| Rate for Payer: Cash Price |
$1,757.00
|
| Rate for Payer: Cash Price |
$1,757.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,434.70
|
| Rate for Payer: Cigna of WY Commercial |
$2,459.80
|
| Rate for Payer: First Choice Health Commercial |
$2,259.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,384.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$476.51
|
| Rate for Payer: HealthUtah PPO |
$2,510.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,434.70
|
| Rate for Payer: Multiplan Medicare/VA |
$405.03
|
| Rate for Payer: One Health Plan of WY PPO |
$2,459.80
|
| Rate for Payer: PacificSource Commercial |
$2,259.00
|
| Rate for Payer: PHCS PPO |
$2,384.50
|
| Rate for Payer: Three Rivers PPO |
$1,882.50
|
| Rate for Payer: TriWest Veterans Administration |
$476.51
|
| Rate for Payer: United Healthcare Commercial |
$2,183.70
|
| Rate for Payer: United Healthcare Medicare |
$476.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,133.50
|
|
