|
REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27486
|
| Hospital Charge Code |
27486
|
| Min. Negotiated Rate |
$1,144.19 |
| Max. Negotiated Rate |
$7,263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,117.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,346.11
|
| Rate for Payer: Beech Street Commercial |
$6,899.85
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,045.11
|
| Rate for Payer: Cigna of WY Commercial |
$7,117.74
|
| Rate for Payer: First Choice Health Commercial |
$6,536.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,899.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,346.11
|
| Rate for Payer: HealthUtah PPO |
$7,263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,045.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,144.19
|
| Rate for Payer: One Health Plan of WY PPO |
$7,117.74
|
| Rate for Payer: PacificSource Commercial |
$6,536.70
|
| Rate for Payer: PHCS PPO |
$6,899.85
|
| Rate for Payer: Three Rivers PPO |
$5,447.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,346.11
|
| Rate for Payer: United Healthcare Commercial |
$6,318.81
|
| Rate for Payer: United Healthcare Medicare |
$1,346.11
|
| Rate for Payer: WINHealth Partners Commercial |
$6,173.55
|
|
|
REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27486 80
|
| Hospital Charge Code |
27486
|
| Min. Negotiated Rate |
$1,144.19 |
| Max. Negotiated Rate |
$7,263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,117.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,346.11
|
| Rate for Payer: Beech Street Commercial |
$6,899.85
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,045.11
|
| Rate for Payer: Cigna of WY Commercial |
$7,117.74
|
| Rate for Payer: First Choice Health Commercial |
$6,536.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,899.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,346.11
|
| Rate for Payer: HealthUtah PPO |
$7,263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,045.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,144.19
|
| Rate for Payer: One Health Plan of WY PPO |
$7,117.74
|
| Rate for Payer: PacificSource Commercial |
$6,536.70
|
| Rate for Payer: PHCS PPO |
$6,899.85
|
| Rate for Payer: Three Rivers PPO |
$5,447.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,346.11
|
| Rate for Payer: United Healthcare Commercial |
$6,318.81
|
| Rate for Payer: United Healthcare Medicare |
$1,346.11
|
| Rate for Payer: WINHealth Partners Commercial |
$6,173.55
|
|
|
REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$7,598.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
27137
|
| Min. Negotiated Rate |
$1,190.43 |
| Max. Negotiated Rate |
$7,598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,446.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,400.51
|
| Rate for Payer: Beech Street Commercial |
$7,218.10
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,370.06
|
| Rate for Payer: Cigna of WY Commercial |
$7,446.04
|
| Rate for Payer: First Choice Health Commercial |
$6,838.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,218.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,400.51
|
| Rate for Payer: HealthUtah PPO |
$7,598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,370.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1,190.43
|
| Rate for Payer: One Health Plan of WY PPO |
$7,446.04
|
| Rate for Payer: PacificSource Commercial |
$6,838.20
|
| Rate for Payer: PHCS PPO |
$7,218.10
|
| Rate for Payer: Three Rivers PPO |
$5,698.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,400.51
|
| Rate for Payer: United Healthcare Commercial |
$6,610.26
|
| Rate for Payer: United Healthcare Medicare |
$1,400.51
|
| Rate for Payer: WINHealth Partners Commercial |
$6,458.30
|
|
|
REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$7,598.00
|
|
|
Service Code
|
HCPCS 27137 80
|
| Hospital Charge Code |
27137
|
| Min. Negotiated Rate |
$1,190.43 |
| Max. Negotiated Rate |
$7,598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,446.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,400.51
|
| Rate for Payer: Beech Street Commercial |
$7,218.10
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,370.06
|
| Rate for Payer: Cigna of WY Commercial |
$7,446.04
|
| Rate for Payer: First Choice Health Commercial |
$6,838.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,218.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,400.51
|
| Rate for Payer: HealthUtah PPO |
$7,598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,370.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1,190.43
|
| Rate for Payer: One Health Plan of WY PPO |
$7,446.04
|
| Rate for Payer: PacificSource Commercial |
$6,838.20
|
| Rate for Payer: PHCS PPO |
$7,218.10
|
| Rate for Payer: Three Rivers PPO |
$5,698.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,400.51
|
| Rate for Payer: United Healthcare Commercial |
$6,610.26
|
| Rate for Payer: United Healthcare Medicare |
$1,400.51
|
| Rate for Payer: WINHealth Partners Commercial |
$6,458.30
|
|
|
REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$7,598.00
|
|
|
Service Code
|
HCPCS 27137 AS
|
| Hospital Charge Code |
27137
|
| Min. Negotiated Rate |
$1,190.43 |
| Max. Negotiated Rate |
$7,598.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,446.04
|
| Rate for Payer: Aetna of WY Medicare |
$1,400.51
|
| Rate for Payer: Beech Street Commercial |
$7,218.10
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: Cash Price |
$5,318.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,370.06
|
| Rate for Payer: Cigna of WY Commercial |
$7,446.04
|
| Rate for Payer: First Choice Health Commercial |
$6,838.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,218.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,400.51
|
| Rate for Payer: HealthUtah PPO |
$7,598.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,370.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1,190.43
|
| Rate for Payer: One Health Plan of WY PPO |
$7,446.04
|
| Rate for Payer: PacificSource Commercial |
$6,838.20
|
| Rate for Payer: PHCS PPO |
$7,218.10
|
| Rate for Payer: Three Rivers PPO |
$5,698.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,400.51
|
| Rate for Payer: United Healthcare Commercial |
$6,610.26
|
| Rate for Payer: United Healthcare Medicare |
$1,400.51
|
| Rate for Payer: WINHealth Partners Commercial |
$6,458.30
|
|
|
REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$9,883.00
|
|
|
Service Code
|
HCPCS 27134 80
|
| Hospital Charge Code |
27134
|
| Min. Negotiated Rate |
$1,542.24 |
| Max. Negotiated Rate |
$9,883.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,685.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,814.40
|
| Rate for Payer: Beech Street Commercial |
$9,388.85
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,586.51
|
| Rate for Payer: Cigna of WY Commercial |
$9,685.34
|
| Rate for Payer: First Choice Health Commercial |
$8,894.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,388.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,814.40
|
| Rate for Payer: HealthUtah PPO |
$9,883.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,586.51
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.24
|
| Rate for Payer: One Health Plan of WY PPO |
$9,685.34
|
| Rate for Payer: PacificSource Commercial |
$8,894.70
|
| Rate for Payer: PHCS PPO |
$9,388.85
|
| Rate for Payer: Three Rivers PPO |
$7,412.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,814.40
|
| Rate for Payer: United Healthcare Commercial |
$8,598.21
|
| Rate for Payer: United Healthcare Medicare |
$1,814.40
|
| Rate for Payer: WINHealth Partners Commercial |
$8,400.55
|
|
|
REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$9,883.00
|
|
|
Service Code
|
HCPCS 27134
|
| Hospital Charge Code |
27134
|
| Min. Negotiated Rate |
$1,542.24 |
| Max. Negotiated Rate |
$9,883.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,685.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,814.40
|
| Rate for Payer: Beech Street Commercial |
$9,388.85
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,586.51
|
| Rate for Payer: Cigna of WY Commercial |
$9,685.34
|
| Rate for Payer: First Choice Health Commercial |
$8,894.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,388.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,814.40
|
| Rate for Payer: HealthUtah PPO |
$9,883.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,586.51
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.24
|
| Rate for Payer: One Health Plan of WY PPO |
$9,685.34
|
| Rate for Payer: PacificSource Commercial |
$8,894.70
|
| Rate for Payer: PHCS PPO |
$9,388.85
|
| Rate for Payer: Three Rivers PPO |
$7,412.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,814.40
|
| Rate for Payer: United Healthcare Commercial |
$8,598.21
|
| Rate for Payer: United Healthcare Medicare |
$1,814.40
|
| Rate for Payer: WINHealth Partners Commercial |
$8,400.55
|
|
|
REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$9,883.00
|
|
|
Service Code
|
HCPCS 27134 AS
|
| Hospital Charge Code |
27134
|
| Min. Negotiated Rate |
$1,542.24 |
| Max. Negotiated Rate |
$9,883.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,685.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,814.40
|
| Rate for Payer: Beech Street Commercial |
$9,388.85
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: Cash Price |
$6,918.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,586.51
|
| Rate for Payer: Cigna of WY Commercial |
$9,685.34
|
| Rate for Payer: First Choice Health Commercial |
$8,894.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,388.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,814.40
|
| Rate for Payer: HealthUtah PPO |
$9,883.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,586.51
|
| Rate for Payer: Multiplan Medicare/VA |
$1,542.24
|
| Rate for Payer: One Health Plan of WY PPO |
$9,685.34
|
| Rate for Payer: PacificSource Commercial |
$8,894.70
|
| Rate for Payer: PHCS PPO |
$9,388.85
|
| Rate for Payer: Three Rivers PPO |
$7,412.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,814.40
|
| Rate for Payer: United Healthcare Commercial |
$8,598.21
|
| Rate for Payer: United Healthcare Medicare |
$1,814.40
|
| Rate for Payer: WINHealth Partners Commercial |
$8,400.55
|
|
|
REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$7,895.00
|
|
|
Service Code
|
HCPCS 27138 80
|
| Hospital Charge Code |
27138
|
| Min. Negotiated Rate |
$1,236.01 |
| Max. Negotiated Rate |
$7,895.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,737.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,454.13
|
| Rate for Payer: Beech Street Commercial |
$7,500.25
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,658.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,737.10
|
| Rate for Payer: First Choice Health Commercial |
$7,105.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,454.13
|
| Rate for Payer: HealthUtah PPO |
$7,895.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,658.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,236.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7,737.10
|
| Rate for Payer: PacificSource Commercial |
$7,105.50
|
| Rate for Payer: PHCS PPO |
$7,500.25
|
| Rate for Payer: Three Rivers PPO |
$5,921.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,454.13
|
| Rate for Payer: United Healthcare Commercial |
$6,868.65
|
| Rate for Payer: United Healthcare Medicare |
$1,454.13
|
| Rate for Payer: WINHealth Partners Commercial |
$6,710.75
|
|
|
REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$7,895.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
27138
|
| Min. Negotiated Rate |
$1,236.01 |
| Max. Negotiated Rate |
$7,895.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,737.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,454.13
|
| Rate for Payer: Beech Street Commercial |
$7,500.25
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,658.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,737.10
|
| Rate for Payer: First Choice Health Commercial |
$7,105.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,454.13
|
| Rate for Payer: HealthUtah PPO |
$7,895.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,658.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,236.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7,737.10
|
| Rate for Payer: PacificSource Commercial |
$7,105.50
|
| Rate for Payer: PHCS PPO |
$7,500.25
|
| Rate for Payer: Three Rivers PPO |
$5,921.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,454.13
|
| Rate for Payer: United Healthcare Commercial |
$6,868.65
|
| Rate for Payer: United Healthcare Medicare |
$1,454.13
|
| Rate for Payer: WINHealth Partners Commercial |
$6,710.75
|
|
|
REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT
|
Professional
|
Both
|
$7,895.00
|
|
|
Service Code
|
HCPCS 27138 AS
|
| Hospital Charge Code |
27138
|
| Min. Negotiated Rate |
$1,236.01 |
| Max. Negotiated Rate |
$7,895.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,737.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,454.13
|
| Rate for Payer: Beech Street Commercial |
$7,500.25
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: Cash Price |
$5,526.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,658.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,737.10
|
| Rate for Payer: First Choice Health Commercial |
$7,105.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,500.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,454.13
|
| Rate for Payer: HealthUtah PPO |
$7,895.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,658.15
|
| Rate for Payer: Multiplan Medicare/VA |
$1,236.01
|
| Rate for Payer: One Health Plan of WY PPO |
$7,737.10
|
| Rate for Payer: PacificSource Commercial |
$7,105.50
|
| Rate for Payer: PHCS PPO |
$7,500.25
|
| Rate for Payer: Three Rivers PPO |
$5,921.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,454.13
|
| Rate for Payer: United Healthcare Commercial |
$6,868.65
|
| Rate for Payer: United Healthcare Medicare |
$1,454.13
|
| Rate for Payer: WINHealth Partners Commercial |
$6,710.75
|
|
|
REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$9,080.00
|
|
|
Service Code
|
HCPCS 27487 AS
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,423.73 |
| Max. Negotiated Rate |
$9,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,898.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.98
|
| Rate for Payer: Beech Street Commercial |
$8,626.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,807.60
|
| Rate for Payer: Cigna of WY Commercial |
$8,898.40
|
| Rate for Payer: First Choice Health Commercial |
$8,172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,626.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.98
|
| Rate for Payer: HealthUtah PPO |
$9,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,807.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,423.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8,898.40
|
| Rate for Payer: PacificSource Commercial |
$8,172.00
|
| Rate for Payer: PHCS PPO |
$8,626.00
|
| Rate for Payer: Three Rivers PPO |
$6,810.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.98
|
| Rate for Payer: United Healthcare Commercial |
$7,899.60
|
| Rate for Payer: United Healthcare Medicare |
$1,674.98
|
| Rate for Payer: WINHealth Partners Commercial |
$7,718.00
|
|
|
REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$9,080.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,423.73 |
| Max. Negotiated Rate |
$9,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,898.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.98
|
| Rate for Payer: Beech Street Commercial |
$8,626.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,807.60
|
| Rate for Payer: Cigna of WY Commercial |
$8,898.40
|
| Rate for Payer: First Choice Health Commercial |
$8,172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,626.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.98
|
| Rate for Payer: HealthUtah PPO |
$9,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,807.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,423.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8,898.40
|
| Rate for Payer: PacificSource Commercial |
$8,172.00
|
| Rate for Payer: PHCS PPO |
$8,626.00
|
| Rate for Payer: Three Rivers PPO |
$6,810.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.98
|
| Rate for Payer: United Healthcare Commercial |
$7,899.60
|
| Rate for Payer: United Healthcare Medicare |
$1,674.98
|
| Rate for Payer: WINHealth Partners Commercial |
$7,718.00
|
|
|
REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$9,080.00
|
|
|
Service Code
|
HCPCS 27487 80
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,423.73 |
| Max. Negotiated Rate |
$9,080.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,898.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.98
|
| Rate for Payer: Beech Street Commercial |
$8,626.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: Cash Price |
$6,356.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,807.60
|
| Rate for Payer: Cigna of WY Commercial |
$8,898.40
|
| Rate for Payer: First Choice Health Commercial |
$8,172.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,626.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.98
|
| Rate for Payer: HealthUtah PPO |
$9,080.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,807.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1,423.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8,898.40
|
| Rate for Payer: PacificSource Commercial |
$8,172.00
|
| Rate for Payer: PHCS PPO |
$8,626.00
|
| Rate for Payer: Three Rivers PPO |
$6,810.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.98
|
| Rate for Payer: United Healthcare Commercial |
$7,899.60
|
| Rate for Payer: United Healthcare Medicare |
$1,674.98
|
| Rate for Payer: WINHealth Partners Commercial |
$7,718.00
|
|
|
REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
64595
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$1,078.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,056.44
|
| Rate for Payer: Aetna of WY Medicare |
$220.82
|
| Rate for Payer: Beech Street Commercial |
$1,024.10
|
| Rate for Payer: Cash Price |
$754.60
|
| Rate for Payer: Cash Price |
$754.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,045.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,056.44
|
| Rate for Payer: First Choice Health Commercial |
$970.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,024.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$220.82
|
| Rate for Payer: HealthUtah PPO |
$1,078.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,045.66
|
| Rate for Payer: Multiplan Medicare/VA |
$187.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1,056.44
|
| Rate for Payer: PacificSource Commercial |
$970.20
|
| Rate for Payer: PHCS PPO |
$1,024.10
|
| Rate for Payer: Three Rivers PPO |
$808.50
|
| Rate for Payer: TriWest Veterans Administration |
$220.82
|
| Rate for Payer: United Healthcare Commercial |
$937.86
|
| Rate for Payer: United Healthcare Medicare |
$220.82
|
| Rate for Payer: WINHealth Partners Commercial |
$916.30
|
|
|
RF BOSTON GROUND PAD
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
RF BOSTON GROUND PAD
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
RF DISPOSABLE ELECTRODE 10CM
|
Facility
|
OP
|
$260.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.67 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.54
|
| Rate for Payer: Aetna of WY Medicare |
$172.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.32
|
| Rate for Payer: Altius Commercial |
$250.32
|
| Rate for Payer: Beech Street Commercial |
$255.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.08
|
| Rate for Payer: Cash Price |
$182.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.93
|
| Rate for Payer: Cigna of WY Commercial |
$255.54
|
| Rate for Payer: Entrust Commercial |
$247.71
|
| Rate for Payer: First Choice Health Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.24
|
| Rate for Payer: HealthUtah PPO |
$260.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.93
|
| Rate for Payer: Multiplan Medicare/VA |
$143.67
|
| Rate for Payer: One Health Plan of WY PPO |
$255.54
|
| Rate for Payer: PacificSource Commercial |
$234.68
|
| Rate for Payer: PHCS PPO |
$255.54
|
| Rate for Payer: Three Rivers PPO |
$195.56
|
| Rate for Payer: TriWest Veterans Administration |
$151.24
|
| Rate for Payer: United Healthcare Commercial |
$226.85
|
| Rate for Payer: United Healthcare Medicare |
$151.24
|
| Rate for Payer: WINHealth Partners Commercial |
$255.54
|
| Rate for Payer: Wise Provider Network Commercial |
$247.71
|
|
|
RF DISPOSABLE ELECTRODE 10CM
|
Facility
|
IP
|
$260.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.49 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.32
|
| Rate for Payer: Altius Commercial |
$250.32
|
| Rate for Payer: Beech Street Commercial |
$255.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.08
|
| Rate for Payer: Cash Price |
$182.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.93
|
| Rate for Payer: Cigna of WY Commercial |
$255.54
|
| Rate for Payer: Entrust Commercial |
$247.71
|
| Rate for Payer: First Choice Health Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.10
|
| Rate for Payer: HealthUtah PPO |
$260.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.93
|
| Rate for Payer: Multiplan Medicare/VA |
$163.49
|
| Rate for Payer: One Health Plan of WY PPO |
$255.54
|
| Rate for Payer: PacificSource Commercial |
$234.68
|
| Rate for Payer: PHCS PPO |
$255.54
|
| Rate for Payer: Three Rivers PPO |
$195.56
|
| Rate for Payer: TriWest Veterans Administration |
$172.10
|
| Rate for Payer: United Healthcare Commercial |
$226.85
|
| Rate for Payer: United Healthcare Medicare |
$172.10
|
| Rate for Payer: WINHealth Partners Commercial |
$247.71
|
| Rate for Payer: Wise Provider Network Commercial |
$247.71
|
|
|
RF DISPOSABLE ELECTRODE 15CM
|
Facility
|
IP
|
$260.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.49 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.32
|
| Rate for Payer: Altius Commercial |
$250.32
|
| Rate for Payer: Beech Street Commercial |
$255.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.08
|
| Rate for Payer: Cash Price |
$182.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.93
|
| Rate for Payer: Cigna of WY Commercial |
$255.54
|
| Rate for Payer: Entrust Commercial |
$247.71
|
| Rate for Payer: First Choice Health Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.10
|
| Rate for Payer: HealthUtah PPO |
$260.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.93
|
| Rate for Payer: Multiplan Medicare/VA |
$163.49
|
| Rate for Payer: One Health Plan of WY PPO |
$255.54
|
| Rate for Payer: PacificSource Commercial |
$234.68
|
| Rate for Payer: PHCS PPO |
$255.54
|
| Rate for Payer: Three Rivers PPO |
$195.56
|
| Rate for Payer: TriWest Veterans Administration |
$172.10
|
| Rate for Payer: United Healthcare Commercial |
$226.85
|
| Rate for Payer: United Healthcare Medicare |
$172.10
|
| Rate for Payer: WINHealth Partners Commercial |
$247.71
|
| Rate for Payer: Wise Provider Network Commercial |
$247.71
|
|
|
RF DISPOSABLE ELECTRODE 15CM
|
Facility
|
OP
|
$260.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.67 |
| Max. Negotiated Rate |
$260.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.54
|
| Rate for Payer: Aetna of WY Medicare |
$172.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.32
|
| Rate for Payer: Altius Commercial |
$250.32
|
| Rate for Payer: Beech Street Commercial |
$255.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.08
|
| Rate for Payer: Cash Price |
$182.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$252.93
|
| Rate for Payer: Cigna of WY Commercial |
$255.54
|
| Rate for Payer: Entrust Commercial |
$247.71
|
| Rate for Payer: First Choice Health Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.24
|
| Rate for Payer: HealthUtah PPO |
$260.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$252.93
|
| Rate for Payer: Multiplan Medicare/VA |
$143.67
|
| Rate for Payer: One Health Plan of WY PPO |
$255.54
|
| Rate for Payer: PacificSource Commercial |
$234.68
|
| Rate for Payer: PHCS PPO |
$255.54
|
| Rate for Payer: Three Rivers PPO |
$195.56
|
| Rate for Payer: TriWest Veterans Administration |
$151.24
|
| Rate for Payer: United Healthcare Commercial |
$226.85
|
| Rate for Payer: United Healthcare Medicare |
$151.24
|
| Rate for Payer: WINHealth Partners Commercial |
$255.54
|
| Rate for Payer: Wise Provider Network Commercial |
$247.71
|
|
|
RF SIDEKICK NEEDLE 20G 10CM
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
RF SIDEKICK NEEDLE 20G 10CM
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
RF SIDEKICK NEEDLE 20G 15CM
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.30
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$65.84
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$69.30
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
RF SIDEKICK NEEDLE 20G 15CM
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$100.80
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.20
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.90
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$57.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$60.90
|
| Rate for Payer: United Healthcare Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare |
$60.90
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
