|
SHOULDER AND HIP PACK
|
Facility
|
IP
|
$442.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.43 |
| Max. Negotiated Rate |
$442.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$424.77
|
| Rate for Payer: Altius Commercial |
$424.77
|
| Rate for Payer: Beech Street Commercial |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$363.27
|
| Rate for Payer: Cash Price |
$309.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$429.20
|
| Rate for Payer: Cigna of WY Commercial |
$433.62
|
| Rate for Payer: Entrust Commercial |
$420.35
|
| Rate for Payer: First Choice Health Commercial |
$420.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$420.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$292.03
|
| Rate for Payer: HealthUtah PPO |
$442.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$429.20
|
| Rate for Payer: Multiplan Medicare/VA |
$277.43
|
| Rate for Payer: One Health Plan of WY PPO |
$433.62
|
| Rate for Payer: PacificSource Commercial |
$398.22
|
| Rate for Payer: PHCS PPO |
$433.62
|
| Rate for Payer: Three Rivers PPO |
$331.85
|
| Rate for Payer: TriWest Veterans Administration |
$292.03
|
| Rate for Payer: United Healthcare Commercial |
$384.95
|
| Rate for Payer: United Healthcare Medicare |
$292.03
|
| Rate for Payer: WINHealth Partners Commercial |
$420.35
|
| Rate for Payer: Wise Provider Network Commercial |
$420.35
|
|
|
SHOULDER AND HIP PACK
|
Facility
|
OP
|
$442.47
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.80 |
| Max. Negotiated Rate |
$442.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$433.62
|
| Rate for Payer: Aetna of WY Medicare |
$292.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$424.77
|
| Rate for Payer: Altius Commercial |
$424.77
|
| Rate for Payer: Beech Street Commercial |
$433.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$363.27
|
| Rate for Payer: Cash Price |
$309.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$429.20
|
| Rate for Payer: Cigna of WY Commercial |
$433.62
|
| Rate for Payer: Entrust Commercial |
$420.35
|
| Rate for Payer: First Choice Health Commercial |
$420.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$420.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.63
|
| Rate for Payer: HealthUtah PPO |
$442.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$429.20
|
| Rate for Payer: Multiplan Medicare/VA |
$243.80
|
| Rate for Payer: One Health Plan of WY PPO |
$433.62
|
| Rate for Payer: PacificSource Commercial |
$398.22
|
| Rate for Payer: PHCS PPO |
$433.62
|
| Rate for Payer: Three Rivers PPO |
$331.85
|
| Rate for Payer: TriWest Veterans Administration |
$256.63
|
| Rate for Payer: United Healthcare Commercial |
$384.95
|
| Rate for Payer: United Healthcare Medicare |
$256.63
|
| Rate for Payer: WINHealth Partners Commercial |
$433.62
|
| Rate for Payer: Wise Provider Network Commercial |
$420.35
|
|
|
SHOULDER ARTHROSCOPY PACK
|
Facility
|
IP
|
$470.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$461.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$452.04
|
| Rate for Payer: Altius Commercial |
$452.04
|
| Rate for Payer: Beech Street Commercial |
$461.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$386.59
|
| Rate for Payer: Cash Price |
$329.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$456.75
|
| Rate for Payer: Cigna of WY Commercial |
$461.46
|
| Rate for Payer: Entrust Commercial |
$447.34
|
| Rate for Payer: First Choice Health Commercial |
$447.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$447.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.78
|
| Rate for Payer: HealthUtah PPO |
$470.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$456.75
|
| Rate for Payer: Multiplan Medicare/VA |
$295.24
|
| Rate for Payer: One Health Plan of WY PPO |
$461.46
|
| Rate for Payer: PacificSource Commercial |
$423.79
|
| Rate for Payer: PHCS PPO |
$461.46
|
| Rate for Payer: Three Rivers PPO |
$353.16
|
| Rate for Payer: TriWest Veterans Administration |
$310.78
|
| Rate for Payer: United Healthcare Commercial |
$409.67
|
| Rate for Payer: United Healthcare Medicare |
$310.78
|
| Rate for Payer: WINHealth Partners Commercial |
$447.34
|
| Rate for Payer: Wise Provider Network Commercial |
$447.34
|
|
|
SHOULDER ARTHROSCOPY PACK
|
Facility
|
OP
|
$470.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.45 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$461.46
|
| Rate for Payer: Aetna of WY Medicare |
$310.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$452.04
|
| Rate for Payer: Altius Commercial |
$452.04
|
| Rate for Payer: Beech Street Commercial |
$461.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$386.59
|
| Rate for Payer: Cash Price |
$329.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$456.75
|
| Rate for Payer: Cigna of WY Commercial |
$461.46
|
| Rate for Payer: Entrust Commercial |
$447.34
|
| Rate for Payer: First Choice Health Commercial |
$447.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$447.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$273.11
|
| Rate for Payer: HealthUtah PPO |
$470.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$456.75
|
| Rate for Payer: Multiplan Medicare/VA |
$259.45
|
| Rate for Payer: One Health Plan of WY PPO |
$461.46
|
| Rate for Payer: PacificSource Commercial |
$423.79
|
| Rate for Payer: PHCS PPO |
$461.46
|
| Rate for Payer: Three Rivers PPO |
$353.16
|
| Rate for Payer: TriWest Veterans Administration |
$273.11
|
| Rate for Payer: United Healthcare Commercial |
$409.67
|
| Rate for Payer: United Healthcare Medicare |
$273.11
|
| Rate for Payer: WINHealth Partners Commercial |
$461.46
|
| Rate for Payer: Wise Provider Network Commercial |
$447.34
|
|
|
SHOULDER STABILIZATION KIT
|
Facility
|
IP
|
$176.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.89 |
| Max. Negotiated Rate |
$176.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$169.79
|
| Rate for Payer: Altius Commercial |
$169.79
|
| Rate for Payer: Beech Street Commercial |
$173.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.20
|
| Rate for Payer: Cash Price |
$123.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.55
|
| Rate for Payer: Cigna of WY Commercial |
$173.32
|
| Rate for Payer: Entrust Commercial |
$168.02
|
| Rate for Payer: First Choice Health Commercial |
$168.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.73
|
| Rate for Payer: HealthUtah PPO |
$176.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.55
|
| Rate for Payer: Multiplan Medicare/VA |
$110.89
|
| Rate for Payer: One Health Plan of WY PPO |
$173.32
|
| Rate for Payer: PacificSource Commercial |
$159.17
|
| Rate for Payer: PHCS PPO |
$173.32
|
| Rate for Payer: Three Rivers PPO |
$132.64
|
| Rate for Payer: TriWest Veterans Administration |
$116.73
|
| Rate for Payer: United Healthcare Commercial |
$153.87
|
| Rate for Payer: United Healthcare Medicare |
$116.73
|
| Rate for Payer: WINHealth Partners Commercial |
$168.02
|
| Rate for Payer: Wise Provider Network Commercial |
$168.02
|
|
|
SHOULDER STABILIZATION KIT
|
Facility
|
OP
|
$176.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.45 |
| Max. Negotiated Rate |
$176.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$173.32
|
| Rate for Payer: Aetna of WY Medicare |
$116.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$169.79
|
| Rate for Payer: Altius Commercial |
$169.79
|
| Rate for Payer: Beech Street Commercial |
$173.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$145.20
|
| Rate for Payer: Cash Price |
$123.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$171.55
|
| Rate for Payer: Cigna of WY Commercial |
$173.32
|
| Rate for Payer: Entrust Commercial |
$168.02
|
| Rate for Payer: First Choice Health Commercial |
$168.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$168.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.58
|
| Rate for Payer: HealthUtah PPO |
$176.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$171.55
|
| Rate for Payer: Multiplan Medicare/VA |
$97.45
|
| Rate for Payer: One Health Plan of WY PPO |
$173.32
|
| Rate for Payer: PacificSource Commercial |
$159.17
|
| Rate for Payer: PHCS PPO |
$173.32
|
| Rate for Payer: Three Rivers PPO |
$132.64
|
| Rate for Payer: TriWest Veterans Administration |
$102.58
|
| Rate for Payer: United Healthcare Commercial |
$153.87
|
| Rate for Payer: United Healthcare Medicare |
$102.58
|
| Rate for Payer: WINHealth Partners Commercial |
$173.32
|
| Rate for Payer: Wise Provider Network Commercial |
$168.02
|
|
|
SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 11311
|
| Hospital Charge Code |
11311
|
| Min. Negotiated Rate |
$50.90 |
| Max. Negotiated Rate |
$319.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$59.88
|
| Rate for Payer: Beech Street Commercial |
$303.05
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.43
|
| Rate for Payer: Cigna of WY Commercial |
$312.62
|
| Rate for Payer: First Choice Health Commercial |
$287.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.88
|
| Rate for Payer: HealthUtah PPO |
$319.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Multiplan Medicare/VA |
$50.90
|
| Rate for Payer: One Health Plan of WY PPO |
$312.62
|
| Rate for Payer: PacificSource Commercial |
$287.10
|
| Rate for Payer: PHCS PPO |
$303.05
|
| Rate for Payer: Three Rivers PPO |
$239.25
|
| Rate for Payer: TriWest Veterans Administration |
$59.88
|
| Rate for Payer: United Healthcare Commercial |
$277.53
|
| Rate for Payer: United Healthcare Medicare |
$59.88
|
| Rate for Payer: WINHealth Partners Commercial |
$271.15
|
|
|
SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 11312
|
| Hospital Charge Code |
11312
|
| Min. Negotiated Rate |
$60.21 |
| Max. Negotiated Rate |
$379.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.42
|
| Rate for Payer: Aetna of WY Medicare |
$70.84
|
| Rate for Payer: Beech Street Commercial |
$360.05
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.63
|
| Rate for Payer: Cigna of WY Commercial |
$371.42
|
| Rate for Payer: First Choice Health Commercial |
$341.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.84
|
| Rate for Payer: HealthUtah PPO |
$379.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.63
|
| Rate for Payer: Multiplan Medicare/VA |
$60.21
|
| Rate for Payer: One Health Plan of WY PPO |
$371.42
|
| Rate for Payer: PacificSource Commercial |
$341.10
|
| Rate for Payer: PHCS PPO |
$360.05
|
| Rate for Payer: Three Rivers PPO |
$284.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.84
|
| Rate for Payer: United Healthcare Commercial |
$329.73
|
| Rate for Payer: United Healthcare Medicare |
$70.84
|
| Rate for Payer: WINHealth Partners Commercial |
$322.15
|
|
|
SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
11301
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.78
|
| Rate for Payer: Aetna of WY Medicare |
$48.92
|
| Rate for Payer: Beech Street Commercial |
$247.95
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.17
|
| Rate for Payer: Cigna of WY Commercial |
$255.78
|
| Rate for Payer: First Choice Health Commercial |
$234.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.92
|
| Rate for Payer: HealthUtah PPO |
$261.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.17
|
| Rate for Payer: Multiplan Medicare/VA |
$41.58
|
| Rate for Payer: One Health Plan of WY PPO |
$255.78
|
| Rate for Payer: PacificSource Commercial |
$234.90
|
| Rate for Payer: PHCS PPO |
$247.95
|
| Rate for Payer: Three Rivers PPO |
$195.75
|
| Rate for Payer: TriWest Veterans Administration |
$48.92
|
| Rate for Payer: United Healthcare Commercial |
$227.07
|
| Rate for Payer: United Healthcare Medicare |
$48.92
|
| Rate for Payer: WINHealth Partners Commercial |
$221.85
|
|
|
SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 11303
|
| Hospital Charge Code |
11303
|
| Min. Negotiated Rate |
$57.71 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$352.80
|
| Rate for Payer: Aetna of WY Medicare |
$67.89
|
| Rate for Payer: Beech Street Commercial |
$342.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$349.20
|
| Rate for Payer: Cigna of WY Commercial |
$352.80
|
| Rate for Payer: First Choice Health Commercial |
$324.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.89
|
| Rate for Payer: HealthUtah PPO |
$360.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$349.20
|
| Rate for Payer: Multiplan Medicare/VA |
$57.71
|
| Rate for Payer: One Health Plan of WY PPO |
$352.80
|
| Rate for Payer: PacificSource Commercial |
$324.00
|
| Rate for Payer: PHCS PPO |
$342.00
|
| Rate for Payer: Three Rivers PPO |
$270.00
|
| Rate for Payer: TriWest Veterans Administration |
$67.89
|
| Rate for Payer: United Healthcare Commercial |
$313.20
|
| Rate for Payer: United Healthcare Medicare |
$67.89
|
| Rate for Payer: WINHealth Partners Commercial |
$306.00
|
|
|
SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 11302
|
| Hospital Charge Code |
11302
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$57.02
|
| Rate for Payer: Beech Street Commercial |
$292.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: First Choice Health Commercial |
$277.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.02
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$48.47
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$292.60
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$57.02
|
| Rate for Payer: United Healthcare Commercial |
$267.96
|
| Rate for Payer: United Healthcare Medicare |
$57.02
|
| Rate for Payer: WINHealth Partners Commercial |
$261.80
|
|
|
SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45330 80
|
| Hospital Charge Code |
45330
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$54.31
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.31
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$46.16
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$54.31
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$54.31
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
45330
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$54.31
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.31
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$46.16
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$54.31
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$54.31
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45330 52
|
| Hospital Charge Code |
45330
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$882.00
|
| Rate for Payer: Aetna of WY Medicare |
$54.31
|
| Rate for Payer: Beech Street Commercial |
$855.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$873.00
|
| Rate for Payer: Cigna of WY Commercial |
$882.00
|
| Rate for Payer: First Choice Health Commercial |
$810.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$855.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.31
|
| Rate for Payer: HealthUtah PPO |
$900.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$873.00
|
| Rate for Payer: Multiplan Medicare/VA |
$46.16
|
| Rate for Payer: One Health Plan of WY PPO |
$882.00
|
| Rate for Payer: PacificSource Commercial |
$810.00
|
| Rate for Payer: PHCS PPO |
$855.00
|
| Rate for Payer: Three Rivers PPO |
$675.00
|
| Rate for Payer: TriWest Veterans Administration |
$54.31
|
| Rate for Payer: United Healthcare Commercial |
$783.00
|
| Rate for Payer: United Healthcare Medicare |
$54.31
|
| Rate for Payer: WINHealth Partners Commercial |
$765.00
|
|
|
SIGMOIDOSCOPY FLX TNDSC BALO DILAT
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 45340
|
| Hospital Charge Code |
45340
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Aetna of WY Medicare |
$74.76
|
| Rate for Payer: Beech Street Commercial |
$381.90
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: First Choice Health Commercial |
$361.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.76
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$63.55
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$381.90
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$74.76
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$74.76
|
| Rate for Payer: WINHealth Partners Commercial |
$341.70
|
|
|
SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
45331
|
| Min. Negotiated Rate |
$58.75 |
| Max. Negotiated Rate |
$1,177.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,153.46
|
| Rate for Payer: Aetna of WY Medicare |
$69.12
|
| Rate for Payer: Beech Street Commercial |
$1,118.15
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: Cash Price |
$823.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,141.69
|
| Rate for Payer: Cigna of WY Commercial |
$1,153.46
|
| Rate for Payer: First Choice Health Commercial |
$1,059.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,118.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.12
|
| Rate for Payer: HealthUtah PPO |
$1,177.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,141.69
|
| Rate for Payer: Multiplan Medicare/VA |
$58.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,153.46
|
| Rate for Payer: PacificSource Commercial |
$1,059.30
|
| Rate for Payer: PHCS PPO |
$1,118.15
|
| Rate for Payer: Three Rivers PPO |
$882.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.12
|
| Rate for Payer: United Healthcare Commercial |
$1,023.99
|
| Rate for Payer: United Healthcare Medicare |
$69.12
|
| Rate for Payer: WINHealth Partners Commercial |
$1,000.45
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
OP
|
$2.96
|
|
|
Service Code
|
NDC 5026871711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.90
|
| Rate for Payer: Aetna of WY Medicare |
$1.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.84
|
| Rate for Payer: Altius Commercial |
$2.84
|
| Rate for Payer: Beech Street Commercial |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.87
|
| Rate for Payer: Cigna of WY Commercial |
$2.90
|
| Rate for Payer: Entrust Commercial |
$2.81
|
| Rate for Payer: First Choice Health Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.72
|
| Rate for Payer: HealthUtah PPO |
$2.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.87
|
| Rate for Payer: Multiplan Medicare/VA |
$1.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2.90
|
| Rate for Payer: PacificSource Commercial |
$2.66
|
| Rate for Payer: PHCS PPO |
$2.90
|
| Rate for Payer: Three Rivers PPO |
$2.22
|
| Rate for Payer: TriWest Veterans Administration |
$1.72
|
| Rate for Payer: United Healthcare Commercial |
$2.58
|
| Rate for Payer: United Healthcare Medicare |
$1.72
|
| Rate for Payer: WINHealth Partners Commercial |
$2.90
|
| Rate for Payer: Wise Provider Network Commercial |
$2.81
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
IP
|
$3.93
|
|
|
Service Code
|
NDC 6068741621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.77
|
| Rate for Payer: Altius Commercial |
$3.77
|
| Rate for Payer: Beech Street Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.81
|
| Rate for Payer: Cigna of WY Commercial |
$3.85
|
| Rate for Payer: Entrust Commercial |
$3.73
|
| Rate for Payer: First Choice Health Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.59
|
| Rate for Payer: HealthUtah PPO |
$3.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.81
|
| Rate for Payer: Multiplan Medicare/VA |
$2.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3.85
|
| Rate for Payer: PacificSource Commercial |
$3.54
|
| Rate for Payer: PHCS PPO |
$3.85
|
| Rate for Payer: Three Rivers PPO |
$2.95
|
| Rate for Payer: TriWest Veterans Administration |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WINHealth Partners Commercial |
$3.73
|
| Rate for Payer: Wise Provider Network Commercial |
$3.73
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
IP
|
$2.96
|
|
|
Service Code
|
NDC 5026871711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.84
|
| Rate for Payer: Altius Commercial |
$2.84
|
| Rate for Payer: Beech Street Commercial |
$2.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.87
|
| Rate for Payer: Cigna of WY Commercial |
$2.90
|
| Rate for Payer: Entrust Commercial |
$2.81
|
| Rate for Payer: First Choice Health Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.95
|
| Rate for Payer: HealthUtah PPO |
$2.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.87
|
| Rate for Payer: Multiplan Medicare/VA |
$1.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2.90
|
| Rate for Payer: PacificSource Commercial |
$2.66
|
| Rate for Payer: PHCS PPO |
$2.90
|
| Rate for Payer: Three Rivers PPO |
$2.22
|
| Rate for Payer: TriWest Veterans Administration |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$2.58
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
| Rate for Payer: WINHealth Partners Commercial |
$2.81
|
| Rate for Payer: Wise Provider Network Commercial |
$2.81
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 6068778811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.56
|
| Rate for Payer: Aetna of WY Medicare |
$3.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.46
|
| Rate for Payer: Altius Commercial |
$4.46
|
| Rate for Payer: Beech Street Commercial |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.51
|
| Rate for Payer: Cigna of WY Commercial |
$4.56
|
| Rate for Payer: Entrust Commercial |
$4.42
|
| Rate for Payer: First Choice Health Commercial |
$4.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.70
|
| Rate for Payer: HealthUtah PPO |
$4.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.51
|
| Rate for Payer: Multiplan Medicare/VA |
$2.56
|
| Rate for Payer: One Health Plan of WY PPO |
$4.56
|
| Rate for Payer: PacificSource Commercial |
$4.18
|
| Rate for Payer: PHCS PPO |
$4.56
|
| Rate for Payer: Three Rivers PPO |
$3.49
|
| Rate for Payer: TriWest Veterans Administration |
$2.70
|
| Rate for Payer: United Healthcare Commercial |
$4.05
|
| Rate for Payer: United Healthcare Medicare |
$2.70
|
| Rate for Payer: WINHealth Partners Commercial |
$4.56
|
| Rate for Payer: Wise Provider Network Commercial |
$4.42
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
IP
|
$3.93
|
|
|
Service Code
|
NDC 6068741611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.77
|
| Rate for Payer: Altius Commercial |
$3.77
|
| Rate for Payer: Beech Street Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.81
|
| Rate for Payer: Cigna of WY Commercial |
$3.85
|
| Rate for Payer: Entrust Commercial |
$3.73
|
| Rate for Payer: First Choice Health Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.59
|
| Rate for Payer: HealthUtah PPO |
$3.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.81
|
| Rate for Payer: Multiplan Medicare/VA |
$2.46
|
| Rate for Payer: One Health Plan of WY PPO |
$3.85
|
| Rate for Payer: PacificSource Commercial |
$3.54
|
| Rate for Payer: PHCS PPO |
$3.85
|
| Rate for Payer: Three Rivers PPO |
$2.95
|
| Rate for Payer: TriWest Veterans Administration |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WINHealth Partners Commercial |
$3.73
|
| Rate for Payer: Wise Provider Network Commercial |
$3.73
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
OP
|
$3.93
|
|
|
Service Code
|
NDC 6068741621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.85
|
| Rate for Payer: Aetna of WY Medicare |
$2.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.77
|
| Rate for Payer: Altius Commercial |
$3.77
|
| Rate for Payer: Beech Street Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.81
|
| Rate for Payer: Cigna of WY Commercial |
$3.85
|
| Rate for Payer: Entrust Commercial |
$3.73
|
| Rate for Payer: First Choice Health Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.28
|
| Rate for Payer: HealthUtah PPO |
$3.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.81
|
| Rate for Payer: Multiplan Medicare/VA |
$2.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3.85
|
| Rate for Payer: PacificSource Commercial |
$3.54
|
| Rate for Payer: PHCS PPO |
$3.85
|
| Rate for Payer: Three Rivers PPO |
$2.95
|
| Rate for Payer: TriWest Veterans Administration |
$2.28
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare |
$2.28
|
| Rate for Payer: WINHealth Partners Commercial |
$3.85
|
| Rate for Payer: Wise Provider Network Commercial |
$3.73
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
OP
|
$3.93
|
|
|
Service Code
|
NDC 6068741611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.85
|
| Rate for Payer: Aetna of WY Medicare |
$2.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.77
|
| Rate for Payer: Altius Commercial |
$3.77
|
| Rate for Payer: Beech Street Commercial |
$3.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.81
|
| Rate for Payer: Cigna of WY Commercial |
$3.85
|
| Rate for Payer: Entrust Commercial |
$3.73
|
| Rate for Payer: First Choice Health Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.28
|
| Rate for Payer: HealthUtah PPO |
$3.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.81
|
| Rate for Payer: Multiplan Medicare/VA |
$2.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3.85
|
| Rate for Payer: PacificSource Commercial |
$3.54
|
| Rate for Payer: PHCS PPO |
$3.85
|
| Rate for Payer: Three Rivers PPO |
$2.95
|
| Rate for Payer: TriWest Veterans Administration |
$2.28
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
| Rate for Payer: United Healthcare Medicare |
$2.28
|
| Rate for Payer: WINHealth Partners Commercial |
$3.85
|
| Rate for Payer: Wise Provider Network Commercial |
$3.73
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET [38724]
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 6068778811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.46
|
| Rate for Payer: Altius Commercial |
$4.46
|
| Rate for Payer: Beech Street Commercial |
$4.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.51
|
| Rate for Payer: Cigna of WY Commercial |
$4.56
|
| Rate for Payer: Entrust Commercial |
$4.42
|
| Rate for Payer: First Choice Health Commercial |
$4.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.07
|
| Rate for Payer: HealthUtah PPO |
$4.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.51
|
| Rate for Payer: Multiplan Medicare/VA |
$2.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4.56
|
| Rate for Payer: PacificSource Commercial |
$4.18
|
| Rate for Payer: PHCS PPO |
$4.56
|
| Rate for Payer: Three Rivers PPO |
$3.49
|
| Rate for Payer: TriWest Veterans Administration |
$3.07
|
| Rate for Payer: United Healthcare Commercial |
$4.05
|
| Rate for Payer: United Healthcare Medicare |
$3.07
|
| Rate for Payer: WINHealth Partners Commercial |
$4.42
|
| Rate for Payer: Wise Provider Network Commercial |
$4.42
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [42671]
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 1287000012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.75
|
| Rate for Payer: Aetna of WY Medicare |
$1.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.70
|
| Rate for Payer: Altius Commercial |
$2.70
|
| Rate for Payer: Beech Street Commercial |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.73
|
| Rate for Payer: Cigna of WY Commercial |
$2.75
|
| Rate for Payer: Entrust Commercial |
$2.67
|
| Rate for Payer: First Choice Health Commercial |
$2.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.63
|
| Rate for Payer: HealthUtah PPO |
$2.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.73
|
| Rate for Payer: Multiplan Medicare/VA |
$1.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2.75
|
| Rate for Payer: PacificSource Commercial |
$2.53
|
| Rate for Payer: PHCS PPO |
$2.75
|
| Rate for Payer: Three Rivers PPO |
$2.11
|
| Rate for Payer: TriWest Veterans Administration |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$2.44
|
| Rate for Payer: United Healthcare Medicare |
$1.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2.67
|
|
