|
SPIRONOLACTONE 25 MG TABLET [8082]
|
Facility
|
IP
|
$0.76
|
|
|
Service Code
|
NDC 6068746511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.73
|
| Rate for Payer: Altius Commercial |
$0.73
|
| Rate for Payer: Beech Street Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.74
|
| Rate for Payer: Cigna of WY Commercial |
$0.74
|
| Rate for Payer: Entrust Commercial |
$0.72
|
| Rate for Payer: First Choice Health Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.50
|
| Rate for Payer: HealthUtah PPO |
$0.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.74
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.74
|
| Rate for Payer: PacificSource Commercial |
$0.68
|
| Rate for Payer: PHCS PPO |
$0.74
|
| Rate for Payer: Three Rivers PPO |
$0.57
|
| Rate for Payer: TriWest Veterans Administration |
$0.50
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare |
$0.50
|
| Rate for Payer: WINHealth Partners Commercial |
$0.72
|
| Rate for Payer: Wise Provider Network Commercial |
$0.72
|
|
|
SPIRONOLACTONE 25 MG TABLET [8082]
|
Facility
|
OP
|
$0.76
|
|
|
Service Code
|
NDC 6068746501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.74
|
| Rate for Payer: Aetna of WY Medicare |
$0.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.73
|
| Rate for Payer: Altius Commercial |
$0.73
|
| Rate for Payer: Beech Street Commercial |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.74
|
| Rate for Payer: Cigna of WY Commercial |
$0.74
|
| Rate for Payer: Entrust Commercial |
$0.72
|
| Rate for Payer: First Choice Health Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.44
|
| Rate for Payer: HealthUtah PPO |
$0.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.74
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.74
|
| Rate for Payer: PacificSource Commercial |
$0.68
|
| Rate for Payer: PHCS PPO |
$0.74
|
| Rate for Payer: Three Rivers PPO |
$0.57
|
| Rate for Payer: TriWest Veterans Administration |
$0.44
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
| Rate for Payer: WINHealth Partners Commercial |
$0.74
|
| Rate for Payer: Wise Provider Network Commercial |
$0.72
|
|
|
SPLASHCAP WOUND IRRIGATION
|
Facility
|
IP
|
$11.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.14
|
| Rate for Payer: Altius Commercial |
$11.14
|
| Rate for Payer: Beech Street Commercial |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.25
|
| Rate for Payer: Cigna of WY Commercial |
$11.37
|
| Rate for Payer: Entrust Commercial |
$11.02
|
| Rate for Payer: First Choice Health Commercial |
$11.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.66
|
| Rate for Payer: HealthUtah PPO |
$11.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.25
|
| Rate for Payer: Multiplan Medicare/VA |
$7.27
|
| Rate for Payer: One Health Plan of WY PPO |
$11.37
|
| Rate for Payer: PacificSource Commercial |
$10.44
|
| Rate for Payer: PHCS PPO |
$11.37
|
| Rate for Payer: Three Rivers PPO |
$8.70
|
| Rate for Payer: TriWest Veterans Administration |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$10.09
|
| Rate for Payer: United Healthcare Medicare |
$7.66
|
| Rate for Payer: WINHealth Partners Commercial |
$11.02
|
| Rate for Payer: Wise Provider Network Commercial |
$11.02
|
|
|
SPLASHCAP WOUND IRRIGATION
|
Facility
|
OP
|
$11.60
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.37
|
| Rate for Payer: Aetna of WY Medicare |
$7.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.14
|
| Rate for Payer: Altius Commercial |
$11.14
|
| Rate for Payer: Beech Street Commercial |
$11.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.52
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.25
|
| Rate for Payer: Cigna of WY Commercial |
$11.37
|
| Rate for Payer: Entrust Commercial |
$11.02
|
| Rate for Payer: First Choice Health Commercial |
$11.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.73
|
| Rate for Payer: HealthUtah PPO |
$11.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.25
|
| Rate for Payer: Multiplan Medicare/VA |
$6.39
|
| Rate for Payer: One Health Plan of WY PPO |
$11.37
|
| Rate for Payer: PacificSource Commercial |
$10.44
|
| Rate for Payer: PHCS PPO |
$11.37
|
| Rate for Payer: Three Rivers PPO |
$8.70
|
| Rate for Payer: TriWest Veterans Administration |
$6.73
|
| Rate for Payer: United Healthcare Commercial |
$10.09
|
| Rate for Payer: United Healthcare Medicare |
$6.73
|
| Rate for Payer: WINHealth Partners Commercial |
$11.37
|
| Rate for Payer: Wise Provider Network Commercial |
$11.02
|
|
|
SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,968.00
|
|
|
Service Code
|
HCPCS 38100
|
| Hospital Charge Code |
38100
|
| Min. Negotiated Rate |
$924.69 |
| Max. Negotiated Rate |
$5,968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,848.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,087.87
|
| Rate for Payer: Beech Street Commercial |
$5,669.60
|
| Rate for Payer: Cash Price |
$4,177.60
|
| Rate for Payer: Cash Price |
$4,177.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,788.96
|
| Rate for Payer: Cigna of WY Commercial |
$5,848.64
|
| Rate for Payer: First Choice Health Commercial |
$5,371.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,669.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,087.87
|
| Rate for Payer: HealthUtah PPO |
$5,968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,788.96
|
| Rate for Payer: Multiplan Medicare/VA |
$924.69
|
| Rate for Payer: One Health Plan of WY PPO |
$5,848.64
|
| Rate for Payer: PacificSource Commercial |
$5,371.20
|
| Rate for Payer: PHCS PPO |
$5,669.60
|
| Rate for Payer: Three Rivers PPO |
$4,476.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,087.87
|
| Rate for Payer: United Healthcare Commercial |
$5,192.16
|
| Rate for Payer: United Healthcare Medicare |
$1,087.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,072.80
|
|
|
SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,968.00
|
|
|
Service Code
|
HCPCS 38100 AS
|
| Hospital Charge Code |
38100
|
| Min. Negotiated Rate |
$924.69 |
| Max. Negotiated Rate |
$5,968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,848.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,087.87
|
| Rate for Payer: Beech Street Commercial |
$5,669.60
|
| Rate for Payer: Cash Price |
$4,177.60
|
| Rate for Payer: Cash Price |
$4,177.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,788.96
|
| Rate for Payer: Cigna of WY Commercial |
$5,848.64
|
| Rate for Payer: First Choice Health Commercial |
$5,371.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,669.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,087.87
|
| Rate for Payer: HealthUtah PPO |
$5,968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,788.96
|
| Rate for Payer: Multiplan Medicare/VA |
$924.69
|
| Rate for Payer: One Health Plan of WY PPO |
$5,848.64
|
| Rate for Payer: PacificSource Commercial |
$5,371.20
|
| Rate for Payer: PHCS PPO |
$5,669.60
|
| Rate for Payer: Three Rivers PPO |
$4,476.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,087.87
|
| Rate for Payer: United Healthcare Commercial |
$5,192.16
|
| Rate for Payer: United Healthcare Medicare |
$1,087.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,072.80
|
|
|
SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$5,968.00
|
|
|
Service Code
|
HCPCS 38100 80
|
| Hospital Charge Code |
38100
|
| Min. Negotiated Rate |
$924.69 |
| Max. Negotiated Rate |
$5,968.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,848.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,087.87
|
| Rate for Payer: Beech Street Commercial |
$5,669.60
|
| Rate for Payer: Cash Price |
$4,177.60
|
| Rate for Payer: Cash Price |
$4,177.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,788.96
|
| Rate for Payer: Cigna of WY Commercial |
$5,848.64
|
| Rate for Payer: First Choice Health Commercial |
$5,371.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,669.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,087.87
|
| Rate for Payer: HealthUtah PPO |
$5,968.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,788.96
|
| Rate for Payer: Multiplan Medicare/VA |
$924.69
|
| Rate for Payer: One Health Plan of WY PPO |
$5,848.64
|
| Rate for Payer: PacificSource Commercial |
$5,371.20
|
| Rate for Payer: PHCS PPO |
$5,669.60
|
| Rate for Payer: Three Rivers PPO |
$4,476.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,087.87
|
| Rate for Payer: United Healthcare Commercial |
$5,192.16
|
| Rate for Payer: United Healthcare Medicare |
$1,087.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,072.80
|
|
|
SPLINT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS A4570
|
| Hospital Charge Code |
A4570
|
| Min. Negotiated Rate |
$20.25 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.46
|
| Rate for Payer: Beech Street Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.19
|
| Rate for Payer: Cigna of WY Commercial |
$26.46
|
| Rate for Payer: First Choice Health Commercial |
$24.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.65
|
| Rate for Payer: HealthUtah PPO |
$27.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.19
|
| Rate for Payer: One Health Plan of WY PPO |
$26.46
|
| Rate for Payer: PacificSource Commercial |
$24.30
|
| Rate for Payer: PHCS PPO |
$25.65
|
| Rate for Payer: Three Rivers PPO |
$20.25
|
| Rate for Payer: United Healthcare Commercial |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$25.65
|
|
|
SPLINT ONESTEP SCOTCHCAST 3X12
|
Facility
|
IP
|
$13.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$13.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.56
|
| Rate for Payer: Altius Commercial |
$12.56
|
| Rate for Payer: Beech Street Commercial |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.74
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.69
|
| Rate for Payer: Cigna of WY Commercial |
$12.82
|
| Rate for Payer: Entrust Commercial |
$12.43
|
| Rate for Payer: First Choice Health Commercial |
$12.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.63
|
| Rate for Payer: HealthUtah PPO |
$13.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.69
|
| Rate for Payer: Multiplan Medicare/VA |
$8.20
|
| Rate for Payer: One Health Plan of WY PPO |
$12.82
|
| Rate for Payer: PacificSource Commercial |
$11.77
|
| Rate for Payer: PHCS PPO |
$12.82
|
| Rate for Payer: Three Rivers PPO |
$9.81
|
| Rate for Payer: TriWest Veterans Administration |
$8.63
|
| Rate for Payer: United Healthcare Commercial |
$11.38
|
| Rate for Payer: United Healthcare Medicare |
$8.63
|
| Rate for Payer: WINHealth Partners Commercial |
$12.43
|
| Rate for Payer: Wise Provider Network Commercial |
$12.43
|
|
|
SPLINT ONESTEP SCOTCHCAST 3X12
|
Facility
|
OP
|
$13.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$13.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.82
|
| Rate for Payer: Aetna of WY Medicare |
$8.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.56
|
| Rate for Payer: Altius Commercial |
$12.56
|
| Rate for Payer: Beech Street Commercial |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.74
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.69
|
| Rate for Payer: Cigna of WY Commercial |
$12.82
|
| Rate for Payer: Entrust Commercial |
$12.43
|
| Rate for Payer: First Choice Health Commercial |
$12.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.59
|
| Rate for Payer: HealthUtah PPO |
$13.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.69
|
| Rate for Payer: Multiplan Medicare/VA |
$7.21
|
| Rate for Payer: One Health Plan of WY PPO |
$12.82
|
| Rate for Payer: PacificSource Commercial |
$11.77
|
| Rate for Payer: PHCS PPO |
$12.82
|
| Rate for Payer: Three Rivers PPO |
$9.81
|
| Rate for Payer: TriWest Veterans Administration |
$7.59
|
| Rate for Payer: United Healthcare Commercial |
$11.38
|
| Rate for Payer: United Healthcare Medicare |
$7.59
|
| Rate for Payer: WINHealth Partners Commercial |
$12.82
|
| Rate for Payer: Wise Provider Network Commercial |
$12.43
|
|
|
SPLINT ONESTEP SCOTCHCAST 4X15
|
Facility
|
OP
|
$19.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Medicare |
$12.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.80
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.36
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Multiplan Medicare/VA |
$10.79
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: TriWest Veterans Administration |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$17.03
|
| Rate for Payer: United Healthcare Medicare |
$11.36
|
| Rate for Payer: WINHealth Partners Commercial |
$19.19
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
|
|
SPLINT ONESTEP SCOTCHCAST 4X15
|
Facility
|
IP
|
$19.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.80
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.92
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Multiplan Medicare/VA |
$12.28
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: TriWest Veterans Administration |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$17.03
|
| Rate for Payer: United Healthcare Medicare |
$12.92
|
| Rate for Payer: WINHealth Partners Commercial |
$18.60
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
|
|
SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,995.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$584.66 |
| Max. Negotiated Rate |
$2,995.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,935.10
|
| Rate for Payer: Aetna of WY Medicare |
$687.83
|
| Rate for Payer: Beech Street Commercial |
$2,845.25
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,905.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,935.10
|
| Rate for Payer: First Choice Health Commercial |
$2,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,845.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$687.83
|
| Rate for Payer: HealthUtah PPO |
$2,995.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,905.15
|
| Rate for Payer: Multiplan Medicare/VA |
$584.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,935.10
|
| Rate for Payer: PacificSource Commercial |
$2,695.50
|
| Rate for Payer: PHCS PPO |
$2,845.25
|
| Rate for Payer: Three Rivers PPO |
$2,246.25
|
| Rate for Payer: TriWest Veterans Administration |
$687.83
|
| Rate for Payer: United Healthcare Commercial |
$2,605.65
|
| Rate for Payer: United Healthcare Medicare |
$687.83
|
| Rate for Payer: WINHealth Partners Commercial |
$2,545.75
|
|
|
SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,995.00
|
|
|
Service Code
|
HCPCS 15100 80
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$584.66 |
| Max. Negotiated Rate |
$2,995.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,935.10
|
| Rate for Payer: Aetna of WY Medicare |
$687.83
|
| Rate for Payer: Beech Street Commercial |
$2,845.25
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: Cash Price |
$2,096.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,905.15
|
| Rate for Payer: Cigna of WY Commercial |
$2,935.10
|
| Rate for Payer: First Choice Health Commercial |
$2,695.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,845.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$687.83
|
| Rate for Payer: HealthUtah PPO |
$2,995.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,905.15
|
| Rate for Payer: Multiplan Medicare/VA |
$584.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,935.10
|
| Rate for Payer: PacificSource Commercial |
$2,695.50
|
| Rate for Payer: PHCS PPO |
$2,845.25
|
| Rate for Payer: Three Rivers PPO |
$2,246.25
|
| Rate for Payer: TriWest Veterans Administration |
$687.83
|
| Rate for Payer: United Healthcare Commercial |
$2,605.65
|
| Rate for Payer: United Healthcare Medicare |
$687.83
|
| Rate for Payer: WINHealth Partners Commercial |
$2,545.75
|
|
|
SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 94010 26
|
| Hospital Charge Code |
94010
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$58.90
|
|
|
SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
94010
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.54
|
| Rate for Payer: Aetna of WY Medicare |
$26.68
|
| Rate for Payer: Beech Street Commercial |
$116.85
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$119.31
|
| Rate for Payer: Cigna of WY Commercial |
$120.54
|
| Rate for Payer: First Choice Health Commercial |
$110.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.68
|
| Rate for Payer: HealthUtah PPO |
$123.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$119.31
|
| Rate for Payer: Multiplan Medicare/VA |
$22.68
|
| Rate for Payer: One Health Plan of WY PPO |
$120.54
|
| Rate for Payer: PacificSource Commercial |
$110.70
|
| Rate for Payer: PHCS PPO |
$116.85
|
| Rate for Payer: Three Rivers PPO |
$92.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.68
|
| Rate for Payer: United Healthcare Commercial |
$107.01
|
| Rate for Payer: United Healthcare Medicare |
$26.68
|
| Rate for Payer: WINHealth Partners Commercial |
$116.85
|
|
|
SPO2 OXIMAX NASAL SENSOR
|
Facility
|
IP
|
$68.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.95 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.21
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$42.95
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$45.21
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$45.21
|
| Rate for Payer: WINHealth Partners Commercial |
$65.08
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
SPO2 OXIMAX NASAL SENSOR
|
Facility
|
OP
|
$68.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.74 |
| Max. Negotiated Rate |
$68.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.13
|
| Rate for Payer: Aetna of WY Medicare |
$45.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.76
|
| Rate for Payer: Altius Commercial |
$65.76
|
| Rate for Payer: Beech Street Commercial |
$67.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.24
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.44
|
| Rate for Payer: Cigna of WY Commercial |
$67.13
|
| Rate for Payer: Entrust Commercial |
$65.08
|
| Rate for Payer: First Choice Health Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.73
|
| Rate for Payer: HealthUtah PPO |
$68.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.44
|
| Rate for Payer: Multiplan Medicare/VA |
$37.74
|
| Rate for Payer: One Health Plan of WY PPO |
$67.13
|
| Rate for Payer: PacificSource Commercial |
$61.65
|
| Rate for Payer: PHCS PPO |
$67.13
|
| Rate for Payer: Three Rivers PPO |
$51.38
|
| Rate for Payer: TriWest Veterans Administration |
$39.73
|
| Rate for Payer: United Healthcare Commercial |
$59.60
|
| Rate for Payer: United Healthcare Medicare |
$39.73
|
| Rate for Payer: WINHealth Partners Commercial |
$67.13
|
| Rate for Payer: Wise Provider Network Commercial |
$65.08
|
|
|
SPO2 PORTABLE FINGER PULSE OX
|
Facility
|
IP
|
$94.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.14 |
| Max. Negotiated Rate |
$94.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$92.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$90.56
|
| Rate for Payer: Altius Commercial |
$90.56
|
| Rate for Payer: Beech Street Commercial |
$92.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.44
|
| Rate for Payer: Cash Price |
$66.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$91.50
|
| Rate for Payer: Cigna of WY Commercial |
$92.44
|
| Rate for Payer: Entrust Commercial |
$89.61
|
| Rate for Payer: First Choice Health Commercial |
$89.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.26
|
| Rate for Payer: HealthUtah PPO |
$94.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$91.50
|
| Rate for Payer: Multiplan Medicare/VA |
$59.14
|
| Rate for Payer: One Health Plan of WY PPO |
$92.44
|
| Rate for Payer: PacificSource Commercial |
$84.90
|
| Rate for Payer: PHCS PPO |
$92.44
|
| Rate for Payer: Three Rivers PPO |
$70.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.26
|
| Rate for Payer: United Healthcare Commercial |
$82.07
|
| Rate for Payer: United Healthcare Medicare |
$62.26
|
| Rate for Payer: WINHealth Partners Commercial |
$89.61
|
| Rate for Payer: Wise Provider Network Commercial |
$89.61
|
|
|
SPO2 PORTABLE FINGER PULSE OX
|
Facility
|
OP
|
$94.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$94.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$92.44
|
| Rate for Payer: Aetna of WY Medicare |
$62.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$90.56
|
| Rate for Payer: Altius Commercial |
$90.56
|
| Rate for Payer: Beech Street Commercial |
$92.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.44
|
| Rate for Payer: Cash Price |
$66.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$91.50
|
| Rate for Payer: Cigna of WY Commercial |
$92.44
|
| Rate for Payer: Entrust Commercial |
$89.61
|
| Rate for Payer: First Choice Health Commercial |
$89.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.71
|
| Rate for Payer: HealthUtah PPO |
$94.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$91.50
|
| Rate for Payer: Multiplan Medicare/VA |
$51.98
|
| Rate for Payer: One Health Plan of WY PPO |
$92.44
|
| Rate for Payer: PacificSource Commercial |
$84.90
|
| Rate for Payer: PHCS PPO |
$92.44
|
| Rate for Payer: Three Rivers PPO |
$70.75
|
| Rate for Payer: TriWest Veterans Administration |
$54.71
|
| Rate for Payer: United Healthcare Commercial |
$82.07
|
| Rate for Payer: United Healthcare Medicare |
$54.71
|
| Rate for Payer: WINHealth Partners Commercial |
$92.44
|
| Rate for Payer: Wise Provider Network Commercial |
$89.61
|
|
|
SPONGE LAP 18 X 18
|
Facility
|
OP
|
$4.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.47
|
| Rate for Payer: Aetna of WY Medicare |
$3.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.38
|
| Rate for Payer: Altius Commercial |
$4.38
|
| Rate for Payer: Beech Street Commercial |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.42
|
| Rate for Payer: Cigna of WY Commercial |
$4.47
|
| Rate for Payer: Entrust Commercial |
$4.33
|
| Rate for Payer: First Choice Health Commercial |
$4.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.64
|
| Rate for Payer: HealthUtah PPO |
$4.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.42
|
| Rate for Payer: Multiplan Medicare/VA |
$2.51
|
| Rate for Payer: One Health Plan of WY PPO |
$4.47
|
| Rate for Payer: PacificSource Commercial |
$4.10
|
| Rate for Payer: PHCS PPO |
$4.47
|
| Rate for Payer: Three Rivers PPO |
$3.42
|
| Rate for Payer: TriWest Veterans Administration |
$2.64
|
| Rate for Payer: United Healthcare Commercial |
$3.97
|
| Rate for Payer: United Healthcare Medicare |
$2.64
|
| Rate for Payer: WINHealth Partners Commercial |
$4.47
|
| Rate for Payer: Wise Provider Network Commercial |
$4.33
|
|
|
SPONGE LAP 18 X 18
|
Facility
|
IP
|
$4.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.38
|
| Rate for Payer: Altius Commercial |
$4.38
|
| Rate for Payer: Beech Street Commercial |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.42
|
| Rate for Payer: Cigna of WY Commercial |
$4.47
|
| Rate for Payer: Entrust Commercial |
$4.33
|
| Rate for Payer: First Choice Health Commercial |
$4.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.01
|
| Rate for Payer: HealthUtah PPO |
$4.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.42
|
| Rate for Payer: Multiplan Medicare/VA |
$2.86
|
| Rate for Payer: One Health Plan of WY PPO |
$4.47
|
| Rate for Payer: PacificSource Commercial |
$4.10
|
| Rate for Payer: PHCS PPO |
$4.47
|
| Rate for Payer: Three Rivers PPO |
$3.42
|
| Rate for Payer: TriWest Veterans Administration |
$3.01
|
| Rate for Payer: United Healthcare Commercial |
$3.97
|
| Rate for Payer: United Healthcare Medicare |
$3.01
|
| Rate for Payer: WINHealth Partners Commercial |
$4.33
|
| Rate for Payer: Wise Provider Network Commercial |
$4.33
|
|
|
SPONGE PEANUT 3/8" X-RAY 5PK
|
Facility
|
OP
|
$7.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.66
|
| Rate for Payer: Aetna of WY Medicare |
$5.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.51
|
| Rate for Payer: Altius Commercial |
$7.51
|
| Rate for Payer: Beech Street Commercial |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.42
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.59
|
| Rate for Payer: Cigna of WY Commercial |
$7.66
|
| Rate for Payer: Entrust Commercial |
$7.43
|
| Rate for Payer: First Choice Health Commercial |
$7.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.54
|
| Rate for Payer: HealthUtah PPO |
$7.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.59
|
| Rate for Payer: Multiplan Medicare/VA |
$4.31
|
| Rate for Payer: One Health Plan of WY PPO |
$7.66
|
| Rate for Payer: PacificSource Commercial |
$7.04
|
| Rate for Payer: PHCS PPO |
$7.66
|
| Rate for Payer: Three Rivers PPO |
$5.86
|
| Rate for Payer: TriWest Veterans Administration |
$4.54
|
| Rate for Payer: United Healthcare Commercial |
$6.80
|
| Rate for Payer: United Healthcare Medicare |
$4.54
|
| Rate for Payer: WINHealth Partners Commercial |
$7.66
|
| Rate for Payer: Wise Provider Network Commercial |
$7.43
|
|
|
SPONGE PEANUT 3/8" X-RAY 5PK
|
Facility
|
IP
|
$7.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.51
|
| Rate for Payer: Altius Commercial |
$7.51
|
| Rate for Payer: Beech Street Commercial |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.42
|
| Rate for Payer: Cash Price |
$5.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.59
|
| Rate for Payer: Cigna of WY Commercial |
$7.66
|
| Rate for Payer: Entrust Commercial |
$7.43
|
| Rate for Payer: First Choice Health Commercial |
$7.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.16
|
| Rate for Payer: HealthUtah PPO |
$7.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.59
|
| Rate for Payer: Multiplan Medicare/VA |
$4.90
|
| Rate for Payer: One Health Plan of WY PPO |
$7.66
|
| Rate for Payer: PacificSource Commercial |
$7.04
|
| Rate for Payer: PHCS PPO |
$7.66
|
| Rate for Payer: Three Rivers PPO |
$5.86
|
| Rate for Payer: TriWest Veterans Administration |
$5.16
|
| Rate for Payer: United Healthcare Commercial |
$6.80
|
| Rate for Payer: United Healthcare Medicare |
$5.16
|
| Rate for Payer: WINHealth Partners Commercial |
$7.43
|
| Rate for Payer: Wise Provider Network Commercial |
$7.43
|
|
|
SPONGE TONSIL LG
|
Facility
|
IP
|
$10.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.45
|
| Rate for Payer: Altius Commercial |
$10.45
|
| Rate for Payer: Beech Street Commercial |
$10.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.56
|
| Rate for Payer: Cigna of WY Commercial |
$10.67
|
| Rate for Payer: Entrust Commercial |
$10.35
|
| Rate for Payer: First Choice Health Commercial |
$10.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.19
|
| Rate for Payer: HealthUtah PPO |
$10.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.56
|
| Rate for Payer: Multiplan Medicare/VA |
$6.83
|
| Rate for Payer: One Health Plan of WY PPO |
$10.67
|
| Rate for Payer: PacificSource Commercial |
$9.80
|
| Rate for Payer: PHCS PPO |
$10.67
|
| Rate for Payer: Three Rivers PPO |
$8.17
|
| Rate for Payer: TriWest Veterans Administration |
$7.19
|
| Rate for Payer: United Healthcare Commercial |
$9.47
|
| Rate for Payer: United Healthcare Medicare |
$7.19
|
| Rate for Payer: WINHealth Partners Commercial |
$10.35
|
| Rate for Payer: Wise Provider Network Commercial |
$10.35
|
|
