|
TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$2,496.00
|
|
|
Service Code
|
HCPCS 25312 AS
|
| Hospital Charge Code |
25312
|
| Min. Negotiated Rate |
$594.28 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,446.08
|
| Rate for Payer: Aetna of WY Medicare |
$699.15
|
| Rate for Payer: Beech Street Commercial |
$2,371.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,421.12
|
| Rate for Payer: Cigna of WY Commercial |
$2,446.08
|
| Rate for Payer: First Choice Health Commercial |
$2,246.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,371.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.15
|
| Rate for Payer: HealthUtah PPO |
$2,496.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,421.12
|
| Rate for Payer: Multiplan Medicare/VA |
$594.28
|
| Rate for Payer: One Health Plan of WY PPO |
$2,446.08
|
| Rate for Payer: PacificSource Commercial |
$2,246.40
|
| Rate for Payer: PHCS PPO |
$2,371.20
|
| Rate for Payer: Three Rivers PPO |
$1,872.00
|
| Rate for Payer: TriWest Veterans Administration |
$699.15
|
| Rate for Payer: United Healthcare Commercial |
$2,171.52
|
| Rate for Payer: United Healthcare Medicare |
$699.15
|
| Rate for Payer: WINHealth Partners Commercial |
$2,121.60
|
|
|
TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
90714
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.98
|
| Rate for Payer: Aetna of WY Medicare |
$18.83
|
| Rate for Payer: Beech Street Commercial |
$95.95
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: Cash Price |
$70.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.97
|
| Rate for Payer: Cigna of WY Commercial |
$98.98
|
| Rate for Payer: First Choice Health Commercial |
$90.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.83
|
| Rate for Payer: HealthUtah PPO |
$101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.97
|
| Rate for Payer: Multiplan Medicare/VA |
$16.00
|
| Rate for Payer: One Health Plan of WY PPO |
$98.98
|
| Rate for Payer: PacificSource Commercial |
$90.90
|
| Rate for Payer: PHCS PPO |
$95.95
|
| Rate for Payer: Three Rivers PPO |
$75.75
|
| Rate for Payer: TriWest Veterans Administration |
$18.83
|
| Rate for Payer: United Healthcare Commercial |
$87.87
|
| Rate for Payer: United Healthcare Medicare |
$18.83
|
| Rate for Payer: WINHealth Partners Commercial |
$101.00
|
|
|
TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99366
|
| Hospital Charge Code |
99366
|
| Min. Negotiated Rate |
$122.25 |
| Max. Negotiated Rate |
$163.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.74
|
| Rate for Payer: Beech Street Commercial |
$154.85
|
| Rate for Payer: Cash Price |
$114.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.11
|
| Rate for Payer: Cigna of WY Commercial |
$159.74
|
| Rate for Payer: First Choice Health Commercial |
$146.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.85
|
| Rate for Payer: HealthUtah PPO |
$163.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.11
|
| Rate for Payer: One Health Plan of WY PPO |
$159.74
|
| Rate for Payer: PacificSource Commercial |
$146.70
|
| Rate for Payer: PHCS PPO |
$154.85
|
| Rate for Payer: Three Rivers PPO |
$122.25
|
| Rate for Payer: United Healthcare Commercial |
$141.81
|
| Rate for Payer: WINHealth Partners Commercial |
$154.85
|
|
|
TEDS KNEE LARGE REGULAR
|
Facility
|
IP
|
$6.61
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.35
|
| Rate for Payer: Altius Commercial |
$6.35
|
| Rate for Payer: Beech Street Commercial |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$4.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.41
|
| Rate for Payer: Cigna of WY Commercial |
$6.48
|
| Rate for Payer: Entrust Commercial |
$6.28
|
| Rate for Payer: First Choice Health Commercial |
$6.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.36
|
| Rate for Payer: HealthUtah PPO |
$6.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.41
|
| Rate for Payer: Multiplan Medicare/VA |
$4.14
|
| Rate for Payer: One Health Plan of WY PPO |
$6.48
|
| Rate for Payer: PacificSource Commercial |
$5.95
|
| Rate for Payer: PHCS PPO |
$6.48
|
| Rate for Payer: Three Rivers PPO |
$4.96
|
| Rate for Payer: TriWest Veterans Administration |
$4.36
|
| Rate for Payer: United Healthcare Commercial |
$5.75
|
| Rate for Payer: United Healthcare Medicare |
$4.36
|
| Rate for Payer: WINHealth Partners Commercial |
$6.28
|
| Rate for Payer: Wise Provider Network Commercial |
$6.28
|
|
|
TEDS KNEE LARGE REGULAR
|
Facility
|
OP
|
$6.61
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$6.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.48
|
| Rate for Payer: Aetna of WY Medicare |
$4.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.35
|
| Rate for Payer: Altius Commercial |
$6.35
|
| Rate for Payer: Beech Street Commercial |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$4.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.41
|
| Rate for Payer: Cigna of WY Commercial |
$6.48
|
| Rate for Payer: Entrust Commercial |
$6.28
|
| Rate for Payer: First Choice Health Commercial |
$6.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.83
|
| Rate for Payer: HealthUtah PPO |
$6.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.41
|
| Rate for Payer: Multiplan Medicare/VA |
$3.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6.48
|
| Rate for Payer: PacificSource Commercial |
$5.95
|
| Rate for Payer: PHCS PPO |
$6.48
|
| Rate for Payer: Three Rivers PPO |
$4.96
|
| Rate for Payer: TriWest Veterans Administration |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$5.75
|
| Rate for Payer: United Healthcare Medicare |
$3.83
|
| Rate for Payer: WINHealth Partners Commercial |
$6.48
|
| Rate for Payer: Wise Provider Network Commercial |
$6.28
|
|
|
TEDS KNEE MEDIUM REGULAR
|
Facility
|
IP
|
$6.60
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.34
|
| Rate for Payer: Altius Commercial |
$6.34
|
| Rate for Payer: Beech Street Commercial |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.40
|
| Rate for Payer: Cigna of WY Commercial |
$6.47
|
| Rate for Payer: Entrust Commercial |
$6.27
|
| Rate for Payer: First Choice Health Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.36
|
| Rate for Payer: HealthUtah PPO |
$6.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.40
|
| Rate for Payer: Multiplan Medicare/VA |
$4.14
|
| Rate for Payer: One Health Plan of WY PPO |
$6.47
|
| Rate for Payer: PacificSource Commercial |
$5.94
|
| Rate for Payer: PHCS PPO |
$6.47
|
| Rate for Payer: Three Rivers PPO |
$4.95
|
| Rate for Payer: TriWest Veterans Administration |
$4.36
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$4.36
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.27
|
|
|
TEDS KNEE MEDIUM REGULAR
|
Facility
|
OP
|
$6.60
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.47
|
| Rate for Payer: Aetna of WY Medicare |
$4.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.34
|
| Rate for Payer: Altius Commercial |
$6.34
|
| Rate for Payer: Beech Street Commercial |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.40
|
| Rate for Payer: Cigna of WY Commercial |
$6.47
|
| Rate for Payer: Entrust Commercial |
$6.27
|
| Rate for Payer: First Choice Health Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.83
|
| Rate for Payer: HealthUtah PPO |
$6.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.40
|
| Rate for Payer: Multiplan Medicare/VA |
$3.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6.47
|
| Rate for Payer: PacificSource Commercial |
$5.94
|
| Rate for Payer: PHCS PPO |
$6.47
|
| Rate for Payer: Three Rivers PPO |
$4.95
|
| Rate for Payer: TriWest Veterans Administration |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$3.83
|
| Rate for Payer: WINHealth Partners Commercial |
$6.47
|
| Rate for Payer: Wise Provider Network Commercial |
$6.27
|
|
|
TEDS KNEE SMALL REGULAR
|
Facility
|
IP
|
$6.60
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.34
|
| Rate for Payer: Altius Commercial |
$6.34
|
| Rate for Payer: Beech Street Commercial |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.40
|
| Rate for Payer: Cigna of WY Commercial |
$6.47
|
| Rate for Payer: Entrust Commercial |
$6.27
|
| Rate for Payer: First Choice Health Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.36
|
| Rate for Payer: HealthUtah PPO |
$6.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.40
|
| Rate for Payer: Multiplan Medicare/VA |
$4.14
|
| Rate for Payer: One Health Plan of WY PPO |
$6.47
|
| Rate for Payer: PacificSource Commercial |
$5.94
|
| Rate for Payer: PHCS PPO |
$6.47
|
| Rate for Payer: Three Rivers PPO |
$4.95
|
| Rate for Payer: TriWest Veterans Administration |
$4.36
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$4.36
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.27
|
|
|
TEDS KNEE SMALL REGULAR
|
Facility
|
OP
|
$6.60
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.47
|
| Rate for Payer: Aetna of WY Medicare |
$4.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.34
|
| Rate for Payer: Altius Commercial |
$6.34
|
| Rate for Payer: Beech Street Commercial |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.40
|
| Rate for Payer: Cigna of WY Commercial |
$6.47
|
| Rate for Payer: Entrust Commercial |
$6.27
|
| Rate for Payer: First Choice Health Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.83
|
| Rate for Payer: HealthUtah PPO |
$6.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.40
|
| Rate for Payer: Multiplan Medicare/VA |
$3.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6.47
|
| Rate for Payer: PacificSource Commercial |
$5.94
|
| Rate for Payer: PHCS PPO |
$6.47
|
| Rate for Payer: Three Rivers PPO |
$4.95
|
| Rate for Payer: TriWest Veterans Administration |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$3.83
|
| Rate for Payer: WINHealth Partners Commercial |
$6.47
|
| Rate for Payer: Wise Provider Network Commercial |
$6.27
|
|
|
TEDS KNEE XLARGE REGULAR
|
Facility
|
IP
|
$6.60
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.34
|
| Rate for Payer: Altius Commercial |
$6.34
|
| Rate for Payer: Beech Street Commercial |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.40
|
| Rate for Payer: Cigna of WY Commercial |
$6.47
|
| Rate for Payer: Entrust Commercial |
$6.27
|
| Rate for Payer: First Choice Health Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.36
|
| Rate for Payer: HealthUtah PPO |
$6.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.40
|
| Rate for Payer: Multiplan Medicare/VA |
$4.14
|
| Rate for Payer: One Health Plan of WY PPO |
$6.47
|
| Rate for Payer: PacificSource Commercial |
$5.94
|
| Rate for Payer: PHCS PPO |
$6.47
|
| Rate for Payer: Three Rivers PPO |
$4.95
|
| Rate for Payer: TriWest Veterans Administration |
$4.36
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$4.36
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.27
|
|
|
TEDS KNEE XLARGE REGULAR
|
Facility
|
OP
|
$6.60
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$6.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.47
|
| Rate for Payer: Aetna of WY Medicare |
$4.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.34
|
| Rate for Payer: Altius Commercial |
$6.34
|
| Rate for Payer: Beech Street Commercial |
$6.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.40
|
| Rate for Payer: Cigna of WY Commercial |
$6.47
|
| Rate for Payer: Entrust Commercial |
$6.27
|
| Rate for Payer: First Choice Health Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.83
|
| Rate for Payer: HealthUtah PPO |
$6.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.40
|
| Rate for Payer: Multiplan Medicare/VA |
$3.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6.47
|
| Rate for Payer: PacificSource Commercial |
$5.94
|
| Rate for Payer: PHCS PPO |
$6.47
|
| Rate for Payer: Three Rivers PPO |
$4.95
|
| Rate for Payer: TriWest Veterans Administration |
$3.83
|
| Rate for Payer: United Healthcare Commercial |
$5.74
|
| Rate for Payer: United Healthcare Medicare |
$3.83
|
| Rate for Payer: WINHealth Partners Commercial |
$6.47
|
| Rate for Payer: Wise Provider Network Commercial |
$6.27
|
|
|
TEDS KNEE XXLARGE REGULAR
|
Facility
|
OP
|
$13.02
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$13.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.76
|
| Rate for Payer: Aetna of WY Medicare |
$8.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.50
|
| Rate for Payer: Altius Commercial |
$12.50
|
| Rate for Payer: Beech Street Commercial |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.69
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.63
|
| Rate for Payer: Cigna of WY Commercial |
$12.76
|
| Rate for Payer: Entrust Commercial |
$12.37
|
| Rate for Payer: First Choice Health Commercial |
$12.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.55
|
| Rate for Payer: HealthUtah PPO |
$13.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.63
|
| Rate for Payer: Multiplan Medicare/VA |
$7.17
|
| Rate for Payer: One Health Plan of WY PPO |
$12.76
|
| Rate for Payer: PacificSource Commercial |
$11.72
|
| Rate for Payer: PHCS PPO |
$12.76
|
| Rate for Payer: Three Rivers PPO |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$7.55
|
| Rate for Payer: United Healthcare Commercial |
$11.33
|
| Rate for Payer: United Healthcare Medicare |
$7.55
|
| Rate for Payer: WINHealth Partners Commercial |
$12.76
|
| Rate for Payer: Wise Provider Network Commercial |
$12.37
|
|
|
TEDS KNEE XXLARGE REGULAR
|
Facility
|
IP
|
$13.02
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$13.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.50
|
| Rate for Payer: Altius Commercial |
$12.50
|
| Rate for Payer: Beech Street Commercial |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.69
|
| Rate for Payer: Cash Price |
$9.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.63
|
| Rate for Payer: Cigna of WY Commercial |
$12.76
|
| Rate for Payer: Entrust Commercial |
$12.37
|
| Rate for Payer: First Choice Health Commercial |
$12.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.59
|
| Rate for Payer: HealthUtah PPO |
$13.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.63
|
| Rate for Payer: Multiplan Medicare/VA |
$8.16
|
| Rate for Payer: One Health Plan of WY PPO |
$12.76
|
| Rate for Payer: PacificSource Commercial |
$11.72
|
| Rate for Payer: PHCS PPO |
$12.76
|
| Rate for Payer: Three Rivers PPO |
$9.76
|
| Rate for Payer: TriWest Veterans Administration |
$8.59
|
| Rate for Payer: United Healthcare Commercial |
$11.33
|
| Rate for Payer: United Healthcare Medicare |
$8.59
|
| Rate for Payer: WINHealth Partners Commercial |
$12.37
|
| Rate for Payer: Wise Provider Network Commercial |
$12.37
|
|
|
TEDS THIGH LARGE REGULAR
|
Facility
|
OP
|
$12.76
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Aetna of WY Medicare |
$8.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.40
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$7.03
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$7.40
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WINHealth Partners Commercial |
$12.50
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
TEDS THIGH LARGE REGULAR
|
Facility
|
IP
|
$12.76
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.42
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$8.00
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$8.42
|
| Rate for Payer: WINHealth Partners Commercial |
$12.12
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
TEDS THIGH MEDIUM REGULAR
|
Facility
|
OP
|
$12.76
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Aetna of WY Medicare |
$8.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.40
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$7.03
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$7.40
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WINHealth Partners Commercial |
$12.50
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
TEDS THIGH MEDIUM REGULAR
|
Facility
|
IP
|
$12.76
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.42
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$8.00
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$8.42
|
| Rate for Payer: WINHealth Partners Commercial |
$12.12
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
TEDS THIGH SMALL REGULAR
|
Facility
|
IP
|
$12.76
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.42
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$8.00
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$8.42
|
| Rate for Payer: WINHealth Partners Commercial |
$12.12
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
TEDS THIGH SMALL REGULAR
|
Facility
|
OP
|
$12.76
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
| Rate for Payer: Aetna of WY Medicare |
$8.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.25
|
| Rate for Payer: Altius Commercial |
$12.25
|
| Rate for Payer: Beech Street Commercial |
$12.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.48
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.38
|
| Rate for Payer: Cigna of WY Commercial |
$12.50
|
| Rate for Payer: Entrust Commercial |
$12.12
|
| Rate for Payer: First Choice Health Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.40
|
| Rate for Payer: HealthUtah PPO |
$12.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.38
|
| Rate for Payer: Multiplan Medicare/VA |
$7.03
|
| Rate for Payer: One Health Plan of WY PPO |
$12.50
|
| Rate for Payer: PacificSource Commercial |
$11.48
|
| Rate for Payer: PHCS PPO |
$12.50
|
| Rate for Payer: Three Rivers PPO |
$9.57
|
| Rate for Payer: TriWest Veterans Administration |
$7.40
|
| Rate for Payer: United Healthcare Commercial |
$11.10
|
| Rate for Payer: United Healthcare Medicare |
$7.40
|
| Rate for Payer: WINHealth Partners Commercial |
$12.50
|
| Rate for Payer: Wise Provider Network Commercial |
$12.12
|
|
|
TEDS THIGH XLARGE REGULAR
|
Facility
|
OP
|
$18.86
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.48
|
| Rate for Payer: Aetna of WY Medicare |
$12.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.11
|
| Rate for Payer: Altius Commercial |
$18.11
|
| Rate for Payer: Beech Street Commercial |
$18.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.29
|
| Rate for Payer: Cigna of WY Commercial |
$18.48
|
| Rate for Payer: Entrust Commercial |
$17.92
|
| Rate for Payer: First Choice Health Commercial |
$17.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.94
|
| Rate for Payer: HealthUtah PPO |
$18.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.29
|
| Rate for Payer: Multiplan Medicare/VA |
$10.39
|
| Rate for Payer: One Health Plan of WY PPO |
$18.48
|
| Rate for Payer: PacificSource Commercial |
$16.97
|
| Rate for Payer: PHCS PPO |
$18.48
|
| Rate for Payer: Three Rivers PPO |
$14.14
|
| Rate for Payer: TriWest Veterans Administration |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$16.41
|
| Rate for Payer: United Healthcare Medicare |
$10.94
|
| Rate for Payer: WINHealth Partners Commercial |
$18.48
|
| Rate for Payer: Wise Provider Network Commercial |
$17.92
|
|
|
TEDS THIGH XLARGE REGULAR
|
Facility
|
IP
|
$18.86
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.11
|
| Rate for Payer: Altius Commercial |
$18.11
|
| Rate for Payer: Beech Street Commercial |
$18.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.48
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.29
|
| Rate for Payer: Cigna of WY Commercial |
$18.48
|
| Rate for Payer: Entrust Commercial |
$17.92
|
| Rate for Payer: First Choice Health Commercial |
$17.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.45
|
| Rate for Payer: HealthUtah PPO |
$18.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.29
|
| Rate for Payer: Multiplan Medicare/VA |
$11.83
|
| Rate for Payer: One Health Plan of WY PPO |
$18.48
|
| Rate for Payer: PacificSource Commercial |
$16.97
|
| Rate for Payer: PHCS PPO |
$18.48
|
| Rate for Payer: Three Rivers PPO |
$14.14
|
| Rate for Payer: TriWest Veterans Administration |
$12.45
|
| Rate for Payer: United Healthcare Commercial |
$16.41
|
| Rate for Payer: United Healthcare Medicare |
$12.45
|
| Rate for Payer: WINHealth Partners Commercial |
$17.92
|
| Rate for Payer: Wise Provider Network Commercial |
$17.92
|
|
|
TEDS THIGH XXLARGE REGULAR
|
Facility
|
IP
|
$21.04
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$21.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.20
|
| Rate for Payer: Altius Commercial |
$20.20
|
| Rate for Payer: Beech Street Commercial |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$14.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.41
|
| Rate for Payer: Cigna of WY Commercial |
$20.62
|
| Rate for Payer: Entrust Commercial |
$19.99
|
| Rate for Payer: First Choice Health Commercial |
$19.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.89
|
| Rate for Payer: HealthUtah PPO |
$21.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.41
|
| Rate for Payer: Multiplan Medicare/VA |
$13.19
|
| Rate for Payer: One Health Plan of WY PPO |
$20.62
|
| Rate for Payer: PacificSource Commercial |
$18.94
|
| Rate for Payer: PHCS PPO |
$20.62
|
| Rate for Payer: Three Rivers PPO |
$15.78
|
| Rate for Payer: TriWest Veterans Administration |
$13.89
|
| Rate for Payer: United Healthcare Commercial |
$18.30
|
| Rate for Payer: United Healthcare Medicare |
$13.89
|
| Rate for Payer: WINHealth Partners Commercial |
$19.99
|
| Rate for Payer: Wise Provider Network Commercial |
$19.99
|
|
|
TEDS THIGH XXLARGE REGULAR
|
Facility
|
OP
|
$21.04
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$21.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.62
|
| Rate for Payer: Aetna of WY Medicare |
$13.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.20
|
| Rate for Payer: Altius Commercial |
$20.20
|
| Rate for Payer: Beech Street Commercial |
$20.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$14.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.41
|
| Rate for Payer: Cigna of WY Commercial |
$20.62
|
| Rate for Payer: Entrust Commercial |
$19.99
|
| Rate for Payer: First Choice Health Commercial |
$19.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.20
|
| Rate for Payer: HealthUtah PPO |
$21.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.41
|
| Rate for Payer: Multiplan Medicare/VA |
$11.59
|
| Rate for Payer: One Health Plan of WY PPO |
$20.62
|
| Rate for Payer: PacificSource Commercial |
$18.94
|
| Rate for Payer: PHCS PPO |
$20.62
|
| Rate for Payer: Three Rivers PPO |
$15.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.20
|
| Rate for Payer: United Healthcare Commercial |
$18.30
|
| Rate for Payer: United Healthcare Medicare |
$12.20
|
| Rate for Payer: WINHealth Partners Commercial |
$20.62
|
| Rate for Payer: Wise Provider Network Commercial |
$19.99
|
|
|
TELEHEALTH FACILITY FEE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
Q3014
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.16
|
| Rate for Payer: Beech Street Commercial |
$39.90
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.74
|
| Rate for Payer: Cigna of WY Commercial |
$41.16
|
| Rate for Payer: First Choice Health Commercial |
$37.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.90
|
| Rate for Payer: HealthUtah PPO |
$42.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.74
|
| Rate for Payer: One Health Plan of WY PPO |
$41.16
|
| Rate for Payer: PacificSource Commercial |
$37.80
|
| Rate for Payer: PHCS PPO |
$39.90
|
| Rate for Payer: Three Rivers PPO |
$31.50
|
| Rate for Payer: United Healthcare Commercial |
$36.54
|
| Rate for Payer: WINHealth Partners Commercial |
$39.90
|
|
|
TELEPHONE ASSMT&MGMT SVC NQHP EST PT 11-20 MIN
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 98967
|
| Hospital Charge Code |
98967
|
| Min. Negotiated Rate |
$18.22 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$116.62
|
| Rate for Payer: Aetna of WY Medicare |
$21.44
|
| Rate for Payer: Beech Street Commercial |
$113.05
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: Cash Price |
$83.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$115.43
|
| Rate for Payer: Cigna of WY Commercial |
$116.62
|
| Rate for Payer: First Choice Health Commercial |
$107.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$113.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.44
|
| Rate for Payer: HealthUtah PPO |
$119.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$115.43
|
| Rate for Payer: Multiplan Medicare/VA |
$18.22
|
| Rate for Payer: One Health Plan of WY PPO |
$116.62
|
| Rate for Payer: PacificSource Commercial |
$107.10
|
| Rate for Payer: PHCS PPO |
$113.05
|
| Rate for Payer: Three Rivers PPO |
$89.25
|
| Rate for Payer: TriWest Veterans Administration |
$21.44
|
| Rate for Payer: United Healthcare Commercial |
$103.53
|
| Rate for Payer: United Healthcare Medicare |
$21.44
|
| Rate for Payer: WINHealth Partners Commercial |
$113.05
|
|
