|
BUTTON ROUND JUGGERLOC SS KIT
|
Facility
|
OP
|
$2,499.00
|
|
| Hospital Charge Code |
3003079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.21 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,449.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,649.34
|
| Rate for Payer: Altius Commercial |
$2,399.04
|
| Rate for Payer: Beech Street Commercial |
$2,449.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,424.03
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,424.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,449.02
|
| Rate for Payer: Entrust Commercial |
$2,374.05
|
| Rate for Payer: First Choice Health Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,424.43
|
| Rate for Payer: HealthUtah PPO |
$2,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,424.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,353.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,449.02
|
| Rate for Payer: PacificSource Commercial |
$2,249.10
|
| Rate for Payer: PHCS PPO |
$2,449.02
|
| Rate for Payer: Three Rivers PPO |
$1,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,424.43
|
| Rate for Payer: United Healthcare Commercial |
$2,386.54
|
| Rate for Payer: United Healthcare Medicare |
$1,424.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,449.02
|
| Rate for Payer: Wise Provider Network Commercial |
$2,374.05
|
|
|
BUTTON ROUND JUGGERLOC SS KIT
|
Facility
|
IP
|
$2,499.00
|
|
| Hospital Charge Code |
3003079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.17 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,449.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,599.36
|
| Rate for Payer: Altius Commercial |
$2,399.04
|
| Rate for Payer: Beech Street Commercial |
$2,449.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,424.03
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,424.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,449.02
|
| Rate for Payer: Entrust Commercial |
$2,374.05
|
| Rate for Payer: First Choice Health Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,524.39
|
| Rate for Payer: HealthUtah PPO |
$2,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,424.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,448.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,449.02
|
| Rate for Payer: PacificSource Commercial |
$2,249.10
|
| Rate for Payer: PHCS PPO |
$2,449.02
|
| Rate for Payer: Three Rivers PPO |
$1,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,524.39
|
| Rate for Payer: United Healthcare Commercial |
$2,386.54
|
| Rate for Payer: United Healthcare Medicare |
$1,524.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,374.05
|
| Rate for Payer: Wise Provider Network Commercial |
$2,374.05
|
|
|
BUTTON ROUND JUGGERLOC TI KIT
|
Facility
|
IP
|
$2,499.00
|
|
| Hospital Charge Code |
3003078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.17 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,449.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,599.36
|
| Rate for Payer: Altius Commercial |
$2,399.04
|
| Rate for Payer: Beech Street Commercial |
$2,449.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,424.03
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,424.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,449.02
|
| Rate for Payer: Entrust Commercial |
$2,374.05
|
| Rate for Payer: First Choice Health Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,524.39
|
| Rate for Payer: HealthUtah PPO |
$2,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,424.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,448.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2,449.02
|
| Rate for Payer: PacificSource Commercial |
$2,249.10
|
| Rate for Payer: PHCS PPO |
$2,449.02
|
| Rate for Payer: Three Rivers PPO |
$1,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,524.39
|
| Rate for Payer: United Healthcare Commercial |
$2,386.54
|
| Rate for Payer: United Healthcare Medicare |
$1,524.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,374.05
|
| Rate for Payer: Wise Provider Network Commercial |
$2,374.05
|
|
|
BUTTON ROUND JUGGERLOC TI KIT
|
Facility
|
OP
|
$2,499.00
|
|
| Hospital Charge Code |
3003078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.21 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,449.02
|
| Rate for Payer: Aetna of WY Medicare |
$1,649.34
|
| Rate for Payer: Altius Commercial |
$2,399.04
|
| Rate for Payer: Beech Street Commercial |
$2,449.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,424.03
|
| Rate for Payer: Cash Price |
$1,749.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,424.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,449.02
|
| Rate for Payer: Entrust Commercial |
$2,374.05
|
| Rate for Payer: First Choice Health Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,374.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,424.43
|
| Rate for Payer: HealthUtah PPO |
$2,499.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,424.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1,353.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,449.02
|
| Rate for Payer: PacificSource Commercial |
$2,249.10
|
| Rate for Payer: PHCS PPO |
$2,449.02
|
| Rate for Payer: Three Rivers PPO |
$1,874.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,424.43
|
| Rate for Payer: United Healthcare Commercial |
$2,386.54
|
| Rate for Payer: United Healthcare Medicare |
$1,424.43
|
| Rate for Payer: WINHealth Partners Commercial |
$2,449.02
|
| Rate for Payer: Wise Provider Network Commercial |
$2,374.05
|
|
|
BVM AMBU HYPERINFLATION INF
|
Facility
|
OP
|
$23.11
|
|
| Hospital Charge Code |
2100088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: United Healthcare Commercial |
$22.07
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.65
|
| Rate for Payer: Aetna of WY Medicare |
$15.25
|
| Rate for Payer: Altius Commercial |
$22.19
|
| Rate for Payer: Beech Street Commercial |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.42
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.42
|
| Rate for Payer: Cigna of WY Commercial |
$22.65
|
| Rate for Payer: Entrust Commercial |
$21.95
|
| Rate for Payer: First Choice Health Commercial |
$21.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.17
|
| Rate for Payer: HealthUtah PPO |
$23.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.42
|
| Rate for Payer: Multiplan Medicare/VA |
$12.51
|
| Rate for Payer: One Health Plan of WY PPO |
$22.65
|
| Rate for Payer: PacificSource Commercial |
$20.80
|
| Rate for Payer: PHCS PPO |
$22.65
|
| Rate for Payer: Three Rivers PPO |
$17.33
|
| Rate for Payer: TriWest Veterans Administration |
$13.17
|
| Rate for Payer: United Healthcare Medicare |
$13.17
|
| Rate for Payer: WINHealth Partners Commercial |
$22.65
|
| Rate for Payer: Wise Provider Network Commercial |
$21.95
|
|
|
BVM AMBU HYPERINFLATION INF
|
Facility
|
IP
|
$23.11
|
|
| Hospital Charge Code |
2100088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.65
|
| Rate for Payer: Aetna of WY Medicare |
$14.79
|
| Rate for Payer: Altius Commercial |
$22.19
|
| Rate for Payer: Beech Street Commercial |
$22.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.42
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.42
|
| Rate for Payer: Cigna of WY Commercial |
$22.65
|
| Rate for Payer: Entrust Commercial |
$21.95
|
| Rate for Payer: First Choice Health Commercial |
$21.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.10
|
| Rate for Payer: HealthUtah PPO |
$23.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.42
|
| Rate for Payer: Multiplan Medicare/VA |
$13.39
|
| Rate for Payer: One Health Plan of WY PPO |
$22.65
|
| Rate for Payer: PacificSource Commercial |
$20.80
|
| Rate for Payer: PHCS PPO |
$22.65
|
| Rate for Payer: Three Rivers PPO |
$17.33
|
| Rate for Payer: TriWest Veterans Administration |
$14.10
|
| Rate for Payer: United Healthcare Commercial |
$22.07
|
| Rate for Payer: United Healthcare Medicare |
$14.10
|
| Rate for Payer: WINHealth Partners Commercial |
$21.95
|
| Rate for Payer: Wise Provider Network Commercial |
$21.95
|
|
|
BVM SUNMED HYPERINFLATION INF
|
Facility
|
OP
|
$604.87
|
|
| Hospital Charge Code |
2100182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$327.54 |
| Max. Negotiated Rate |
$604.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.77
|
| Rate for Payer: Aetna of WY Medicare |
$399.21
|
| Rate for Payer: Altius Commercial |
$580.68
|
| Rate for Payer: Beech Street Commercial |
$592.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$586.72
|
| Rate for Payer: Cash Price |
$423.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.72
|
| Rate for Payer: Cigna of WY Commercial |
$592.77
|
| Rate for Payer: Entrust Commercial |
$574.63
|
| Rate for Payer: First Choice Health Commercial |
$574.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$344.78
|
| Rate for Payer: HealthUtah PPO |
$604.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.72
|
| Rate for Payer: Multiplan Medicare/VA |
$327.54
|
| Rate for Payer: One Health Plan of WY PPO |
$592.77
|
| Rate for Payer: PacificSource Commercial |
$544.38
|
| Rate for Payer: PHCS PPO |
$592.77
|
| Rate for Payer: Three Rivers PPO |
$453.65
|
| Rate for Payer: TriWest Veterans Administration |
$344.78
|
| Rate for Payer: United Healthcare Commercial |
$577.65
|
| Rate for Payer: United Healthcare Medicare |
$344.78
|
| Rate for Payer: WINHealth Partners Commercial |
$592.77
|
| Rate for Payer: Wise Provider Network Commercial |
$574.63
|
|
|
BVM SUNMED HYPERINFLATION INF
|
Facility
|
IP
|
$604.87
|
|
| Hospital Charge Code |
2100182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$350.52 |
| Max. Negotiated Rate |
$604.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$592.77
|
| Rate for Payer: Aetna of WY Medicare |
$387.12
|
| Rate for Payer: Altius Commercial |
$580.68
|
| Rate for Payer: Beech Street Commercial |
$592.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$586.72
|
| Rate for Payer: Cash Price |
$423.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$586.72
|
| Rate for Payer: Cigna of WY Commercial |
$592.77
|
| Rate for Payer: Entrust Commercial |
$574.63
|
| Rate for Payer: First Choice Health Commercial |
$574.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$574.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$368.97
|
| Rate for Payer: HealthUtah PPO |
$604.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$586.72
|
| Rate for Payer: Multiplan Medicare/VA |
$350.52
|
| Rate for Payer: One Health Plan of WY PPO |
$592.77
|
| Rate for Payer: PacificSource Commercial |
$544.38
|
| Rate for Payer: PHCS PPO |
$592.77
|
| Rate for Payer: Three Rivers PPO |
$453.65
|
| Rate for Payer: TriWest Veterans Administration |
$368.97
|
| Rate for Payer: United Healthcare Commercial |
$577.65
|
| Rate for Payer: United Healthcare Medicare |
$368.97
|
| Rate for Payer: WINHealth Partners Commercial |
$574.63
|
| Rate for Payer: Wise Provider Network Commercial |
$574.63
|
|
|
BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$3,429.00
|
|
|
Service Code
|
HCPCS 45100
|
| Min. Negotiated Rate |
$250.05 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,360.42
|
| Rate for Payer: Aetna of WY Medicare |
$294.18
|
| Rate for Payer: Beech Street Commercial |
$3,257.55
|
| Rate for Payer: Cash Price |
$2,400.30
|
| Rate for Payer: Cash Price |
$2,400.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,326.13
|
| Rate for Payer: Cigna of WY Commercial |
$3,360.42
|
| Rate for Payer: First Choice Health Commercial |
$3,086.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,257.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.18
|
| Rate for Payer: HealthUtah PPO |
$3,429.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,326.13
|
| Rate for Payer: Multiplan Medicare/VA |
$250.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,360.42
|
| Rate for Payer: PacificSource Commercial |
$3,086.10
|
| Rate for Payer: PHCS PPO |
$3,257.55
|
| Rate for Payer: Three Rivers PPO |
$2,571.75
|
| Rate for Payer: TriWest Veterans Administration |
$294.18
|
| Rate for Payer: United Healthcare Commercial |
$3,257.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,914.65
|
|
|
BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 19100
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$299.88
|
| Rate for Payer: Aetna of WY Medicare |
$64.80
|
| Rate for Payer: Beech Street Commercial |
$290.70
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$296.82
|
| Rate for Payer: Cigna of WY Commercial |
$299.88
|
| Rate for Payer: First Choice Health Commercial |
$275.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$290.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.80
|
| Rate for Payer: HealthUtah PPO |
$306.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$296.82
|
| Rate for Payer: Multiplan Medicare/VA |
$55.08
|
| Rate for Payer: One Health Plan of WY PPO |
$299.88
|
| Rate for Payer: PacificSource Commercial |
$275.40
|
| Rate for Payer: PHCS PPO |
$290.70
|
| Rate for Payer: Three Rivers PPO |
$229.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$290.70
|
| Rate for Payer: WINHealth Partners Commercial |
$260.10
|
|
|
BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,933.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$359.59 |
| Max. Negotiated Rate |
$1,933.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,894.34
|
| Rate for Payer: Aetna of WY Medicare |
$423.05
|
| Rate for Payer: Beech Street Commercial |
$1,836.35
|
| Rate for Payer: Cash Price |
$1,353.10
|
| Rate for Payer: Cash Price |
$1,353.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,875.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,894.34
|
| Rate for Payer: First Choice Health Commercial |
$1,739.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,836.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.05
|
| Rate for Payer: HealthUtah PPO |
$1,933.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,875.01
|
| Rate for Payer: Multiplan Medicare/VA |
$359.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,894.34
|
| Rate for Payer: PacificSource Commercial |
$1,739.70
|
| Rate for Payer: PHCS PPO |
$1,836.35
|
| Rate for Payer: Three Rivers PPO |
$1,449.75
|
| Rate for Payer: TriWest Veterans Administration |
$423.05
|
| Rate for Payer: United Healthcare Commercial |
$1,836.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,643.05
|
|
|
BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,845.00
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$340.76 |
| Max. Negotiated Rate |
$1,845.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,808.10
|
| Rate for Payer: Aetna of WY Medicare |
$400.90
|
| Rate for Payer: Beech Street Commercial |
$1,752.75
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: Cash Price |
$1,291.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,789.65
|
| Rate for Payer: Cigna of WY Commercial |
$1,808.10
|
| Rate for Payer: First Choice Health Commercial |
$1,660.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,752.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.90
|
| Rate for Payer: HealthUtah PPO |
$1,845.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,789.65
|
| Rate for Payer: Multiplan Medicare/VA |
$340.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,808.10
|
| Rate for Payer: PacificSource Commercial |
$1,660.50
|
| Rate for Payer: PHCS PPO |
$1,752.75
|
| Rate for Payer: Three Rivers PPO |
$1,383.75
|
| Rate for Payer: TriWest Veterans Administration |
$400.90
|
| Rate for Payer: United Healthcare Commercial |
$1,752.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1,568.25
|
|
|
BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$207.77 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,102.50
|
| Rate for Payer: Aetna of WY Medicare |
$244.44
|
| Rate for Payer: Beech Street Commercial |
$1,068.75
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: Cash Price |
$787.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,091.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,102.50
|
| Rate for Payer: First Choice Health Commercial |
$1,012.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,068.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.44
|
| Rate for Payer: HealthUtah PPO |
$1,125.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,091.25
|
| Rate for Payer: Multiplan Medicare/VA |
$207.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,102.50
|
| Rate for Payer: PacificSource Commercial |
$1,012.50
|
| Rate for Payer: PHCS PPO |
$1,068.75
|
| Rate for Payer: Three Rivers PPO |
$843.75
|
| Rate for Payer: TriWest Veterans Administration |
$244.44
|
| Rate for Payer: United Healthcare Commercial |
$1,068.75
|
| Rate for Payer: WINHealth Partners Commercial |
$956.25
|
|
|
BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 47001 80
|
| Min. Negotiated Rate |
$335.25 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$438.06
|
| Rate for Payer: Beech Street Commercial |
$424.65
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.59
|
| Rate for Payer: Cigna of WY Commercial |
$438.06
|
| Rate for Payer: First Choice Health Commercial |
$402.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.65
|
| Rate for Payer: HealthUtah PPO |
$447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.59
|
| Rate for Payer: One Health Plan of WY PPO |
$438.06
|
| Rate for Payer: PacificSource Commercial |
$402.30
|
| Rate for Payer: PHCS PPO |
$424.65
|
| Rate for Payer: Three Rivers PPO |
$335.25
|
| Rate for Payer: United Healthcare Commercial |
$424.65
|
| Rate for Payer: WINHealth Partners Commercial |
$379.95
|
|
|
BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$96.51
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.51
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$96.51
|
| Rate for Payer: United Healthcare Commercial |
$437.00
|
| Rate for Payer: WINHealth Partners Commercial |
$391.00
|
|
|
CABLE ZIMMER 1.8MMX635MM
|
Facility
|
OP
|
$1,085.35
|
|
| Hospital Charge Code |
2650663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$587.72 |
| Max. Negotiated Rate |
$1,085.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.64
|
| Rate for Payer: Aetna of WY Medicare |
$716.33
|
| Rate for Payer: Altius Commercial |
$1,041.94
|
| Rate for Payer: Beech Street Commercial |
$1,063.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,052.79
|
| Rate for Payer: Cash Price |
$759.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.64
|
| Rate for Payer: Entrust Commercial |
$1,031.08
|
| Rate for Payer: First Choice Health Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$618.65
|
| Rate for Payer: HealthUtah PPO |
$1,085.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.79
|
| Rate for Payer: Multiplan Medicare/VA |
$587.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.64
|
| Rate for Payer: PacificSource Commercial |
$976.82
|
| Rate for Payer: PHCS PPO |
$1,063.64
|
| Rate for Payer: Three Rivers PPO |
$814.01
|
| Rate for Payer: TriWest Veterans Administration |
$618.65
|
| Rate for Payer: United Healthcare Commercial |
$1,036.51
|
| Rate for Payer: United Healthcare Medicare |
$618.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,063.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1,031.08
|
|
|
CABLE ZIMMER 1.8MMX635MM
|
Facility
|
IP
|
$1,085.35
|
|
| Hospital Charge Code |
2650663
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.96 |
| Max. Negotiated Rate |
$1,085.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.64
|
| Rate for Payer: Aetna of WY Medicare |
$694.62
|
| Rate for Payer: Altius Commercial |
$1,041.94
|
| Rate for Payer: Beech Street Commercial |
$1,063.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,052.79
|
| Rate for Payer: Cash Price |
$759.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.64
|
| Rate for Payer: Entrust Commercial |
$1,031.08
|
| Rate for Payer: First Choice Health Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,031.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$662.06
|
| Rate for Payer: HealthUtah PPO |
$1,085.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.79
|
| Rate for Payer: Multiplan Medicare/VA |
$628.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.64
|
| Rate for Payer: PacificSource Commercial |
$976.82
|
| Rate for Payer: PHCS PPO |
$1,063.64
|
| Rate for Payer: Three Rivers PPO |
$814.01
|
| Rate for Payer: TriWest Veterans Administration |
$662.06
|
| Rate for Payer: United Healthcare Commercial |
$1,036.51
|
| Rate for Payer: United Healthcare Medicare |
$662.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,031.08
|
| Rate for Payer: Wise Provider Network Commercial |
$1,031.08
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
IP
|
$54.69
|
|
|
Service Code
|
NDC 0517250210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.60
|
| Rate for Payer: Aetna of WY Medicare |
$35.00
|
| Rate for Payer: Altius Commercial |
$52.50
|
| Rate for Payer: Beech Street Commercial |
$53.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.05
|
| Rate for Payer: Cigna of WY Commercial |
$53.60
|
| Rate for Payer: Entrust Commercial |
$51.96
|
| Rate for Payer: First Choice Health Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.36
|
| Rate for Payer: HealthUtah PPO |
$54.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.05
|
| Rate for Payer: Multiplan Medicare/VA |
$31.69
|
| Rate for Payer: One Health Plan of WY PPO |
$53.60
|
| Rate for Payer: PacificSource Commercial |
$49.22
|
| Rate for Payer: PHCS PPO |
$53.60
|
| Rate for Payer: Three Rivers PPO |
$41.02
|
| Rate for Payer: TriWest Veterans Administration |
$33.36
|
| Rate for Payer: United Healthcare Commercial |
$52.23
|
| Rate for Payer: United Healthcare Medicare |
$33.36
|
| Rate for Payer: WINHealth Partners Commercial |
$51.96
|
| Rate for Payer: Wise Provider Network Commercial |
$51.96
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
OP
|
$54.69
|
|
|
Service Code
|
NDC 0517250210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.60
|
| Rate for Payer: Aetna of WY Medicare |
$36.10
|
| Rate for Payer: Altius Commercial |
$52.50
|
| Rate for Payer: Beech Street Commercial |
$53.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.05
|
| Rate for Payer: Cigna of WY Commercial |
$53.60
|
| Rate for Payer: Entrust Commercial |
$51.96
|
| Rate for Payer: First Choice Health Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.17
|
| Rate for Payer: HealthUtah PPO |
$54.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.05
|
| Rate for Payer: Multiplan Medicare/VA |
$29.61
|
| Rate for Payer: One Health Plan of WY PPO |
$53.60
|
| Rate for Payer: PacificSource Commercial |
$49.22
|
| Rate for Payer: PHCS PPO |
$53.60
|
| Rate for Payer: Three Rivers PPO |
$41.02
|
| Rate for Payer: TriWest Veterans Administration |
$31.17
|
| Rate for Payer: United Healthcare Commercial |
$52.23
|
| Rate for Payer: United Healthcare Medicare |
$31.17
|
| Rate for Payer: WINHealth Partners Commercial |
$53.60
|
| Rate for Payer: Wise Provider Network Commercial |
$51.96
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
IP
|
$54.69
|
|
|
Service Code
|
NDC 0517250201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.60
|
| Rate for Payer: Aetna of WY Medicare |
$35.00
|
| Rate for Payer: Altius Commercial |
$52.50
|
| Rate for Payer: Beech Street Commercial |
$53.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.05
|
| Rate for Payer: Cigna of WY Commercial |
$53.60
|
| Rate for Payer: Entrust Commercial |
$51.96
|
| Rate for Payer: First Choice Health Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.36
|
| Rate for Payer: HealthUtah PPO |
$54.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.05
|
| Rate for Payer: Multiplan Medicare/VA |
$31.69
|
| Rate for Payer: One Health Plan of WY PPO |
$53.60
|
| Rate for Payer: PacificSource Commercial |
$49.22
|
| Rate for Payer: PHCS PPO |
$53.60
|
| Rate for Payer: Three Rivers PPO |
$41.02
|
| Rate for Payer: TriWest Veterans Administration |
$33.36
|
| Rate for Payer: United Healthcare Commercial |
$52.23
|
| Rate for Payer: United Healthcare Medicare |
$33.36
|
| Rate for Payer: WINHealth Partners Commercial |
$51.96
|
| Rate for Payer: Wise Provider Network Commercial |
$51.96
|
|
|
CAFFEINE-SODIUM BENZOATE 250 MG/ML(125 MG/ML CAFFEINE) INJECTION SOLN [9358]
|
Facility
|
OP
|
$54.69
|
|
|
Service Code
|
NDC 0517250201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.60
|
| Rate for Payer: Aetna of WY Medicare |
$36.10
|
| Rate for Payer: Altius Commercial |
$52.50
|
| Rate for Payer: Beech Street Commercial |
$53.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.05
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.05
|
| Rate for Payer: Cigna of WY Commercial |
$53.60
|
| Rate for Payer: Entrust Commercial |
$51.96
|
| Rate for Payer: First Choice Health Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.17
|
| Rate for Payer: HealthUtah PPO |
$54.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.05
|
| Rate for Payer: Multiplan Medicare/VA |
$29.61
|
| Rate for Payer: One Health Plan of WY PPO |
$53.60
|
| Rate for Payer: PacificSource Commercial |
$49.22
|
| Rate for Payer: PHCS PPO |
$53.60
|
| Rate for Payer: Three Rivers PPO |
$41.02
|
| Rate for Payer: TriWest Veterans Administration |
$31.17
|
| Rate for Payer: United Healthcare Commercial |
$52.23
|
| Rate for Payer: United Healthcare Medicare |
$31.17
|
| Rate for Payer: WINHealth Partners Commercial |
$53.60
|
| Rate for Payer: Wise Provider Network Commercial |
$51.96
|
|
|
CAGE 4 X 25 X 09 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 25 X 09 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 25 X 10 MM GS MED
|
Facility
|
IP
|
$9,450.00
|
|
| Hospital Charge Code |
2800263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.28 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,048.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,764.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,476.28
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,764.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,764.50
|
| Rate for Payer: WINHealth Partners Commercial |
$8,977.50
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
|
CAGE 4 X 25 X 10 MM GS MED
|
Facility
|
OP
|
$9,450.00
|
|
| Hospital Charge Code |
2800263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,117.18 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,261.00
|
| Rate for Payer: Aetna of WY Medicare |
$6,237.00
|
| Rate for Payer: Altius Commercial |
$9,072.00
|
| Rate for Payer: Beech Street Commercial |
$9,261.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,166.50
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,166.50
|
| Rate for Payer: Cigna of WY Commercial |
$9,261.00
|
| Rate for Payer: Entrust Commercial |
$8,977.50
|
| Rate for Payer: First Choice Health Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,977.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,386.50
|
| Rate for Payer: HealthUtah PPO |
$9,450.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,166.50
|
| Rate for Payer: Multiplan Medicare/VA |
$5,117.18
|
| Rate for Payer: One Health Plan of WY PPO |
$9,261.00
|
| Rate for Payer: PacificSource Commercial |
$8,505.00
|
| Rate for Payer: PHCS PPO |
$9,261.00
|
| Rate for Payer: Three Rivers PPO |
$7,087.50
|
| Rate for Payer: TriWest Veterans Administration |
$5,386.50
|
| Rate for Payer: United Healthcare Commercial |
$9,024.75
|
| Rate for Payer: United Healthcare Medicare |
$5,386.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9,261.00
|
| Rate for Payer: Wise Provider Network Commercial |
$8,977.50
|
|
