|
CATH KIT PERITON DIALYSIS 62CM
|
Facility
|
OP
|
$487.20
|
|
| Hospital Charge Code |
2650936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.82 |
| Max. Negotiated Rate |
$487.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$477.46
|
| Rate for Payer: Aetna of WY Medicare |
$321.55
|
| Rate for Payer: Altius Commercial |
$467.71
|
| Rate for Payer: Beech Street Commercial |
$477.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.58
|
| Rate for Payer: Cash Price |
$341.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$472.58
|
| Rate for Payer: Cigna of WY Commercial |
$477.46
|
| Rate for Payer: Entrust Commercial |
$462.84
|
| Rate for Payer: First Choice Health Commercial |
$462.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$462.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.70
|
| Rate for Payer: HealthUtah PPO |
$487.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$472.58
|
| Rate for Payer: Multiplan Medicare/VA |
$263.82
|
| Rate for Payer: One Health Plan of WY PPO |
$477.46
|
| Rate for Payer: PacificSource Commercial |
$438.48
|
| Rate for Payer: PHCS PPO |
$477.46
|
| Rate for Payer: Three Rivers PPO |
$365.40
|
| Rate for Payer: TriWest Veterans Administration |
$277.70
|
| Rate for Payer: United Healthcare Commercial |
$465.28
|
| Rate for Payer: United Healthcare Medicare |
$277.70
|
| Rate for Payer: WINHealth Partners Commercial |
$477.46
|
| Rate for Payer: Wise Provider Network Commercial |
$462.84
|
|
|
CATH KIT PERITON DIALYSIS 62CM
|
Facility
|
IP
|
$487.20
|
|
| Hospital Charge Code |
2650936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.33 |
| Max. Negotiated Rate |
$487.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$477.46
|
| Rate for Payer: Aetna of WY Medicare |
$311.81
|
| Rate for Payer: Altius Commercial |
$467.71
|
| Rate for Payer: Beech Street Commercial |
$477.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$472.58
|
| Rate for Payer: Cash Price |
$341.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$472.58
|
| Rate for Payer: Cigna of WY Commercial |
$477.46
|
| Rate for Payer: Entrust Commercial |
$462.84
|
| Rate for Payer: First Choice Health Commercial |
$462.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$462.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$297.19
|
| Rate for Payer: HealthUtah PPO |
$487.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$472.58
|
| Rate for Payer: Multiplan Medicare/VA |
$282.33
|
| Rate for Payer: One Health Plan of WY PPO |
$477.46
|
| Rate for Payer: PacificSource Commercial |
$438.48
|
| Rate for Payer: PHCS PPO |
$477.46
|
| Rate for Payer: Three Rivers PPO |
$365.40
|
| Rate for Payer: TriWest Veterans Administration |
$297.19
|
| Rate for Payer: United Healthcare Commercial |
$465.28
|
| Rate for Payer: United Healthcare Medicare |
$297.19
|
| Rate for Payer: WINHealth Partners Commercial |
$462.84
|
| Rate for Payer: Wise Provider Network Commercial |
$462.84
|
|
|
CATH LEG STRAP
|
Facility
|
OP
|
$2.10
|
|
| Hospital Charge Code |
2750027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Aetna of WY Medicare |
$1.39
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
CATH LEG STRAP
|
Facility
|
IP
|
$2.10
|
|
| Hospital Charge Code |
2750027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Aetna of WY Medicare |
$1.34
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.28
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
| Rate for Payer: WINHealth Partners Commercial |
$2.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
CATH MALE EXTERNAL LG 36MM
|
Facility
|
OP
|
$3.57
|
|
| Hospital Charge Code |
2750030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.50
|
| Rate for Payer: Aetna of WY Medicare |
$2.36
|
| Rate for Payer: Altius Commercial |
$3.43
|
| Rate for Payer: Beech Street Commercial |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.46
|
| Rate for Payer: Cigna of WY Commercial |
$3.50
|
| Rate for Payer: Entrust Commercial |
$3.39
|
| Rate for Payer: First Choice Health Commercial |
$3.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.03
|
| Rate for Payer: HealthUtah PPO |
$3.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1.93
|
| Rate for Payer: One Health Plan of WY PPO |
$3.50
|
| Rate for Payer: PacificSource Commercial |
$3.21
|
| Rate for Payer: PHCS PPO |
$3.50
|
| Rate for Payer: Three Rivers PPO |
$2.68
|
| Rate for Payer: TriWest Veterans Administration |
$2.03
|
| Rate for Payer: United Healthcare Commercial |
$3.41
|
| Rate for Payer: United Healthcare Medicare |
$2.03
|
| Rate for Payer: WINHealth Partners Commercial |
$3.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3.39
|
|
|
CATH MALE EXTERNAL LG 36MM
|
Facility
|
IP
|
$3.57
|
|
| Hospital Charge Code |
2750030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.50
|
| Rate for Payer: Aetna of WY Medicare |
$2.28
|
| Rate for Payer: Altius Commercial |
$3.43
|
| Rate for Payer: Beech Street Commercial |
$3.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.46
|
| Rate for Payer: Cigna of WY Commercial |
$3.50
|
| Rate for Payer: Entrust Commercial |
$3.39
|
| Rate for Payer: First Choice Health Commercial |
$3.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.18
|
| Rate for Payer: HealthUtah PPO |
$3.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.46
|
| Rate for Payer: Multiplan Medicare/VA |
$2.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3.50
|
| Rate for Payer: PacificSource Commercial |
$3.21
|
| Rate for Payer: PHCS PPO |
$3.50
|
| Rate for Payer: Three Rivers PPO |
$2.68
|
| Rate for Payer: TriWest Veterans Administration |
$2.18
|
| Rate for Payer: United Healthcare Commercial |
$3.41
|
| Rate for Payer: United Healthcare Medicare |
$2.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3.39
|
| Rate for Payer: Wise Provider Network Commercial |
$3.39
|
|
|
CATH MALE EXTERNAL SM 25MM
|
Facility
|
IP
|
$5.28
|
|
| Hospital Charge Code |
2750031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.17
|
| Rate for Payer: Aetna of WY Medicare |
$3.38
|
| Rate for Payer: Altius Commercial |
$5.07
|
| Rate for Payer: Beech Street Commercial |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.12
|
| Rate for Payer: Cigna of WY Commercial |
$5.17
|
| Rate for Payer: Entrust Commercial |
$5.02
|
| Rate for Payer: First Choice Health Commercial |
$5.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.22
|
| Rate for Payer: HealthUtah PPO |
$5.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.12
|
| Rate for Payer: Multiplan Medicare/VA |
$3.06
|
| Rate for Payer: One Health Plan of WY PPO |
$5.17
|
| Rate for Payer: PacificSource Commercial |
$4.75
|
| Rate for Payer: PHCS PPO |
$5.17
|
| Rate for Payer: Three Rivers PPO |
$3.96
|
| Rate for Payer: TriWest Veterans Administration |
$3.22
|
| Rate for Payer: United Healthcare Commercial |
$5.04
|
| Rate for Payer: United Healthcare Medicare |
$3.22
|
| Rate for Payer: WINHealth Partners Commercial |
$5.02
|
| Rate for Payer: Wise Provider Network Commercial |
$5.02
|
|
|
CATH MALE EXTERNAL SM 25MM
|
Facility
|
OP
|
$5.28
|
|
| Hospital Charge Code |
2750031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.17
|
| Rate for Payer: Aetna of WY Medicare |
$3.48
|
| Rate for Payer: Altius Commercial |
$5.07
|
| Rate for Payer: Beech Street Commercial |
$5.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.12
|
| Rate for Payer: Cigna of WY Commercial |
$5.17
|
| Rate for Payer: Entrust Commercial |
$5.02
|
| Rate for Payer: First Choice Health Commercial |
$5.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.01
|
| Rate for Payer: HealthUtah PPO |
$5.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5.17
|
| Rate for Payer: PacificSource Commercial |
$4.75
|
| Rate for Payer: PHCS PPO |
$5.17
|
| Rate for Payer: Three Rivers PPO |
$3.96
|
| Rate for Payer: TriWest Veterans Administration |
$3.01
|
| Rate for Payer: United Healthcare Commercial |
$5.04
|
| Rate for Payer: United Healthcare Medicare |
$3.01
|
| Rate for Payer: WINHealth Partners Commercial |
$5.17
|
| Rate for Payer: Wise Provider Network Commercial |
$5.02
|
|
|
CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,783.00
|
|
|
Service Code
|
HCPCS 93459
|
| Min. Negotiated Rate |
$911.75 |
| Max. Negotiated Rate |
$2,783.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,727.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,072.65
|
| Rate for Payer: Beech Street Commercial |
$2,643.85
|
| Rate for Payer: Cash Price |
$1,948.10
|
| Rate for Payer: Cash Price |
$1,948.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,699.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,727.34
|
| Rate for Payer: First Choice Health Commercial |
$2,504.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,643.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,072.65
|
| Rate for Payer: HealthUtah PPO |
$2,783.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,699.51
|
| Rate for Payer: Multiplan Medicare/VA |
$911.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,727.34
|
| Rate for Payer: PacificSource Commercial |
$2,504.70
|
| Rate for Payer: PHCS PPO |
$2,643.85
|
| Rate for Payer: Three Rivers PPO |
$2,087.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,072.65
|
| Rate for Payer: United Healthcare Commercial |
$2,643.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,643.85
|
|
|
CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$3,813.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$847.99 |
| Max. Negotiated Rate |
$3,813.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,736.74
|
| Rate for Payer: Aetna of WY Medicare |
$997.64
|
| Rate for Payer: Beech Street Commercial |
$3,622.35
|
| Rate for Payer: Cash Price |
$2,669.10
|
| Rate for Payer: Cash Price |
$2,669.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,698.61
|
| Rate for Payer: Cigna of WY Commercial |
$3,736.74
|
| Rate for Payer: First Choice Health Commercial |
$3,431.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,622.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.64
|
| Rate for Payer: HealthUtah PPO |
$3,813.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,698.61
|
| Rate for Payer: Multiplan Medicare/VA |
$847.99
|
| Rate for Payer: One Health Plan of WY PPO |
$3,736.74
|
| Rate for Payer: PacificSource Commercial |
$3,431.70
|
| Rate for Payer: PHCS PPO |
$3,622.35
|
| Rate for Payer: Three Rivers PPO |
$2,859.75
|
| Rate for Payer: TriWest Veterans Administration |
$997.64
|
| Rate for Payer: United Healthcare Commercial |
$3,622.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3,622.35
|
|
|
CATH PLUG
|
Facility
|
IP
|
$1.41
|
|
| Hospital Charge Code |
2750054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.90
|
| Rate for Payer: Altius Commercial |
$1.35
|
| Rate for Payer: Beech Street Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.37
|
| Rate for Payer: Cigna of WY Commercial |
$1.38
|
| Rate for Payer: Entrust Commercial |
$1.34
|
| Rate for Payer: First Choice Health Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.86
|
| Rate for Payer: HealthUtah PPO |
$1.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1.38
|
| Rate for Payer: PacificSource Commercial |
$1.27
|
| Rate for Payer: PHCS PPO |
$1.38
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$0.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1.34
|
|
|
CATH PLUG
|
Facility
|
OP
|
$1.41
|
|
| Hospital Charge Code |
2750054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.93
|
| Rate for Payer: Altius Commercial |
$1.35
|
| Rate for Payer: Beech Street Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.37
|
| Rate for Payer: Cigna of WY Commercial |
$1.38
|
| Rate for Payer: Entrust Commercial |
$1.34
|
| Rate for Payer: First Choice Health Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.80
|
| Rate for Payer: HealthUtah PPO |
$1.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1.38
|
| Rate for Payer: PacificSource Commercial |
$1.27
|
| Rate for Payer: PHCS PPO |
$1.38
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$0.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1.34
|
|
|
CATH PUREWICK FEMALE EXTERNAL
|
Facility
|
IP
|
$23.02
|
|
| Hospital Charge Code |
2750137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.56
|
| Rate for Payer: Aetna of WY Medicare |
$14.73
|
| Rate for Payer: Altius Commercial |
$22.10
|
| Rate for Payer: Beech Street Commercial |
$22.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.33
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.33
|
| Rate for Payer: Cigna of WY Commercial |
$22.56
|
| Rate for Payer: Entrust Commercial |
$21.87
|
| Rate for Payer: First Choice Health Commercial |
$21.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.04
|
| Rate for Payer: HealthUtah PPO |
$23.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.33
|
| Rate for Payer: Multiplan Medicare/VA |
$13.34
|
| Rate for Payer: One Health Plan of WY PPO |
$22.56
|
| Rate for Payer: PacificSource Commercial |
$20.72
|
| Rate for Payer: PHCS PPO |
$22.56
|
| Rate for Payer: Three Rivers PPO |
$17.26
|
| Rate for Payer: TriWest Veterans Administration |
$14.04
|
| Rate for Payer: United Healthcare Commercial |
$21.98
|
| Rate for Payer: United Healthcare Medicare |
$14.04
|
| Rate for Payer: WINHealth Partners Commercial |
$21.87
|
| Rate for Payer: Wise Provider Network Commercial |
$21.87
|
|
|
CATH PUREWICK FEMALE EXTERNAL
|
Facility
|
OP
|
$23.02
|
|
| Hospital Charge Code |
2750137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$23.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.56
|
| Rate for Payer: Aetna of WY Medicare |
$15.19
|
| Rate for Payer: Altius Commercial |
$22.10
|
| Rate for Payer: Beech Street Commercial |
$22.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.33
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.33
|
| Rate for Payer: Cigna of WY Commercial |
$22.56
|
| Rate for Payer: Entrust Commercial |
$21.87
|
| Rate for Payer: First Choice Health Commercial |
$21.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.12
|
| Rate for Payer: HealthUtah PPO |
$23.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.33
|
| Rate for Payer: Multiplan Medicare/VA |
$12.47
|
| Rate for Payer: One Health Plan of WY PPO |
$22.56
|
| Rate for Payer: PacificSource Commercial |
$20.72
|
| Rate for Payer: PHCS PPO |
$22.56
|
| Rate for Payer: Three Rivers PPO |
$17.26
|
| Rate for Payer: TriWest Veterans Administration |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$21.98
|
| Rate for Payer: United Healthcare Medicare |
$13.12
|
| Rate for Payer: WINHealth Partners Commercial |
$22.56
|
| Rate for Payer: Wise Provider Network Commercial |
$21.87
|
|
|
CATH RED RUBBER 10F 277710
|
Facility
|
OP
|
$0.28
|
|
| Hospital Charge Code |
2750028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Aetna of WY Medicare |
$0.18
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
CATH RED RUBBER 10F 277710
|
Facility
|
IP
|
$0.28
|
|
| Hospital Charge Code |
2750028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.27
|
| Rate for Payer: Aetna of WY Medicare |
$0.18
|
| Rate for Payer: Altius Commercial |
$0.27
|
| Rate for Payer: Beech Street Commercial |
$0.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.27
|
| Rate for Payer: Cigna of WY Commercial |
$0.27
|
| Rate for Payer: Entrust Commercial |
$0.27
|
| Rate for Payer: First Choice Health Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.27
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.27
|
| Rate for Payer: PacificSource Commercial |
$0.25
|
| Rate for Payer: PHCS PPO |
$0.27
|
| Rate for Payer: Three Rivers PPO |
$0.21
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.27
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.27
|
| Rate for Payer: Wise Provider Network Commercial |
$0.27
|
|
|
CATH RED RUBBER 14F 277714
|
Facility
|
IP
|
$0.40
|
|
| Hospital Charge Code |
2750029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Commercial |
$0.38
|
| Rate for Payer: Beech Street Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.39
|
| Rate for Payer: Cigna of WY Commercial |
$0.39
|
| Rate for Payer: Entrust Commercial |
$0.38
|
| Rate for Payer: First Choice Health Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.24
|
| Rate for Payer: HealthUtah PPO |
$0.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.23
|
| Rate for Payer: One Health Plan of WY PPO |
$0.39
|
| Rate for Payer: PacificSource Commercial |
$0.36
|
| Rate for Payer: PHCS PPO |
$0.39
|
| Rate for Payer: Three Rivers PPO |
$0.30
|
| Rate for Payer: TriWest Veterans Administration |
$0.24
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
| Rate for Payer: WINHealth Partners Commercial |
$0.38
|
| Rate for Payer: Wise Provider Network Commercial |
$0.38
|
|
|
CATH RED RUBBER 14F 277714
|
Facility
|
OP
|
$0.40
|
|
| Hospital Charge Code |
2750029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Commercial |
$0.38
|
| Rate for Payer: Beech Street Commercial |
$0.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.39
|
| Rate for Payer: Cash Price |
$0.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.39
|
| Rate for Payer: Cigna of WY Commercial |
$0.39
|
| Rate for Payer: Entrust Commercial |
$0.38
|
| Rate for Payer: First Choice Health Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.39
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.39
|
| Rate for Payer: PacificSource Commercial |
$0.36
|
| Rate for Payer: PHCS PPO |
$0.39
|
| Rate for Payer: Three Rivers PPO |
$0.30
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.39
|
| Rate for Payer: Wise Provider Network Commercial |
$0.38
|
|
|
CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$466.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$456.68
|
| Rate for Payer: Aetna of WY Medicare |
$55.45
|
| Rate for Payer: Beech Street Commercial |
$442.70
|
| Rate for Payer: Cash Price |
$326.20
|
| Rate for Payer: Cash Price |
$326.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.02
|
| Rate for Payer: Cigna of WY Commercial |
$456.68
|
| Rate for Payer: First Choice Health Commercial |
$419.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$442.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.45
|
| Rate for Payer: HealthUtah PPO |
$466.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.02
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$456.68
|
| Rate for Payer: PacificSource Commercial |
$419.40
|
| Rate for Payer: PHCS PPO |
$442.70
|
| Rate for Payer: Three Rivers PPO |
$349.50
|
| Rate for Payer: TriWest Veterans Administration |
$55.45
|
| Rate for Payer: United Healthcare Commercial |
$442.70
|
| Rate for Payer: WINHealth Partners Commercial |
$396.10
|
|
|
CATH SILICONE FOL 3-WAY 20FR
|
Facility
|
OP
|
$31.68
|
|
| Hospital Charge Code |
2750125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.05
|
| Rate for Payer: Aetna of WY Medicare |
$20.91
|
| Rate for Payer: Altius Commercial |
$30.41
|
| Rate for Payer: Beech Street Commercial |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.73
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.73
|
| Rate for Payer: Cigna of WY Commercial |
$31.05
|
| Rate for Payer: Entrust Commercial |
$30.10
|
| Rate for Payer: First Choice Health Commercial |
$30.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.06
|
| Rate for Payer: HealthUtah PPO |
$31.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.73
|
| Rate for Payer: Multiplan Medicare/VA |
$17.15
|
| Rate for Payer: One Health Plan of WY PPO |
$31.05
|
| Rate for Payer: PacificSource Commercial |
$28.51
|
| Rate for Payer: PHCS PPO |
$31.05
|
| Rate for Payer: Three Rivers PPO |
$23.76
|
| Rate for Payer: TriWest Veterans Administration |
$18.06
|
| Rate for Payer: United Healthcare Commercial |
$30.25
|
| Rate for Payer: United Healthcare Medicare |
$18.06
|
| Rate for Payer: WINHealth Partners Commercial |
$31.05
|
| Rate for Payer: Wise Provider Network Commercial |
$30.10
|
|
|
CATH SILICONE FOL 3-WAY 20FR
|
Facility
|
IP
|
$31.68
|
|
| Hospital Charge Code |
2750125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.05
|
| Rate for Payer: Aetna of WY Medicare |
$20.28
|
| Rate for Payer: Altius Commercial |
$30.41
|
| Rate for Payer: Beech Street Commercial |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.73
|
| Rate for Payer: Cash Price |
$22.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.73
|
| Rate for Payer: Cigna of WY Commercial |
$31.05
|
| Rate for Payer: Entrust Commercial |
$30.10
|
| Rate for Payer: First Choice Health Commercial |
$30.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.32
|
| Rate for Payer: HealthUtah PPO |
$31.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.73
|
| Rate for Payer: Multiplan Medicare/VA |
$18.36
|
| Rate for Payer: One Health Plan of WY PPO |
$31.05
|
| Rate for Payer: PacificSource Commercial |
$28.51
|
| Rate for Payer: PHCS PPO |
$31.05
|
| Rate for Payer: Three Rivers PPO |
$23.76
|
| Rate for Payer: TriWest Veterans Administration |
$19.32
|
| Rate for Payer: United Healthcare Commercial |
$30.25
|
| Rate for Payer: United Healthcare Medicare |
$19.32
|
| Rate for Payer: WINHealth Partners Commercial |
$30.10
|
| Rate for Payer: Wise Provider Network Commercial |
$30.10
|
|
|
CATH SUPRAPUBIC INTRO 16F
|
Facility
|
OP
|
$66.50
|
|
| Hospital Charge Code |
2650307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.01 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Aetna of WY Medicare |
$43.89
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.50
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.90
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$36.01
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$37.90
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$37.90
|
| Rate for Payer: WINHealth Partners Commercial |
$65.17
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
CATH SUPRAPUBIC INTRO 16F
|
Facility
|
IP
|
$66.50
|
|
| Hospital Charge Code |
2650307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.54 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Aetna of WY Medicare |
$42.56
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$64.50
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.56
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$38.54
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$40.56
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$40.56
|
| Rate for Payer: WINHealth Partners Commercial |
$63.18
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
CATH UMBILICAL 3.5F 8888160333
|
Facility
|
OP
|
$36.72
|
|
| Hospital Charge Code |
2450007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.99
|
| Rate for Payer: Aetna of WY Medicare |
$24.24
|
| Rate for Payer: Altius Commercial |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$35.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.62
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.62
|
| Rate for Payer: Cigna of WY Commercial |
$35.99
|
| Rate for Payer: Entrust Commercial |
$34.88
|
| Rate for Payer: First Choice Health Commercial |
$34.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.93
|
| Rate for Payer: HealthUtah PPO |
$36.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.62
|
| Rate for Payer: Multiplan Medicare/VA |
$19.88
|
| Rate for Payer: One Health Plan of WY PPO |
$35.99
|
| Rate for Payer: PacificSource Commercial |
$33.05
|
| Rate for Payer: PHCS PPO |
$35.99
|
| Rate for Payer: Three Rivers PPO |
$27.54
|
| Rate for Payer: TriWest Veterans Administration |
$20.93
|
| Rate for Payer: United Healthcare Commercial |
$35.07
|
| Rate for Payer: United Healthcare Medicare |
$20.93
|
| Rate for Payer: WINHealth Partners Commercial |
$35.99
|
| Rate for Payer: Wise Provider Network Commercial |
$34.88
|
|
|
CATH UMBILICAL 3.5F 8888160333
|
Facility
|
IP
|
$36.72
|
|
| Hospital Charge Code |
2450007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.99
|
| Rate for Payer: Aetna of WY Medicare |
$23.50
|
| Rate for Payer: Altius Commercial |
$35.25
|
| Rate for Payer: Beech Street Commercial |
$35.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.62
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.62
|
| Rate for Payer: Cigna of WY Commercial |
$35.99
|
| Rate for Payer: Entrust Commercial |
$34.88
|
| Rate for Payer: First Choice Health Commercial |
$34.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.40
|
| Rate for Payer: HealthUtah PPO |
$36.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.62
|
| Rate for Payer: Multiplan Medicare/VA |
$21.28
|
| Rate for Payer: One Health Plan of WY PPO |
$35.99
|
| Rate for Payer: PacificSource Commercial |
$33.05
|
| Rate for Payer: PHCS PPO |
$35.99
|
| Rate for Payer: Three Rivers PPO |
$27.54
|
| Rate for Payer: TriWest Veterans Administration |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$35.07
|
| Rate for Payer: United Healthcare Medicare |
$22.40
|
| Rate for Payer: WINHealth Partners Commercial |
$34.88
|
| Rate for Payer: Wise Provider Network Commercial |
$34.88
|
|
