|
COBAN 1" TAN NS
|
Facility
|
IP
|
$7.26
|
|
| Hospital Charge Code |
2900001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.11
|
| Rate for Payer: Aetna of WY Medicare |
$4.65
|
| Rate for Payer: Altius Commercial |
$6.97
|
| Rate for Payer: Beech Street Commercial |
$7.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.04
|
| Rate for Payer: Cigna of WY Commercial |
$7.11
|
| Rate for Payer: Entrust Commercial |
$6.90
|
| Rate for Payer: First Choice Health Commercial |
$6.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.43
|
| Rate for Payer: HealthUtah PPO |
$7.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.04
|
| Rate for Payer: Multiplan Medicare/VA |
$4.21
|
| Rate for Payer: One Health Plan of WY PPO |
$7.11
|
| Rate for Payer: PacificSource Commercial |
$6.53
|
| Rate for Payer: PHCS PPO |
$7.11
|
| Rate for Payer: Three Rivers PPO |
$5.44
|
| Rate for Payer: TriWest Veterans Administration |
$4.43
|
| Rate for Payer: United Healthcare Commercial |
$6.93
|
| Rate for Payer: United Healthcare Medicare |
$4.43
|
| Rate for Payer: WINHealth Partners Commercial |
$6.90
|
| Rate for Payer: Wise Provider Network Commercial |
$6.90
|
|
|
COBAN 1" TAN NS
|
Facility
|
OP
|
$7.26
|
|
| Hospital Charge Code |
2900001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.11
|
| Rate for Payer: Aetna of WY Medicare |
$4.79
|
| Rate for Payer: Altius Commercial |
$6.97
|
| Rate for Payer: Beech Street Commercial |
$7.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.04
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.04
|
| Rate for Payer: Cigna of WY Commercial |
$7.11
|
| Rate for Payer: Entrust Commercial |
$6.90
|
| Rate for Payer: First Choice Health Commercial |
$6.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.14
|
| Rate for Payer: HealthUtah PPO |
$7.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.04
|
| Rate for Payer: Multiplan Medicare/VA |
$3.93
|
| Rate for Payer: One Health Plan of WY PPO |
$7.11
|
| Rate for Payer: PacificSource Commercial |
$6.53
|
| Rate for Payer: PHCS PPO |
$7.11
|
| Rate for Payer: Three Rivers PPO |
$5.44
|
| Rate for Payer: TriWest Veterans Administration |
$4.14
|
| Rate for Payer: United Healthcare Commercial |
$6.93
|
| Rate for Payer: United Healthcare Medicare |
$4.14
|
| Rate for Payer: WINHealth Partners Commercial |
$7.11
|
| Rate for Payer: Wise Provider Network Commercial |
$6.90
|
|
|
COBAN 2 LAYER WRAP 4" ER 2094N
|
Facility
|
OP
|
$37.32
|
|
| Hospital Charge Code |
2000092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.57
|
| Rate for Payer: Aetna of WY Medicare |
$24.63
|
| Rate for Payer: Altius Commercial |
$35.83
|
| Rate for Payer: Beech Street Commercial |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.20
|
| Rate for Payer: Cigna of WY Commercial |
$36.57
|
| Rate for Payer: Entrust Commercial |
$35.45
|
| Rate for Payer: First Choice Health Commercial |
$35.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.27
|
| Rate for Payer: HealthUtah PPO |
$37.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.20
|
| Rate for Payer: Multiplan Medicare/VA |
$20.21
|
| Rate for Payer: One Health Plan of WY PPO |
$36.57
|
| Rate for Payer: PacificSource Commercial |
$33.59
|
| Rate for Payer: PHCS PPO |
$36.57
|
| Rate for Payer: Three Rivers PPO |
$27.99
|
| Rate for Payer: TriWest Veterans Administration |
$21.27
|
| Rate for Payer: United Healthcare Commercial |
$35.64
|
| Rate for Payer: United Healthcare Medicare |
$21.27
|
| Rate for Payer: WINHealth Partners Commercial |
$36.57
|
| Rate for Payer: Wise Provider Network Commercial |
$35.45
|
|
|
COBAN 2 LAYER WRAP 4" ER 2094N
|
Facility
|
IP
|
$37.32
|
|
| Hospital Charge Code |
2000092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$37.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.57
|
| Rate for Payer: Aetna of WY Medicare |
$23.88
|
| Rate for Payer: Altius Commercial |
$35.83
|
| Rate for Payer: Beech Street Commercial |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$26.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.20
|
| Rate for Payer: Cigna of WY Commercial |
$36.57
|
| Rate for Payer: Entrust Commercial |
$35.45
|
| Rate for Payer: First Choice Health Commercial |
$35.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.77
|
| Rate for Payer: HealthUtah PPO |
$37.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.20
|
| Rate for Payer: Multiplan Medicare/VA |
$21.63
|
| Rate for Payer: One Health Plan of WY PPO |
$36.57
|
| Rate for Payer: PacificSource Commercial |
$33.59
|
| Rate for Payer: PHCS PPO |
$36.57
|
| Rate for Payer: Three Rivers PPO |
$27.99
|
| Rate for Payer: TriWest Veterans Administration |
$22.77
|
| Rate for Payer: United Healthcare Commercial |
$35.64
|
| Rate for Payer: United Healthcare Medicare |
$22.77
|
| Rate for Payer: WINHealth Partners Commercial |
$35.45
|
| Rate for Payer: Wise Provider Network Commercial |
$35.45
|
|
|
COBAN 2" TAN NS
|
Facility
|
IP
|
$3.18
|
|
| Hospital Charge Code |
2900031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.12
|
| Rate for Payer: Aetna of WY Medicare |
$2.04
|
| Rate for Payer: Altius Commercial |
$3.05
|
| Rate for Payer: Beech Street Commercial |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.08
|
| Rate for Payer: Cigna of WY Commercial |
$3.12
|
| Rate for Payer: Entrust Commercial |
$3.02
|
| Rate for Payer: First Choice Health Commercial |
$3.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.94
|
| Rate for Payer: HealthUtah PPO |
$3.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1.84
|
| Rate for Payer: One Health Plan of WY PPO |
$3.12
|
| Rate for Payer: PacificSource Commercial |
$2.86
|
| Rate for Payer: PHCS PPO |
$3.12
|
| Rate for Payer: Three Rivers PPO |
$2.38
|
| Rate for Payer: TriWest Veterans Administration |
$1.94
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Medicare |
$1.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3.02
|
| Rate for Payer: Wise Provider Network Commercial |
$3.02
|
|
|
COBAN 2" TAN NS
|
Facility
|
OP
|
$3.18
|
|
| Hospital Charge Code |
2900031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.12
|
| Rate for Payer: Aetna of WY Medicare |
$2.10
|
| Rate for Payer: Altius Commercial |
$3.05
|
| Rate for Payer: Beech Street Commercial |
$3.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.08
|
| Rate for Payer: Cigna of WY Commercial |
$3.12
|
| Rate for Payer: Entrust Commercial |
$3.02
|
| Rate for Payer: First Choice Health Commercial |
$3.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.81
|
| Rate for Payer: HealthUtah PPO |
$3.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3.12
|
| Rate for Payer: PacificSource Commercial |
$2.86
|
| Rate for Payer: PHCS PPO |
$3.12
|
| Rate for Payer: Three Rivers PPO |
$2.38
|
| Rate for Payer: TriWest Veterans Administration |
$1.81
|
| Rate for Payer: United Healthcare Commercial |
$3.04
|
| Rate for Payer: United Healthcare Medicare |
$1.81
|
| Rate for Payer: WINHealth Partners Commercial |
$3.12
|
| Rate for Payer: Wise Provider Network Commercial |
$3.02
|
|
|
COBAN 3" TAN NS
|
Facility
|
OP
|
$3.36
|
|
| Hospital Charge Code |
2900002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.29
|
| Rate for Payer: Aetna of WY Medicare |
$2.22
|
| Rate for Payer: Altius Commercial |
$3.23
|
| Rate for Payer: Beech Street Commercial |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.26
|
| Rate for Payer: Cigna of WY Commercial |
$3.29
|
| Rate for Payer: Entrust Commercial |
$3.19
|
| Rate for Payer: First Choice Health Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.92
|
| Rate for Payer: HealthUtah PPO |
$3.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3.29
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.29
|
| Rate for Payer: Three Rivers PPO |
$2.52
|
| Rate for Payer: TriWest Veterans Administration |
$1.92
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$1.92
|
| Rate for Payer: WINHealth Partners Commercial |
$3.29
|
| Rate for Payer: Wise Provider Network Commercial |
$3.19
|
|
|
COBAN 3" TAN NS
|
Facility
|
IP
|
$3.36
|
|
| Hospital Charge Code |
2900002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.29
|
| Rate for Payer: Aetna of WY Medicare |
$2.15
|
| Rate for Payer: Altius Commercial |
$3.23
|
| Rate for Payer: Beech Street Commercial |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.26
|
| Rate for Payer: Cigna of WY Commercial |
$3.29
|
| Rate for Payer: Entrust Commercial |
$3.19
|
| Rate for Payer: First Choice Health Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.05
|
| Rate for Payer: HealthUtah PPO |
$3.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1.95
|
| Rate for Payer: One Health Plan of WY PPO |
$3.29
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.29
|
| Rate for Payer: Three Rivers PPO |
$2.52
|
| Rate for Payer: TriWest Veterans Administration |
$2.05
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$2.05
|
| Rate for Payer: WINHealth Partners Commercial |
$3.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3.19
|
|
|
COBAN 3" TAN STERILE
|
Facility
|
OP
|
$5.64
|
|
| Hospital Charge Code |
2900019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.53
|
| Rate for Payer: Aetna of WY Medicare |
$3.72
|
| Rate for Payer: Altius Commercial |
$5.41
|
| Rate for Payer: Beech Street Commercial |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.47
|
| Rate for Payer: Cigna of WY Commercial |
$5.53
|
| Rate for Payer: Entrust Commercial |
$5.36
|
| Rate for Payer: First Choice Health Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.21
|
| Rate for Payer: HealthUtah PPO |
$5.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.47
|
| Rate for Payer: Multiplan Medicare/VA |
$3.05
|
| Rate for Payer: One Health Plan of WY PPO |
$5.53
|
| Rate for Payer: PacificSource Commercial |
$5.08
|
| Rate for Payer: PHCS PPO |
$5.53
|
| Rate for Payer: Three Rivers PPO |
$4.23
|
| Rate for Payer: TriWest Veterans Administration |
$3.21
|
| Rate for Payer: United Healthcare Commercial |
$5.39
|
| Rate for Payer: United Healthcare Medicare |
$3.21
|
| Rate for Payer: WINHealth Partners Commercial |
$5.53
|
| Rate for Payer: Wise Provider Network Commercial |
$5.36
|
|
|
COBAN 3" TAN STERILE
|
Facility
|
IP
|
$5.64
|
|
| Hospital Charge Code |
2900019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.53
|
| Rate for Payer: Aetna of WY Medicare |
$3.61
|
| Rate for Payer: Altius Commercial |
$5.41
|
| Rate for Payer: Beech Street Commercial |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.47
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.47
|
| Rate for Payer: Cigna of WY Commercial |
$5.53
|
| Rate for Payer: Entrust Commercial |
$5.36
|
| Rate for Payer: First Choice Health Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.44
|
| Rate for Payer: HealthUtah PPO |
$5.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.47
|
| Rate for Payer: Multiplan Medicare/VA |
$3.27
|
| Rate for Payer: One Health Plan of WY PPO |
$5.53
|
| Rate for Payer: PacificSource Commercial |
$5.08
|
| Rate for Payer: PHCS PPO |
$5.53
|
| Rate for Payer: Three Rivers PPO |
$4.23
|
| Rate for Payer: TriWest Veterans Administration |
$3.44
|
| Rate for Payer: United Healthcare Commercial |
$5.39
|
| Rate for Payer: United Healthcare Medicare |
$3.44
|
| Rate for Payer: WINHealth Partners Commercial |
$5.36
|
| Rate for Payer: Wise Provider Network Commercial |
$5.36
|
|
|
COBAN 4" TAN NS
|
Facility
|
IP
|
$4.25
|
|
| Hospital Charge Code |
2900003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.16
|
| Rate for Payer: Aetna of WY Medicare |
$2.72
|
| Rate for Payer: Altius Commercial |
$4.08
|
| Rate for Payer: Beech Street Commercial |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.12
|
| Rate for Payer: Cigna of WY Commercial |
$4.16
|
| Rate for Payer: Entrust Commercial |
$4.04
|
| Rate for Payer: First Choice Health Commercial |
$4.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.59
|
| Rate for Payer: HealthUtah PPO |
$4.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2.46
|
| Rate for Payer: One Health Plan of WY PPO |
$4.16
|
| Rate for Payer: PacificSource Commercial |
$3.82
|
| Rate for Payer: PHCS PPO |
$4.16
|
| Rate for Payer: Three Rivers PPO |
$3.19
|
| Rate for Payer: TriWest Veterans Administration |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$4.06
|
| Rate for Payer: United Healthcare Medicare |
$2.59
|
| Rate for Payer: WINHealth Partners Commercial |
$4.04
|
| Rate for Payer: Wise Provider Network Commercial |
$4.04
|
|
|
COBAN 4" TAN NS
|
Facility
|
OP
|
$4.25
|
|
| Hospital Charge Code |
2900003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.16
|
| Rate for Payer: Aetna of WY Medicare |
$2.80
|
| Rate for Payer: Altius Commercial |
$4.08
|
| Rate for Payer: Beech Street Commercial |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.12
|
| Rate for Payer: Cigna of WY Commercial |
$4.16
|
| Rate for Payer: Entrust Commercial |
$4.04
|
| Rate for Payer: First Choice Health Commercial |
$4.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.42
|
| Rate for Payer: HealthUtah PPO |
$4.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.12
|
| Rate for Payer: Multiplan Medicare/VA |
$2.30
|
| Rate for Payer: One Health Plan of WY PPO |
$4.16
|
| Rate for Payer: PacificSource Commercial |
$3.82
|
| Rate for Payer: PHCS PPO |
$4.16
|
| Rate for Payer: Three Rivers PPO |
$3.19
|
| Rate for Payer: TriWest Veterans Administration |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$4.06
|
| Rate for Payer: United Healthcare Medicare |
$2.42
|
| Rate for Payer: WINHealth Partners Commercial |
$4.16
|
| Rate for Payer: Wise Provider Network Commercial |
$4.04
|
|
|
COBAN 4" TAN STERILE
|
Facility
|
OP
|
$6.66
|
|
| Hospital Charge Code |
2900017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.53
|
| Rate for Payer: Aetna of WY Medicare |
$4.40
|
| Rate for Payer: Altius Commercial |
$6.39
|
| Rate for Payer: Beech Street Commercial |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.46
|
| Rate for Payer: Cigna of WY Commercial |
$6.53
|
| Rate for Payer: Entrust Commercial |
$6.33
|
| Rate for Payer: First Choice Health Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.80
|
| Rate for Payer: HealthUtah PPO |
$6.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.46
|
| Rate for Payer: Multiplan Medicare/VA |
$3.61
|
| Rate for Payer: One Health Plan of WY PPO |
$6.53
|
| Rate for Payer: PacificSource Commercial |
$5.99
|
| Rate for Payer: PHCS PPO |
$6.53
|
| Rate for Payer: Three Rivers PPO |
$5.00
|
| Rate for Payer: TriWest Veterans Administration |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$6.36
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.53
|
| Rate for Payer: Wise Provider Network Commercial |
$6.33
|
|
|
COBAN 4" TAN STERILE
|
Facility
|
IP
|
$6.66
|
|
| Hospital Charge Code |
2900017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.53
|
| Rate for Payer: Aetna of WY Medicare |
$4.26
|
| Rate for Payer: Altius Commercial |
$6.39
|
| Rate for Payer: Beech Street Commercial |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.46
|
| Rate for Payer: Cigna of WY Commercial |
$6.53
|
| Rate for Payer: Entrust Commercial |
$6.33
|
| Rate for Payer: First Choice Health Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.06
|
| Rate for Payer: HealthUtah PPO |
$6.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.46
|
| Rate for Payer: Multiplan Medicare/VA |
$3.86
|
| Rate for Payer: One Health Plan of WY PPO |
$6.53
|
| Rate for Payer: PacificSource Commercial |
$5.99
|
| Rate for Payer: PHCS PPO |
$6.53
|
| Rate for Payer: Three Rivers PPO |
$5.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.06
|
| Rate for Payer: United Healthcare Commercial |
$6.36
|
| Rate for Payer: United Healthcare Medicare |
$4.06
|
| Rate for Payer: WINHealth Partners Commercial |
$6.33
|
| Rate for Payer: Wise Provider Network Commercial |
$6.33
|
|
|
COBAN 6" TAN NS
|
Facility
|
IP
|
$6.66
|
|
| Hospital Charge Code |
2000009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.53
|
| Rate for Payer: Aetna of WY Medicare |
$4.26
|
| Rate for Payer: Altius Commercial |
$6.39
|
| Rate for Payer: Beech Street Commercial |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.46
|
| Rate for Payer: Cigna of WY Commercial |
$6.53
|
| Rate for Payer: Entrust Commercial |
$6.33
|
| Rate for Payer: First Choice Health Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.06
|
| Rate for Payer: HealthUtah PPO |
$6.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.46
|
| Rate for Payer: Multiplan Medicare/VA |
$3.86
|
| Rate for Payer: One Health Plan of WY PPO |
$6.53
|
| Rate for Payer: PacificSource Commercial |
$5.99
|
| Rate for Payer: PHCS PPO |
$6.53
|
| Rate for Payer: Three Rivers PPO |
$5.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.06
|
| Rate for Payer: United Healthcare Commercial |
$6.36
|
| Rate for Payer: United Healthcare Medicare |
$4.06
|
| Rate for Payer: WINHealth Partners Commercial |
$6.33
|
| Rate for Payer: Wise Provider Network Commercial |
$6.33
|
|
|
COBAN 6" TAN NS
|
Facility
|
OP
|
$6.66
|
|
| Hospital Charge Code |
2000009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.53
|
| Rate for Payer: Aetna of WY Medicare |
$4.40
|
| Rate for Payer: Altius Commercial |
$6.39
|
| Rate for Payer: Beech Street Commercial |
$6.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.46
|
| Rate for Payer: Cigna of WY Commercial |
$6.53
|
| Rate for Payer: Entrust Commercial |
$6.33
|
| Rate for Payer: First Choice Health Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.80
|
| Rate for Payer: HealthUtah PPO |
$6.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.46
|
| Rate for Payer: Multiplan Medicare/VA |
$3.61
|
| Rate for Payer: One Health Plan of WY PPO |
$6.53
|
| Rate for Payer: PacificSource Commercial |
$5.99
|
| Rate for Payer: PHCS PPO |
$6.53
|
| Rate for Payer: Three Rivers PPO |
$5.00
|
| Rate for Payer: TriWest Veterans Administration |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$6.36
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.53
|
| Rate for Payer: Wise Provider Network Commercial |
$6.33
|
|
|
COBAN 6" TAN STERILE
|
Facility
|
IP
|
$10.16
|
|
| Hospital Charge Code |
2900018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$10.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.96
|
| Rate for Payer: Aetna of WY Medicare |
$6.50
|
| Rate for Payer: Altius Commercial |
$9.75
|
| Rate for Payer: Beech Street Commercial |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.86
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.86
|
| Rate for Payer: Cigna of WY Commercial |
$9.96
|
| Rate for Payer: Entrust Commercial |
$9.65
|
| Rate for Payer: First Choice Health Commercial |
$9.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.20
|
| Rate for Payer: HealthUtah PPO |
$10.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.86
|
| Rate for Payer: Multiplan Medicare/VA |
$5.89
|
| Rate for Payer: One Health Plan of WY PPO |
$9.96
|
| Rate for Payer: PacificSource Commercial |
$9.14
|
| Rate for Payer: PHCS PPO |
$9.96
|
| Rate for Payer: Three Rivers PPO |
$7.62
|
| Rate for Payer: TriWest Veterans Administration |
$6.20
|
| Rate for Payer: United Healthcare Commercial |
$9.70
|
| Rate for Payer: United Healthcare Medicare |
$6.20
|
| Rate for Payer: WINHealth Partners Commercial |
$9.65
|
| Rate for Payer: Wise Provider Network Commercial |
$9.65
|
|
|
COBAN 6" TAN STERILE
|
Facility
|
OP
|
$10.16
|
|
| Hospital Charge Code |
2900018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.16 |
| Rate for Payer: United Healthcare Commercial |
$9.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.96
|
| Rate for Payer: Aetna of WY Medicare |
$6.71
|
| Rate for Payer: Altius Commercial |
$9.75
|
| Rate for Payer: Beech Street Commercial |
$9.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.86
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.86
|
| Rate for Payer: Cigna of WY Commercial |
$9.96
|
| Rate for Payer: Entrust Commercial |
$9.65
|
| Rate for Payer: First Choice Health Commercial |
$9.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.79
|
| Rate for Payer: HealthUtah PPO |
$10.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.86
|
| Rate for Payer: Multiplan Medicare/VA |
$5.50
|
| Rate for Payer: One Health Plan of WY PPO |
$9.96
|
| Rate for Payer: PacificSource Commercial |
$9.14
|
| Rate for Payer: PHCS PPO |
$9.96
|
| Rate for Payer: Three Rivers PPO |
$7.62
|
| Rate for Payer: TriWest Veterans Administration |
$5.79
|
| Rate for Payer: United Healthcare Medicare |
$5.79
|
| Rate for Payer: WINHealth Partners Commercial |
$9.96
|
| Rate for Payer: Wise Provider Network Commercial |
$9.65
|
|
|
COBAN LITE 2 LAYER 4" PT 2794N
|
Facility
|
IP
|
$37.62
|
|
| Hospital Charge Code |
2000095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$37.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.87
|
| Rate for Payer: Aetna of WY Medicare |
$24.08
|
| Rate for Payer: Altius Commercial |
$36.12
|
| Rate for Payer: Beech Street Commercial |
$36.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.49
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.49
|
| Rate for Payer: Cigna of WY Commercial |
$36.87
|
| Rate for Payer: Entrust Commercial |
$35.74
|
| Rate for Payer: First Choice Health Commercial |
$35.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.95
|
| Rate for Payer: HealthUtah PPO |
$37.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.49
|
| Rate for Payer: Multiplan Medicare/VA |
$21.80
|
| Rate for Payer: One Health Plan of WY PPO |
$36.87
|
| Rate for Payer: PacificSource Commercial |
$33.86
|
| Rate for Payer: PHCS PPO |
$36.87
|
| Rate for Payer: Three Rivers PPO |
$28.22
|
| Rate for Payer: TriWest Veterans Administration |
$22.95
|
| Rate for Payer: United Healthcare Commercial |
$35.93
|
| Rate for Payer: United Healthcare Medicare |
$22.95
|
| Rate for Payer: WINHealth Partners Commercial |
$35.74
|
| Rate for Payer: Wise Provider Network Commercial |
$35.74
|
|
|
COBAN LITE 2 LAYER 4" PT 2794N
|
Facility
|
OP
|
$37.62
|
|
| Hospital Charge Code |
2000095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$37.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.87
|
| Rate for Payer: Aetna of WY Medicare |
$24.83
|
| Rate for Payer: Altius Commercial |
$36.12
|
| Rate for Payer: Beech Street Commercial |
$36.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.49
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.49
|
| Rate for Payer: Cigna of WY Commercial |
$36.87
|
| Rate for Payer: Entrust Commercial |
$35.74
|
| Rate for Payer: First Choice Health Commercial |
$35.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.44
|
| Rate for Payer: HealthUtah PPO |
$37.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.49
|
| Rate for Payer: Multiplan Medicare/VA |
$20.37
|
| Rate for Payer: One Health Plan of WY PPO |
$36.87
|
| Rate for Payer: PacificSource Commercial |
$33.86
|
| Rate for Payer: PHCS PPO |
$36.87
|
| Rate for Payer: Three Rivers PPO |
$28.22
|
| Rate for Payer: TriWest Veterans Administration |
$21.44
|
| Rate for Payer: United Healthcare Commercial |
$35.93
|
| Rate for Payer: United Healthcare Medicare |
$21.44
|
| Rate for Payer: WINHealth Partners Commercial |
$36.87
|
| Rate for Payer: Wise Provider Network Commercial |
$35.74
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
OP
|
$111.47
|
|
|
Service Code
|
NDC 0527197174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.36 |
| Max. Negotiated Rate |
$111.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.24
|
| Rate for Payer: Aetna of WY Medicare |
$73.57
|
| Rate for Payer: Altius Commercial |
$107.01
|
| Rate for Payer: Beech Street Commercial |
$109.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.13
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.13
|
| Rate for Payer: Cigna of WY Commercial |
$109.24
|
| Rate for Payer: Entrust Commercial |
$105.90
|
| Rate for Payer: First Choice Health Commercial |
$105.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.54
|
| Rate for Payer: HealthUtah PPO |
$111.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.13
|
| Rate for Payer: Multiplan Medicare/VA |
$60.36
|
| Rate for Payer: One Health Plan of WY PPO |
$109.24
|
| Rate for Payer: PacificSource Commercial |
$100.32
|
| Rate for Payer: PHCS PPO |
$109.24
|
| Rate for Payer: Three Rivers PPO |
$83.60
|
| Rate for Payer: TriWest Veterans Administration |
$63.54
|
| Rate for Payer: United Healthcare Commercial |
$106.45
|
| Rate for Payer: United Healthcare Medicare |
$63.54
|
| Rate for Payer: WINHealth Partners Commercial |
$109.24
|
| Rate for Payer: Wise Provider Network Commercial |
$105.90
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
IP
|
$172.06
|
|
|
Service Code
|
NDC 8166530102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.71 |
| Max. Negotiated Rate |
$172.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.62
|
| Rate for Payer: Aetna of WY Medicare |
$110.12
|
| Rate for Payer: Altius Commercial |
$165.18
|
| Rate for Payer: Beech Street Commercial |
$168.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.90
|
| Rate for Payer: Cash Price |
$120.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.90
|
| Rate for Payer: Cigna of WY Commercial |
$168.62
|
| Rate for Payer: Entrust Commercial |
$163.46
|
| Rate for Payer: First Choice Health Commercial |
$163.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.96
|
| Rate for Payer: HealthUtah PPO |
$172.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.90
|
| Rate for Payer: Multiplan Medicare/VA |
$99.71
|
| Rate for Payer: One Health Plan of WY PPO |
$168.62
|
| Rate for Payer: PacificSource Commercial |
$154.85
|
| Rate for Payer: PHCS PPO |
$168.62
|
| Rate for Payer: Three Rivers PPO |
$129.04
|
| Rate for Payer: TriWest Veterans Administration |
$104.96
|
| Rate for Payer: United Healthcare Commercial |
$164.32
|
| Rate for Payer: United Healthcare Medicare |
$104.96
|
| Rate for Payer: WINHealth Partners Commercial |
$163.46
|
| Rate for Payer: Wise Provider Network Commercial |
$163.46
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
IP
|
$111.47
|
|
|
Service Code
|
NDC 0527197174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$111.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.24
|
| Rate for Payer: Aetna of WY Medicare |
$71.34
|
| Rate for Payer: Altius Commercial |
$107.01
|
| Rate for Payer: Beech Street Commercial |
$109.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.13
|
| Rate for Payer: Cash Price |
$78.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.13
|
| Rate for Payer: Cigna of WY Commercial |
$109.24
|
| Rate for Payer: Entrust Commercial |
$105.90
|
| Rate for Payer: First Choice Health Commercial |
$105.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$105.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.00
|
| Rate for Payer: HealthUtah PPO |
$111.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.13
|
| Rate for Payer: Multiplan Medicare/VA |
$64.60
|
| Rate for Payer: One Health Plan of WY PPO |
$109.24
|
| Rate for Payer: PacificSource Commercial |
$100.32
|
| Rate for Payer: PHCS PPO |
$109.24
|
| Rate for Payer: Three Rivers PPO |
$83.60
|
| Rate for Payer: TriWest Veterans Administration |
$68.00
|
| Rate for Payer: United Healthcare Commercial |
$106.45
|
| Rate for Payer: United Healthcare Medicare |
$68.00
|
| Rate for Payer: WINHealth Partners Commercial |
$105.90
|
| Rate for Payer: Wise Provider Network Commercial |
$105.90
|
|
|
COCAINE 4 % NASAL SOLUTION [151490]
|
Facility
|
OP
|
$172.06
|
|
|
Service Code
|
NDC 8166530102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.17 |
| Max. Negotiated Rate |
$172.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.62
|
| Rate for Payer: Aetna of WY Medicare |
$113.56
|
| Rate for Payer: Altius Commercial |
$165.18
|
| Rate for Payer: Beech Street Commercial |
$168.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.90
|
| Rate for Payer: Cash Price |
$120.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.90
|
| Rate for Payer: Cigna of WY Commercial |
$168.62
|
| Rate for Payer: Entrust Commercial |
$163.46
|
| Rate for Payer: First Choice Health Commercial |
$163.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.07
|
| Rate for Payer: HealthUtah PPO |
$172.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.90
|
| Rate for Payer: Multiplan Medicare/VA |
$93.17
|
| Rate for Payer: One Health Plan of WY PPO |
$168.62
|
| Rate for Payer: PacificSource Commercial |
$154.85
|
| Rate for Payer: PHCS PPO |
$168.62
|
| Rate for Payer: Three Rivers PPO |
$129.04
|
| Rate for Payer: TriWest Veterans Administration |
$98.07
|
| Rate for Payer: United Healthcare Commercial |
$164.32
|
| Rate for Payer: United Healthcare Medicare |
$98.07
|
| Rate for Payer: WINHealth Partners Commercial |
$168.62
|
| Rate for Payer: Wise Provider Network Commercial |
$163.46
|
|
|
COCHLEAR BI300 IMPLANT 3MM
|
Facility
|
OP
|
$5,950.00
|
|
| Hospital Charge Code |
2700020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,221.92 |
| Max. Negotiated Rate |
$5,950.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,831.00
|
| Rate for Payer: Aetna of WY Medicare |
$3,927.00
|
| Rate for Payer: Altius Commercial |
$5,712.00
|
| Rate for Payer: Beech Street Commercial |
$5,831.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,771.50
|
| Rate for Payer: Cash Price |
$4,165.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,771.50
|
| Rate for Payer: Cigna of WY Commercial |
$5,831.00
|
| Rate for Payer: Entrust Commercial |
$5,652.50
|
| Rate for Payer: First Choice Health Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,652.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,391.50
|
| Rate for Payer: HealthUtah PPO |
$5,950.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,771.50
|
| Rate for Payer: Multiplan Medicare/VA |
$3,221.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,831.00
|
| Rate for Payer: PacificSource Commercial |
$5,355.00
|
| Rate for Payer: PHCS PPO |
$5,831.00
|
| Rate for Payer: Three Rivers PPO |
$4,462.50
|
| Rate for Payer: TriWest Veterans Administration |
$3,391.50
|
| Rate for Payer: United Healthcare Commercial |
$5,682.25
|
| Rate for Payer: United Healthcare Medicare |
$3,391.50
|
| Rate for Payer: WINHealth Partners Commercial |
$5,831.00
|
| Rate for Payer: Wise Provider Network Commercial |
$5,652.50
|
|
