|
COCHLEAR WIDENING DRILL 4MM
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
2700023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.78 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$537.60
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$486.78
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$512.40
|
| Rate for Payer: WINHealth Partners Commercial |
$798.00
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
COCHLEAR WIDENING DRILL 4MM
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
2700023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.86 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$554.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.80
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$454.86
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$478.80
|
| Rate for Payer: WINHealth Partners Commercial |
$823.20
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
OP
|
$15.22
|
|
|
Service Code
|
NDC 0121077504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.05
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.68
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.24
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$8.68
|
| Rate for Payer: WINHealth Partners Commercial |
$14.92
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
IP
|
$15.22
|
|
|
Service Code
|
NDC 0121077504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$14.46
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
IP
|
$15.22
|
|
|
Service Code
|
NDC 9991605701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$14.46
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID [16057]
|
Facility
|
OP
|
$15.22
|
|
|
Service Code
|
NDC 9991605701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.05
|
| Rate for Payer: Altius Commercial |
$14.61
|
| Rate for Payer: Beech Street Commercial |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.76
|
| Rate for Payer: Cigna of WY Commercial |
$14.92
|
| Rate for Payer: Entrust Commercial |
$14.46
|
| Rate for Payer: First Choice Health Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.68
|
| Rate for Payer: HealthUtah PPO |
$15.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.24
|
| Rate for Payer: One Health Plan of WY PPO |
$14.92
|
| Rate for Payer: PacificSource Commercial |
$13.70
|
| Rate for Payer: PHCS PPO |
$14.92
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$8.68
|
| Rate for Payer: WINHealth Partners Commercial |
$14.92
|
| Rate for Payer: Wise Provider Network Commercial |
$14.46
|
|
|
CO DIFFUSING CAPACITY
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 94729 26
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.48
|
| Rate for Payer: Aetna of WY Medicare |
$8.43
|
| Rate for Payer: Beech Street Commercial |
$24.70
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.22
|
| Rate for Payer: Cigna of WY Commercial |
$25.48
|
| Rate for Payer: First Choice Health Commercial |
$23.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.43
|
| Rate for Payer: HealthUtah PPO |
$26.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.22
|
| Rate for Payer: Multiplan Medicare/VA |
$7.17
|
| Rate for Payer: One Health Plan of WY PPO |
$25.48
|
| Rate for Payer: PacificSource Commercial |
$23.40
|
| Rate for Payer: PHCS PPO |
$24.70
|
| Rate for Payer: Three Rivers PPO |
$19.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.43
|
| Rate for Payer: United Healthcare Commercial |
$24.70
|
| Rate for Payer: WINHealth Partners Commercial |
$24.70
|
|
|
CODMAN SURGERY PATTIE .5"X1.5"
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
2650947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
CODMAN SURGERY PATTIE .5"X1.5"
|
Facility
|
IP
|
$0.08
|
|
| Hospital Charge Code |
2650947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
CODMAN SURGERY PATTIE .5"X3"
|
Facility
|
IP
|
$18.35
|
|
| Hospital Charge Code |
2650088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.98
|
| Rate for Payer: Aetna of WY Medicare |
$11.74
|
| Rate for Payer: Altius Commercial |
$17.62
|
| Rate for Payer: Beech Street Commercial |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.80
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.80
|
| Rate for Payer: Cigna of WY Commercial |
$17.98
|
| Rate for Payer: Entrust Commercial |
$17.43
|
| Rate for Payer: First Choice Health Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.19
|
| Rate for Payer: HealthUtah PPO |
$18.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.63
|
| Rate for Payer: One Health Plan of WY PPO |
$17.98
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PHCS PPO |
$17.98
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: TriWest Veterans Administration |
$11.19
|
| Rate for Payer: United Healthcare Commercial |
$17.52
|
| Rate for Payer: United Healthcare Medicare |
$11.19
|
| Rate for Payer: WINHealth Partners Commercial |
$17.43
|
| Rate for Payer: Wise Provider Network Commercial |
$17.43
|
|
|
CODMAN SURGERY PATTIE .5"X3"
|
Facility
|
OP
|
$18.35
|
|
| Hospital Charge Code |
2650088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$18.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.98
|
| Rate for Payer: Aetna of WY Medicare |
$12.11
|
| Rate for Payer: Altius Commercial |
$17.62
|
| Rate for Payer: Beech Street Commercial |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.80
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.80
|
| Rate for Payer: Cigna of WY Commercial |
$17.98
|
| Rate for Payer: Entrust Commercial |
$17.43
|
| Rate for Payer: First Choice Health Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.46
|
| Rate for Payer: HealthUtah PPO |
$18.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.94
|
| Rate for Payer: One Health Plan of WY PPO |
$17.98
|
| Rate for Payer: PacificSource Commercial |
$16.52
|
| Rate for Payer: PHCS PPO |
$17.98
|
| Rate for Payer: Three Rivers PPO |
$13.76
|
| Rate for Payer: TriWest Veterans Administration |
$10.46
|
| Rate for Payer: United Healthcare Commercial |
$17.52
|
| Rate for Payer: United Healthcare Medicare |
$10.46
|
| Rate for Payer: WINHealth Partners Commercial |
$17.98
|
| Rate for Payer: Wise Provider Network Commercial |
$17.43
|
|
|
CODMAN SURGERY PATTIE .5"X.5"
|
Facility
|
OP
|
$17.57
|
|
| Hospital Charge Code |
2650082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Medicare |
$11.60
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.04
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.01
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$9.51
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.01
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare |
$10.01
|
| Rate for Payer: WINHealth Partners Commercial |
$17.22
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
CODMAN SURGERY PATTIE .5"X.5"
|
Facility
|
IP
|
$17.57
|
|
| Hospital Charge Code |
2650082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$17.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.22
|
| Rate for Payer: Aetna of WY Medicare |
$11.24
|
| Rate for Payer: Altius Commercial |
$16.87
|
| Rate for Payer: Beech Street Commercial |
$17.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.04
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.04
|
| Rate for Payer: Cigna of WY Commercial |
$17.22
|
| Rate for Payer: Entrust Commercial |
$16.69
|
| Rate for Payer: First Choice Health Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.72
|
| Rate for Payer: HealthUtah PPO |
$17.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.04
|
| Rate for Payer: Multiplan Medicare/VA |
$10.18
|
| Rate for Payer: One Health Plan of WY PPO |
$17.22
|
| Rate for Payer: PacificSource Commercial |
$15.81
|
| Rate for Payer: PHCS PPO |
$17.22
|
| Rate for Payer: Three Rivers PPO |
$13.18
|
| Rate for Payer: TriWest Veterans Administration |
$10.72
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare |
$10.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.69
|
| Rate for Payer: Wise Provider Network Commercial |
$16.69
|
|
|
CODMAN SURGERY PATTIE .75X.75"
|
Facility
|
OP
|
$1.76
|
|
| Hospital Charge Code |
2650948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.00
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$0.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.68
|
| Rate for Payer: United Healthcare Medicare |
$1.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1.72
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
CODMAN SURGERY PATTIE .75X.75"
|
Facility
|
IP
|
$1.76
|
|
| Hospital Charge Code |
2650948
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.72
|
| Rate for Payer: Aetna of WY Medicare |
$1.13
|
| Rate for Payer: Altius Commercial |
$1.69
|
| Rate for Payer: Beech Street Commercial |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.71
|
| Rate for Payer: Cigna of WY Commercial |
$1.72
|
| Rate for Payer: Entrust Commercial |
$1.67
|
| Rate for Payer: First Choice Health Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.07
|
| Rate for Payer: HealthUtah PPO |
$1.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.71
|
| Rate for Payer: Multiplan Medicare/VA |
$1.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1.72
|
| Rate for Payer: PacificSource Commercial |
$1.58
|
| Rate for Payer: PHCS PPO |
$1.72
|
| Rate for Payer: Three Rivers PPO |
$1.32
|
| Rate for Payer: TriWest Veterans Administration |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.68
|
| Rate for Payer: United Healthcare Medicare |
$1.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1.67
|
| Rate for Payer: Wise Provider Network Commercial |
$1.67
|
|
|
COFLEX 1" COLORED LF
|
Facility
|
OP
|
$1.65
|
|
| Hospital Charge Code |
2900004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.62
|
| Rate for Payer: Aetna of WY Medicare |
$1.09
|
| Rate for Payer: Altius Commercial |
$1.58
|
| Rate for Payer: Beech Street Commercial |
$1.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.60
|
| Rate for Payer: Cigna of WY Commercial |
$1.62
|
| Rate for Payer: Entrust Commercial |
$1.57
|
| Rate for Payer: First Choice Health Commercial |
$1.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.94
|
| Rate for Payer: HealthUtah PPO |
$1.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.60
|
| Rate for Payer: Multiplan Medicare/VA |
$0.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1.62
|
| Rate for Payer: PacificSource Commercial |
$1.48
|
| Rate for Payer: PHCS PPO |
$1.62
|
| Rate for Payer: Three Rivers PPO |
$1.24
|
| Rate for Payer: TriWest Veterans Administration |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$0.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1.57
|
|
|
COFLEX 1" COLORED LF
|
Facility
|
IP
|
$1.65
|
|
| Hospital Charge Code |
2900004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.62
|
| Rate for Payer: Aetna of WY Medicare |
$1.06
|
| Rate for Payer: Altius Commercial |
$1.58
|
| Rate for Payer: Beech Street Commercial |
$1.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.60
|
| Rate for Payer: Cigna of WY Commercial |
$1.62
|
| Rate for Payer: Entrust Commercial |
$1.57
|
| Rate for Payer: First Choice Health Commercial |
$1.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.01
|
| Rate for Payer: HealthUtah PPO |
$1.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.60
|
| Rate for Payer: Multiplan Medicare/VA |
$0.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1.62
|
| Rate for Payer: PacificSource Commercial |
$1.48
|
| Rate for Payer: PHCS PPO |
$1.62
|
| Rate for Payer: Three Rivers PPO |
$1.24
|
| Rate for Payer: TriWest Veterans Administration |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1.57
|
| Rate for Payer: Wise Provider Network Commercial |
$1.57
|
|
|
COFLEX 2" COLORED LF
|
Facility
|
OP
|
$2.68
|
|
| Hospital Charge Code |
2900005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.63
|
| Rate for Payer: Aetna of WY Medicare |
$1.77
|
| Rate for Payer: Altius Commercial |
$2.57
|
| Rate for Payer: Beech Street Commercial |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.60
|
| Rate for Payer: Cigna of WY Commercial |
$2.63
|
| Rate for Payer: Entrust Commercial |
$2.55
|
| Rate for Payer: First Choice Health Commercial |
$2.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.53
|
| Rate for Payer: HealthUtah PPO |
$2.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2.63
|
| Rate for Payer: PacificSource Commercial |
$2.41
|
| Rate for Payer: PHCS PPO |
$2.63
|
| Rate for Payer: Three Rivers PPO |
$2.01
|
| Rate for Payer: TriWest Veterans Administration |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$2.56
|
| Rate for Payer: United Healthcare Medicare |
$1.53
|
| Rate for Payer: WINHealth Partners Commercial |
$2.63
|
| Rate for Payer: Wise Provider Network Commercial |
$2.55
|
|
|
COFLEX 2" COLORED LF
|
Facility
|
IP
|
$2.68
|
|
| Hospital Charge Code |
2900005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.63
|
| Rate for Payer: Aetna of WY Medicare |
$1.72
|
| Rate for Payer: Altius Commercial |
$2.57
|
| Rate for Payer: Beech Street Commercial |
$2.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.60
|
| Rate for Payer: Cigna of WY Commercial |
$2.63
|
| Rate for Payer: Entrust Commercial |
$2.55
|
| Rate for Payer: First Choice Health Commercial |
$2.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.63
|
| Rate for Payer: HealthUtah PPO |
$2.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.60
|
| Rate for Payer: Multiplan Medicare/VA |
$1.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2.63
|
| Rate for Payer: PacificSource Commercial |
$2.41
|
| Rate for Payer: PHCS PPO |
$2.63
|
| Rate for Payer: Three Rivers PPO |
$2.01
|
| Rate for Payer: TriWest Veterans Administration |
$1.63
|
| Rate for Payer: United Healthcare Commercial |
$2.56
|
| Rate for Payer: United Healthcare Medicare |
$1.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2.55
|
| Rate for Payer: Wise Provider Network Commercial |
$2.55
|
|
|
COFLEX 3" COLORED LF
|
Facility
|
OP
|
$3.86
|
|
| Hospital Charge Code |
2900006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.78
|
| Rate for Payer: Aetna of WY Medicare |
$2.55
|
| Rate for Payer: Altius Commercial |
$3.71
|
| Rate for Payer: Beech Street Commercial |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.74
|
| Rate for Payer: Cigna of WY Commercial |
$3.78
|
| Rate for Payer: Entrust Commercial |
$3.67
|
| Rate for Payer: First Choice Health Commercial |
$3.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.20
|
| Rate for Payer: HealthUtah PPO |
$3.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.74
|
| Rate for Payer: Multiplan Medicare/VA |
$2.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3.78
|
| Rate for Payer: PacificSource Commercial |
$3.47
|
| Rate for Payer: PHCS PPO |
$3.78
|
| Rate for Payer: Three Rivers PPO |
$2.90
|
| Rate for Payer: TriWest Veterans Administration |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$3.69
|
| Rate for Payer: United Healthcare Medicare |
$2.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3.78
|
| Rate for Payer: Wise Provider Network Commercial |
$3.67
|
|
|
COFLEX 3" COLORED LF
|
Facility
|
IP
|
$3.86
|
|
| Hospital Charge Code |
2900006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.78
|
| Rate for Payer: Aetna of WY Medicare |
$2.47
|
| Rate for Payer: Altius Commercial |
$3.71
|
| Rate for Payer: Beech Street Commercial |
$3.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.74
|
| Rate for Payer: Cigna of WY Commercial |
$3.78
|
| Rate for Payer: Entrust Commercial |
$3.67
|
| Rate for Payer: First Choice Health Commercial |
$3.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.35
|
| Rate for Payer: HealthUtah PPO |
$3.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.74
|
| Rate for Payer: Multiplan Medicare/VA |
$2.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3.78
|
| Rate for Payer: PacificSource Commercial |
$3.47
|
| Rate for Payer: PHCS PPO |
$3.78
|
| Rate for Payer: Three Rivers PPO |
$2.90
|
| Rate for Payer: TriWest Veterans Administration |
$2.35
|
| Rate for Payer: United Healthcare Commercial |
$3.69
|
| Rate for Payer: United Healthcare Medicare |
$2.35
|
| Rate for Payer: WINHealth Partners Commercial |
$3.67
|
| Rate for Payer: Wise Provider Network Commercial |
$3.67
|
|
|
COFLEX 4" COLORED LF
|
Facility
|
OP
|
$4.31
|
|
| Hospital Charge Code |
2900007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.84
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.18
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.46
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.33
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$2.46
|
| Rate for Payer: WINHealth Partners Commercial |
$4.22
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
COFLEX 4" COLORED LF
|
Facility
|
IP
|
$4.31
|
|
| Hospital Charge Code |
2900007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.76
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.18
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.63
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.50
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.63
|
| Rate for Payer: United Healthcare Commercial |
$4.12
|
| Rate for Payer: United Healthcare Medicare |
$2.63
|
| Rate for Payer: WINHealth Partners Commercial |
$4.09
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
COHESIVE TAPEWRAP 3"X6YDS BLK
|
Facility
|
OP
|
$8.74
|
|
| Hospital Charge Code |
2900035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.57
|
| Rate for Payer: Aetna of WY Medicare |
$5.77
|
| Rate for Payer: Altius Commercial |
$8.39
|
| Rate for Payer: Beech Street Commercial |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.48
|
| Rate for Payer: Cigna of WY Commercial |
$8.57
|
| Rate for Payer: Entrust Commercial |
$8.30
|
| Rate for Payer: First Choice Health Commercial |
$8.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.98
|
| Rate for Payer: HealthUtah PPO |
$8.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.48
|
| Rate for Payer: Multiplan Medicare/VA |
$4.73
|
| Rate for Payer: One Health Plan of WY PPO |
$8.57
|
| Rate for Payer: PacificSource Commercial |
$7.87
|
| Rate for Payer: PHCS PPO |
$8.57
|
| Rate for Payer: Three Rivers PPO |
$6.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.98
|
| Rate for Payer: United Healthcare Commercial |
$8.35
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
| Rate for Payer: WINHealth Partners Commercial |
$8.57
|
| Rate for Payer: Wise Provider Network Commercial |
$8.30
|
|
|
COHESIVE TAPEWRAP 3"X6YDS BLK
|
Facility
|
IP
|
$8.74
|
|
| Hospital Charge Code |
2900035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.57
|
| Rate for Payer: Aetna of WY Medicare |
$5.59
|
| Rate for Payer: Altius Commercial |
$8.39
|
| Rate for Payer: Beech Street Commercial |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.48
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.48
|
| Rate for Payer: Cigna of WY Commercial |
$8.57
|
| Rate for Payer: Entrust Commercial |
$8.30
|
| Rate for Payer: First Choice Health Commercial |
$8.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.33
|
| Rate for Payer: HealthUtah PPO |
$8.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.48
|
| Rate for Payer: Multiplan Medicare/VA |
$5.06
|
| Rate for Payer: One Health Plan of WY PPO |
$8.57
|
| Rate for Payer: PacificSource Commercial |
$7.87
|
| Rate for Payer: PHCS PPO |
$8.57
|
| Rate for Payer: Three Rivers PPO |
$6.56
|
| Rate for Payer: TriWest Veterans Administration |
$5.33
|
| Rate for Payer: United Healthcare Commercial |
$8.35
|
| Rate for Payer: United Healthcare Medicare |
$5.33
|
| Rate for Payer: WINHealth Partners Commercial |
$8.30
|
| Rate for Payer: Wise Provider Network Commercial |
$8.30
|
|
