|
DRAPE SWITCH SPIDER2 ARM
|
Facility
|
IP
|
$132.30
|
|
| Hospital Charge Code |
3002184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.67 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.65
|
| Rate for Payer: Aetna of WY Medicare |
$84.67
|
| Rate for Payer: Altius Commercial |
$127.01
|
| Rate for Payer: Beech Street Commercial |
$129.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.33
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.33
|
| Rate for Payer: Cigna of WY Commercial |
$129.65
|
| Rate for Payer: Entrust Commercial |
$125.68
|
| Rate for Payer: First Choice Health Commercial |
$125.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.70
|
| Rate for Payer: HealthUtah PPO |
$132.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.33
|
| Rate for Payer: Multiplan Medicare/VA |
$76.67
|
| Rate for Payer: One Health Plan of WY PPO |
$129.65
|
| Rate for Payer: PacificSource Commercial |
$119.07
|
| Rate for Payer: PHCS PPO |
$129.65
|
| Rate for Payer: Three Rivers PPO |
$99.22
|
| Rate for Payer: TriWest Veterans Administration |
$80.70
|
| Rate for Payer: United Healthcare Commercial |
$126.35
|
| Rate for Payer: United Healthcare Medicare |
$80.70
|
| Rate for Payer: WINHealth Partners Commercial |
$125.68
|
| Rate for Payer: Wise Provider Network Commercial |
$125.68
|
|
|
DRAPE TABLE COVER
|
Facility
|
OP
|
$6.33
|
|
| Hospital Charge Code |
2650107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.20
|
| Rate for Payer: Aetna of WY Medicare |
$4.18
|
| Rate for Payer: Altius Commercial |
$6.08
|
| Rate for Payer: Beech Street Commercial |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.14
|
| Rate for Payer: Cigna of WY Commercial |
$6.20
|
| Rate for Payer: Entrust Commercial |
$6.01
|
| Rate for Payer: First Choice Health Commercial |
$6.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.61
|
| Rate for Payer: HealthUtah PPO |
$6.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.14
|
| Rate for Payer: Multiplan Medicare/VA |
$3.43
|
| Rate for Payer: One Health Plan of WY PPO |
$6.20
|
| Rate for Payer: PacificSource Commercial |
$5.70
|
| Rate for Payer: PHCS PPO |
$6.20
|
| Rate for Payer: Three Rivers PPO |
$4.75
|
| Rate for Payer: TriWest Veterans Administration |
$3.61
|
| Rate for Payer: United Healthcare Commercial |
$6.05
|
| Rate for Payer: United Healthcare Medicare |
$3.61
|
| Rate for Payer: WINHealth Partners Commercial |
$6.20
|
| Rate for Payer: Wise Provider Network Commercial |
$6.01
|
|
|
DRAPE TABLE COVER
|
Facility
|
IP
|
$6.33
|
|
| Hospital Charge Code |
2650107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$6.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.20
|
| Rate for Payer: Aetna of WY Medicare |
$4.05
|
| Rate for Payer: Altius Commercial |
$6.08
|
| Rate for Payer: Beech Street Commercial |
$6.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.14
|
| Rate for Payer: Cigna of WY Commercial |
$6.20
|
| Rate for Payer: Entrust Commercial |
$6.01
|
| Rate for Payer: First Choice Health Commercial |
$6.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.86
|
| Rate for Payer: HealthUtah PPO |
$6.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.14
|
| Rate for Payer: Multiplan Medicare/VA |
$3.67
|
| Rate for Payer: One Health Plan of WY PPO |
$6.20
|
| Rate for Payer: PacificSource Commercial |
$5.70
|
| Rate for Payer: PHCS PPO |
$6.20
|
| Rate for Payer: Three Rivers PPO |
$4.75
|
| Rate for Payer: TriWest Veterans Administration |
$3.86
|
| Rate for Payer: United Healthcare Commercial |
$6.05
|
| Rate for Payer: United Healthcare Medicare |
$3.86
|
| Rate for Payer: WINHealth Partners Commercial |
$6.01
|
| Rate for Payer: Wise Provider Network Commercial |
$6.01
|
|
|
DRAPE TABLE SPACE STATION
|
Facility
|
OP
|
$106.46
|
|
| Hospital Charge Code |
2650597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.65 |
| Max. Negotiated Rate |
$106.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.33
|
| Rate for Payer: Aetna of WY Medicare |
$70.26
|
| Rate for Payer: Altius Commercial |
$102.20
|
| Rate for Payer: Beech Street Commercial |
$104.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.27
|
| Rate for Payer: Cash Price |
$74.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.27
|
| Rate for Payer: Cigna of WY Commercial |
$104.33
|
| Rate for Payer: Entrust Commercial |
$101.14
|
| Rate for Payer: First Choice Health Commercial |
$101.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.68
|
| Rate for Payer: HealthUtah PPO |
$106.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.27
|
| Rate for Payer: Multiplan Medicare/VA |
$57.65
|
| Rate for Payer: One Health Plan of WY PPO |
$104.33
|
| Rate for Payer: PacificSource Commercial |
$95.81
|
| Rate for Payer: PHCS PPO |
$104.33
|
| Rate for Payer: Three Rivers PPO |
$79.84
|
| Rate for Payer: TriWest Veterans Administration |
$60.68
|
| Rate for Payer: United Healthcare Commercial |
$101.67
|
| Rate for Payer: United Healthcare Medicare |
$60.68
|
| Rate for Payer: WINHealth Partners Commercial |
$104.33
|
| Rate for Payer: Wise Provider Network Commercial |
$101.14
|
|
|
DRAPE TABLE SPACE STATION
|
Facility
|
IP
|
$106.46
|
|
| Hospital Charge Code |
2650597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$106.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.33
|
| Rate for Payer: Aetna of WY Medicare |
$68.13
|
| Rate for Payer: Altius Commercial |
$102.20
|
| Rate for Payer: Beech Street Commercial |
$104.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.27
|
| Rate for Payer: Cash Price |
$74.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.27
|
| Rate for Payer: Cigna of WY Commercial |
$104.33
|
| Rate for Payer: Entrust Commercial |
$101.14
|
| Rate for Payer: First Choice Health Commercial |
$101.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.94
|
| Rate for Payer: HealthUtah PPO |
$106.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.27
|
| Rate for Payer: Multiplan Medicare/VA |
$61.69
|
| Rate for Payer: One Health Plan of WY PPO |
$104.33
|
| Rate for Payer: PacificSource Commercial |
$95.81
|
| Rate for Payer: PHCS PPO |
$104.33
|
| Rate for Payer: Three Rivers PPO |
$79.84
|
| Rate for Payer: TriWest Veterans Administration |
$64.94
|
| Rate for Payer: United Healthcare Commercial |
$101.67
|
| Rate for Payer: United Healthcare Medicare |
$64.94
|
| Rate for Payer: WINHealth Partners Commercial |
$101.14
|
| Rate for Payer: Wise Provider Network Commercial |
$101.14
|
|
|
DRAPE THYROID
|
Facility
|
IP
|
$23.01
|
|
| Hospital Charge Code |
2650108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.55
|
| Rate for Payer: Aetna of WY Medicare |
$14.73
|
| Rate for Payer: Altius Commercial |
$22.09
|
| Rate for Payer: Beech Street Commercial |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.32
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.32
|
| Rate for Payer: Cigna of WY Commercial |
$22.55
|
| Rate for Payer: Entrust Commercial |
$21.86
|
| Rate for Payer: First Choice Health Commercial |
$21.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.04
|
| Rate for Payer: HealthUtah PPO |
$23.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.32
|
| Rate for Payer: Multiplan Medicare/VA |
$13.33
|
| Rate for Payer: One Health Plan of WY PPO |
$22.55
|
| Rate for Payer: PacificSource Commercial |
$20.71
|
| Rate for Payer: PHCS PPO |
$22.55
|
| Rate for Payer: Three Rivers PPO |
$17.26
|
| Rate for Payer: TriWest Veterans Administration |
$14.04
|
| Rate for Payer: United Healthcare Commercial |
$21.97
|
| Rate for Payer: United Healthcare Medicare |
$14.04
|
| Rate for Payer: WINHealth Partners Commercial |
$21.86
|
| Rate for Payer: Wise Provider Network Commercial |
$21.86
|
|
|
DRAPE THYROID
|
Facility
|
OP
|
$23.01
|
|
| Hospital Charge Code |
2650108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.55
|
| Rate for Payer: Aetna of WY Medicare |
$15.19
|
| Rate for Payer: Altius Commercial |
$22.09
|
| Rate for Payer: Beech Street Commercial |
$22.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.32
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.32
|
| Rate for Payer: Cigna of WY Commercial |
$22.55
|
| Rate for Payer: Entrust Commercial |
$21.86
|
| Rate for Payer: First Choice Health Commercial |
$21.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.12
|
| Rate for Payer: HealthUtah PPO |
$23.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.32
|
| Rate for Payer: Multiplan Medicare/VA |
$12.46
|
| Rate for Payer: One Health Plan of WY PPO |
$22.55
|
| Rate for Payer: PacificSource Commercial |
$20.71
|
| Rate for Payer: PHCS PPO |
$22.55
|
| Rate for Payer: Three Rivers PPO |
$17.26
|
| Rate for Payer: TriWest Veterans Administration |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$21.97
|
| Rate for Payer: United Healthcare Medicare |
$13.12
|
| Rate for Payer: WINHealth Partners Commercial |
$22.55
|
| Rate for Payer: Wise Provider Network Commercial |
$21.86
|
|
|
DRAPE U CLEAR
|
Facility
|
OP
|
$9.17
|
|
| Hospital Charge Code |
2650109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.99
|
| Rate for Payer: Aetna of WY Medicare |
$6.05
|
| Rate for Payer: Altius Commercial |
$8.80
|
| Rate for Payer: Beech Street Commercial |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.89
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.89
|
| Rate for Payer: Cigna of WY Commercial |
$8.99
|
| Rate for Payer: Entrust Commercial |
$8.71
|
| Rate for Payer: First Choice Health Commercial |
$8.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.23
|
| Rate for Payer: HealthUtah PPO |
$9.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.89
|
| Rate for Payer: Multiplan Medicare/VA |
$4.97
|
| Rate for Payer: One Health Plan of WY PPO |
$8.99
|
| Rate for Payer: PacificSource Commercial |
$8.25
|
| Rate for Payer: PHCS PPO |
$8.99
|
| Rate for Payer: Three Rivers PPO |
$6.88
|
| Rate for Payer: TriWest Veterans Administration |
$5.23
|
| Rate for Payer: United Healthcare Commercial |
$8.76
|
| Rate for Payer: United Healthcare Medicare |
$5.23
|
| Rate for Payer: WINHealth Partners Commercial |
$8.99
|
| Rate for Payer: Wise Provider Network Commercial |
$8.71
|
|
|
DRAPE U CLEAR
|
Facility
|
IP
|
$9.17
|
|
| Hospital Charge Code |
2650109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$9.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.99
|
| Rate for Payer: Aetna of WY Medicare |
$5.87
|
| Rate for Payer: Altius Commercial |
$8.80
|
| Rate for Payer: Beech Street Commercial |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.89
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.89
|
| Rate for Payer: Cigna of WY Commercial |
$8.99
|
| Rate for Payer: Entrust Commercial |
$8.71
|
| Rate for Payer: First Choice Health Commercial |
$8.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.59
|
| Rate for Payer: HealthUtah PPO |
$9.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.89
|
| Rate for Payer: Multiplan Medicare/VA |
$5.31
|
| Rate for Payer: One Health Plan of WY PPO |
$8.99
|
| Rate for Payer: PacificSource Commercial |
$8.25
|
| Rate for Payer: PHCS PPO |
$8.99
|
| Rate for Payer: Three Rivers PPO |
$6.88
|
| Rate for Payer: TriWest Veterans Administration |
$5.59
|
| Rate for Payer: United Healthcare Commercial |
$8.76
|
| Rate for Payer: United Healthcare Medicare |
$5.59
|
| Rate for Payer: WINHealth Partners Commercial |
$8.71
|
| Rate for Payer: Wise Provider Network Commercial |
$8.71
|
|
|
DRESSING AQUACEL EXTRA 2"X2"
|
Facility
|
IP
|
$5.04
|
|
| Hospital Charge Code |
2000098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.94
|
| Rate for Payer: Aetna of WY Medicare |
$3.23
|
| Rate for Payer: Altius Commercial |
$4.84
|
| Rate for Payer: Beech Street Commercial |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.89
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.89
|
| Rate for Payer: Cigna of WY Commercial |
$4.94
|
| Rate for Payer: Entrust Commercial |
$4.79
|
| Rate for Payer: First Choice Health Commercial |
$4.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.07
|
| Rate for Payer: HealthUtah PPO |
$5.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.89
|
| Rate for Payer: Multiplan Medicare/VA |
$2.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4.94
|
| Rate for Payer: PacificSource Commercial |
$4.54
|
| Rate for Payer: PHCS PPO |
$4.94
|
| Rate for Payer: Three Rivers PPO |
$3.78
|
| Rate for Payer: TriWest Veterans Administration |
$3.07
|
| Rate for Payer: United Healthcare Commercial |
$4.81
|
| Rate for Payer: United Healthcare Medicare |
$3.07
|
| Rate for Payer: WINHealth Partners Commercial |
$4.79
|
| Rate for Payer: Wise Provider Network Commercial |
$4.79
|
|
|
DRESSING AQUACEL EXTRA 2"X2"
|
Facility
|
OP
|
$5.04
|
|
| Hospital Charge Code |
2000098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.94
|
| Rate for Payer: Aetna of WY Medicare |
$3.33
|
| Rate for Payer: Altius Commercial |
$4.84
|
| Rate for Payer: Beech Street Commercial |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.89
|
| Rate for Payer: Cash Price |
$3.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.89
|
| Rate for Payer: Cigna of WY Commercial |
$4.94
|
| Rate for Payer: Entrust Commercial |
$4.79
|
| Rate for Payer: First Choice Health Commercial |
$4.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.87
|
| Rate for Payer: HealthUtah PPO |
$5.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.89
|
| Rate for Payer: Multiplan Medicare/VA |
$2.73
|
| Rate for Payer: One Health Plan of WY PPO |
$4.94
|
| Rate for Payer: PacificSource Commercial |
$4.54
|
| Rate for Payer: PHCS PPO |
$4.94
|
| Rate for Payer: Three Rivers PPO |
$3.78
|
| Rate for Payer: TriWest Veterans Administration |
$2.87
|
| Rate for Payer: United Healthcare Commercial |
$4.81
|
| Rate for Payer: United Healthcare Medicare |
$2.87
|
| Rate for Payer: WINHealth Partners Commercial |
$4.94
|
| Rate for Payer: Wise Provider Network Commercial |
$4.79
|
|
|
DRESSING CHANGE KIT DTSTK07
|
Facility
|
OP
|
$29.77
|
|
| Hospital Charge Code |
2050012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.17
|
| Rate for Payer: Aetna of WY Medicare |
$19.65
|
| Rate for Payer: Altius Commercial |
$28.58
|
| Rate for Payer: Beech Street Commercial |
$29.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.88
|
| Rate for Payer: Cigna of WY Commercial |
$29.17
|
| Rate for Payer: Entrust Commercial |
$28.28
|
| Rate for Payer: First Choice Health Commercial |
$28.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.97
|
| Rate for Payer: HealthUtah PPO |
$29.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.88
|
| Rate for Payer: Multiplan Medicare/VA |
$16.12
|
| Rate for Payer: One Health Plan of WY PPO |
$29.17
|
| Rate for Payer: PacificSource Commercial |
$26.79
|
| Rate for Payer: PHCS PPO |
$29.17
|
| Rate for Payer: Three Rivers PPO |
$22.33
|
| Rate for Payer: TriWest Veterans Administration |
$16.97
|
| Rate for Payer: United Healthcare Commercial |
$28.43
|
| Rate for Payer: United Healthcare Medicare |
$16.97
|
| Rate for Payer: WINHealth Partners Commercial |
$29.17
|
| Rate for Payer: Wise Provider Network Commercial |
$28.28
|
|
|
DRESSING CHANGE KIT DTSTK07
|
Facility
|
IP
|
$29.77
|
|
| Hospital Charge Code |
2050012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$29.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.17
|
| Rate for Payer: Aetna of WY Medicare |
$19.05
|
| Rate for Payer: Altius Commercial |
$28.58
|
| Rate for Payer: Beech Street Commercial |
$29.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.88
|
| Rate for Payer: Cash Price |
$20.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.88
|
| Rate for Payer: Cigna of WY Commercial |
$29.17
|
| Rate for Payer: Entrust Commercial |
$28.28
|
| Rate for Payer: First Choice Health Commercial |
$28.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.16
|
| Rate for Payer: HealthUtah PPO |
$29.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.88
|
| Rate for Payer: Multiplan Medicare/VA |
$17.25
|
| Rate for Payer: One Health Plan of WY PPO |
$29.17
|
| Rate for Payer: PacificSource Commercial |
$26.79
|
| Rate for Payer: PHCS PPO |
$29.17
|
| Rate for Payer: Three Rivers PPO |
$22.33
|
| Rate for Payer: TriWest Veterans Administration |
$18.16
|
| Rate for Payer: United Healthcare Commercial |
$28.43
|
| Rate for Payer: United Healthcare Medicare |
$18.16
|
| Rate for Payer: WINHealth Partners Commercial |
$28.28
|
| Rate for Payer: Wise Provider Network Commercial |
$28.28
|
|
|
DRESSING DUODERM THIN 4"X4"
|
Facility
|
OP
|
$3.57
|
|
| Hospital Charge Code |
2000006
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
DRESSING DUODERM THIN 4"X4"
|
Facility
|
IP
|
$3.57
|
|
| Hospital Charge Code |
2000006
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
DRESSING GEL MEDIHONEY 1.5OZ
|
Facility
|
OP
|
$40.15
|
|
| Hospital Charge Code |
2000071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.35
|
| Rate for Payer: Aetna of WY Medicare |
$26.50
|
| Rate for Payer: Altius Commercial |
$38.54
|
| Rate for Payer: Beech Street Commercial |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.95
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.95
|
| Rate for Payer: Cigna of WY Commercial |
$39.35
|
| Rate for Payer: Entrust Commercial |
$38.14
|
| Rate for Payer: First Choice Health Commercial |
$38.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.89
|
| Rate for Payer: HealthUtah PPO |
$40.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.74
|
| Rate for Payer: One Health Plan of WY PPO |
$39.35
|
| Rate for Payer: PacificSource Commercial |
$36.14
|
| Rate for Payer: PHCS PPO |
$39.35
|
| Rate for Payer: Three Rivers PPO |
$30.11
|
| Rate for Payer: TriWest Veterans Administration |
$22.89
|
| Rate for Payer: United Healthcare Commercial |
$38.34
|
| Rate for Payer: United Healthcare Medicare |
$22.89
|
| Rate for Payer: WINHealth Partners Commercial |
$39.35
|
| Rate for Payer: Wise Provider Network Commercial |
$38.14
|
|
|
DRESSING GEL MEDIHONEY 1.5OZ
|
Facility
|
IP
|
$40.15
|
|
| Hospital Charge Code |
2000071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.35
|
| Rate for Payer: Aetna of WY Medicare |
$25.70
|
| Rate for Payer: Altius Commercial |
$38.54
|
| Rate for Payer: Beech Street Commercial |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.95
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.95
|
| Rate for Payer: Cigna of WY Commercial |
$39.35
|
| Rate for Payer: Entrust Commercial |
$38.14
|
| Rate for Payer: First Choice Health Commercial |
$38.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.49
|
| Rate for Payer: HealthUtah PPO |
$40.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.95
|
| Rate for Payer: Multiplan Medicare/VA |
$23.27
|
| Rate for Payer: One Health Plan of WY PPO |
$39.35
|
| Rate for Payer: PacificSource Commercial |
$36.14
|
| Rate for Payer: PHCS PPO |
$39.35
|
| Rate for Payer: Three Rivers PPO |
$30.11
|
| Rate for Payer: TriWest Veterans Administration |
$24.49
|
| Rate for Payer: United Healthcare Commercial |
$38.34
|
| Rate for Payer: United Healthcare Medicare |
$24.49
|
| Rate for Payer: WINHealth Partners Commercial |
$38.14
|
| Rate for Payer: Wise Provider Network Commercial |
$38.14
|
|
|
DRESSING GEL MEDIHONEY .5OZ
|
Facility
|
IP
|
$14.70
|
|
| Hospital Charge Code |
2000069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.41
|
| Rate for Payer: Aetna of WY Medicare |
$9.41
|
| Rate for Payer: Altius Commercial |
$14.11
|
| Rate for Payer: Beech Street Commercial |
$14.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.26
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.26
|
| Rate for Payer: Cigna of WY Commercial |
$14.41
|
| Rate for Payer: Entrust Commercial |
$13.96
|
| Rate for Payer: First Choice Health Commercial |
$13.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$14.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.26
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$14.41
|
| Rate for Payer: PacificSource Commercial |
$13.23
|
| Rate for Payer: PHCS PPO |
$14.41
|
| Rate for Payer: Three Rivers PPO |
$11.02
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$14.04
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$13.96
|
| Rate for Payer: Wise Provider Network Commercial |
$13.96
|
|
|
DRESSING GEL MEDIHONEY .5OZ
|
Facility
|
OP
|
$14.70
|
|
| Hospital Charge Code |
2000069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.41
|
| Rate for Payer: Aetna of WY Medicare |
$9.70
|
| Rate for Payer: Altius Commercial |
$14.11
|
| Rate for Payer: Beech Street Commercial |
$14.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.26
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.26
|
| Rate for Payer: Cigna of WY Commercial |
$14.41
|
| Rate for Payer: Entrust Commercial |
$13.96
|
| Rate for Payer: First Choice Health Commercial |
$13.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.38
|
| Rate for Payer: HealthUtah PPO |
$14.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.26
|
| Rate for Payer: Multiplan Medicare/VA |
$7.96
|
| Rate for Payer: One Health Plan of WY PPO |
$14.41
|
| Rate for Payer: PacificSource Commercial |
$13.23
|
| Rate for Payer: PHCS PPO |
$14.41
|
| Rate for Payer: Three Rivers PPO |
$11.02
|
| Rate for Payer: TriWest Veterans Administration |
$8.38
|
| Rate for Payer: United Healthcare Commercial |
$14.04
|
| Rate for Payer: United Healthcare Medicare |
$8.38
|
| Rate for Payer: WINHealth Partners Commercial |
$14.41
|
| Rate for Payer: Wise Provider Network Commercial |
$13.96
|
|
|
DRESSING GLASSCOCK EAR
|
Facility
|
OP
|
$72.83
|
|
| Hospital Charge Code |
2000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.37
|
| Rate for Payer: Aetna of WY Medicare |
$48.07
|
| Rate for Payer: Altius Commercial |
$69.92
|
| Rate for Payer: Beech Street Commercial |
$71.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.65
|
| Rate for Payer: Cash Price |
$50.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.65
|
| Rate for Payer: Cigna of WY Commercial |
$71.37
|
| Rate for Payer: Entrust Commercial |
$69.19
|
| Rate for Payer: First Choice Health Commercial |
$69.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.51
|
| Rate for Payer: HealthUtah PPO |
$72.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.65
|
| Rate for Payer: Multiplan Medicare/VA |
$39.44
|
| Rate for Payer: One Health Plan of WY PPO |
$71.37
|
| Rate for Payer: PacificSource Commercial |
$65.55
|
| Rate for Payer: PHCS PPO |
$71.37
|
| Rate for Payer: Three Rivers PPO |
$54.62
|
| Rate for Payer: TriWest Veterans Administration |
$41.51
|
| Rate for Payer: United Healthcare Commercial |
$69.55
|
| Rate for Payer: United Healthcare Medicare |
$41.51
|
| Rate for Payer: WINHealth Partners Commercial |
$71.37
|
| Rate for Payer: Wise Provider Network Commercial |
$69.19
|
|
|
DRESSING GLASSCOCK EAR
|
Facility
|
IP
|
$72.83
|
|
| Hospital Charge Code |
2000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$72.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.37
|
| Rate for Payer: Aetna of WY Medicare |
$46.61
|
| Rate for Payer: Altius Commercial |
$69.92
|
| Rate for Payer: Beech Street Commercial |
$71.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.65
|
| Rate for Payer: Cash Price |
$50.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.65
|
| Rate for Payer: Cigna of WY Commercial |
$71.37
|
| Rate for Payer: Entrust Commercial |
$69.19
|
| Rate for Payer: First Choice Health Commercial |
$69.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.43
|
| Rate for Payer: HealthUtah PPO |
$72.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.65
|
| Rate for Payer: Multiplan Medicare/VA |
$42.20
|
| Rate for Payer: One Health Plan of WY PPO |
$71.37
|
| Rate for Payer: PacificSource Commercial |
$65.55
|
| Rate for Payer: PHCS PPO |
$71.37
|
| Rate for Payer: Three Rivers PPO |
$54.62
|
| Rate for Payer: TriWest Veterans Administration |
$44.43
|
| Rate for Payer: United Healthcare Commercial |
$69.55
|
| Rate for Payer: United Healthcare Medicare |
$44.43
|
| Rate for Payer: WINHealth Partners Commercial |
$69.19
|
| Rate for Payer: Wise Provider Network Commercial |
$69.19
|
|
|
DRESSING INTERDRY ROLL 10"X144"
|
Facility
|
OP
|
$161.74
|
|
| Hospital Charge Code |
2000100
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.58 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.51
|
| Rate for Payer: Aetna of WY Medicare |
$106.75
|
| Rate for Payer: Altius Commercial |
$155.27
|
| Rate for Payer: Beech Street Commercial |
$158.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.89
|
| Rate for Payer: Cash Price |
$113.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.89
|
| Rate for Payer: Cigna of WY Commercial |
$158.51
|
| Rate for Payer: Entrust Commercial |
$153.65
|
| Rate for Payer: First Choice Health Commercial |
$153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.19
|
| Rate for Payer: HealthUtah PPO |
$161.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.89
|
| Rate for Payer: Multiplan Medicare/VA |
$87.58
|
| Rate for Payer: One Health Plan of WY PPO |
$158.51
|
| Rate for Payer: PacificSource Commercial |
$145.57
|
| Rate for Payer: PHCS PPO |
$158.51
|
| Rate for Payer: Three Rivers PPO |
$121.30
|
| Rate for Payer: TriWest Veterans Administration |
$92.19
|
| Rate for Payer: United Healthcare Commercial |
$154.46
|
| Rate for Payer: United Healthcare Medicare |
$92.19
|
| Rate for Payer: WINHealth Partners Commercial |
$158.51
|
| Rate for Payer: Wise Provider Network Commercial |
$153.65
|
|
|
DRESSING INTERDRY ROLL 10"X144"
|
Facility
|
IP
|
$161.74
|
|
| Hospital Charge Code |
2000100
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.73 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$158.51
|
| Rate for Payer: Aetna of WY Medicare |
$103.51
|
| Rate for Payer: Altius Commercial |
$155.27
|
| Rate for Payer: Beech Street Commercial |
$158.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$156.89
|
| Rate for Payer: Cash Price |
$113.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.89
|
| Rate for Payer: Cigna of WY Commercial |
$158.51
|
| Rate for Payer: Entrust Commercial |
$153.65
|
| Rate for Payer: First Choice Health Commercial |
$153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$153.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.66
|
| Rate for Payer: HealthUtah PPO |
$161.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.89
|
| Rate for Payer: Multiplan Medicare/VA |
$93.73
|
| Rate for Payer: One Health Plan of WY PPO |
$158.51
|
| Rate for Payer: PacificSource Commercial |
$145.57
|
| Rate for Payer: PHCS PPO |
$158.51
|
| Rate for Payer: Three Rivers PPO |
$121.30
|
| Rate for Payer: TriWest Veterans Administration |
$98.66
|
| Rate for Payer: United Healthcare Commercial |
$154.46
|
| Rate for Payer: United Healthcare Medicare |
$98.66
|
| Rate for Payer: WINHealth Partners Commercial |
$153.65
|
| Rate for Payer: Wise Provider Network Commercial |
$153.65
|
|
|
DRESSING INTERDRY SILVER AG 10 X 36"
|
Facility
|
IP
|
$160.79
|
|
| Hospital Charge Code |
2000107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$160.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.57
|
| Rate for Payer: Aetna of WY Medicare |
$102.91
|
| Rate for Payer: Altius Commercial |
$154.36
|
| Rate for Payer: Beech Street Commercial |
$157.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.97
|
| Rate for Payer: Cash Price |
$112.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.97
|
| Rate for Payer: Cigna of WY Commercial |
$157.57
|
| Rate for Payer: Entrust Commercial |
$152.75
|
| Rate for Payer: First Choice Health Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.08
|
| Rate for Payer: HealthUtah PPO |
$160.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.97
|
| Rate for Payer: Multiplan Medicare/VA |
$93.18
|
| Rate for Payer: One Health Plan of WY PPO |
$157.57
|
| Rate for Payer: PacificSource Commercial |
$144.71
|
| Rate for Payer: PHCS PPO |
$157.57
|
| Rate for Payer: Three Rivers PPO |
$120.59
|
| Rate for Payer: TriWest Veterans Administration |
$98.08
|
| Rate for Payer: United Healthcare Commercial |
$153.55
|
| Rate for Payer: United Healthcare Medicare |
$98.08
|
| Rate for Payer: WINHealth Partners Commercial |
$152.75
|
| Rate for Payer: Wise Provider Network Commercial |
$152.75
|
|
|
DRESSING INTERDRY SILVER AG 10 X 36"
|
Facility
|
OP
|
$160.79
|
|
| Hospital Charge Code |
2000107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$160.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.57
|
| Rate for Payer: Aetna of WY Medicare |
$106.12
|
| Rate for Payer: Altius Commercial |
$154.36
|
| Rate for Payer: Beech Street Commercial |
$157.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$155.97
|
| Rate for Payer: Cash Price |
$112.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.97
|
| Rate for Payer: Cigna of WY Commercial |
$157.57
|
| Rate for Payer: Entrust Commercial |
$152.75
|
| Rate for Payer: First Choice Health Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.65
|
| Rate for Payer: HealthUtah PPO |
$160.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.97
|
| Rate for Payer: Multiplan Medicare/VA |
$87.07
|
| Rate for Payer: One Health Plan of WY PPO |
$157.57
|
| Rate for Payer: PacificSource Commercial |
$144.71
|
| Rate for Payer: PHCS PPO |
$157.57
|
| Rate for Payer: Three Rivers PPO |
$120.59
|
| Rate for Payer: TriWest Veterans Administration |
$91.65
|
| Rate for Payer: United Healthcare Commercial |
$153.55
|
| Rate for Payer: United Healthcare Medicare |
$91.65
|
| Rate for Payer: WINHealth Partners Commercial |
$157.57
|
| Rate for Payer: Wise Provider Network Commercial |
$152.75
|
|
