|
DRESSING IODOSORB GEL CAD/IOD
|
Facility
|
IP
|
$99.33
|
|
| Hospital Charge Code |
2000099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$99.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.34
|
| Rate for Payer: Aetna of WY Medicare |
$63.57
|
| Rate for Payer: Altius Commercial |
$95.36
|
| Rate for Payer: Beech Street Commercial |
$97.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.35
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.35
|
| Rate for Payer: Cigna of WY Commercial |
$97.34
|
| Rate for Payer: Entrust Commercial |
$94.36
|
| Rate for Payer: First Choice Health Commercial |
$94.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.59
|
| Rate for Payer: HealthUtah PPO |
$99.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.35
|
| Rate for Payer: Multiplan Medicare/VA |
$57.56
|
| Rate for Payer: One Health Plan of WY PPO |
$97.34
|
| Rate for Payer: PacificSource Commercial |
$89.40
|
| Rate for Payer: PHCS PPO |
$97.34
|
| Rate for Payer: Three Rivers PPO |
$74.50
|
| Rate for Payer: TriWest Veterans Administration |
$60.59
|
| Rate for Payer: United Healthcare Commercial |
$94.86
|
| Rate for Payer: United Healthcare Medicare |
$60.59
|
| Rate for Payer: WINHealth Partners Commercial |
$94.36
|
| Rate for Payer: Wise Provider Network Commercial |
$94.36
|
|
|
DRESSING IODOSORB GEL CAD/IOD
|
Facility
|
OP
|
$99.33
|
|
| Hospital Charge Code |
2000099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.79 |
| Max. Negotiated Rate |
$99.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.34
|
| Rate for Payer: Aetna of WY Medicare |
$65.56
|
| Rate for Payer: Altius Commercial |
$95.36
|
| Rate for Payer: Beech Street Commercial |
$97.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.35
|
| Rate for Payer: Cash Price |
$69.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.35
|
| Rate for Payer: Cigna of WY Commercial |
$97.34
|
| Rate for Payer: Entrust Commercial |
$94.36
|
| Rate for Payer: First Choice Health Commercial |
$94.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.62
|
| Rate for Payer: HealthUtah PPO |
$99.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.35
|
| Rate for Payer: Multiplan Medicare/VA |
$53.79
|
| Rate for Payer: One Health Plan of WY PPO |
$97.34
|
| Rate for Payer: PacificSource Commercial |
$89.40
|
| Rate for Payer: PHCS PPO |
$97.34
|
| Rate for Payer: Three Rivers PPO |
$74.50
|
| Rate for Payer: TriWest Veterans Administration |
$56.62
|
| Rate for Payer: United Healthcare Commercial |
$94.86
|
| Rate for Payer: United Healthcare Medicare |
$56.62
|
| Rate for Payer: WINHealth Partners Commercial |
$97.34
|
| Rate for Payer: Wise Provider Network Commercial |
$94.36
|
|
|
DRESSING OPTILOCK 4X4"
|
Facility
|
IP
|
$6.19
|
|
| Hospital Charge Code |
2000101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.07
|
| Rate for Payer: Aetna of WY Medicare |
$3.96
|
| Rate for Payer: Altius Commercial |
$5.94
|
| Rate for Payer: Beech Street Commercial |
$6.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.00
|
| Rate for Payer: Cigna of WY Commercial |
$6.07
|
| Rate for Payer: Entrust Commercial |
$5.88
|
| Rate for Payer: First Choice Health Commercial |
$5.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.78
|
| Rate for Payer: HealthUtah PPO |
$6.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3.59
|
| Rate for Payer: One Health Plan of WY PPO |
$6.07
|
| Rate for Payer: PacificSource Commercial |
$5.57
|
| Rate for Payer: PHCS PPO |
$6.07
|
| Rate for Payer: Three Rivers PPO |
$4.64
|
| Rate for Payer: TriWest Veterans Administration |
$3.78
|
| Rate for Payer: United Healthcare Commercial |
$5.91
|
| Rate for Payer: United Healthcare Medicare |
$3.78
|
| Rate for Payer: WINHealth Partners Commercial |
$5.88
|
| Rate for Payer: Wise Provider Network Commercial |
$5.88
|
|
|
DRESSING OPTILOCK 4X4"
|
Facility
|
OP
|
$6.19
|
|
| Hospital Charge Code |
2000101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.07
|
| Rate for Payer: Aetna of WY Medicare |
$4.09
|
| Rate for Payer: Altius Commercial |
$5.94
|
| Rate for Payer: Beech Street Commercial |
$6.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.00
|
| Rate for Payer: Cigna of WY Commercial |
$6.07
|
| Rate for Payer: Entrust Commercial |
$5.88
|
| Rate for Payer: First Choice Health Commercial |
$5.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.53
|
| Rate for Payer: HealthUtah PPO |
$6.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.00
|
| Rate for Payer: Multiplan Medicare/VA |
$3.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6.07
|
| Rate for Payer: PacificSource Commercial |
$5.57
|
| Rate for Payer: PHCS PPO |
$6.07
|
| Rate for Payer: Three Rivers PPO |
$4.64
|
| Rate for Payer: TriWest Veterans Administration |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$5.91
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WINHealth Partners Commercial |
$6.07
|
| Rate for Payer: Wise Provider Network Commercial |
$5.88
|
|
|
DRESSING OPTILOCK 5 X 5.5"
|
Facility
|
IP
|
$6.69
|
|
| Hospital Charge Code |
2000105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.56
|
| Rate for Payer: Aetna of WY Medicare |
$4.28
|
| Rate for Payer: Altius Commercial |
$6.42
|
| Rate for Payer: Beech Street Commercial |
$6.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.49
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.49
|
| Rate for Payer: Cigna of WY Commercial |
$6.56
|
| Rate for Payer: Entrust Commercial |
$6.36
|
| Rate for Payer: First Choice Health Commercial |
$6.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.08
|
| Rate for Payer: HealthUtah PPO |
$6.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.49
|
| Rate for Payer: Multiplan Medicare/VA |
$3.88
|
| Rate for Payer: One Health Plan of WY PPO |
$6.56
|
| Rate for Payer: PacificSource Commercial |
$6.02
|
| Rate for Payer: PHCS PPO |
$6.56
|
| Rate for Payer: Three Rivers PPO |
$5.02
|
| Rate for Payer: TriWest Veterans Administration |
$4.08
|
| Rate for Payer: United Healthcare Commercial |
$6.39
|
| Rate for Payer: United Healthcare Medicare |
$4.08
|
| Rate for Payer: WINHealth Partners Commercial |
$6.36
|
| Rate for Payer: Wise Provider Network Commercial |
$6.36
|
|
|
DRESSING OPTILOCK 5 X 5.5"
|
Facility
|
OP
|
$6.69
|
|
| Hospital Charge Code |
2000105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.56
|
| Rate for Payer: Aetna of WY Medicare |
$4.42
|
| Rate for Payer: Altius Commercial |
$6.42
|
| Rate for Payer: Beech Street Commercial |
$6.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.49
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.49
|
| Rate for Payer: Cigna of WY Commercial |
$6.56
|
| Rate for Payer: Entrust Commercial |
$6.36
|
| Rate for Payer: First Choice Health Commercial |
$6.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.81
|
| Rate for Payer: HealthUtah PPO |
$6.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.49
|
| Rate for Payer: Multiplan Medicare/VA |
$3.62
|
| Rate for Payer: One Health Plan of WY PPO |
$6.56
|
| Rate for Payer: PacificSource Commercial |
$6.02
|
| Rate for Payer: PHCS PPO |
$6.56
|
| Rate for Payer: Three Rivers PPO |
$5.02
|
| Rate for Payer: TriWest Veterans Administration |
$3.81
|
| Rate for Payer: United Healthcare Commercial |
$6.39
|
| Rate for Payer: United Healthcare Medicare |
$3.81
|
| Rate for Payer: WINHealth Partners Commercial |
$6.56
|
| Rate for Payer: Wise Provider Network Commercial |
$6.36
|
|
|
DRESSING POLYMEMBRANE 4"X4"
|
Facility
|
IP
|
$1.03
|
|
| Hospital Charge Code |
2000024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Commercial |
$0.99
|
| Rate for Payer: Beech Street Commercial |
$1.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.00
|
| Rate for Payer: Cigna of WY Commercial |
$1.01
|
| Rate for Payer: Entrust Commercial |
$0.98
|
| Rate for Payer: First Choice Health Commercial |
$0.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$1.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.00
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$1.01
|
| Rate for Payer: PacificSource Commercial |
$0.93
|
| Rate for Payer: PHCS PPO |
$1.01
|
| Rate for Payer: Three Rivers PPO |
$0.77
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.98
|
|
|
DRESSING POLYMEMBRANE 4"X4"
|
Facility
|
OP
|
$1.03
|
|
| Hospital Charge Code |
2000024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.68
|
| Rate for Payer: Altius Commercial |
$0.99
|
| Rate for Payer: Beech Street Commercial |
$1.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.00
|
| Rate for Payer: Cigna of WY Commercial |
$1.01
|
| Rate for Payer: Entrust Commercial |
$0.98
|
| Rate for Payer: First Choice Health Commercial |
$0.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.59
|
| Rate for Payer: HealthUtah PPO |
$1.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.00
|
| Rate for Payer: Multiplan Medicare/VA |
$0.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1.01
|
| Rate for Payer: PacificSource Commercial |
$0.93
|
| Rate for Payer: PHCS PPO |
$1.01
|
| Rate for Payer: Three Rivers PPO |
$0.77
|
| Rate for Payer: TriWest Veterans Administration |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$0.98
|
| Rate for Payer: United Healthcare Medicare |
$0.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.98
|
|
|
DRESSING VERSATEL ONE 3"X4"
|
Facility
|
OP
|
$13.44
|
|
| Hospital Charge Code |
2000005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.17
|
| Rate for Payer: Aetna of WY Medicare |
$8.87
|
| Rate for Payer: Altius Commercial |
$12.90
|
| Rate for Payer: Beech Street Commercial |
$13.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.04
|
| Rate for Payer: Cigna of WY Commercial |
$13.17
|
| Rate for Payer: Entrust Commercial |
$12.77
|
| Rate for Payer: First Choice Health Commercial |
$12.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.66
|
| Rate for Payer: HealthUtah PPO |
$13.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.04
|
| Rate for Payer: Multiplan Medicare/VA |
$7.28
|
| Rate for Payer: One Health Plan of WY PPO |
$13.17
|
| Rate for Payer: PacificSource Commercial |
$12.10
|
| Rate for Payer: PHCS PPO |
$13.17
|
| Rate for Payer: Three Rivers PPO |
$10.08
|
| Rate for Payer: TriWest Veterans Administration |
$7.66
|
| Rate for Payer: United Healthcare Commercial |
$12.84
|
| Rate for Payer: United Healthcare Medicare |
$7.66
|
| Rate for Payer: WINHealth Partners Commercial |
$13.17
|
| Rate for Payer: Wise Provider Network Commercial |
$12.77
|
|
|
DRESSING VERSATEL ONE 3"X4"
|
Facility
|
IP
|
$13.44
|
|
| Hospital Charge Code |
2000005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.17
|
| Rate for Payer: Aetna of WY Medicare |
$8.60
|
| Rate for Payer: Altius Commercial |
$12.90
|
| Rate for Payer: Beech Street Commercial |
$13.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.04
|
| Rate for Payer: Cash Price |
$9.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.04
|
| Rate for Payer: Cigna of WY Commercial |
$13.17
|
| Rate for Payer: Entrust Commercial |
$12.77
|
| Rate for Payer: First Choice Health Commercial |
$12.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.20
|
| Rate for Payer: HealthUtah PPO |
$13.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.04
|
| Rate for Payer: Multiplan Medicare/VA |
$7.79
|
| Rate for Payer: One Health Plan of WY PPO |
$13.17
|
| Rate for Payer: PacificSource Commercial |
$12.10
|
| Rate for Payer: PHCS PPO |
$13.17
|
| Rate for Payer: Three Rivers PPO |
$10.08
|
| Rate for Payer: TriWest Veterans Administration |
$8.20
|
| Rate for Payer: United Healthcare Commercial |
$12.84
|
| Rate for Payer: United Healthcare Medicare |
$8.20
|
| Rate for Payer: WINHealth Partners Commercial |
$12.77
|
| Rate for Payer: Wise Provider Network Commercial |
$12.77
|
|
|
DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$658.56
|
| Rate for Payer: Aetna of WY Medicare |
$150.71
|
| Rate for Payer: Beech Street Commercial |
$638.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$651.84
|
| Rate for Payer: Cigna of WY Commercial |
$658.56
|
| Rate for Payer: First Choice Health Commercial |
$604.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$638.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.71
|
| Rate for Payer: HealthUtah PPO |
$672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$651.84
|
| Rate for Payer: Multiplan Medicare/VA |
$128.10
|
| Rate for Payer: One Health Plan of WY PPO |
$658.56
|
| Rate for Payer: PacificSource Commercial |
$604.80
|
| Rate for Payer: PHCS PPO |
$638.40
|
| Rate for Payer: Three Rivers PPO |
$504.00
|
| Rate for Payer: TriWest Veterans Administration |
$150.71
|
| Rate for Payer: United Healthcare Commercial |
$638.40
|
| Rate for Payer: WINHealth Partners Commercial |
$571.20
|
|
|
DRILL 10MM BELLMED
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
2800169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRILL 10MM BELLMED
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
2800169
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRILL 12MM BELLMED
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
2800122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRILL 12MM BELLMED
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
2800122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRILL 1.3 VARIAX HAND SPEC
|
Facility
|
OP
|
$268.14
|
|
| Hospital Charge Code |
3100370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$268.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.78
|
| Rate for Payer: Aetna of WY Medicare |
$176.97
|
| Rate for Payer: Altius Commercial |
$257.41
|
| Rate for Payer: Beech Street Commercial |
$262.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.10
|
| Rate for Payer: Cash Price |
$187.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.10
|
| Rate for Payer: Cigna of WY Commercial |
$262.78
|
| Rate for Payer: Entrust Commercial |
$254.73
|
| Rate for Payer: First Choice Health Commercial |
$254.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.84
|
| Rate for Payer: HealthUtah PPO |
$268.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.10
|
| Rate for Payer: Multiplan Medicare/VA |
$145.20
|
| Rate for Payer: One Health Plan of WY PPO |
$262.78
|
| Rate for Payer: PacificSource Commercial |
$241.33
|
| Rate for Payer: PHCS PPO |
$262.78
|
| Rate for Payer: Three Rivers PPO |
$201.10
|
| Rate for Payer: TriWest Veterans Administration |
$152.84
|
| Rate for Payer: United Healthcare Commercial |
$256.07
|
| Rate for Payer: United Healthcare Medicare |
$152.84
|
| Rate for Payer: WINHealth Partners Commercial |
$262.78
|
| Rate for Payer: Wise Provider Network Commercial |
$254.73
|
|
|
DRILL 1.3 VARIAX HAND SPEC
|
Facility
|
IP
|
$268.14
|
|
| Hospital Charge Code |
3100370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.39 |
| Max. Negotiated Rate |
$268.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.78
|
| Rate for Payer: Aetna of WY Medicare |
$171.61
|
| Rate for Payer: Altius Commercial |
$257.41
|
| Rate for Payer: Beech Street Commercial |
$262.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$260.10
|
| Rate for Payer: Cash Price |
$187.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.10
|
| Rate for Payer: Cigna of WY Commercial |
$262.78
|
| Rate for Payer: Entrust Commercial |
$254.73
|
| Rate for Payer: First Choice Health Commercial |
$254.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.57
|
| Rate for Payer: HealthUtah PPO |
$268.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.10
|
| Rate for Payer: Multiplan Medicare/VA |
$155.39
|
| Rate for Payer: One Health Plan of WY PPO |
$262.78
|
| Rate for Payer: PacificSource Commercial |
$241.33
|
| Rate for Payer: PHCS PPO |
$262.78
|
| Rate for Payer: Three Rivers PPO |
$201.10
|
| Rate for Payer: TriWest Veterans Administration |
$163.57
|
| Rate for Payer: United Healthcare Commercial |
$256.07
|
| Rate for Payer: United Healthcare Medicare |
$163.57
|
| Rate for Payer: WINHealth Partners Commercial |
$254.73
|
| Rate for Payer: Wise Provider Network Commercial |
$254.73
|
|
|
DRILL 14MM 10-90-015-014
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
2800218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRILL 14MM 10-90-015-014
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
2800218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRILL 1.6MM TRIMED
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
3001194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.06 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$263.34
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$387.03
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.43
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$216.06
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$227.43
|
| Rate for Payer: United Healthcare Commercial |
$381.04
|
| Rate for Payer: United Healthcare Medicare |
$227.43
|
| Rate for Payer: WINHealth Partners Commercial |
$391.02
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
DRILL 1.6MM TRIMED
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
3001194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.22 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$255.36
|
| Rate for Payer: Altius Commercial |
$383.04
|
| Rate for Payer: Beech Street Commercial |
$391.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$387.03
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: Entrust Commercial |
$379.05
|
| Rate for Payer: First Choice Health Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$243.39
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$231.22
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$391.02
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$243.39
|
| Rate for Payer: United Healthcare Commercial |
$381.04
|
| Rate for Payer: United Healthcare Medicare |
$243.39
|
| Rate for Payer: WINHealth Partners Commercial |
$379.05
|
| Rate for Payer: Wise Provider Network Commercial |
$379.05
|
|
|
DRILL 1.7MM AR-8916-14
|
Facility
|
IP
|
$276.50
|
|
| Hospital Charge Code |
3002550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.23 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.97
|
| Rate for Payer: Aetna of WY Medicare |
$176.96
|
| Rate for Payer: Altius Commercial |
$265.44
|
| Rate for Payer: Beech Street Commercial |
$270.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$268.20
|
| Rate for Payer: Cash Price |
$193.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.20
|
| Rate for Payer: Cigna of WY Commercial |
$270.97
|
| Rate for Payer: Entrust Commercial |
$262.68
|
| Rate for Payer: First Choice Health Commercial |
$262.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.66
|
| Rate for Payer: HealthUtah PPO |
$276.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.20
|
| Rate for Payer: Multiplan Medicare/VA |
$160.23
|
| Rate for Payer: One Health Plan of WY PPO |
$270.97
|
| Rate for Payer: PacificSource Commercial |
$248.85
|
| Rate for Payer: PHCS PPO |
$270.97
|
| Rate for Payer: Three Rivers PPO |
$207.38
|
| Rate for Payer: TriWest Veterans Administration |
$168.66
|
| Rate for Payer: United Healthcare Commercial |
$264.06
|
| Rate for Payer: United Healthcare Medicare |
$168.66
|
| Rate for Payer: WINHealth Partners Commercial |
$262.68
|
| Rate for Payer: Wise Provider Network Commercial |
$262.68
|
|
|
DRILL 1.7MM AR-8916-14
|
Facility
|
OP
|
$276.50
|
|
| Hospital Charge Code |
3002550
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.72 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: United Healthcare Commercial |
$264.06
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.97
|
| Rate for Payer: Aetna of WY Medicare |
$182.49
|
| Rate for Payer: Altius Commercial |
$265.44
|
| Rate for Payer: Beech Street Commercial |
$270.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$268.20
|
| Rate for Payer: Cash Price |
$193.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.20
|
| Rate for Payer: Cigna of WY Commercial |
$270.97
|
| Rate for Payer: Entrust Commercial |
$262.68
|
| Rate for Payer: First Choice Health Commercial |
$262.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.60
|
| Rate for Payer: HealthUtah PPO |
$276.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.20
|
| Rate for Payer: Multiplan Medicare/VA |
$149.72
|
| Rate for Payer: One Health Plan of WY PPO |
$270.97
|
| Rate for Payer: PacificSource Commercial |
$248.85
|
| Rate for Payer: PHCS PPO |
$270.97
|
| Rate for Payer: Three Rivers PPO |
$207.38
|
| Rate for Payer: TriWest Veterans Administration |
$157.60
|
| Rate for Payer: United Healthcare Medicare |
$157.60
|
| Rate for Payer: WINHealth Partners Commercial |
$270.97
|
| Rate for Payer: Wise Provider Network Commercial |
$262.68
|
|
|
DRILL 1.7MM CANN FUS OSTEO
|
Facility
|
OP
|
$1,452.50
|
|
| Hospital Charge Code |
3002382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$786.53 |
| Max. Negotiated Rate |
$1,452.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,423.45
|
| Rate for Payer: Aetna of WY Medicare |
$958.65
|
| Rate for Payer: Altius Commercial |
$1,394.40
|
| Rate for Payer: Beech Street Commercial |
$1,423.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,408.92
|
| Rate for Payer: Cash Price |
$1,016.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,408.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,423.45
|
| Rate for Payer: Entrust Commercial |
$1,379.88
|
| Rate for Payer: First Choice Health Commercial |
$1,379.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,379.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$827.92
|
| Rate for Payer: HealthUtah PPO |
$1,452.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,408.92
|
| Rate for Payer: Multiplan Medicare/VA |
$786.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,423.45
|
| Rate for Payer: PacificSource Commercial |
$1,307.25
|
| Rate for Payer: PHCS PPO |
$1,423.45
|
| Rate for Payer: Three Rivers PPO |
$1,089.38
|
| Rate for Payer: TriWest Veterans Administration |
$827.92
|
| Rate for Payer: United Healthcare Commercial |
$1,387.14
|
| Rate for Payer: United Healthcare Medicare |
$827.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,423.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,379.88
|
|
|
DRILL 1.7MM CANN FUS OSTEO
|
Facility
|
IP
|
$1,452.50
|
|
| Hospital Charge Code |
3002382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$841.72 |
| Max. Negotiated Rate |
$1,452.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,423.45
|
| Rate for Payer: Aetna of WY Medicare |
$929.60
|
| Rate for Payer: Altius Commercial |
$1,394.40
|
| Rate for Payer: Beech Street Commercial |
$1,423.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,408.92
|
| Rate for Payer: Cash Price |
$1,016.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,408.92
|
| Rate for Payer: Cigna of WY Commercial |
$1,423.45
|
| Rate for Payer: Entrust Commercial |
$1,379.88
|
| Rate for Payer: First Choice Health Commercial |
$1,379.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,379.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$886.02
|
| Rate for Payer: HealthUtah PPO |
$1,452.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,408.92
|
| Rate for Payer: Multiplan Medicare/VA |
$841.72
|
| Rate for Payer: One Health Plan of WY PPO |
$1,423.45
|
| Rate for Payer: PacificSource Commercial |
$1,307.25
|
| Rate for Payer: PHCS PPO |
$1,423.45
|
| Rate for Payer: Three Rivers PPO |
$1,089.38
|
| Rate for Payer: TriWest Veterans Administration |
$886.02
|
| Rate for Payer: United Healthcare Commercial |
$1,387.14
|
| Rate for Payer: United Healthcare Medicare |
$886.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,379.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,379.88
|
|
