|
DRILL 1.9MM FOR FIBERTAKE
|
Facility
|
OP
|
$525.00
|
|
| Hospital Charge Code |
3004400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.29 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Aetna of WY Medicare |
$346.50
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.25
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$299.25
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$284.29
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$299.25
|
| Rate for Payer: United Healthcare Commercial |
$501.38
|
| Rate for Payer: United Healthcare Medicare |
$299.25
|
| Rate for Payer: WINHealth Partners Commercial |
$514.50
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
DRILL 1.9MM FOR FIBERTAKE
|
Facility
|
IP
|
$525.00
|
|
| Hospital Charge Code |
3004400
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.24 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$514.50
|
| Rate for Payer: Aetna of WY Medicare |
$336.00
|
| Rate for Payer: Altius Commercial |
$504.00
|
| Rate for Payer: Beech Street Commercial |
$514.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$509.25
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$509.25
|
| Rate for Payer: Cigna of WY Commercial |
$514.50
|
| Rate for Payer: Entrust Commercial |
$498.75
|
| Rate for Payer: First Choice Health Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$498.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$320.25
|
| Rate for Payer: HealthUtah PPO |
$525.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$509.25
|
| Rate for Payer: Multiplan Medicare/VA |
$304.24
|
| Rate for Payer: One Health Plan of WY PPO |
$514.50
|
| Rate for Payer: PacificSource Commercial |
$472.50
|
| Rate for Payer: PHCS PPO |
$514.50
|
| Rate for Payer: Three Rivers PPO |
$393.75
|
| Rate for Payer: TriWest Veterans Administration |
$320.25
|
| Rate for Payer: United Healthcare Commercial |
$501.38
|
| Rate for Payer: United Healthcare Medicare |
$320.25
|
| Rate for Payer: WINHealth Partners Commercial |
$498.75
|
| Rate for Payer: Wise Provider Network Commercial |
$498.75
|
|
|
DRILL 2.0MM SHORT PILOT OSTEO
|
Facility
|
OP
|
$948.50
|
|
| Hospital Charge Code |
3004134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$513.61 |
| Max. Negotiated Rate |
$948.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$929.53
|
| Rate for Payer: Aetna of WY Medicare |
$626.01
|
| Rate for Payer: Altius Commercial |
$910.56
|
| Rate for Payer: Beech Street Commercial |
$929.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$920.04
|
| Rate for Payer: Cash Price |
$663.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$920.04
|
| Rate for Payer: Cigna of WY Commercial |
$929.53
|
| Rate for Payer: Entrust Commercial |
$901.08
|
| Rate for Payer: First Choice Health Commercial |
$901.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$901.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$540.64
|
| Rate for Payer: HealthUtah PPO |
$948.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$920.04
|
| Rate for Payer: Multiplan Medicare/VA |
$513.61
|
| Rate for Payer: One Health Plan of WY PPO |
$929.53
|
| Rate for Payer: PacificSource Commercial |
$853.65
|
| Rate for Payer: PHCS PPO |
$929.53
|
| Rate for Payer: Three Rivers PPO |
$711.38
|
| Rate for Payer: TriWest Veterans Administration |
$540.64
|
| Rate for Payer: United Healthcare Commercial |
$905.82
|
| Rate for Payer: United Healthcare Medicare |
$540.64
|
| Rate for Payer: WINHealth Partners Commercial |
$929.53
|
| Rate for Payer: Wise Provider Network Commercial |
$901.08
|
|
|
DRILL 2.0MM SHORT PILOT OSTEO
|
Facility
|
IP
|
$948.50
|
|
| Hospital Charge Code |
3004134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.66 |
| Max. Negotiated Rate |
$948.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$929.53
|
| Rate for Payer: Aetna of WY Medicare |
$607.04
|
| Rate for Payer: Altius Commercial |
$910.56
|
| Rate for Payer: Beech Street Commercial |
$929.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$920.04
|
| Rate for Payer: Cash Price |
$663.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$920.04
|
| Rate for Payer: Cigna of WY Commercial |
$929.53
|
| Rate for Payer: Entrust Commercial |
$901.08
|
| Rate for Payer: First Choice Health Commercial |
$901.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$901.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$578.58
|
| Rate for Payer: HealthUtah PPO |
$948.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$920.04
|
| Rate for Payer: Multiplan Medicare/VA |
$549.66
|
| Rate for Payer: One Health Plan of WY PPO |
$929.53
|
| Rate for Payer: PacificSource Commercial |
$853.65
|
| Rate for Payer: PHCS PPO |
$929.53
|
| Rate for Payer: Three Rivers PPO |
$711.38
|
| Rate for Payer: TriWest Veterans Administration |
$578.58
|
| Rate for Payer: United Healthcare Commercial |
$905.82
|
| Rate for Payer: United Healthcare Medicare |
$578.58
|
| Rate for Payer: WINHealth Partners Commercial |
$901.08
|
| Rate for Payer: Wise Provider Network Commercial |
$901.08
|
|
|
DRILL 2.0MM STANDARD
|
Facility
|
IP
|
$732.55
|
|
| Hospital Charge Code |
3002872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.51 |
| Max. Negotiated Rate |
$732.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$717.90
|
| Rate for Payer: Aetna of WY Medicare |
$468.83
|
| Rate for Payer: Altius Commercial |
$703.25
|
| Rate for Payer: Beech Street Commercial |
$717.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$710.57
|
| Rate for Payer: Cash Price |
$512.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$710.57
|
| Rate for Payer: Cigna of WY Commercial |
$717.90
|
| Rate for Payer: Entrust Commercial |
$695.92
|
| Rate for Payer: First Choice Health Commercial |
$695.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$695.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$446.86
|
| Rate for Payer: HealthUtah PPO |
$732.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$710.57
|
| Rate for Payer: Multiplan Medicare/VA |
$424.51
|
| Rate for Payer: One Health Plan of WY PPO |
$717.90
|
| Rate for Payer: PacificSource Commercial |
$659.30
|
| Rate for Payer: PHCS PPO |
$717.90
|
| Rate for Payer: Three Rivers PPO |
$549.41
|
| Rate for Payer: TriWest Veterans Administration |
$446.86
|
| Rate for Payer: United Healthcare Commercial |
$699.59
|
| Rate for Payer: United Healthcare Medicare |
$446.86
|
| Rate for Payer: WINHealth Partners Commercial |
$695.92
|
| Rate for Payer: Wise Provider Network Commercial |
$695.92
|
|
|
DRILL 2.0MM STANDARD
|
Facility
|
OP
|
$732.55
|
|
| Hospital Charge Code |
3002872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.68 |
| Max. Negotiated Rate |
$732.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$717.90
|
| Rate for Payer: Aetna of WY Medicare |
$483.48
|
| Rate for Payer: Altius Commercial |
$703.25
|
| Rate for Payer: Beech Street Commercial |
$717.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$710.57
|
| Rate for Payer: Cash Price |
$512.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$710.57
|
| Rate for Payer: Cigna of WY Commercial |
$717.90
|
| Rate for Payer: Entrust Commercial |
$695.92
|
| Rate for Payer: First Choice Health Commercial |
$695.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$695.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$417.55
|
| Rate for Payer: HealthUtah PPO |
$732.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$710.57
|
| Rate for Payer: Multiplan Medicare/VA |
$396.68
|
| Rate for Payer: One Health Plan of WY PPO |
$717.90
|
| Rate for Payer: PacificSource Commercial |
$659.30
|
| Rate for Payer: PHCS PPO |
$717.90
|
| Rate for Payer: Three Rivers PPO |
$549.41
|
| Rate for Payer: TriWest Veterans Administration |
$417.55
|
| Rate for Payer: United Healthcare Commercial |
$699.59
|
| Rate for Payer: United Healthcare Medicare |
$417.55
|
| Rate for Payer: WINHealth Partners Commercial |
$717.90
|
| Rate for Payer: Wise Provider Network Commercial |
$695.92
|
|
|
DRILL 2.0 X 3.5 QUICK RELEASE
|
Facility
|
OP
|
$605.50
|
|
| Hospital Charge Code |
3002601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.88 |
| Max. Negotiated Rate |
$605.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.39
|
| Rate for Payer: Aetna of WY Medicare |
$399.63
|
| Rate for Payer: Altius Commercial |
$581.28
|
| Rate for Payer: Beech Street Commercial |
$593.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$587.34
|
| Rate for Payer: Cash Price |
$423.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.34
|
| Rate for Payer: Cigna of WY Commercial |
$593.39
|
| Rate for Payer: Entrust Commercial |
$575.22
|
| Rate for Payer: First Choice Health Commercial |
$575.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$345.14
|
| Rate for Payer: HealthUtah PPO |
$605.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.34
|
| Rate for Payer: Multiplan Medicare/VA |
$327.88
|
| Rate for Payer: One Health Plan of WY PPO |
$593.39
|
| Rate for Payer: PacificSource Commercial |
$544.95
|
| Rate for Payer: PHCS PPO |
$593.39
|
| Rate for Payer: Three Rivers PPO |
$454.12
|
| Rate for Payer: TriWest Veterans Administration |
$345.14
|
| Rate for Payer: United Healthcare Commercial |
$578.25
|
| Rate for Payer: United Healthcare Medicare |
$345.14
|
| Rate for Payer: WINHealth Partners Commercial |
$593.39
|
| Rate for Payer: Wise Provider Network Commercial |
$575.22
|
|
|
DRILL 2.0 X 3.5 QUICK RELEASE
|
Facility
|
IP
|
$605.50
|
|
| Hospital Charge Code |
3002601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.89 |
| Max. Negotiated Rate |
$605.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$593.39
|
| Rate for Payer: Aetna of WY Medicare |
$387.52
|
| Rate for Payer: Altius Commercial |
$581.28
|
| Rate for Payer: Beech Street Commercial |
$593.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$587.34
|
| Rate for Payer: Cash Price |
$423.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$587.34
|
| Rate for Payer: Cigna of WY Commercial |
$593.39
|
| Rate for Payer: Entrust Commercial |
$575.22
|
| Rate for Payer: First Choice Health Commercial |
$575.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$575.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$369.36
|
| Rate for Payer: HealthUtah PPO |
$605.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$587.34
|
| Rate for Payer: Multiplan Medicare/VA |
$350.89
|
| Rate for Payer: One Health Plan of WY PPO |
$593.39
|
| Rate for Payer: PacificSource Commercial |
$544.95
|
| Rate for Payer: PHCS PPO |
$593.39
|
| Rate for Payer: Three Rivers PPO |
$454.12
|
| Rate for Payer: TriWest Veterans Administration |
$369.36
|
| Rate for Payer: United Healthcare Commercial |
$578.25
|
| Rate for Payer: United Healthcare Medicare |
$369.36
|
| Rate for Payer: WINHealth Partners Commercial |
$575.22
|
| Rate for Payer: Wise Provider Network Commercial |
$575.22
|
|
|
DRILL 2.3 VARIAX HAND
|
Facility
|
OP
|
$268.14
|
|
| Hospital Charge Code |
3100502
|
|
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 2.3 VARIAX HAND
|
Facility
|
IP
|
$268.14
|
|
| Hospital Charge Code |
3100502
|
|
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 2.5MM CALIBRA AR8916-06
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
3002549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$233.24
|
| Rate for Payer: Aetna of WY Medicare |
$152.32
|
| Rate for Payer: Altius Commercial |
$228.48
|
| Rate for Payer: Beech Street Commercial |
$233.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$230.86
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$230.86
|
| Rate for Payer: Cigna of WY Commercial |
$233.24
|
| Rate for Payer: Entrust Commercial |
$226.10
|
| Rate for Payer: First Choice Health Commercial |
$226.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$226.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.18
|
| Rate for Payer: HealthUtah PPO |
$238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$230.86
|
| Rate for Payer: Multiplan Medicare/VA |
$137.92
|
| Rate for Payer: One Health Plan of WY PPO |
$233.24
|
| Rate for Payer: PacificSource Commercial |
$214.20
|
| Rate for Payer: PHCS PPO |
$233.24
|
| Rate for Payer: Three Rivers PPO |
$178.50
|
| Rate for Payer: TriWest Veterans Administration |
$145.18
|
| Rate for Payer: United Healthcare Commercial |
$227.29
|
| Rate for Payer: United Healthcare Medicare |
$145.18
|
| Rate for Payer: WINHealth Partners Commercial |
$226.10
|
| Rate for Payer: Wise Provider Network Commercial |
$226.10
|
|
|
DRILL 2.5MM CALIBRA AR8916-06
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
3002549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.88 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$233.24
|
| Rate for Payer: Aetna of WY Medicare |
$157.08
|
| Rate for Payer: Altius Commercial |
$228.48
|
| Rate for Payer: Beech Street Commercial |
$233.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$230.86
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$230.86
|
| Rate for Payer: Cigna of WY Commercial |
$233.24
|
| Rate for Payer: Entrust Commercial |
$226.10
|
| Rate for Payer: First Choice Health Commercial |
$226.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$226.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.66
|
| Rate for Payer: HealthUtah PPO |
$238.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$230.86
|
| Rate for Payer: Multiplan Medicare/VA |
$128.88
|
| Rate for Payer: One Health Plan of WY PPO |
$233.24
|
| Rate for Payer: PacificSource Commercial |
$214.20
|
| Rate for Payer: PHCS PPO |
$233.24
|
| Rate for Payer: Three Rivers PPO |
$178.50
|
| Rate for Payer: TriWest Veterans Administration |
$135.66
|
| Rate for Payer: United Healthcare Commercial |
$227.29
|
| Rate for Payer: United Healthcare Medicare |
$135.66
|
| Rate for Payer: WINHealth Partners Commercial |
$233.24
|
| Rate for Payer: Wise Provider Network Commercial |
$226.10
|
|
|
DRILL 2.5MM CANN DRIVER HEX
|
Facility
|
IP
|
$703.15
|
|
| Hospital Charge Code |
3003507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.48 |
| Max. Negotiated Rate |
$703.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$689.09
|
| Rate for Payer: Aetna of WY Medicare |
$450.02
|
| Rate for Payer: Altius Commercial |
$675.02
|
| Rate for Payer: Beech Street Commercial |
$689.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$682.06
|
| Rate for Payer: Cash Price |
$492.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$682.06
|
| Rate for Payer: Cigna of WY Commercial |
$689.09
|
| Rate for Payer: Entrust Commercial |
$667.99
|
| Rate for Payer: First Choice Health Commercial |
$667.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$667.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$428.92
|
| Rate for Payer: HealthUtah PPO |
$703.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$682.06
|
| Rate for Payer: Multiplan Medicare/VA |
$407.48
|
| Rate for Payer: One Health Plan of WY PPO |
$689.09
|
| Rate for Payer: PacificSource Commercial |
$632.84
|
| Rate for Payer: PHCS PPO |
$689.09
|
| Rate for Payer: Three Rivers PPO |
$527.36
|
| Rate for Payer: TriWest Veterans Administration |
$428.92
|
| Rate for Payer: United Healthcare Commercial |
$671.51
|
| Rate for Payer: United Healthcare Medicare |
$428.92
|
| Rate for Payer: WINHealth Partners Commercial |
$667.99
|
| Rate for Payer: Wise Provider Network Commercial |
$667.99
|
|
|
DRILL 2.5MM CANN DRIVER HEX
|
Facility
|
OP
|
$703.15
|
|
| Hospital Charge Code |
3003507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.76 |
| Max. Negotiated Rate |
$703.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$689.09
|
| Rate for Payer: Aetna of WY Medicare |
$464.08
|
| Rate for Payer: Altius Commercial |
$675.02
|
| Rate for Payer: Beech Street Commercial |
$689.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$682.06
|
| Rate for Payer: Cash Price |
$492.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$682.06
|
| Rate for Payer: Cigna of WY Commercial |
$689.09
|
| Rate for Payer: Entrust Commercial |
$667.99
|
| Rate for Payer: First Choice Health Commercial |
$667.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$667.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.80
|
| Rate for Payer: HealthUtah PPO |
$703.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$682.06
|
| Rate for Payer: Multiplan Medicare/VA |
$380.76
|
| Rate for Payer: One Health Plan of WY PPO |
$689.09
|
| Rate for Payer: PacificSource Commercial |
$632.84
|
| Rate for Payer: PHCS PPO |
$689.09
|
| Rate for Payer: Three Rivers PPO |
$527.36
|
| Rate for Payer: TriWest Veterans Administration |
$400.80
|
| Rate for Payer: United Healthcare Commercial |
$671.51
|
| Rate for Payer: United Healthcare Medicare |
$400.80
|
| Rate for Payer: WINHealth Partners Commercial |
$689.09
|
| Rate for Payer: Wise Provider Network Commercial |
$667.99
|
|
|
DRILL 25MM LOW PRO SCR 1355D
|
Facility
|
IP
|
$287.00
|
|
| Hospital Charge Code |
3003879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$183.68
|
| Rate for Payer: Altius Commercial |
$275.52
|
| Rate for Payer: Beech Street Commercial |
$281.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$278.39
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$278.39
|
| Rate for Payer: Cigna of WY Commercial |
$281.26
|
| Rate for Payer: Entrust Commercial |
$272.65
|
| Rate for Payer: First Choice Health Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.07
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$166.32
|
| Rate for Payer: One Health Plan of WY PPO |
$281.26
|
| Rate for Payer: PacificSource Commercial |
$258.30
|
| Rate for Payer: PHCS PPO |
$281.26
|
| Rate for Payer: Three Rivers PPO |
$215.25
|
| Rate for Payer: TriWest Veterans Administration |
$175.07
|
| Rate for Payer: United Healthcare Commercial |
$274.08
|
| Rate for Payer: United Healthcare Medicare |
$175.07
|
| Rate for Payer: WINHealth Partners Commercial |
$272.65
|
| Rate for Payer: Wise Provider Network Commercial |
$272.65
|
|
|
DRILL 25MM LOW PRO SCR 1355D
|
Facility
|
OP
|
$287.00
|
|
| Hospital Charge Code |
3003879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.41 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$281.26
|
| Rate for Payer: Aetna of WY Medicare |
$189.42
|
| Rate for Payer: Altius Commercial |
$275.52
|
| Rate for Payer: Beech Street Commercial |
$281.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$278.39
|
| Rate for Payer: Cash Price |
$200.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$278.39
|
| Rate for Payer: Cigna of WY Commercial |
$281.26
|
| Rate for Payer: Entrust Commercial |
$272.65
|
| Rate for Payer: First Choice Health Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$272.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.59
|
| Rate for Payer: HealthUtah PPO |
$287.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$278.39
|
| Rate for Payer: Multiplan Medicare/VA |
$155.41
|
| Rate for Payer: One Health Plan of WY PPO |
$281.26
|
| Rate for Payer: PacificSource Commercial |
$258.30
|
| Rate for Payer: PHCS PPO |
$281.26
|
| Rate for Payer: Three Rivers PPO |
$215.25
|
| Rate for Payer: TriWest Veterans Administration |
$163.59
|
| Rate for Payer: United Healthcare Commercial |
$274.08
|
| Rate for Payer: United Healthcare Medicare |
$163.59
|
| Rate for Payer: WINHealth Partners Commercial |
$281.26
|
| Rate for Payer: Wise Provider Network Commercial |
$272.65
|
|
|
DRILL 2.5MM QUICK CONNECT B25
|
Facility
|
OP
|
$319.38
|
|
| Hospital Charge Code |
3100679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.94 |
| Max. Negotiated Rate |
$319.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.99
|
| Rate for Payer: Aetna of WY Medicare |
$210.79
|
| Rate for Payer: Altius Commercial |
$306.60
|
| Rate for Payer: Beech Street Commercial |
$312.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$309.80
|
| Rate for Payer: Cash Price |
$223.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.80
|
| Rate for Payer: Cigna of WY Commercial |
$312.99
|
| Rate for Payer: Entrust Commercial |
$303.41
|
| Rate for Payer: First Choice Health Commercial |
$303.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.05
|
| Rate for Payer: HealthUtah PPO |
$319.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.80
|
| Rate for Payer: Multiplan Medicare/VA |
$172.94
|
| Rate for Payer: One Health Plan of WY PPO |
$312.99
|
| Rate for Payer: PacificSource Commercial |
$287.44
|
| Rate for Payer: PHCS PPO |
$312.99
|
| Rate for Payer: Three Rivers PPO |
$239.54
|
| Rate for Payer: TriWest Veterans Administration |
$182.05
|
| Rate for Payer: United Healthcare Commercial |
$305.01
|
| Rate for Payer: United Healthcare Medicare |
$182.05
|
| Rate for Payer: WINHealth Partners Commercial |
$312.99
|
| Rate for Payer: Wise Provider Network Commercial |
$303.41
|
|
|
DRILL 2.5MM QUICK CONNECT B25
|
Facility
|
IP
|
$319.38
|
|
| Hospital Charge Code |
3100679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.08 |
| Max. Negotiated Rate |
$319.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.99
|
| Rate for Payer: Aetna of WY Medicare |
$204.40
|
| Rate for Payer: Altius Commercial |
$306.60
|
| Rate for Payer: Beech Street Commercial |
$312.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$309.80
|
| Rate for Payer: Cash Price |
$223.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.80
|
| Rate for Payer: Cigna of WY Commercial |
$312.99
|
| Rate for Payer: Entrust Commercial |
$303.41
|
| Rate for Payer: First Choice Health Commercial |
$303.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.82
|
| Rate for Payer: HealthUtah PPO |
$319.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.80
|
| Rate for Payer: Multiplan Medicare/VA |
$185.08
|
| Rate for Payer: One Health Plan of WY PPO |
$312.99
|
| Rate for Payer: PacificSource Commercial |
$287.44
|
| Rate for Payer: PHCS PPO |
$312.99
|
| Rate for Payer: Three Rivers PPO |
$239.54
|
| Rate for Payer: TriWest Veterans Administration |
$194.82
|
| Rate for Payer: United Healthcare Commercial |
$305.01
|
| Rate for Payer: United Healthcare Medicare |
$194.82
|
| Rate for Payer: WINHealth Partners Commercial |
$303.41
|
| Rate for Payer: Wise Provider Network Commercial |
$303.41
|
|
|
DRILL 2.75 .066 CAN AR-7000-14
|
Facility
|
IP
|
$1,225.00
|
|
| Hospital Charge Code |
3003297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$709.89 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.50
|
| Rate for Payer: Aetna of WY Medicare |
$784.00
|
| Rate for Payer: Altius Commercial |
$1,176.00
|
| Rate for Payer: Beech Street Commercial |
$1,200.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,188.25
|
| Rate for Payer: Cash Price |
$857.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.50
|
| Rate for Payer: Entrust Commercial |
$1,163.75
|
| Rate for Payer: First Choice Health Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$747.25
|
| Rate for Payer: HealthUtah PPO |
$1,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.25
|
| Rate for Payer: Multiplan Medicare/VA |
$709.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.50
|
| Rate for Payer: PacificSource Commercial |
$1,102.50
|
| Rate for Payer: PHCS PPO |
$1,200.50
|
| Rate for Payer: Three Rivers PPO |
$918.75
|
| Rate for Payer: TriWest Veterans Administration |
$747.25
|
| Rate for Payer: United Healthcare Commercial |
$1,169.88
|
| Rate for Payer: United Healthcare Medicare |
$747.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,163.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,163.75
|
|
|
DRILL 2.75 .066 CAN AR-7000-14
|
Facility
|
OP
|
$1,225.00
|
|
| Hospital Charge Code |
3003297
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$663.34 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.50
|
| Rate for Payer: Aetna of WY Medicare |
$808.50
|
| Rate for Payer: Altius Commercial |
$1,176.00
|
| Rate for Payer: Beech Street Commercial |
$1,200.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,188.25
|
| Rate for Payer: Cash Price |
$857.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.25
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.50
|
| Rate for Payer: Entrust Commercial |
$1,163.75
|
| Rate for Payer: First Choice Health Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,163.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$698.25
|
| Rate for Payer: HealthUtah PPO |
$1,225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.25
|
| Rate for Payer: Multiplan Medicare/VA |
$663.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.50
|
| Rate for Payer: PacificSource Commercial |
$1,102.50
|
| Rate for Payer: PHCS PPO |
$1,200.50
|
| Rate for Payer: Three Rivers PPO |
$918.75
|
| Rate for Payer: TriWest Veterans Administration |
$698.25
|
| Rate for Payer: United Healthcare Commercial |
$1,169.88
|
| Rate for Payer: United Healthcare Medicare |
$698.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,200.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,163.75
|
|
|
DRILL 2.7 MM AO CANNULATED
|
Facility
|
OP
|
$608.65
|
|
| Hospital Charge Code |
3003485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.58 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$596.48
|
| Rate for Payer: Aetna of WY Medicare |
$401.71
|
| Rate for Payer: Altius Commercial |
$584.30
|
| Rate for Payer: Beech Street Commercial |
$596.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$590.39
|
| Rate for Payer: Cash Price |
$426.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$590.39
|
| Rate for Payer: Cigna of WY Commercial |
$596.48
|
| Rate for Payer: Entrust Commercial |
$578.22
|
| Rate for Payer: First Choice Health Commercial |
$578.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$578.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$346.93
|
| Rate for Payer: HealthUtah PPO |
$608.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$590.39
|
| Rate for Payer: Multiplan Medicare/VA |
$329.58
|
| Rate for Payer: One Health Plan of WY PPO |
$596.48
|
| Rate for Payer: PacificSource Commercial |
$547.78
|
| Rate for Payer: PHCS PPO |
$596.48
|
| Rate for Payer: Three Rivers PPO |
$456.49
|
| Rate for Payer: TriWest Veterans Administration |
$346.93
|
| Rate for Payer: United Healthcare Commercial |
$581.26
|
| Rate for Payer: United Healthcare Medicare |
$346.93
|
| Rate for Payer: WINHealth Partners Commercial |
$596.48
|
| Rate for Payer: Wise Provider Network Commercial |
$578.22
|
|
|
DRILL 2.7 MM AO CANNULATED
|
Facility
|
IP
|
$608.65
|
|
| Hospital Charge Code |
3003485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.71 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$596.48
|
| Rate for Payer: Aetna of WY Medicare |
$389.54
|
| Rate for Payer: Altius Commercial |
$584.30
|
| Rate for Payer: Beech Street Commercial |
$596.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$590.39
|
| Rate for Payer: Cash Price |
$426.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$590.39
|
| Rate for Payer: Cigna of WY Commercial |
$596.48
|
| Rate for Payer: Entrust Commercial |
$578.22
|
| Rate for Payer: First Choice Health Commercial |
$578.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$578.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$371.28
|
| Rate for Payer: HealthUtah PPO |
$608.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$590.39
|
| Rate for Payer: Multiplan Medicare/VA |
$352.71
|
| Rate for Payer: One Health Plan of WY PPO |
$596.48
|
| Rate for Payer: PacificSource Commercial |
$547.78
|
| Rate for Payer: PHCS PPO |
$596.48
|
| Rate for Payer: Three Rivers PPO |
$456.49
|
| Rate for Payer: TriWest Veterans Administration |
$371.28
|
| Rate for Payer: United Healthcare Commercial |
$581.26
|
| Rate for Payer: United Healthcare Medicare |
$371.28
|
| Rate for Payer: WINHealth Partners Commercial |
$578.22
|
| Rate for Payer: Wise Provider Network Commercial |
$578.22
|
|
|
DRILL 2.7MM CANNULATED Q/C
|
Facility
|
IP
|
$1,166.20
|
|
| Hospital Charge Code |
3002992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$675.81 |
| Max. Negotiated Rate |
$1,166.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,142.88
|
| Rate for Payer: Aetna of WY Medicare |
$746.37
|
| Rate for Payer: Altius Commercial |
$1,119.55
|
| Rate for Payer: Beech Street Commercial |
$1,142.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,131.21
|
| Rate for Payer: Cash Price |
$816.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,131.21
|
| Rate for Payer: Cigna of WY Commercial |
$1,142.88
|
| Rate for Payer: Entrust Commercial |
$1,107.89
|
| Rate for Payer: First Choice Health Commercial |
$1,107.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,107.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$711.38
|
| Rate for Payer: HealthUtah PPO |
$1,166.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,131.21
|
| Rate for Payer: Multiplan Medicare/VA |
$675.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,142.88
|
| Rate for Payer: PacificSource Commercial |
$1,049.58
|
| Rate for Payer: PHCS PPO |
$1,142.88
|
| Rate for Payer: Three Rivers PPO |
$874.65
|
| Rate for Payer: TriWest Veterans Administration |
$711.38
|
| Rate for Payer: United Healthcare Commercial |
$1,113.72
|
| Rate for Payer: United Healthcare Medicare |
$711.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.89
|
| Rate for Payer: Wise Provider Network Commercial |
$1,107.89
|
|
|
DRILL 2.7MM CANNULATED Q/C
|
Facility
|
OP
|
$1,166.20
|
|
| Hospital Charge Code |
3002992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$631.50 |
| Max. Negotiated Rate |
$1,166.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,142.88
|
| Rate for Payer: Aetna of WY Medicare |
$769.69
|
| Rate for Payer: Altius Commercial |
$1,119.55
|
| Rate for Payer: Beech Street Commercial |
$1,142.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,131.21
|
| Rate for Payer: Cash Price |
$816.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,131.21
|
| Rate for Payer: Cigna of WY Commercial |
$1,142.88
|
| Rate for Payer: Entrust Commercial |
$1,107.89
|
| Rate for Payer: First Choice Health Commercial |
$1,107.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,107.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$664.73
|
| Rate for Payer: HealthUtah PPO |
$1,166.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,131.21
|
| Rate for Payer: Multiplan Medicare/VA |
$631.50
|
| Rate for Payer: One Health Plan of WY PPO |
$1,142.88
|
| Rate for Payer: PacificSource Commercial |
$1,049.58
|
| Rate for Payer: PHCS PPO |
$1,142.88
|
| Rate for Payer: Three Rivers PPO |
$874.65
|
| Rate for Payer: TriWest Veterans Administration |
$664.73
|
| Rate for Payer: United Healthcare Commercial |
$1,113.72
|
| Rate for Payer: United Healthcare Medicare |
$664.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1,142.88
|
| Rate for Payer: Wise Provider Network Commercial |
$1,107.89
|
|
|
DRILL 2.7MM CMP FT CALIBRATED
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
3002481
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$436.80
|
| Rate for Payer: Altius Commercial |
$655.20
|
| Rate for Payer: Beech Street Commercial |
$668.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$662.02
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.02
|
| Rate for Payer: Cigna of WY Commercial |
$668.85
|
| Rate for Payer: Entrust Commercial |
$648.38
|
| Rate for Payer: First Choice Health Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.32
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$395.51
|
| Rate for Payer: One Health Plan of WY PPO |
$668.85
|
| Rate for Payer: PacificSource Commercial |
$614.25
|
| Rate for Payer: PHCS PPO |
$668.85
|
| Rate for Payer: Three Rivers PPO |
$511.88
|
| Rate for Payer: TriWest Veterans Administration |
$416.32
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$416.32
|
| Rate for Payer: WINHealth Partners Commercial |
$648.38
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
