|
DRILL BIT 1.7MM CAN AR1201-7DC
|
Facility
|
IP
|
$612.50
|
|
| Hospital Charge Code |
3002451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.94 |
| Max. Negotiated Rate |
$612.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$600.25
|
| Rate for Payer: Aetna of WY Medicare |
$392.00
|
| Rate for Payer: Altius Commercial |
$588.00
|
| Rate for Payer: Beech Street Commercial |
$600.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$594.12
|
| Rate for Payer: Cash Price |
$428.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$594.12
|
| Rate for Payer: Cigna of WY Commercial |
$600.25
|
| Rate for Payer: Entrust Commercial |
$581.88
|
| Rate for Payer: First Choice Health Commercial |
$581.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$373.62
|
| Rate for Payer: HealthUtah PPO |
$612.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$594.12
|
| Rate for Payer: Multiplan Medicare/VA |
$354.94
|
| Rate for Payer: One Health Plan of WY PPO |
$600.25
|
| Rate for Payer: PacificSource Commercial |
$551.25
|
| Rate for Payer: PHCS PPO |
$600.25
|
| Rate for Payer: Three Rivers PPO |
$459.38
|
| Rate for Payer: TriWest Veterans Administration |
$373.62
|
| Rate for Payer: United Healthcare Commercial |
$584.94
|
| Rate for Payer: United Healthcare Medicare |
$373.62
|
| Rate for Payer: WINHealth Partners Commercial |
$581.88
|
| Rate for Payer: Wise Provider Network Commercial |
$581.88
|
|
|
DRILL BIT 1.7MM CAN AR1201-7DC
|
Facility
|
OP
|
$612.50
|
|
| Hospital Charge Code |
3002451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.67 |
| Max. Negotiated Rate |
$612.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$600.25
|
| Rate for Payer: Aetna of WY Medicare |
$404.25
|
| Rate for Payer: Altius Commercial |
$588.00
|
| Rate for Payer: Beech Street Commercial |
$600.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$594.12
|
| Rate for Payer: Cash Price |
$428.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$594.12
|
| Rate for Payer: Cigna of WY Commercial |
$600.25
|
| Rate for Payer: Entrust Commercial |
$581.88
|
| Rate for Payer: First Choice Health Commercial |
$581.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$581.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.12
|
| Rate for Payer: HealthUtah PPO |
$612.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$594.12
|
| Rate for Payer: Multiplan Medicare/VA |
$331.67
|
| Rate for Payer: One Health Plan of WY PPO |
$600.25
|
| Rate for Payer: PacificSource Commercial |
$551.25
|
| Rate for Payer: PHCS PPO |
$600.25
|
| Rate for Payer: Three Rivers PPO |
$459.38
|
| Rate for Payer: TriWest Veterans Administration |
$349.12
|
| Rate for Payer: United Healthcare Commercial |
$584.94
|
| Rate for Payer: United Healthcare Medicare |
$349.12
|
| Rate for Payer: WINHealth Partners Commercial |
$600.25
|
| Rate for Payer: Wise Provider Network Commercial |
$581.88
|
|
|
DRILL BIT 1.8 X 90 MM TRIMED
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
3004230
|
|
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 BIT 1.8 X 90 MM TRIMED
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
3004230
|
|
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 BIT 1.9 AO DISTAL RADIUS
|
Facility
|
IP
|
$271.42
|
|
| Hospital Charge Code |
3300145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$173.71
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.57
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$157.29
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$165.57
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$165.57
|
| Rate for Payer: WINHealth Partners Commercial |
$257.85
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9 AO DISTAL RADIUS
|
Facility
|
OP
|
$271.42
|
|
| Hospital Charge Code |
3300145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$179.14
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.71
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$146.97
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$154.71
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
| Rate for Payer: WINHealth Partners Commercial |
$265.99
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9 MM
|
Facility
|
OP
|
$271.42
|
|
| Hospital Charge Code |
3100148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$179.14
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.71
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$146.97
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$154.71
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
| Rate for Payer: WINHealth Partners Commercial |
$265.99
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9 MM
|
Facility
|
IP
|
$271.42
|
|
| Hospital Charge Code |
3100148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$173.71
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.57
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$157.29
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$165.57
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$165.57
|
| Rate for Payer: WINHealth Partners Commercial |
$257.85
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9MM STRYKER
|
Facility
|
OP
|
$271.42
|
|
| Hospital Charge Code |
3100341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$179.14
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.71
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$146.97
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$154.71
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
| Rate for Payer: WINHealth Partners Commercial |
$265.99
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9MM STRYKER
|
Facility
|
IP
|
$271.42
|
|
| Hospital Charge Code |
3100341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$173.71
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.57
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$157.29
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$165.57
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$165.57
|
| Rate for Payer: WINHealth Partners Commercial |
$257.85
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9 X 27MM
|
Facility
|
IP
|
$271.42
|
|
| Hospital Charge Code |
3100161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$173.71
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.57
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$157.29
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$165.57
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$165.57
|
| Rate for Payer: WINHealth Partners Commercial |
$257.85
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 1.9 X 27MM
|
Facility
|
OP
|
$271.42
|
|
| Hospital Charge Code |
3100161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$179.14
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.71
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$146.97
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$154.71
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
| Rate for Payer: WINHealth Partners Commercial |
$265.99
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 2.0/095 TRIMED
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
3002889
|
|
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 BIT 2.0/095 TRIMED
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
3002889
|
|
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 BIT 2.0 ACUMED
|
Facility
|
IP
|
$290.50
|
|
| Hospital Charge Code |
3001026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.34 |
| Max. Negotiated Rate |
$290.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.69
|
| Rate for Payer: Aetna of WY Medicare |
$185.92
|
| Rate for Payer: Altius Commercial |
$278.88
|
| Rate for Payer: Beech Street Commercial |
$284.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$281.78
|
| Rate for Payer: Cash Price |
$203.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.78
|
| Rate for Payer: Cigna of WY Commercial |
$284.69
|
| Rate for Payer: Entrust Commercial |
$275.98
|
| Rate for Payer: First Choice Health Commercial |
$275.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.20
|
| Rate for Payer: HealthUtah PPO |
$290.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.78
|
| Rate for Payer: Multiplan Medicare/VA |
$168.34
|
| Rate for Payer: One Health Plan of WY PPO |
$284.69
|
| Rate for Payer: PacificSource Commercial |
$261.45
|
| Rate for Payer: PHCS PPO |
$284.69
|
| Rate for Payer: Three Rivers PPO |
$217.88
|
| Rate for Payer: TriWest Veterans Administration |
$177.20
|
| Rate for Payer: United Healthcare Commercial |
$277.43
|
| Rate for Payer: United Healthcare Medicare |
$177.20
|
| Rate for Payer: WINHealth Partners Commercial |
$275.98
|
| Rate for Payer: Wise Provider Network Commercial |
$275.98
|
|
|
DRILL BIT 2.0 ACUMED
|
Facility
|
OP
|
$290.50
|
|
| Hospital Charge Code |
3001026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.31 |
| Max. Negotiated Rate |
$290.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$284.69
|
| Rate for Payer: Aetna of WY Medicare |
$191.73
|
| Rate for Payer: Altius Commercial |
$278.88
|
| Rate for Payer: Beech Street Commercial |
$284.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$281.78
|
| Rate for Payer: Cash Price |
$203.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$281.78
|
| Rate for Payer: Cigna of WY Commercial |
$284.69
|
| Rate for Payer: Entrust Commercial |
$275.98
|
| Rate for Payer: First Choice Health Commercial |
$275.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$275.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.58
|
| Rate for Payer: HealthUtah PPO |
$290.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$281.78
|
| Rate for Payer: Multiplan Medicare/VA |
$157.31
|
| Rate for Payer: One Health Plan of WY PPO |
$284.69
|
| Rate for Payer: PacificSource Commercial |
$261.45
|
| Rate for Payer: PHCS PPO |
$284.69
|
| Rate for Payer: Three Rivers PPO |
$217.88
|
| Rate for Payer: TriWest Veterans Administration |
$165.58
|
| Rate for Payer: United Healthcare Commercial |
$277.43
|
| Rate for Payer: United Healthcare Medicare |
$165.58
|
| Rate for Payer: WINHealth Partners Commercial |
$284.69
|
| Rate for Payer: Wise Provider Network Commercial |
$275.98
|
|
|
DRILL BIT 2.0 ANCHORAGE SET
|
Facility
|
OP
|
$446.88
|
|
| Hospital Charge Code |
3100272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.99 |
| Max. Negotiated Rate |
$446.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.94
|
| Rate for Payer: Aetna of WY Medicare |
$294.94
|
| Rate for Payer: Altius Commercial |
$429.00
|
| Rate for Payer: Beech Street Commercial |
$437.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$433.47
|
| Rate for Payer: Cash Price |
$312.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.47
|
| Rate for Payer: Cigna of WY Commercial |
$437.94
|
| Rate for Payer: Entrust Commercial |
$424.54
|
| Rate for Payer: First Choice Health Commercial |
$424.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.72
|
| Rate for Payer: HealthUtah PPO |
$446.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.47
|
| Rate for Payer: Multiplan Medicare/VA |
$241.99
|
| Rate for Payer: One Health Plan of WY PPO |
$437.94
|
| Rate for Payer: PacificSource Commercial |
$402.19
|
| Rate for Payer: PHCS PPO |
$437.94
|
| Rate for Payer: Three Rivers PPO |
$335.16
|
| Rate for Payer: TriWest Veterans Administration |
$254.72
|
| Rate for Payer: United Healthcare Commercial |
$426.77
|
| Rate for Payer: United Healthcare Medicare |
$254.72
|
| Rate for Payer: WINHealth Partners Commercial |
$437.94
|
| Rate for Payer: Wise Provider Network Commercial |
$424.54
|
|
|
DRILL BIT 2.0 ANCHORAGE SET
|
Facility
|
IP
|
$446.88
|
|
| Hospital Charge Code |
3100272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.97 |
| Max. Negotiated Rate |
$446.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.94
|
| Rate for Payer: Aetna of WY Medicare |
$286.00
|
| Rate for Payer: Altius Commercial |
$429.00
|
| Rate for Payer: Beech Street Commercial |
$437.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$433.47
|
| Rate for Payer: Cash Price |
$312.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.47
|
| Rate for Payer: Cigna of WY Commercial |
$437.94
|
| Rate for Payer: Entrust Commercial |
$424.54
|
| Rate for Payer: First Choice Health Commercial |
$424.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.60
|
| Rate for Payer: HealthUtah PPO |
$446.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.47
|
| Rate for Payer: Multiplan Medicare/VA |
$258.97
|
| Rate for Payer: One Health Plan of WY PPO |
$437.94
|
| Rate for Payer: PacificSource Commercial |
$402.19
|
| Rate for Payer: PHCS PPO |
$437.94
|
| Rate for Payer: Three Rivers PPO |
$335.16
|
| Rate for Payer: TriWest Veterans Administration |
$272.60
|
| Rate for Payer: United Healthcare Commercial |
$426.77
|
| Rate for Payer: United Healthcare Medicare |
$272.60
|
| Rate for Payer: WINHealth Partners Commercial |
$424.54
|
| Rate for Payer: Wise Provider Network Commercial |
$424.54
|
|
|
DRILL BIT 2.0 DISTAL RADIUS
|
Facility
|
IP
|
$271.42
|
|
| Hospital Charge Code |
3300115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$173.71
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$165.57
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$157.29
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$165.57
|
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: United Healthcare Medicare |
$165.57
|
| Rate for Payer: WINHealth Partners Commercial |
$257.85
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 2.0 DISTAL RADIUS
|
Facility
|
OP
|
$271.42
|
|
| Hospital Charge Code |
3300115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: United Healthcare Commercial |
$259.21
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$265.99
|
| Rate for Payer: Aetna of WY Medicare |
$179.14
|
| Rate for Payer: Altius Commercial |
$260.56
|
| Rate for Payer: Beech Street Commercial |
$265.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$263.28
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$263.28
|
| Rate for Payer: Cigna of WY Commercial |
$265.99
|
| Rate for Payer: Entrust Commercial |
$257.85
|
| Rate for Payer: First Choice Health Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$257.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.71
|
| Rate for Payer: HealthUtah PPO |
$271.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$263.28
|
| Rate for Payer: Multiplan Medicare/VA |
$146.97
|
| Rate for Payer: One Health Plan of WY PPO |
$265.99
|
| Rate for Payer: PacificSource Commercial |
$244.28
|
| Rate for Payer: PHCS PPO |
$265.99
|
| Rate for Payer: Three Rivers PPO |
$203.56
|
| Rate for Payer: TriWest Veterans Administration |
$154.71
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
| Rate for Payer: WINHealth Partners Commercial |
$265.99
|
| Rate for Payer: Wise Provider Network Commercial |
$257.85
|
|
|
DRILL BIT 2.0MM ACUMED
|
Facility
|
OP
|
$903.00
|
|
| Hospital Charge Code |
3002199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.97 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$884.94
|
| Rate for Payer: Aetna of WY Medicare |
$595.98
|
| Rate for Payer: Altius Commercial |
$866.88
|
| Rate for Payer: Beech Street Commercial |
$884.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$875.91
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$875.91
|
| Rate for Payer: Cigna of WY Commercial |
$884.94
|
| Rate for Payer: Entrust Commercial |
$857.85
|
| Rate for Payer: First Choice Health Commercial |
$857.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$857.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$514.71
|
| Rate for Payer: HealthUtah PPO |
$903.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$875.91
|
| Rate for Payer: Multiplan Medicare/VA |
$488.97
|
| Rate for Payer: One Health Plan of WY PPO |
$884.94
|
| Rate for Payer: PacificSource Commercial |
$812.70
|
| Rate for Payer: PHCS PPO |
$884.94
|
| Rate for Payer: Three Rivers PPO |
$677.25
|
| Rate for Payer: TriWest Veterans Administration |
$514.71
|
| Rate for Payer: United Healthcare Commercial |
$862.36
|
| Rate for Payer: United Healthcare Medicare |
$514.71
|
| Rate for Payer: WINHealth Partners Commercial |
$884.94
|
| Rate for Payer: Wise Provider Network Commercial |
$857.85
|
|
|
DRILL BIT 2.0MM ACUMED
|
Facility
|
IP
|
$903.00
|
|
| Hospital Charge Code |
3002199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$523.29 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$884.94
|
| Rate for Payer: Aetna of WY Medicare |
$577.92
|
| Rate for Payer: Altius Commercial |
$866.88
|
| Rate for Payer: Beech Street Commercial |
$884.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$875.91
|
| Rate for Payer: Cash Price |
$632.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$875.91
|
| Rate for Payer: Cigna of WY Commercial |
$884.94
|
| Rate for Payer: Entrust Commercial |
$857.85
|
| Rate for Payer: First Choice Health Commercial |
$857.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$857.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$550.83
|
| Rate for Payer: HealthUtah PPO |
$903.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$875.91
|
| Rate for Payer: Multiplan Medicare/VA |
$523.29
|
| Rate for Payer: One Health Plan of WY PPO |
$884.94
|
| Rate for Payer: PacificSource Commercial |
$812.70
|
| Rate for Payer: PHCS PPO |
$884.94
|
| Rate for Payer: Three Rivers PPO |
$677.25
|
| Rate for Payer: TriWest Veterans Administration |
$550.83
|
| Rate for Payer: United Healthcare Commercial |
$862.36
|
| Rate for Payer: United Healthcare Medicare |
$550.83
|
| Rate for Payer: WINHealth Partners Commercial |
$857.85
|
| Rate for Payer: Wise Provider Network Commercial |
$857.85
|
|
|
DRILL BIT 2.0MM MINI-QUICK CON
|
Facility
|
IP
|
$227.50
|
|
| Hospital Charge Code |
3003910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.95
|
| Rate for Payer: Aetna of WY Medicare |
$145.60
|
| Rate for Payer: Altius Commercial |
$218.40
|
| Rate for Payer: Beech Street Commercial |
$222.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$220.68
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.68
|
| Rate for Payer: Cigna of WY Commercial |
$222.95
|
| Rate for Payer: Entrust Commercial |
$216.12
|
| Rate for Payer: First Choice Health Commercial |
$216.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.78
|
| Rate for Payer: HealthUtah PPO |
$227.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.68
|
| Rate for Payer: Multiplan Medicare/VA |
$131.84
|
| Rate for Payer: One Health Plan of WY PPO |
$222.95
|
| Rate for Payer: PacificSource Commercial |
$204.75
|
| Rate for Payer: PHCS PPO |
$222.95
|
| Rate for Payer: Three Rivers PPO |
$170.62
|
| Rate for Payer: TriWest Veterans Administration |
$138.78
|
| Rate for Payer: United Healthcare Commercial |
$217.26
|
| Rate for Payer: United Healthcare Medicare |
$138.78
|
| Rate for Payer: WINHealth Partners Commercial |
$216.12
|
| Rate for Payer: Wise Provider Network Commercial |
$216.12
|
|
|
DRILL BIT 2.0MM MINI-QUICK CON
|
Facility
|
OP
|
$227.50
|
|
| Hospital Charge Code |
3003910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.19 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.95
|
| Rate for Payer: Aetna of WY Medicare |
$150.15
|
| Rate for Payer: Altius Commercial |
$218.40
|
| Rate for Payer: Beech Street Commercial |
$222.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$220.68
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.68
|
| Rate for Payer: Cigna of WY Commercial |
$222.95
|
| Rate for Payer: Entrust Commercial |
$216.12
|
| Rate for Payer: First Choice Health Commercial |
$216.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$216.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$129.68
|
| Rate for Payer: HealthUtah PPO |
$227.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.68
|
| Rate for Payer: Multiplan Medicare/VA |
$123.19
|
| Rate for Payer: One Health Plan of WY PPO |
$222.95
|
| Rate for Payer: PacificSource Commercial |
$204.75
|
| Rate for Payer: PHCS PPO |
$222.95
|
| Rate for Payer: Three Rivers PPO |
$170.62
|
| Rate for Payer: TriWest Veterans Administration |
$129.68
|
| Rate for Payer: United Healthcare Commercial |
$217.26
|
| Rate for Payer: United Healthcare Medicare |
$129.68
|
| Rate for Payer: WINHealth Partners Commercial |
$222.95
|
| Rate for Payer: Wise Provider Network Commercial |
$216.12
|
|
|
DRILL BIT 2.0MM QUICK W/ DEPTH
|
Facility
|
IP
|
$1,137.50
|
|
| Hospital Charge Code |
3003515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$659.18 |
| Max. Negotiated Rate |
$1,137.50 |
| Rate for Payer: United Healthcare Commercial |
$1,086.31
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,114.75
|
| Rate for Payer: Aetna of WY Medicare |
$728.00
|
| Rate for Payer: Altius Commercial |
$1,092.00
|
| Rate for Payer: Beech Street Commercial |
$1,114.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,103.38
|
| Rate for Payer: Cash Price |
$796.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,103.38
|
| Rate for Payer: Cigna of WY Commercial |
$1,114.75
|
| Rate for Payer: Entrust Commercial |
$1,080.62
|
| Rate for Payer: First Choice Health Commercial |
$1,080.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,080.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$693.88
|
| Rate for Payer: HealthUtah PPO |
$1,137.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.38
|
| Rate for Payer: Multiplan Medicare/VA |
$659.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,114.75
|
| Rate for Payer: PacificSource Commercial |
$1,023.75
|
| Rate for Payer: PHCS PPO |
$1,114.75
|
| Rate for Payer: Three Rivers PPO |
$853.12
|
| Rate for Payer: TriWest Veterans Administration |
$693.88
|
| Rate for Payer: United Healthcare Medicare |
$693.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,080.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,080.62
|
|
