|
DRILL BIT 2.8MM X 5" ACUMED
|
Facility
|
IP
|
$451.50
|
|
| Hospital Charge Code |
3000030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.64 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$442.47
|
| Rate for Payer: Aetna of WY Medicare |
$288.96
|
| Rate for Payer: Altius Commercial |
$433.44
|
| Rate for Payer: Beech Street Commercial |
$442.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.96
|
| Rate for Payer: Cash Price |
$316.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.96
|
| Rate for Payer: Cigna of WY Commercial |
$442.47
|
| Rate for Payer: Entrust Commercial |
$428.92
|
| Rate for Payer: First Choice Health Commercial |
$428.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.42
|
| Rate for Payer: HealthUtah PPO |
$451.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.96
|
| Rate for Payer: Multiplan Medicare/VA |
$261.64
|
| Rate for Payer: One Health Plan of WY PPO |
$442.47
|
| Rate for Payer: PacificSource Commercial |
$406.35
|
| Rate for Payer: PHCS PPO |
$442.47
|
| Rate for Payer: Three Rivers PPO |
$338.62
|
| Rate for Payer: TriWest Veterans Administration |
$275.42
|
| Rate for Payer: United Healthcare Commercial |
$431.18
|
| Rate for Payer: United Healthcare Medicare |
$275.42
|
| Rate for Payer: WINHealth Partners Commercial |
$428.92
|
| Rate for Payer: Wise Provider Network Commercial |
$428.92
|
|
|
DRILL BIT 2.8MM X 5" ACUMED
|
Facility
|
OP
|
$451.50
|
|
| Hospital Charge Code |
3000030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.49 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$442.47
|
| Rate for Payer: Aetna of WY Medicare |
$297.99
|
| Rate for Payer: Altius Commercial |
$433.44
|
| Rate for Payer: Beech Street Commercial |
$442.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.96
|
| Rate for Payer: Cash Price |
$316.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.96
|
| Rate for Payer: Cigna of WY Commercial |
$442.47
|
| Rate for Payer: Entrust Commercial |
$428.92
|
| Rate for Payer: First Choice Health Commercial |
$428.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.36
|
| Rate for Payer: HealthUtah PPO |
$451.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.96
|
| Rate for Payer: Multiplan Medicare/VA |
$244.49
|
| Rate for Payer: One Health Plan of WY PPO |
$442.47
|
| Rate for Payer: PacificSource Commercial |
$406.35
|
| Rate for Payer: PHCS PPO |
$442.47
|
| Rate for Payer: Three Rivers PPO |
$338.62
|
| Rate for Payer: TriWest Veterans Administration |
$257.36
|
| Rate for Payer: United Healthcare Commercial |
$431.18
|
| Rate for Payer: United Healthcare Medicare |
$257.36
|
| Rate for Payer: WINHealth Partners Commercial |
$442.47
|
| Rate for Payer: Wise Provider Network Commercial |
$428.92
|
|
|
DRILL BIT 2.9MM CAN DEPUY
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
3000495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.78 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$537.60
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$486.78
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$512.40
|
| Rate for Payer: WINHealth Partners Commercial |
$798.00
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
DRILL BIT 2.9MM CAN DEPUY
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
3000495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.86 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$554.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$478.80
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$454.86
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$478.80
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$478.80
|
| Rate for Payer: WINHealth Partners Commercial |
$823.20
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
DRILL BIT 2X100MM QC
|
Facility
|
IP
|
$208.25
|
|
| Hospital Charge Code |
2650881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.08
|
| Rate for Payer: Aetna of WY Medicare |
$133.28
|
| Rate for Payer: Altius Commercial |
$199.92
|
| Rate for Payer: Beech Street Commercial |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$145.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.00
|
| Rate for Payer: Cigna of WY Commercial |
$204.08
|
| Rate for Payer: Entrust Commercial |
$197.84
|
| Rate for Payer: First Choice Health Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$127.03
|
| Rate for Payer: HealthUtah PPO |
$208.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.00
|
| Rate for Payer: Multiplan Medicare/VA |
$120.68
|
| Rate for Payer: One Health Plan of WY PPO |
$204.08
|
| Rate for Payer: PacificSource Commercial |
$187.42
|
| Rate for Payer: PHCS PPO |
$204.08
|
| Rate for Payer: Three Rivers PPO |
$156.19
|
| Rate for Payer: TriWest Veterans Administration |
$127.03
|
| Rate for Payer: United Healthcare Commercial |
$198.88
|
| Rate for Payer: United Healthcare Medicare |
$127.03
|
| Rate for Payer: WINHealth Partners Commercial |
$197.84
|
| Rate for Payer: Wise Provider Network Commercial |
$197.84
|
|
|
DRILL BIT 2X100MM QC
|
Facility
|
OP
|
$208.25
|
|
| Hospital Charge Code |
2650881
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.77 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.08
|
| Rate for Payer: Aetna of WY Medicare |
$137.44
|
| Rate for Payer: Altius Commercial |
$199.92
|
| Rate for Payer: Beech Street Commercial |
$204.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$202.00
|
| Rate for Payer: Cash Price |
$145.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.00
|
| Rate for Payer: Cigna of WY Commercial |
$204.08
|
| Rate for Payer: Entrust Commercial |
$197.84
|
| Rate for Payer: First Choice Health Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.70
|
| Rate for Payer: HealthUtah PPO |
$208.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.00
|
| Rate for Payer: Multiplan Medicare/VA |
$112.77
|
| Rate for Payer: One Health Plan of WY PPO |
$204.08
|
| Rate for Payer: PacificSource Commercial |
$187.42
|
| Rate for Payer: PHCS PPO |
$204.08
|
| Rate for Payer: Three Rivers PPO |
$156.19
|
| Rate for Payer: TriWest Veterans Administration |
$118.70
|
| Rate for Payer: United Healthcare Commercial |
$198.88
|
| Rate for Payer: United Healthcare Medicare |
$118.70
|
| Rate for Payer: WINHealth Partners Commercial |
$204.08
|
| Rate for Payer: Wise Provider Network Commercial |
$197.84
|
|
|
DRILL BIT 3.0MM AR-8970-30
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
3002448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.57 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$450.45
|
| 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 |
$389.02
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$369.57
|
| 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 |
$389.02
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$389.02
|
| Rate for Payer: WINHealth Partners Commercial |
$668.85
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
DRILL BIT 3.0MM AR-8970-30
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
3002448
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| 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 Medicare |
$416.32
|
| Rate for Payer: WINHealth Partners Commercial |
$648.38
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
DRILL BIT 3.1 X 204MM
|
Facility
|
OP
|
$364.42
|
|
| Hospital Charge Code |
3100070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.33 |
| Max. Negotiated Rate |
$364.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.13
|
| Rate for Payer: Aetna of WY Medicare |
$240.52
|
| Rate for Payer: Altius Commercial |
$349.84
|
| Rate for Payer: Beech Street Commercial |
$357.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.49
|
| Rate for Payer: Cash Price |
$255.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.49
|
| Rate for Payer: Cigna of WY Commercial |
$357.13
|
| Rate for Payer: Entrust Commercial |
$346.20
|
| Rate for Payer: First Choice Health Commercial |
$346.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.72
|
| Rate for Payer: HealthUtah PPO |
$364.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.49
|
| Rate for Payer: Multiplan Medicare/VA |
$197.33
|
| Rate for Payer: One Health Plan of WY PPO |
$357.13
|
| Rate for Payer: PacificSource Commercial |
$327.98
|
| Rate for Payer: PHCS PPO |
$357.13
|
| Rate for Payer: Three Rivers PPO |
$273.32
|
| Rate for Payer: TriWest Veterans Administration |
$207.72
|
| Rate for Payer: United Healthcare Commercial |
$348.02
|
| Rate for Payer: United Healthcare Medicare |
$207.72
|
| Rate for Payer: WINHealth Partners Commercial |
$357.13
|
| Rate for Payer: Wise Provider Network Commercial |
$346.20
|
|
|
DRILL BIT 3.1 X 204MM
|
Facility
|
IP
|
$364.42
|
|
| Hospital Charge Code |
3100070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.18 |
| Max. Negotiated Rate |
$364.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.13
|
| Rate for Payer: Aetna of WY Medicare |
$233.23
|
| Rate for Payer: Altius Commercial |
$349.84
|
| Rate for Payer: Beech Street Commercial |
$357.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.49
|
| Rate for Payer: Cash Price |
$255.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.49
|
| Rate for Payer: Cigna of WY Commercial |
$357.13
|
| Rate for Payer: Entrust Commercial |
$346.20
|
| Rate for Payer: First Choice Health Commercial |
$346.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.30
|
| Rate for Payer: HealthUtah PPO |
$364.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.49
|
| Rate for Payer: Multiplan Medicare/VA |
$211.18
|
| Rate for Payer: One Health Plan of WY PPO |
$357.13
|
| Rate for Payer: PacificSource Commercial |
$327.98
|
| Rate for Payer: PHCS PPO |
$357.13
|
| Rate for Payer: Three Rivers PPO |
$273.32
|
| Rate for Payer: TriWest Veterans Administration |
$222.30
|
| Rate for Payer: United Healthcare Commercial |
$348.02
|
| Rate for Payer: United Healthcare Medicare |
$222.30
|
| Rate for Payer: WINHealth Partners Commercial |
$346.20
|
| Rate for Payer: Wise Provider Network Commercial |
$346.20
|
|
|
DRILL BIT 3.2/150 TRIMED
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
3003976
|
|
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 3.2/150 TRIMED
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
3003976
|
|
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 3.2 AO
|
Facility
|
IP
|
$450.73
|
|
| Hospital Charge Code |
3100255
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$450.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.72
|
| Rate for Payer: Aetna of WY Medicare |
$288.47
|
| Rate for Payer: Altius Commercial |
$432.70
|
| Rate for Payer: Beech Street Commercial |
$441.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$315.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.21
|
| Rate for Payer: Cigna of WY Commercial |
$441.72
|
| Rate for Payer: Entrust Commercial |
$428.19
|
| Rate for Payer: First Choice Health Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$274.95
|
| Rate for Payer: HealthUtah PPO |
$450.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.21
|
| Rate for Payer: Multiplan Medicare/VA |
$261.20
|
| Rate for Payer: One Health Plan of WY PPO |
$441.72
|
| Rate for Payer: PacificSource Commercial |
$405.66
|
| Rate for Payer: PHCS PPO |
$441.72
|
| Rate for Payer: Three Rivers PPO |
$338.05
|
| Rate for Payer: TriWest Veterans Administration |
$274.95
|
| Rate for Payer: United Healthcare Commercial |
$430.45
|
| Rate for Payer: United Healthcare Medicare |
$274.95
|
| Rate for Payer: WINHealth Partners Commercial |
$428.19
|
| Rate for Payer: Wise Provider Network Commercial |
$428.19
|
|
|
DRILL BIT 3.2 AO
|
Facility
|
OP
|
$450.73
|
|
| Hospital Charge Code |
3100255
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.07 |
| Max. Negotiated Rate |
$450.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.72
|
| Rate for Payer: Aetna of WY Medicare |
$297.48
|
| Rate for Payer: Altius Commercial |
$432.70
|
| Rate for Payer: Beech Street Commercial |
$441.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.21
|
| Rate for Payer: Cash Price |
$315.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.21
|
| Rate for Payer: Cigna of WY Commercial |
$441.72
|
| Rate for Payer: Entrust Commercial |
$428.19
|
| Rate for Payer: First Choice Health Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.92
|
| Rate for Payer: HealthUtah PPO |
$450.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.21
|
| Rate for Payer: Multiplan Medicare/VA |
$244.07
|
| Rate for Payer: One Health Plan of WY PPO |
$441.72
|
| Rate for Payer: PacificSource Commercial |
$405.66
|
| Rate for Payer: PHCS PPO |
$441.72
|
| Rate for Payer: Three Rivers PPO |
$338.05
|
| Rate for Payer: TriWest Veterans Administration |
$256.92
|
| Rate for Payer: United Healthcare Commercial |
$430.45
|
| Rate for Payer: United Healthcare Medicare |
$256.92
|
| Rate for Payer: WINHealth Partners Commercial |
$441.72
|
| Rate for Payer: Wise Provider Network Commercial |
$428.19
|
|
|
DRILL BIT 3.2MM AR-8737-50
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
3002301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.57 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$450.45
|
| 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 |
$389.02
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$369.57
|
| 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 |
$389.02
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$389.02
|
| Rate for Payer: WINHealth Partners Commercial |
$668.85
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
DRILL BIT 3.2MM AR-8737-50
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
3002301
|
|
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
|
|
|
DRILL BIT 3.2 MM CALIBRATED
|
Facility
|
OP
|
$665.00
|
|
| Hospital Charge Code |
3003055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.10 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$645.05
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$379.05
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$360.10
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$379.05
|
| Rate for Payer: United Healthcare Commercial |
$635.08
|
| Rate for Payer: United Healthcare Medicare |
$379.05
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
DRILL BIT 3.2 MM CALIBRATED
|
Facility
|
IP
|
$665.00
|
|
| Hospital Charge Code |
3003055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.37 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$425.60
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$645.05
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$405.65
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$385.37
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$405.65
|
| Rate for Payer: United Healthcare Commercial |
$635.08
|
| Rate for Payer: United Healthcare Medicare |
$405.65
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
DRILL BIT 3.2MM EXACTECH
|
Facility
|
IP
|
$1,137.50
|
|
| Hospital Charge Code |
3004506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.18 |
| Max. Negotiated Rate |
$1,137.50 |
| 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 Commercial |
$1,086.31
|
| 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
|
|
|
DRILL BIT 3.2MM EXACTECH
|
Facility
|
OP
|
$1,137.50
|
|
| Hospital Charge Code |
3004506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.96 |
| Max. Negotiated Rate |
$1,137.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,114.75
|
| Rate for Payer: Aetna of WY Medicare |
$750.75
|
| 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 |
$648.38
|
| Rate for Payer: HealthUtah PPO |
$1,137.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,103.38
|
| Rate for Payer: Multiplan Medicare/VA |
$615.96
|
| 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 |
$648.38
|
| Rate for Payer: United Healthcare Commercial |
$1,086.31
|
| Rate for Payer: United Healthcare Medicare |
$648.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,114.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,080.62
|
|
|
DRILL BIT 3.2MM HOFFMAN
|
Facility
|
IP
|
$254.03
|
|
| Hospital Charge Code |
3100705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.21 |
| Max. Negotiated Rate |
$254.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$248.95
|
| Rate for Payer: Aetna of WY Medicare |
$162.58
|
| Rate for Payer: Altius Commercial |
$243.87
|
| Rate for Payer: Beech Street Commercial |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.41
|
| Rate for Payer: Cash Price |
$177.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$246.41
|
| Rate for Payer: Cigna of WY Commercial |
$248.95
|
| Rate for Payer: Entrust Commercial |
$241.33
|
| Rate for Payer: First Choice Health Commercial |
$241.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$241.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.96
|
| Rate for Payer: HealthUtah PPO |
$254.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$246.41
|
| Rate for Payer: Multiplan Medicare/VA |
$147.21
|
| Rate for Payer: One Health Plan of WY PPO |
$248.95
|
| Rate for Payer: PacificSource Commercial |
$228.63
|
| Rate for Payer: PHCS PPO |
$248.95
|
| Rate for Payer: Three Rivers PPO |
$190.52
|
| Rate for Payer: TriWest Veterans Administration |
$154.96
|
| Rate for Payer: United Healthcare Commercial |
$242.60
|
| Rate for Payer: United Healthcare Medicare |
$154.96
|
| Rate for Payer: WINHealth Partners Commercial |
$241.33
|
| Rate for Payer: Wise Provider Network Commercial |
$241.33
|
|
|
DRILL BIT 3.2MM HOFFMAN
|
Facility
|
OP
|
$254.03
|
|
| Hospital Charge Code |
3100705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$254.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$248.95
|
| Rate for Payer: Aetna of WY Medicare |
$167.66
|
| Rate for Payer: Altius Commercial |
$243.87
|
| Rate for Payer: Beech Street Commercial |
$248.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$246.41
|
| Rate for Payer: Cash Price |
$177.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$246.41
|
| Rate for Payer: Cigna of WY Commercial |
$248.95
|
| Rate for Payer: Entrust Commercial |
$241.33
|
| Rate for Payer: First Choice Health Commercial |
$241.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$241.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.80
|
| Rate for Payer: HealthUtah PPO |
$254.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$246.41
|
| Rate for Payer: Multiplan Medicare/VA |
$137.56
|
| Rate for Payer: One Health Plan of WY PPO |
$248.95
|
| Rate for Payer: PacificSource Commercial |
$228.63
|
| Rate for Payer: PHCS PPO |
$248.95
|
| Rate for Payer: Three Rivers PPO |
$190.52
|
| Rate for Payer: TriWest Veterans Administration |
$144.80
|
| Rate for Payer: United Healthcare Commercial |
$242.60
|
| Rate for Payer: United Healthcare Medicare |
$144.80
|
| Rate for Payer: WINHealth Partners Commercial |
$248.95
|
| Rate for Payer: Wise Provider Network Commercial |
$241.33
|
|
|
DRILL BIT 3.2 T2 KIDS
|
Facility
|
OP
|
$196.56
|
|
| Hospital Charge Code |
3002319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.44 |
| Max. Negotiated Rate |
$196.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$192.63
|
| Rate for Payer: Aetna of WY Medicare |
$129.73
|
| Rate for Payer: Altius Commercial |
$188.70
|
| Rate for Payer: Beech Street Commercial |
$192.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$190.66
|
| Rate for Payer: Cash Price |
$137.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$190.66
|
| Rate for Payer: Cigna of WY Commercial |
$192.63
|
| Rate for Payer: Entrust Commercial |
$186.73
|
| Rate for Payer: First Choice Health Commercial |
$186.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$186.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.04
|
| Rate for Payer: HealthUtah PPO |
$196.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$190.66
|
| Rate for Payer: Multiplan Medicare/VA |
$106.44
|
| Rate for Payer: One Health Plan of WY PPO |
$192.63
|
| Rate for Payer: PacificSource Commercial |
$176.90
|
| Rate for Payer: PHCS PPO |
$192.63
|
| Rate for Payer: Three Rivers PPO |
$147.42
|
| Rate for Payer: TriWest Veterans Administration |
$112.04
|
| Rate for Payer: United Healthcare Commercial |
$187.71
|
| Rate for Payer: United Healthcare Medicare |
$112.04
|
| Rate for Payer: WINHealth Partners Commercial |
$192.63
|
| Rate for Payer: Wise Provider Network Commercial |
$186.73
|
|
|
DRILL BIT 3.2 T2 KIDS
|
Facility
|
IP
|
$196.56
|
|
| Hospital Charge Code |
3002319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.91 |
| Max. Negotiated Rate |
$196.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$192.63
|
| Rate for Payer: Aetna of WY Medicare |
$125.80
|
| Rate for Payer: Altius Commercial |
$188.70
|
| Rate for Payer: Beech Street Commercial |
$192.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$190.66
|
| Rate for Payer: Cash Price |
$137.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$190.66
|
| Rate for Payer: Cigna of WY Commercial |
$192.63
|
| Rate for Payer: Entrust Commercial |
$186.73
|
| Rate for Payer: First Choice Health Commercial |
$186.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$186.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.90
|
| Rate for Payer: HealthUtah PPO |
$196.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$190.66
|
| Rate for Payer: Multiplan Medicare/VA |
$113.91
|
| Rate for Payer: One Health Plan of WY PPO |
$192.63
|
| Rate for Payer: PacificSource Commercial |
$176.90
|
| Rate for Payer: PHCS PPO |
$192.63
|
| Rate for Payer: Three Rivers PPO |
$147.42
|
| Rate for Payer: TriWest Veterans Administration |
$119.90
|
| Rate for Payer: United Healthcare Commercial |
$187.71
|
| Rate for Payer: United Healthcare Medicare |
$119.90
|
| Rate for Payer: WINHealth Partners Commercial |
$186.73
|
| Rate for Payer: Wise Provider Network Commercial |
$186.73
|
|
|
DRILLBIT 3.2X145 AO
|
Facility
|
IP
|
$417.83
|
|
| Hospital Charge Code |
3200009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.13 |
| Max. Negotiated Rate |
$417.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$409.47
|
| Rate for Payer: Aetna of WY Medicare |
$267.41
|
| Rate for Payer: Altius Commercial |
$401.12
|
| Rate for Payer: Beech Street Commercial |
$409.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$405.30
|
| Rate for Payer: Cash Price |
$292.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$405.30
|
| Rate for Payer: Cigna of WY Commercial |
$409.47
|
| Rate for Payer: Entrust Commercial |
$396.94
|
| Rate for Payer: First Choice Health Commercial |
$396.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$396.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$254.88
|
| Rate for Payer: HealthUtah PPO |
$417.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$405.30
|
| Rate for Payer: Multiplan Medicare/VA |
$242.13
|
| Rate for Payer: One Health Plan of WY PPO |
$409.47
|
| Rate for Payer: PacificSource Commercial |
$376.05
|
| Rate for Payer: PHCS PPO |
$409.47
|
| Rate for Payer: Three Rivers PPO |
$313.37
|
| Rate for Payer: TriWest Veterans Administration |
$254.88
|
| Rate for Payer: United Healthcare Commercial |
$399.03
|
| Rate for Payer: United Healthcare Medicare |
$254.88
|
| Rate for Payer: WINHealth Partners Commercial |
$396.94
|
| Rate for Payer: Wise Provider Network Commercial |
$396.94
|
|
