|
DRIVER BIT 1.5MM
|
Facility
|
OP
|
$294.00
|
|
| Hospital Charge Code |
3002949
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$288.12
|
| Rate for Payer: Aetna of WY Medicare |
$194.04
|
| Rate for Payer: Altius Commercial |
$282.24
|
| Rate for Payer: Beech Street Commercial |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$285.18
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$285.18
|
| Rate for Payer: Cigna of WY Commercial |
$288.12
|
| Rate for Payer: Entrust Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.58
|
| Rate for Payer: HealthUtah PPO |
$294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$285.18
|
| Rate for Payer: Multiplan Medicare/VA |
$159.20
|
| Rate for Payer: One Health Plan of WY PPO |
$288.12
|
| Rate for Payer: PacificSource Commercial |
$264.60
|
| Rate for Payer: PHCS PPO |
$288.12
|
| Rate for Payer: Three Rivers PPO |
$220.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.58
|
| Rate for Payer: United Healthcare Commercial |
$280.77
|
| Rate for Payer: United Healthcare Medicare |
$167.58
|
| Rate for Payer: WINHealth Partners Commercial |
$288.12
|
| Rate for Payer: Wise Provider Network Commercial |
$279.30
|
|
|
DRIVER BIT 2.0/2.5 MM
|
Facility
|
IP
|
$294.00
|
|
| Hospital Charge Code |
3003285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.37 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$288.12
|
| Rate for Payer: Aetna of WY Medicare |
$188.16
|
| Rate for Payer: Altius Commercial |
$282.24
|
| Rate for Payer: Beech Street Commercial |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$285.18
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$285.18
|
| Rate for Payer: Cigna of WY Commercial |
$288.12
|
| Rate for Payer: Entrust Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.34
|
| Rate for Payer: HealthUtah PPO |
$294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$285.18
|
| Rate for Payer: Multiplan Medicare/VA |
$170.37
|
| Rate for Payer: One Health Plan of WY PPO |
$288.12
|
| Rate for Payer: PacificSource Commercial |
$264.60
|
| Rate for Payer: PHCS PPO |
$288.12
|
| Rate for Payer: Three Rivers PPO |
$220.50
|
| Rate for Payer: TriWest Veterans Administration |
$179.34
|
| Rate for Payer: United Healthcare Commercial |
$280.77
|
| Rate for Payer: United Healthcare Medicare |
$179.34
|
| Rate for Payer: WINHealth Partners Commercial |
$279.30
|
| Rate for Payer: Wise Provider Network Commercial |
$279.30
|
|
|
DRIVER BIT 2.0/2.5 MM
|
Facility
|
OP
|
$294.00
|
|
| Hospital Charge Code |
3003285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$288.12
|
| Rate for Payer: Aetna of WY Medicare |
$194.04
|
| Rate for Payer: Altius Commercial |
$282.24
|
| Rate for Payer: Beech Street Commercial |
$288.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$285.18
|
| Rate for Payer: Cash Price |
$205.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$285.18
|
| Rate for Payer: Cigna of WY Commercial |
$288.12
|
| Rate for Payer: Entrust Commercial |
$279.30
|
| Rate for Payer: First Choice Health Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$279.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$167.58
|
| Rate for Payer: HealthUtah PPO |
$294.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$285.18
|
| Rate for Payer: Multiplan Medicare/VA |
$159.20
|
| Rate for Payer: One Health Plan of WY PPO |
$288.12
|
| Rate for Payer: PacificSource Commercial |
$264.60
|
| Rate for Payer: PHCS PPO |
$288.12
|
| Rate for Payer: Three Rivers PPO |
$220.50
|
| Rate for Payer: TriWest Veterans Administration |
$167.58
|
| Rate for Payer: United Healthcare Commercial |
$280.77
|
| Rate for Payer: United Healthcare Medicare |
$167.58
|
| Rate for Payer: WINHealth Partners Commercial |
$288.12
|
| Rate for Payer: Wise Provider Network Commercial |
$279.30
|
|
|
DRIVER BIT 2.0MM HAND OSTEOMED
|
Facility
|
IP
|
$717.50
|
|
| Hospital Charge Code |
3003840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.79 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$459.20
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.68
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$415.79
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$437.68
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$437.68
|
| Rate for Payer: WINHealth Partners Commercial |
$681.62
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
DRIVER BIT 2.0MM HAND OSTEOMED
|
Facility
|
OP
|
$717.50
|
|
| Hospital Charge Code |
3003840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.53 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$473.55
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.98
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$388.53
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$408.98
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$408.98
|
| Rate for Payer: WINHealth Partners Commercial |
$703.15
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
DRIVER BIT 2.4MM HAND FUSION
|
Facility
|
IP
|
$927.50
|
|
| Hospital Charge Code |
3003841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.49 |
| Max. Negotiated Rate |
$927.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$908.95
|
| Rate for Payer: Aetna of WY Medicare |
$593.60
|
| Rate for Payer: Altius Commercial |
$890.40
|
| Rate for Payer: Beech Street Commercial |
$908.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$899.68
|
| Rate for Payer: Cash Price |
$649.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$899.68
|
| Rate for Payer: Cigna of WY Commercial |
$908.95
|
| Rate for Payer: Entrust Commercial |
$881.12
|
| Rate for Payer: First Choice Health Commercial |
$881.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$881.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$565.78
|
| Rate for Payer: HealthUtah PPO |
$927.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$899.68
|
| Rate for Payer: Multiplan Medicare/VA |
$537.49
|
| Rate for Payer: One Health Plan of WY PPO |
$908.95
|
| Rate for Payer: PacificSource Commercial |
$834.75
|
| Rate for Payer: PHCS PPO |
$908.95
|
| Rate for Payer: Three Rivers PPO |
$695.62
|
| Rate for Payer: TriWest Veterans Administration |
$565.78
|
| Rate for Payer: United Healthcare Commercial |
$885.76
|
| Rate for Payer: United Healthcare Medicare |
$565.78
|
| Rate for Payer: WINHealth Partners Commercial |
$881.12
|
| Rate for Payer: Wise Provider Network Commercial |
$881.12
|
|
|
DRIVER BIT 2.4MM HAND FUSION
|
Facility
|
OP
|
$927.50
|
|
| Hospital Charge Code |
3003841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.24 |
| Max. Negotiated Rate |
$927.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$908.95
|
| Rate for Payer: Aetna of WY Medicare |
$612.15
|
| Rate for Payer: Altius Commercial |
$890.40
|
| Rate for Payer: Beech Street Commercial |
$908.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$899.68
|
| Rate for Payer: Cash Price |
$649.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$899.68
|
| Rate for Payer: Cigna of WY Commercial |
$908.95
|
| Rate for Payer: Entrust Commercial |
$881.12
|
| Rate for Payer: First Choice Health Commercial |
$881.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$881.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$528.68
|
| Rate for Payer: HealthUtah PPO |
$927.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$899.68
|
| Rate for Payer: Multiplan Medicare/VA |
$502.24
|
| Rate for Payer: One Health Plan of WY PPO |
$908.95
|
| Rate for Payer: PacificSource Commercial |
$834.75
|
| Rate for Payer: PHCS PPO |
$908.95
|
| Rate for Payer: Three Rivers PPO |
$695.62
|
| Rate for Payer: TriWest Veterans Administration |
$528.68
|
| Rate for Payer: United Healthcare Commercial |
$885.76
|
| Rate for Payer: United Healthcare Medicare |
$528.68
|
| Rate for Payer: WINHealth Partners Commercial |
$908.95
|
| Rate for Payer: Wise Provider Network Commercial |
$881.12
|
|
|
DRIVER BLADE ASNIS 3.0
|
Facility
|
IP
|
$595.00
|
|
| Hospital Charge Code |
3100324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: United Healthcare Commercial |
$568.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$583.10
|
| Rate for Payer: Aetna of WY Medicare |
$380.80
|
| Rate for Payer: Altius Commercial |
$571.20
|
| Rate for Payer: Beech Street Commercial |
$583.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$577.15
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$577.15
|
| Rate for Payer: Cigna of WY Commercial |
$583.10
|
| Rate for Payer: Entrust Commercial |
$565.25
|
| Rate for Payer: First Choice Health Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$362.95
|
| Rate for Payer: HealthUtah PPO |
$595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$577.15
|
| Rate for Payer: Multiplan Medicare/VA |
$344.80
|
| Rate for Payer: One Health Plan of WY PPO |
$583.10
|
| Rate for Payer: PacificSource Commercial |
$535.50
|
| Rate for Payer: PHCS PPO |
$583.10
|
| Rate for Payer: Three Rivers PPO |
$446.25
|
| Rate for Payer: TriWest Veterans Administration |
$362.95
|
| Rate for Payer: United Healthcare Medicare |
$362.95
|
| Rate for Payer: WINHealth Partners Commercial |
$565.25
|
| Rate for Payer: Wise Provider Network Commercial |
$565.25
|
|
|
DRIVER BLADE ASNIS 3.0
|
Facility
|
OP
|
$595.00
|
|
| Hospital Charge Code |
3100324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.19 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$583.10
|
| Rate for Payer: Aetna of WY Medicare |
$392.70
|
| Rate for Payer: Altius Commercial |
$571.20
|
| Rate for Payer: Beech Street Commercial |
$583.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$577.15
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$577.15
|
| Rate for Payer: Cigna of WY Commercial |
$583.10
|
| Rate for Payer: Entrust Commercial |
$565.25
|
| Rate for Payer: First Choice Health Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.15
|
| Rate for Payer: HealthUtah PPO |
$595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$577.15
|
| Rate for Payer: Multiplan Medicare/VA |
$322.19
|
| Rate for Payer: One Health Plan of WY PPO |
$583.10
|
| Rate for Payer: PacificSource Commercial |
$535.50
|
| Rate for Payer: PHCS PPO |
$583.10
|
| Rate for Payer: Three Rivers PPO |
$446.25
|
| Rate for Payer: TriWest Veterans Administration |
$339.15
|
| Rate for Payer: United Healthcare Commercial |
$568.22
|
| Rate for Payer: United Healthcare Medicare |
$339.15
|
| Rate for Payer: WINHealth Partners Commercial |
$583.10
|
| Rate for Payer: Wise Provider Network Commercial |
$565.25
|
|
|
DRIVER CANNULATED
|
Facility
|
IP
|
$1,302.00
|
|
| Hospital Charge Code |
3100266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$754.51 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,275.96
|
| Rate for Payer: Aetna of WY Medicare |
$833.28
|
| Rate for Payer: Altius Commercial |
$1,249.92
|
| Rate for Payer: Beech Street Commercial |
$1,275.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,262.94
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,262.94
|
| Rate for Payer: Cigna of WY Commercial |
$1,275.96
|
| Rate for Payer: Entrust Commercial |
$1,236.90
|
| Rate for Payer: First Choice Health Commercial |
$1,236.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,236.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$794.22
|
| Rate for Payer: HealthUtah PPO |
$1,302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,262.94
|
| Rate for Payer: Multiplan Medicare/VA |
$754.51
|
| Rate for Payer: One Health Plan of WY PPO |
$1,275.96
|
| Rate for Payer: PacificSource Commercial |
$1,171.80
|
| Rate for Payer: PHCS PPO |
$1,275.96
|
| Rate for Payer: Three Rivers PPO |
$976.50
|
| Rate for Payer: TriWest Veterans Administration |
$794.22
|
| Rate for Payer: United Healthcare Commercial |
$1,243.41
|
| Rate for Payer: United Healthcare Medicare |
$794.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1,236.90
|
| Rate for Payer: Wise Provider Network Commercial |
$1,236.90
|
|
|
DRIVER CANNULATED
|
Facility
|
OP
|
$1,302.00
|
|
| Hospital Charge Code |
3100266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.03 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,275.96
|
| Rate for Payer: Aetna of WY Medicare |
$859.32
|
| Rate for Payer: Altius Commercial |
$1,249.92
|
| Rate for Payer: Beech Street Commercial |
$1,275.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,262.94
|
| Rate for Payer: Cash Price |
$911.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,262.94
|
| Rate for Payer: Cigna of WY Commercial |
$1,275.96
|
| Rate for Payer: Entrust Commercial |
$1,236.90
|
| Rate for Payer: First Choice Health Commercial |
$1,236.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,236.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$742.14
|
| Rate for Payer: HealthUtah PPO |
$1,302.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,262.94
|
| Rate for Payer: Multiplan Medicare/VA |
$705.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,275.96
|
| Rate for Payer: PacificSource Commercial |
$1,171.80
|
| Rate for Payer: PHCS PPO |
$1,275.96
|
| Rate for Payer: Three Rivers PPO |
$976.50
|
| Rate for Payer: TriWest Veterans Administration |
$742.14
|
| Rate for Payer: United Healthcare Commercial |
$1,243.41
|
| Rate for Payer: United Healthcare Medicare |
$742.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1,275.96
|
| Rate for Payer: Wise Provider Network Commercial |
$1,236.90
|
|
|
DRIVER HEX 1.5 X 070 MM AO
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
3003598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRIVER HEX 1.5 X 070 MM AO
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
3003598
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
DRIVER HEX 2.0 X 110 MM AO
|
Facility
|
OP
|
$385.00
|
|
| Hospital Charge Code |
3002890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.48 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$254.10
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.45
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.45
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$208.48
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$219.45
|
| Rate for Payer: United Healthcare Commercial |
$367.68
|
| Rate for Payer: United Healthcare Medicare |
$219.45
|
| Rate for Payer: WINHealth Partners Commercial |
$377.30
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
DRIVER HEX 2.0 X 110 MM AO
|
Facility
|
IP
|
$385.00
|
|
| Hospital Charge Code |
3002890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.11 |
| Max. Negotiated Rate |
$385.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$377.30
|
| Rate for Payer: Aetna of WY Medicare |
$246.40
|
| Rate for Payer: Altius Commercial |
$369.60
|
| Rate for Payer: Beech Street Commercial |
$377.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$373.45
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$373.45
|
| Rate for Payer: Cigna of WY Commercial |
$377.30
|
| Rate for Payer: Entrust Commercial |
$365.75
|
| Rate for Payer: First Choice Health Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$365.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$234.85
|
| Rate for Payer: HealthUtah PPO |
$385.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$373.45
|
| Rate for Payer: Multiplan Medicare/VA |
$223.11
|
| Rate for Payer: One Health Plan of WY PPO |
$377.30
|
| Rate for Payer: PacificSource Commercial |
$346.50
|
| Rate for Payer: PHCS PPO |
$377.30
|
| Rate for Payer: Three Rivers PPO |
$288.75
|
| Rate for Payer: TriWest Veterans Administration |
$234.85
|
| Rate for Payer: United Healthcare Commercial |
$367.68
|
| Rate for Payer: United Healthcare Medicare |
$234.85
|
| Rate for Payer: WINHealth Partners Commercial |
$365.75
|
| Rate for Payer: Wise Provider Network Commercial |
$365.75
|
|
|
DRIVER HEX 2.5MM
|
Facility
|
IP
|
$308.00
|
|
| Hospital Charge Code |
4400199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$197.12
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.76
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$187.88
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$178.49
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$187.88
|
| Rate for Payer: United Healthcare Commercial |
$294.14
|
| Rate for Payer: United Healthcare Medicare |
$187.88
|
| Rate for Payer: WINHealth Partners Commercial |
$292.60
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
DRIVER HEX 2.5MM
|
Facility
|
OP
|
$308.00
|
|
| Hospital Charge Code |
4400199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$203.28
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.76
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.56
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$166.78
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$294.14
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
| Rate for Payer: WINHealth Partners Commercial |
$301.84
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
DRIVER HEX 2.5 X 110 MM AO
|
Facility
|
IP
|
$364.00
|
|
| Hospital Charge Code |
3002891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.94 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$232.96
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.08
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.04
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$210.94
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$222.04
|
| Rate for Payer: United Healthcare Commercial |
$347.62
|
| Rate for Payer: United Healthcare Medicare |
$222.04
|
| Rate for Payer: WINHealth Partners Commercial |
$345.80
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
DRIVER HEX 2.5 X 110 MM AO
|
Facility
|
OP
|
$364.00
|
|
| Hospital Charge Code |
3002891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$356.72
|
| Rate for Payer: Aetna of WY Medicare |
$240.24
|
| Rate for Payer: Altius Commercial |
$349.44
|
| Rate for Payer: Beech Street Commercial |
$356.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$353.08
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$353.08
|
| Rate for Payer: Cigna of WY Commercial |
$356.72
|
| Rate for Payer: Entrust Commercial |
$345.80
|
| Rate for Payer: First Choice Health Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$345.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.48
|
| Rate for Payer: HealthUtah PPO |
$364.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$353.08
|
| Rate for Payer: Multiplan Medicare/VA |
$197.11
|
| Rate for Payer: One Health Plan of WY PPO |
$356.72
|
| Rate for Payer: PacificSource Commercial |
$327.60
|
| Rate for Payer: PHCS PPO |
$356.72
|
| Rate for Payer: Three Rivers PPO |
$273.00
|
| Rate for Payer: TriWest Veterans Administration |
$207.48
|
| Rate for Payer: United Healthcare Commercial |
$347.62
|
| Rate for Payer: United Healthcare Medicare |
$207.48
|
| Rate for Payer: WINHealth Partners Commercial |
$356.72
|
| Rate for Payer: Wise Provider Network Commercial |
$345.80
|
|
|
DRIVER HEX 2MM SET
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
3004484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.96 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Medicare |
$508.20
|
| Rate for Payer: Altius Commercial |
$739.20
|
| Rate for Payer: Beech Street Commercial |
$754.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$746.90
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: Entrust Commercial |
$731.50
|
| Rate for Payer: First Choice Health Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.90
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$416.96
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$754.60
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$438.90
|
| Rate for Payer: United Healthcare Commercial |
$735.35
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
| Rate for Payer: WINHealth Partners Commercial |
$754.60
|
| Rate for Payer: Wise Provider Network Commercial |
$731.50
|
|
|
DRIVER HEX 2MM SET
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
3004484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.22 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$754.60
|
| Rate for Payer: Aetna of WY Medicare |
$492.80
|
| Rate for Payer: Altius Commercial |
$739.20
|
| Rate for Payer: Beech Street Commercial |
$754.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$746.90
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$746.90
|
| Rate for Payer: Cigna of WY Commercial |
$754.60
|
| Rate for Payer: Entrust Commercial |
$731.50
|
| Rate for Payer: First Choice Health Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$731.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$469.70
|
| Rate for Payer: HealthUtah PPO |
$770.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$746.90
|
| Rate for Payer: Multiplan Medicare/VA |
$446.22
|
| Rate for Payer: One Health Plan of WY PPO |
$754.60
|
| Rate for Payer: PacificSource Commercial |
$693.00
|
| Rate for Payer: PHCS PPO |
$754.60
|
| Rate for Payer: Three Rivers PPO |
$577.50
|
| Rate for Payer: TriWest Veterans Administration |
$469.70
|
| Rate for Payer: United Healthcare Commercial |
$735.35
|
| Rate for Payer: United Healthcare Medicare |
$469.70
|
| Rate for Payer: WINHealth Partners Commercial |
$731.50
|
| Rate for Payer: Wise Provider Network Commercial |
$731.50
|
|
|
DRIVER HEX 3.5MM COMP RVS
|
Facility
|
IP
|
$535.50
|
|
| Hospital Charge Code |
3004306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.32 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.79
|
| Rate for Payer: Aetna of WY Medicare |
$342.72
|
| Rate for Payer: Altius Commercial |
$514.08
|
| Rate for Payer: Beech Street Commercial |
$524.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$519.44
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$519.44
|
| Rate for Payer: Cigna of WY Commercial |
$524.79
|
| Rate for Payer: Entrust Commercial |
$508.72
|
| Rate for Payer: First Choice Health Commercial |
$508.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.66
|
| Rate for Payer: HealthUtah PPO |
$535.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$519.44
|
| Rate for Payer: Multiplan Medicare/VA |
$310.32
|
| Rate for Payer: One Health Plan of WY PPO |
$524.79
|
| Rate for Payer: PacificSource Commercial |
$481.95
|
| Rate for Payer: PHCS PPO |
$524.79
|
| Rate for Payer: Three Rivers PPO |
$401.62
|
| Rate for Payer: TriWest Veterans Administration |
$326.66
|
| Rate for Payer: United Healthcare Commercial |
$511.40
|
| Rate for Payer: United Healthcare Medicare |
$326.66
|
| Rate for Payer: WINHealth Partners Commercial |
$508.72
|
| Rate for Payer: Wise Provider Network Commercial |
$508.72
|
|
|
DRIVER HEX 3.5MM COMP RVS
|
Facility
|
OP
|
$535.50
|
|
| Hospital Charge Code |
3004306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.97 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.79
|
| Rate for Payer: Aetna of WY Medicare |
$353.43
|
| Rate for Payer: Altius Commercial |
$514.08
|
| Rate for Payer: Beech Street Commercial |
$524.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$519.44
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$519.44
|
| Rate for Payer: Cigna of WY Commercial |
$524.79
|
| Rate for Payer: Entrust Commercial |
$508.72
|
| Rate for Payer: First Choice Health Commercial |
$508.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$305.24
|
| Rate for Payer: HealthUtah PPO |
$535.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$519.44
|
| Rate for Payer: Multiplan Medicare/VA |
$289.97
|
| Rate for Payer: One Health Plan of WY PPO |
$524.79
|
| Rate for Payer: PacificSource Commercial |
$481.95
|
| Rate for Payer: PHCS PPO |
$524.79
|
| Rate for Payer: Three Rivers PPO |
$401.62
|
| Rate for Payer: TriWest Veterans Administration |
$305.24
|
| Rate for Payer: United Healthcare Commercial |
$511.40
|
| Rate for Payer: United Healthcare Medicare |
$305.24
|
| Rate for Payer: WINHealth Partners Commercial |
$524.79
|
| Rate for Payer: Wise Provider Network Commercial |
$508.72
|
|
|
DRIVER HIGH TORQUE
|
Facility
|
OP
|
$367.50
|
|
| Hospital Charge Code |
3003721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.00 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.15
|
| Rate for Payer: Aetna of WY Medicare |
$242.55
|
| Rate for Payer: Altius Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$356.48
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.48
|
| Rate for Payer: Cigna of WY Commercial |
$360.15
|
| Rate for Payer: Entrust Commercial |
$349.12
|
| Rate for Payer: First Choice Health Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$209.48
|
| Rate for Payer: HealthUtah PPO |
$367.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.48
|
| Rate for Payer: Multiplan Medicare/VA |
$199.00
|
| Rate for Payer: One Health Plan of WY PPO |
$360.15
|
| Rate for Payer: PacificSource Commercial |
$330.75
|
| Rate for Payer: PHCS PPO |
$360.15
|
| Rate for Payer: Three Rivers PPO |
$275.62
|
| Rate for Payer: TriWest Veterans Administration |
$209.48
|
| Rate for Payer: United Healthcare Commercial |
$350.96
|
| Rate for Payer: United Healthcare Medicare |
$209.48
|
| Rate for Payer: WINHealth Partners Commercial |
$360.15
|
| Rate for Payer: Wise Provider Network Commercial |
$349.12
|
|
|
DRIVER HIGH TORQUE
|
Facility
|
IP
|
$367.50
|
|
| Hospital Charge Code |
3003721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$212.97 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$360.15
|
| Rate for Payer: Aetna of WY Medicare |
$235.20
|
| Rate for Payer: Altius Commercial |
$352.80
|
| Rate for Payer: Beech Street Commercial |
$360.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$356.48
|
| Rate for Payer: Cash Price |
$257.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$356.48
|
| Rate for Payer: Cigna of WY Commercial |
$360.15
|
| Rate for Payer: Entrust Commercial |
$349.12
|
| Rate for Payer: First Choice Health Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$349.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.18
|
| Rate for Payer: HealthUtah PPO |
$367.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$356.48
|
| Rate for Payer: Multiplan Medicare/VA |
$212.97
|
| Rate for Payer: One Health Plan of WY PPO |
$360.15
|
| Rate for Payer: PacificSource Commercial |
$330.75
|
| Rate for Payer: PHCS PPO |
$360.15
|
| Rate for Payer: Three Rivers PPO |
$275.62
|
| Rate for Payer: TriWest Veterans Administration |
$224.18
|
| Rate for Payer: United Healthcare Commercial |
$350.96
|
| Rate for Payer: United Healthcare Medicare |
$224.18
|
| Rate for Payer: WINHealth Partners Commercial |
$349.12
|
| Rate for Payer: Wise Provider Network Commercial |
$349.12
|
|
