|
END CAP TIBIA 11.5 +15MM
|
Facility
|
OP
|
$620.27
|
|
| Hospital Charge Code |
3100746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.88 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$409.38
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.55
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$335.88
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$353.55
|
| Rate for Payer: WINHealth Partners Commercial |
$607.86
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +15MM
|
Facility
|
IP
|
$620.27
|
|
| Hospital Charge Code |
3100746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.45 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$396.97
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.36
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$359.45
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$378.36
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$378.36
|
| Rate for Payer: WINHealth Partners Commercial |
$589.26
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +20MM
|
Facility
|
IP
|
$620.27
|
|
| Hospital Charge Code |
3100747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.45 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$396.97
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.36
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$359.45
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$378.36
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$378.36
|
| Rate for Payer: WINHealth Partners Commercial |
$589.26
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +20MM
|
Facility
|
OP
|
$620.27
|
|
| Hospital Charge Code |
3100747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.88 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$409.38
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.55
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$335.88
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$353.55
|
| Rate for Payer: WINHealth Partners Commercial |
$607.86
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +25MM
|
Facility
|
IP
|
$620.27
|
|
| Hospital Charge Code |
3100748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.45 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$396.97
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.36
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$359.45
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$378.36
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$378.36
|
| Rate for Payer: WINHealth Partners Commercial |
$589.26
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +25MM
|
Facility
|
OP
|
$620.27
|
|
| Hospital Charge Code |
3100748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.88 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$409.38
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.55
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$335.88
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$353.55
|
| Rate for Payer: WINHealth Partners Commercial |
$607.86
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +5MM
|
Facility
|
OP
|
$620.27
|
|
| Hospital Charge Code |
3100744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.88 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$409.38
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.55
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$335.88
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$353.55
|
| Rate for Payer: WINHealth Partners Commercial |
$607.86
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +5MM
|
Facility
|
IP
|
$620.27
|
|
| Hospital Charge Code |
3100744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.45 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$396.97
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.36
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$359.45
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$378.36
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$378.36
|
| Rate for Payer: WINHealth Partners Commercial |
$589.26
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
ENDOBRONCHIAL TUBE LEFT 35 FR
|
Facility
|
OP
|
$163.28
|
|
| Hospital Charge Code |
2500028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.42 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$107.76
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.38
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.07
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$88.42
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$93.07
|
| Rate for Payer: United Healthcare Commercial |
$155.93
|
| Rate for Payer: United Healthcare Medicare |
$93.07
|
| Rate for Payer: WINHealth Partners Commercial |
$160.01
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 35 FR
|
Facility
|
IP
|
$163.28
|
|
| Hospital Charge Code |
2500028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.62 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$104.50
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.38
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.60
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$94.62
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$99.60
|
| Rate for Payer: United Healthcare Commercial |
$155.93
|
| Rate for Payer: United Healthcare Medicare |
$99.60
|
| Rate for Payer: WINHealth Partners Commercial |
$155.12
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 37 FR
|
Facility
|
IP
|
$163.28
|
|
| Hospital Charge Code |
2500029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.62 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$104.50
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.38
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.60
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$94.62
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$99.60
|
| Rate for Payer: United Healthcare Commercial |
$155.93
|
| Rate for Payer: United Healthcare Medicare |
$99.60
|
| Rate for Payer: WINHealth Partners Commercial |
$155.12
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 37 FR
|
Facility
|
OP
|
$163.28
|
|
| Hospital Charge Code |
2500029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.42 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$107.76
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.38
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.07
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$88.42
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$93.07
|
| Rate for Payer: United Healthcare Commercial |
$155.93
|
| Rate for Payer: United Healthcare Medicare |
$93.07
|
| Rate for Payer: WINHealth Partners Commercial |
$160.01
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 39 FR
|
Facility
|
OP
|
$163.28
|
|
| Hospital Charge Code |
2500030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.42 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$107.76
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.38
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.07
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$88.42
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$93.07
|
| Rate for Payer: United Healthcare Commercial |
$155.93
|
| Rate for Payer: United Healthcare Medicare |
$93.07
|
| Rate for Payer: WINHealth Partners Commercial |
$160.01
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 39 FR
|
Facility
|
IP
|
$163.28
|
|
| Hospital Charge Code |
2500030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.62 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$104.50
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.38
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.60
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$94.62
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$99.60
|
| Rate for Payer: United Healthcare Commercial |
$155.93
|
| Rate for Payer: United Healthcare Medicare |
$99.60
|
| Rate for Payer: WINHealth Partners Commercial |
$155.12
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$423.36
|
| Rate for Payer: Aetna of WY Medicare |
$107.00
|
| Rate for Payer: Beech Street Commercial |
$410.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$419.04
|
| Rate for Payer: Cigna of WY Commercial |
$423.36
|
| Rate for Payer: First Choice Health Commercial |
$388.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$410.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.00
|
| Rate for Payer: HealthUtah PPO |
$432.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$419.04
|
| Rate for Payer: Multiplan Medicare/VA |
$90.95
|
| Rate for Payer: One Health Plan of WY PPO |
$423.36
|
| Rate for Payer: PacificSource Commercial |
$388.80
|
| Rate for Payer: PHCS PPO |
$410.40
|
| Rate for Payer: Three Rivers PPO |
$324.00
|
| Rate for Payer: TriWest Veterans Administration |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$410.40
|
| Rate for Payer: WINHealth Partners Commercial |
$367.20
|
|
|
ENDOCLOT APPLICATOR
|
Facility
|
OP
|
$173.60
|
|
| Hospital Charge Code |
2650964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$173.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.13
|
| Rate for Payer: Aetna of WY Medicare |
$114.58
|
| Rate for Payer: Altius Commercial |
$166.66
|
| Rate for Payer: Beech Street Commercial |
$170.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.39
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.39
|
| Rate for Payer: Cigna of WY Commercial |
$170.13
|
| Rate for Payer: Entrust Commercial |
$164.92
|
| Rate for Payer: First Choice Health Commercial |
$164.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.95
|
| Rate for Payer: HealthUtah PPO |
$173.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.39
|
| Rate for Payer: Multiplan Medicare/VA |
$94.00
|
| Rate for Payer: One Health Plan of WY PPO |
$170.13
|
| Rate for Payer: PacificSource Commercial |
$156.24
|
| Rate for Payer: PHCS PPO |
$170.13
|
| Rate for Payer: Three Rivers PPO |
$130.20
|
| Rate for Payer: TriWest Veterans Administration |
$98.95
|
| Rate for Payer: United Healthcare Commercial |
$165.79
|
| Rate for Payer: United Healthcare Medicare |
$98.95
|
| Rate for Payer: WINHealth Partners Commercial |
$170.13
|
| Rate for Payer: Wise Provider Network Commercial |
$164.92
|
|
|
ENDOCLOT APPLICATOR
|
Facility
|
IP
|
$173.60
|
|
| Hospital Charge Code |
2650964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$173.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.13
|
| Rate for Payer: Aetna of WY Medicare |
$111.10
|
| Rate for Payer: Altius Commercial |
$166.66
|
| Rate for Payer: Beech Street Commercial |
$170.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$168.39
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$168.39
|
| Rate for Payer: Cigna of WY Commercial |
$170.13
|
| Rate for Payer: Entrust Commercial |
$164.92
|
| Rate for Payer: First Choice Health Commercial |
$164.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.90
|
| Rate for Payer: HealthUtah PPO |
$173.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$168.39
|
| Rate for Payer: Multiplan Medicare/VA |
$100.60
|
| Rate for Payer: One Health Plan of WY PPO |
$170.13
|
| Rate for Payer: PacificSource Commercial |
$156.24
|
| Rate for Payer: PHCS PPO |
$170.13
|
| Rate for Payer: Three Rivers PPO |
$130.20
|
| Rate for Payer: TriWest Veterans Administration |
$105.90
|
| Rate for Payer: United Healthcare Commercial |
$165.79
|
| Rate for Payer: United Healthcare Medicare |
$105.90
|
| Rate for Payer: WINHealth Partners Commercial |
$164.92
|
| Rate for Payer: Wise Provider Network Commercial |
$164.92
|
|
|
ENDOCLOT PHS 3G
|
Facility
|
IP
|
$4,200.00
|
|
| Hospital Charge Code |
2650963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.90 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,688.00
|
| Rate for Payer: Altius Commercial |
$4,032.00
|
| Rate for Payer: Beech Street Commercial |
$4,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.00
|
| Rate for Payer: Cash Price |
$2,940.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.00
|
| Rate for Payer: Entrust Commercial |
$3,990.00
|
| Rate for Payer: First Choice Health Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,562.00
|
| Rate for Payer: HealthUtah PPO |
$4,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,433.90
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.00
|
| Rate for Payer: PacificSource Commercial |
$3,780.00
|
| Rate for Payer: PHCS PPO |
$4,116.00
|
| Rate for Payer: Three Rivers PPO |
$3,150.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,562.00
|
| Rate for Payer: United Healthcare Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare Medicare |
$2,562.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,990.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,990.00
|
|
|
ENDOCLOT PHS 3G
|
Facility
|
OP
|
$4,200.00
|
|
| Hospital Charge Code |
2650963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.30 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,116.00
|
| Rate for Payer: Aetna of WY Medicare |
$2,772.00
|
| Rate for Payer: Altius Commercial |
$4,032.00
|
| Rate for Payer: Beech Street Commercial |
$4,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,074.00
|
| Rate for Payer: Cash Price |
$2,940.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,074.00
|
| Rate for Payer: Cigna of WY Commercial |
$4,116.00
|
| Rate for Payer: Entrust Commercial |
$3,990.00
|
| Rate for Payer: First Choice Health Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,990.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,394.00
|
| Rate for Payer: HealthUtah PPO |
$4,200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,074.00
|
| Rate for Payer: Multiplan Medicare/VA |
$2,274.30
|
| Rate for Payer: One Health Plan of WY PPO |
$4,116.00
|
| Rate for Payer: PacificSource Commercial |
$3,780.00
|
| Rate for Payer: PHCS PPO |
$4,116.00
|
| Rate for Payer: Three Rivers PPO |
$3,150.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,394.00
|
| Rate for Payer: United Healthcare Commercial |
$4,011.00
|
| Rate for Payer: United Healthcare Medicare |
$2,394.00
|
| Rate for Payer: WINHealth Partners Commercial |
$4,116.00
|
| Rate for Payer: Wise Provider Network Commercial |
$3,990.00
|
|
|
ENDO GIA ROT 43 3.5 030455
|
Facility
|
IP
|
$346.50
|
|
| Hospital Charge Code |
2650125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$339.57
|
| Rate for Payer: Aetna of WY Medicare |
$221.76
|
| Rate for Payer: Altius Commercial |
$332.64
|
| Rate for Payer: Beech Street Commercial |
$339.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.10
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.10
|
| Rate for Payer: Cigna of WY Commercial |
$339.57
|
| Rate for Payer: Entrust Commercial |
$329.18
|
| Rate for Payer: First Choice Health Commercial |
$329.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$211.36
|
| Rate for Payer: HealthUtah PPO |
$346.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.10
|
| Rate for Payer: Multiplan Medicare/VA |
$200.80
|
| Rate for Payer: One Health Plan of WY PPO |
$339.57
|
| Rate for Payer: PacificSource Commercial |
$311.85
|
| Rate for Payer: PHCS PPO |
$339.57
|
| Rate for Payer: Three Rivers PPO |
$259.88
|
| Rate for Payer: TriWest Veterans Administration |
$211.36
|
| Rate for Payer: United Healthcare Commercial |
$330.91
|
| Rate for Payer: United Healthcare Medicare |
$211.36
|
| Rate for Payer: WINHealth Partners Commercial |
$329.18
|
| Rate for Payer: Wise Provider Network Commercial |
$329.18
|
|
|
ENDO GIA ROT 43 3.5 030455
|
Facility
|
OP
|
$346.50
|
|
| Hospital Charge Code |
2650125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.63 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$339.57
|
| Rate for Payer: Aetna of WY Medicare |
$228.69
|
| Rate for Payer: Altius Commercial |
$332.64
|
| Rate for Payer: Beech Street Commercial |
$339.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$336.10
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$336.10
|
| Rate for Payer: Cigna of WY Commercial |
$339.57
|
| Rate for Payer: Entrust Commercial |
$329.18
|
| Rate for Payer: First Choice Health Commercial |
$329.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$329.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$197.50
|
| Rate for Payer: HealthUtah PPO |
$346.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$336.10
|
| Rate for Payer: Multiplan Medicare/VA |
$187.63
|
| Rate for Payer: One Health Plan of WY PPO |
$339.57
|
| Rate for Payer: PacificSource Commercial |
$311.85
|
| Rate for Payer: PHCS PPO |
$339.57
|
| Rate for Payer: Three Rivers PPO |
$259.88
|
| Rate for Payer: TriWest Veterans Administration |
$197.50
|
| Rate for Payer: United Healthcare Commercial |
$330.91
|
| Rate for Payer: United Healthcare Medicare |
$197.50
|
| Rate for Payer: WINHealth Partners Commercial |
$339.57
|
| Rate for Payer: Wise Provider Network Commercial |
$329.18
|
|
|
ENDO GIA UNIV 12MM 1 USE
|
Facility
|
OP
|
$443.87
|
|
| Hospital Charge Code |
2650128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.36 |
| Max. Negotiated Rate |
$443.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$434.99
|
| Rate for Payer: Aetna of WY Medicare |
$292.95
|
| Rate for Payer: Altius Commercial |
$426.12
|
| Rate for Payer: Beech Street Commercial |
$434.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$430.55
|
| Rate for Payer: Cash Price |
$310.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$430.55
|
| Rate for Payer: Cigna of WY Commercial |
$434.99
|
| Rate for Payer: Entrust Commercial |
$421.68
|
| Rate for Payer: First Choice Health Commercial |
$421.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$421.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$253.01
|
| Rate for Payer: HealthUtah PPO |
$443.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$430.55
|
| Rate for Payer: Multiplan Medicare/VA |
$240.36
|
| Rate for Payer: One Health Plan of WY PPO |
$434.99
|
| Rate for Payer: PacificSource Commercial |
$399.48
|
| Rate for Payer: PHCS PPO |
$434.99
|
| Rate for Payer: Three Rivers PPO |
$332.90
|
| Rate for Payer: TriWest Veterans Administration |
$253.01
|
| Rate for Payer: United Healthcare Commercial |
$423.90
|
| Rate for Payer: United Healthcare Medicare |
$253.01
|
| Rate for Payer: WINHealth Partners Commercial |
$434.99
|
| Rate for Payer: Wise Provider Network Commercial |
$421.68
|
|
|
ENDO GIA UNIV 12MM 1 USE
|
Facility
|
IP
|
$443.87
|
|
| Hospital Charge Code |
2650128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.22 |
| Max. Negotiated Rate |
$443.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$434.99
|
| Rate for Payer: Aetna of WY Medicare |
$284.08
|
| Rate for Payer: Altius Commercial |
$426.12
|
| Rate for Payer: Beech Street Commercial |
$434.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$430.55
|
| Rate for Payer: Cash Price |
$310.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$430.55
|
| Rate for Payer: Cigna of WY Commercial |
$434.99
|
| Rate for Payer: Entrust Commercial |
$421.68
|
| Rate for Payer: First Choice Health Commercial |
$421.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$421.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$270.76
|
| Rate for Payer: HealthUtah PPO |
$443.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$430.55
|
| Rate for Payer: Multiplan Medicare/VA |
$257.22
|
| Rate for Payer: One Health Plan of WY PPO |
$434.99
|
| Rate for Payer: PacificSource Commercial |
$399.48
|
| Rate for Payer: PHCS PPO |
$434.99
|
| Rate for Payer: Three Rivers PPO |
$332.90
|
| Rate for Payer: TriWest Veterans Administration |
$270.76
|
| Rate for Payer: United Healthcare Commercial |
$423.90
|
| Rate for Payer: United Healthcare Medicare |
$270.76
|
| Rate for Payer: WINHealth Partners Commercial |
$421.68
|
| Rate for Payer: Wise Provider Network Commercial |
$421.68
|
|
|
ENDOLOOP PDS II LIGATURE
|
Facility
|
IP
|
$94.92
|
|
| Hospital Charge Code |
2150052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.02
|
| Rate for Payer: Aetna of WY Medicare |
$60.75
|
| Rate for Payer: Altius Commercial |
$91.12
|
| Rate for Payer: Beech Street Commercial |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.07
|
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.07
|
| Rate for Payer: Cigna of WY Commercial |
$93.02
|
| Rate for Payer: Entrust Commercial |
$90.17
|
| Rate for Payer: First Choice Health Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.90
|
| Rate for Payer: HealthUtah PPO |
$94.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.07
|
| Rate for Payer: Multiplan Medicare/VA |
$55.01
|
| Rate for Payer: One Health Plan of WY PPO |
$93.02
|
| Rate for Payer: PacificSource Commercial |
$85.43
|
| Rate for Payer: PHCS PPO |
$93.02
|
| Rate for Payer: Three Rivers PPO |
$71.19
|
| Rate for Payer: TriWest Veterans Administration |
$57.90
|
| Rate for Payer: United Healthcare Commercial |
$90.65
|
| Rate for Payer: United Healthcare Medicare |
$57.90
|
| Rate for Payer: WINHealth Partners Commercial |
$90.17
|
| Rate for Payer: Wise Provider Network Commercial |
$90.17
|
|
|
ENDOLOOP PDS II LIGATURE
|
Facility
|
OP
|
$94.92
|
|
| Hospital Charge Code |
2150052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.02
|
| Rate for Payer: Aetna of WY Medicare |
$62.65
|
| Rate for Payer: Altius Commercial |
$91.12
|
| Rate for Payer: Beech Street Commercial |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.07
|
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.07
|
| Rate for Payer: Cigna of WY Commercial |
$93.02
|
| Rate for Payer: Entrust Commercial |
$90.17
|
| Rate for Payer: First Choice Health Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.10
|
| Rate for Payer: HealthUtah PPO |
$94.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.07
|
| Rate for Payer: Multiplan Medicare/VA |
$51.40
|
| Rate for Payer: One Health Plan of WY PPO |
$93.02
|
| Rate for Payer: PacificSource Commercial |
$85.43
|
| Rate for Payer: PHCS PPO |
$93.02
|
| Rate for Payer: Three Rivers PPO |
$71.19
|
| Rate for Payer: TriWest Veterans Administration |
$54.10
|
| Rate for Payer: United Healthcare Commercial |
$90.65
|
| Rate for Payer: United Healthcare Medicare |
$54.10
|
| Rate for Payer: WINHealth Partners Commercial |
$93.02
|
| Rate for Payer: Wise Provider Network Commercial |
$90.17
|
|
