|
1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$414.54
|
| Rate for Payer: Aetna of WY Medicare |
$103.83
|
| Rate for Payer: Beech Street Commercial |
$401.85
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$410.31
|
| Rate for Payer: Cigna of WY Commercial |
$414.54
|
| Rate for Payer: First Choice Health Commercial |
$380.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$401.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.83
|
| Rate for Payer: HealthUtah PPO |
$423.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$410.31
|
| Rate for Payer: Multiplan Medicare/VA |
$88.26
|
| Rate for Payer: One Health Plan of WY PPO |
$414.54
|
| Rate for Payer: PacificSource Commercial |
$380.70
|
| Rate for Payer: PHCS PPO |
$401.85
|
| Rate for Payer: Three Rivers PPO |
$317.25
|
| Rate for Payer: TriWest Veterans Administration |
$103.83
|
| Rate for Payer: United Healthcare Commercial |
$401.85
|
| Rate for Payer: WINHealth Partners Commercial |
$401.85
|
|
|
1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$141.17 |
| Max. Negotiated Rate |
$428.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.26
|
| Rate for Payer: Aetna of WY Medicare |
$166.08
|
| Rate for Payer: Beech Street Commercial |
$415.15
|
| Rate for Payer: Cash Price |
$305.90
|
| Rate for Payer: Cash Price |
$305.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$423.89
|
| Rate for Payer: Cigna of WY Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.08
|
| Rate for Payer: HealthUtah PPO |
$191.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$423.89
|
| Rate for Payer: Multiplan Medicare/VA |
$141.17
|
| Rate for Payer: One Health Plan of WY PPO |
$428.26
|
| Rate for Payer: PacificSource Commercial |
$393.30
|
| Rate for Payer: PHCS PPO |
$415.15
|
| Rate for Payer: Three Rivers PPO |
$327.75
|
| Rate for Payer: TriWest Veterans Administration |
$166.08
|
| Rate for Payer: United Healthcare Commercial |
$415.15
|
| Rate for Payer: WINHealth Partners Commercial |
$415.15
|
|
|
1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$346.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$346.92
|
| Rate for Payer: Aetna of WY Medicare |
$125.08
|
| Rate for Payer: Beech Street Commercial |
$336.30
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$343.38
|
| Rate for Payer: Cigna of WY Commercial |
$346.92
|
| Rate for Payer: First Choice Health Commercial |
$318.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$336.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.08
|
| Rate for Payer: HealthUtah PPO |
$137.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$343.38
|
| Rate for Payer: Multiplan Medicare/VA |
$106.32
|
| Rate for Payer: One Health Plan of WY PPO |
$346.92
|
| Rate for Payer: PacificSource Commercial |
$318.60
|
| Rate for Payer: PHCS PPO |
$336.30
|
| Rate for Payer: Three Rivers PPO |
$265.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.08
|
| Rate for Payer: United Healthcare Commercial |
$336.30
|
| Rate for Payer: WINHealth Partners Commercial |
$336.30
|
|
|
1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$260.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.68
|
| Rate for Payer: Aetna of WY Medicare |
$79.01
|
| Rate for Payer: Beech Street Commercial |
$252.70
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$258.02
|
| Rate for Payer: Cigna of WY Commercial |
$260.68
|
| Rate for Payer: First Choice Health Commercial |
$239.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.01
|
| Rate for Payer: HealthUtah PPO |
$82.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$258.02
|
| Rate for Payer: Multiplan Medicare/VA |
$67.16
|
| Rate for Payer: One Health Plan of WY PPO |
$260.68
|
| Rate for Payer: PacificSource Commercial |
$239.40
|
| Rate for Payer: PHCS PPO |
$252.70
|
| Rate for Payer: Three Rivers PPO |
$199.50
|
| Rate for Payer: TriWest Veterans Administration |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$252.70
|
| Rate for Payer: WINHealth Partners Commercial |
$252.70
|
|
|
1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,823.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$727.86 |
| Max. Negotiated Rate |
$1,823.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,786.54
|
| Rate for Payer: Aetna of WY Medicare |
$856.30
|
| Rate for Payer: Beech Street Commercial |
$1,731.85
|
| Rate for Payer: Cash Price |
$1,276.10
|
| Rate for Payer: Cash Price |
$1,276.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,768.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,786.54
|
| Rate for Payer: First Choice Health Commercial |
$1,640.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,731.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$856.30
|
| Rate for Payer: HealthUtah PPO |
$1,823.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,768.31
|
| Rate for Payer: Multiplan Medicare/VA |
$727.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,786.54
|
| Rate for Payer: PacificSource Commercial |
$1,640.70
|
| Rate for Payer: PHCS PPO |
$1,731.85
|
| Rate for Payer: Three Rivers PPO |
$1,367.25
|
| Rate for Payer: TriWest Veterans Administration |
$856.30
|
| Rate for Payer: United Healthcare Commercial |
$1,731.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,731.85
|
|
|
#2-0 FIBERSTICK #2-0 FIBERWIRE
|
Facility
|
IP
|
$171.71
|
|
| Hospital Charge Code |
3002724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.51 |
| Max. Negotiated Rate |
$171.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.28
|
| Rate for Payer: Aetna of WY Medicare |
$109.89
|
| Rate for Payer: Altius Commercial |
$164.84
|
| Rate for Payer: Beech Street Commercial |
$168.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.56
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.56
|
| Rate for Payer: Cigna of WY Commercial |
$168.28
|
| Rate for Payer: Entrust Commercial |
$163.12
|
| Rate for Payer: First Choice Health Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.74
|
| Rate for Payer: HealthUtah PPO |
$171.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.56
|
| Rate for Payer: Multiplan Medicare/VA |
$99.51
|
| Rate for Payer: One Health Plan of WY PPO |
$168.28
|
| Rate for Payer: PacificSource Commercial |
$154.54
|
| Rate for Payer: PHCS PPO |
$168.28
|
| Rate for Payer: Three Rivers PPO |
$128.78
|
| Rate for Payer: TriWest Veterans Administration |
$104.74
|
| Rate for Payer: United Healthcare Commercial |
$163.98
|
| Rate for Payer: United Healthcare Medicare |
$104.74
|
| Rate for Payer: WINHealth Partners Commercial |
$163.12
|
| Rate for Payer: Wise Provider Network Commercial |
$163.12
|
|
|
#2-0 FIBERSTICK #2-0 FIBERWIRE
|
Facility
|
OP
|
$171.71
|
|
| Hospital Charge Code |
3002724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.98 |
| Max. Negotiated Rate |
$171.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.28
|
| Rate for Payer: Aetna of WY Medicare |
$113.33
|
| Rate for Payer: Altius Commercial |
$164.84
|
| Rate for Payer: Beech Street Commercial |
$168.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$166.56
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.56
|
| Rate for Payer: Cigna of WY Commercial |
$168.28
|
| Rate for Payer: Entrust Commercial |
$163.12
|
| Rate for Payer: First Choice Health Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.87
|
| Rate for Payer: HealthUtah PPO |
$171.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.56
|
| Rate for Payer: Multiplan Medicare/VA |
$92.98
|
| Rate for Payer: One Health Plan of WY PPO |
$168.28
|
| Rate for Payer: PacificSource Commercial |
$154.54
|
| Rate for Payer: PHCS PPO |
$168.28
|
| Rate for Payer: Three Rivers PPO |
$128.78
|
| Rate for Payer: TriWest Veterans Administration |
$97.87
|
| Rate for Payer: United Healthcare Commercial |
$163.98
|
| Rate for Payer: United Healthcare Medicare |
$97.87
|
| Rate for Payer: WINHealth Partners Commercial |
$168.28
|
| Rate for Payer: Wise Provider Network Commercial |
$163.12
|
|
|
23GX.75" WINGSET SFTY 367342
|
Facility
|
OP
|
$5.59
|
|
| Hospital Charge Code |
2350002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.48
|
| Rate for Payer: Aetna of WY Medicare |
$3.69
|
| Rate for Payer: Altius Commercial |
$5.37
|
| Rate for Payer: Beech Street Commercial |
$5.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.42
|
| Rate for Payer: Cigna of WY Commercial |
$5.48
|
| Rate for Payer: Entrust Commercial |
$5.31
|
| Rate for Payer: First Choice Health Commercial |
$5.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.19
|
| Rate for Payer: HealthUtah PPO |
$5.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.42
|
| Rate for Payer: Multiplan Medicare/VA |
$3.03
|
| Rate for Payer: One Health Plan of WY PPO |
$5.48
|
| Rate for Payer: PacificSource Commercial |
$5.03
|
| Rate for Payer: PHCS PPO |
$5.48
|
| Rate for Payer: Three Rivers PPO |
$4.19
|
| Rate for Payer: TriWest Veterans Administration |
$3.19
|
| Rate for Payer: United Healthcare Commercial |
$5.34
|
| Rate for Payer: United Healthcare Medicare |
$3.19
|
| Rate for Payer: WINHealth Partners Commercial |
$5.48
|
| Rate for Payer: Wise Provider Network Commercial |
$5.31
|
|
|
23GX.75" WINGSET SFTY 367342
|
Facility
|
IP
|
$5.59
|
|
| Hospital Charge Code |
2350002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.48
|
| Rate for Payer: Aetna of WY Medicare |
$3.58
|
| Rate for Payer: Altius Commercial |
$5.37
|
| Rate for Payer: Beech Street Commercial |
$5.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.42
|
| Rate for Payer: Cigna of WY Commercial |
$5.48
|
| Rate for Payer: Entrust Commercial |
$5.31
|
| Rate for Payer: First Choice Health Commercial |
$5.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.41
|
| Rate for Payer: HealthUtah PPO |
$5.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.42
|
| Rate for Payer: Multiplan Medicare/VA |
$3.24
|
| Rate for Payer: One Health Plan of WY PPO |
$5.48
|
| Rate for Payer: PacificSource Commercial |
$5.03
|
| Rate for Payer: PHCS PPO |
$5.48
|
| Rate for Payer: Three Rivers PPO |
$4.19
|
| Rate for Payer: TriWest Veterans Administration |
$3.41
|
| Rate for Payer: United Healthcare Commercial |
$5.34
|
| Rate for Payer: United Healthcare Medicare |
$3.41
|
| Rate for Payer: WINHealth Partners Commercial |
$5.31
|
| Rate for Payer: Wise Provider Network Commercial |
$5.31
|
|
|
25CM 8 CONTACT EXTENSION KIT
|
Facility
|
IP
|
$2,625.00
|
|
| Hospital Charge Code |
2800252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.19 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,680.00
|
| Rate for Payer: Altius Commercial |
$2,520.00
|
| Rate for Payer: Beech Street Commercial |
$2,572.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,546.25
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: Entrust Commercial |
$2,493.75
|
| Rate for Payer: First Choice Health Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,601.25
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,521.19
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,572.50
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,601.25
|
| Rate for Payer: United Healthcare Commercial |
$2,506.88
|
| Rate for Payer: United Healthcare Medicare |
$1,601.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,493.75
|
| Rate for Payer: Wise Provider Network Commercial |
$2,493.75
|
|
|
25CM 8 CONTACT EXTENSION KIT
|
Facility
|
OP
|
$2,625.00
|
|
| Hospital Charge Code |
2800252
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.44 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,572.50
|
| Rate for Payer: Aetna of WY Medicare |
$1,732.50
|
| Rate for Payer: Altius Commercial |
$2,520.00
|
| Rate for Payer: Beech Street Commercial |
$2,572.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,546.25
|
| Rate for Payer: Cash Price |
$1,837.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,546.25
|
| Rate for Payer: Cigna of WY Commercial |
$2,572.50
|
| Rate for Payer: Entrust Commercial |
$2,493.75
|
| Rate for Payer: First Choice Health Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,493.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,496.25
|
| Rate for Payer: HealthUtah PPO |
$2,625.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,546.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,421.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2,572.50
|
| Rate for Payer: PacificSource Commercial |
$2,362.50
|
| Rate for Payer: PHCS PPO |
$2,572.50
|
| Rate for Payer: Three Rivers PPO |
$1,968.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,496.25
|
| Rate for Payer: United Healthcare Commercial |
$2,506.88
|
| Rate for Payer: United Healthcare Medicare |
$1,496.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,572.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2,493.75
|
|
|
2.5 X 800 MM GUIDE WIRE
|
Facility
|
OP
|
$964.60
|
|
| Hospital Charge Code |
3002139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.33 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$945.31
|
| Rate for Payer: Aetna of WY Medicare |
$636.64
|
| Rate for Payer: Altius Commercial |
$926.02
|
| Rate for Payer: Beech Street Commercial |
$945.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.66
|
| Rate for Payer: Cash Price |
$675.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$935.66
|
| Rate for Payer: Cigna of WY Commercial |
$945.31
|
| Rate for Payer: Entrust Commercial |
$916.37
|
| Rate for Payer: First Choice Health Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$549.82
|
| Rate for Payer: HealthUtah PPO |
$964.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$935.66
|
| Rate for Payer: Multiplan Medicare/VA |
$522.33
|
| Rate for Payer: One Health Plan of WY PPO |
$945.31
|
| Rate for Payer: PacificSource Commercial |
$868.14
|
| Rate for Payer: PHCS PPO |
$945.31
|
| Rate for Payer: Three Rivers PPO |
$723.45
|
| Rate for Payer: TriWest Veterans Administration |
$549.82
|
| Rate for Payer: United Healthcare Commercial |
$921.19
|
| Rate for Payer: United Healthcare Medicare |
$549.82
|
| Rate for Payer: WINHealth Partners Commercial |
$945.31
|
| Rate for Payer: Wise Provider Network Commercial |
$916.37
|
|
|
2.5 X 800 MM GUIDE WIRE
|
Facility
|
IP
|
$964.60
|
|
| Hospital Charge Code |
3002139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$558.99 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$945.31
|
| Rate for Payer: Aetna of WY Medicare |
$617.34
|
| Rate for Payer: Altius Commercial |
$926.02
|
| Rate for Payer: Beech Street Commercial |
$945.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$935.66
|
| Rate for Payer: Cash Price |
$675.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$935.66
|
| Rate for Payer: Cigna of WY Commercial |
$945.31
|
| Rate for Payer: Entrust Commercial |
$916.37
|
| Rate for Payer: First Choice Health Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$916.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$588.41
|
| Rate for Payer: HealthUtah PPO |
$964.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$935.66
|
| Rate for Payer: Multiplan Medicare/VA |
$558.99
|
| Rate for Payer: One Health Plan of WY PPO |
$945.31
|
| Rate for Payer: PacificSource Commercial |
$868.14
|
| Rate for Payer: PHCS PPO |
$945.31
|
| Rate for Payer: Three Rivers PPO |
$723.45
|
| Rate for Payer: TriWest Veterans Administration |
$588.41
|
| Rate for Payer: United Healthcare Commercial |
$921.19
|
| Rate for Payer: United Healthcare Medicare |
$588.41
|
| Rate for Payer: WINHealth Partners Commercial |
$916.37
|
| Rate for Payer: Wise Provider Network Commercial |
$916.37
|
|
|
#2 FIBERSTICK, #2 FIBERWIRE
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
3001638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$115.50
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.75
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.75
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$94.76
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.75
|
| Rate for Payer: United Healthcare Commercial |
$167.12
|
| Rate for Payer: United Healthcare Medicare |
$99.75
|
| Rate for Payer: WINHealth Partners Commercial |
$171.50
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
#2 FIBERSTICK, #2 FIBERWIRE
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
3001638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.50
|
| Rate for Payer: Aetna of WY Medicare |
$112.00
|
| Rate for Payer: Altius Commercial |
$168.00
|
| Rate for Payer: Beech Street Commercial |
$171.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.75
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.75
|
| Rate for Payer: Cigna of WY Commercial |
$171.50
|
| Rate for Payer: Entrust Commercial |
$166.25
|
| Rate for Payer: First Choice Health Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.75
|
| Rate for Payer: HealthUtah PPO |
$175.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.75
|
| Rate for Payer: Multiplan Medicare/VA |
$101.41
|
| Rate for Payer: One Health Plan of WY PPO |
$171.50
|
| Rate for Payer: PacificSource Commercial |
$157.50
|
| Rate for Payer: PHCS PPO |
$171.50
|
| Rate for Payer: Three Rivers PPO |
$131.25
|
| Rate for Payer: TriWest Veterans Administration |
$106.75
|
| Rate for Payer: United Healthcare Commercial |
$167.12
|
| Rate for Payer: United Healthcare Medicare |
$106.75
|
| Rate for Payer: WINHealth Partners Commercial |
$166.25
|
| Rate for Payer: Wise Provider Network Commercial |
$166.25
|
|
|
2 SYRINGE 150ML W/T-CONN&SPIKE
|
Facility
|
IP
|
$753.90
|
|
| Hospital Charge Code |
6550077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$436.89 |
| Max. Negotiated Rate |
$753.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$738.82
|
| Rate for Payer: Aetna of WY Medicare |
$482.50
|
| Rate for Payer: Altius Commercial |
$723.74
|
| Rate for Payer: Beech Street Commercial |
$738.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$731.28
|
| Rate for Payer: Cash Price |
$527.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$731.28
|
| Rate for Payer: Cigna of WY Commercial |
$738.82
|
| Rate for Payer: Entrust Commercial |
$716.20
|
| Rate for Payer: First Choice Health Commercial |
$716.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$716.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$459.88
|
| Rate for Payer: HealthUtah PPO |
$753.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$731.28
|
| Rate for Payer: Multiplan Medicare/VA |
$436.89
|
| Rate for Payer: One Health Plan of WY PPO |
$738.82
|
| Rate for Payer: PacificSource Commercial |
$678.51
|
| Rate for Payer: PHCS PPO |
$738.82
|
| Rate for Payer: Three Rivers PPO |
$565.42
|
| Rate for Payer: TriWest Veterans Administration |
$459.88
|
| Rate for Payer: United Healthcare Commercial |
$719.97
|
| Rate for Payer: United Healthcare Medicare |
$459.88
|
| Rate for Payer: WINHealth Partners Commercial |
$716.20
|
| Rate for Payer: Wise Provider Network Commercial |
$716.20
|
|
|
2 SYRINGE 150ML W/T-CONN&SPIKE
|
Facility
|
OP
|
$753.90
|
|
| Hospital Charge Code |
6550077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.24 |
| Max. Negotiated Rate |
$753.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$738.82
|
| Rate for Payer: Aetna of WY Medicare |
$497.57
|
| Rate for Payer: Altius Commercial |
$723.74
|
| Rate for Payer: Beech Street Commercial |
$738.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$731.28
|
| Rate for Payer: Cash Price |
$527.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$731.28
|
| Rate for Payer: Cigna of WY Commercial |
$738.82
|
| Rate for Payer: Entrust Commercial |
$716.20
|
| Rate for Payer: First Choice Health Commercial |
$716.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$716.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$429.72
|
| Rate for Payer: HealthUtah PPO |
$753.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$731.28
|
| Rate for Payer: Multiplan Medicare/VA |
$408.24
|
| Rate for Payer: One Health Plan of WY PPO |
$738.82
|
| Rate for Payer: PacificSource Commercial |
$678.51
|
| Rate for Payer: PHCS PPO |
$738.82
|
| Rate for Payer: Three Rivers PPO |
$565.42
|
| Rate for Payer: TriWest Veterans Administration |
$429.72
|
| Rate for Payer: United Healthcare Commercial |
$719.97
|
| Rate for Payer: United Healthcare Medicare |
$429.72
|
| Rate for Payer: WINHealth Partners Commercial |
$738.82
|
| Rate for Payer: Wise Provider Network Commercial |
$716.20
|
|
|
300 MM ROD NEURO
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
300 MM ROD NEURO
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
300 MM STRAIGHT ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
300 MM STRAIGHT ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
30 DEGREE ANGLED POST HOFFMAN
|
Facility
|
IP
|
$434.42
|
|
| Hospital Charge Code |
3100408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.75 |
| Max. Negotiated Rate |
$434.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$425.73
|
| Rate for Payer: Aetna of WY Medicare |
$278.03
|
| Rate for Payer: Altius Commercial |
$417.04
|
| Rate for Payer: Beech Street Commercial |
$425.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.39
|
| Rate for Payer: Cash Price |
$304.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.39
|
| Rate for Payer: Cigna of WY Commercial |
$425.73
|
| Rate for Payer: Entrust Commercial |
$412.70
|
| Rate for Payer: First Choice Health Commercial |
$412.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$412.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$265.00
|
| Rate for Payer: HealthUtah PPO |
$434.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.39
|
| Rate for Payer: Multiplan Medicare/VA |
$251.75
|
| Rate for Payer: One Health Plan of WY PPO |
$425.73
|
| Rate for Payer: PacificSource Commercial |
$390.98
|
| Rate for Payer: PHCS PPO |
$425.73
|
| Rate for Payer: Three Rivers PPO |
$325.82
|
| Rate for Payer: TriWest Veterans Administration |
$265.00
|
| Rate for Payer: United Healthcare Commercial |
$414.87
|
| Rate for Payer: United Healthcare Medicare |
$265.00
|
| Rate for Payer: WINHealth Partners Commercial |
$412.70
|
| Rate for Payer: Wise Provider Network Commercial |
$412.70
|
|
|
30 DEGREE ANGLED POST HOFFMAN
|
Facility
|
OP
|
$434.42
|
|
| Hospital Charge Code |
3100408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.24 |
| Max. Negotiated Rate |
$434.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$425.73
|
| Rate for Payer: Aetna of WY Medicare |
$286.72
|
| Rate for Payer: Altius Commercial |
$417.04
|
| Rate for Payer: Beech Street Commercial |
$425.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$421.39
|
| Rate for Payer: Cash Price |
$304.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$421.39
|
| Rate for Payer: Cigna of WY Commercial |
$425.73
|
| Rate for Payer: Entrust Commercial |
$412.70
|
| Rate for Payer: First Choice Health Commercial |
$412.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$412.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.62
|
| Rate for Payer: HealthUtah PPO |
$434.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$421.39
|
| Rate for Payer: Multiplan Medicare/VA |
$235.24
|
| Rate for Payer: One Health Plan of WY PPO |
$425.73
|
| Rate for Payer: PacificSource Commercial |
$390.98
|
| Rate for Payer: PHCS PPO |
$425.73
|
| Rate for Payer: Three Rivers PPO |
$325.82
|
| Rate for Payer: TriWest Veterans Administration |
$247.62
|
| Rate for Payer: United Healthcare Commercial |
$414.87
|
| Rate for Payer: United Healthcare Medicare |
$247.62
|
| Rate for Payer: WINHealth Partners Commercial |
$425.73
|
| Rate for Payer: Wise Provider Network Commercial |
$412.70
|
|
|
30 MM CURVED ROD
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
2800261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.62 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,155.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$947.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$997.50
|
| Rate for Payer: United Healthcare Medicare |
$997.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,715.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
|
30 MM CURVED ROD
|
Facility
|
IP
|
$1,750.00
|
|
| Hospital Charge Code |
2800261
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.12 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,715.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,120.00
|
| Rate for Payer: Altius Commercial |
$1,680.00
|
| Rate for Payer: Beech Street Commercial |
$1,715.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,697.50
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,697.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,715.00
|
| Rate for Payer: Entrust Commercial |
$1,662.50
|
| Rate for Payer: First Choice Health Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,662.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,067.50
|
| Rate for Payer: HealthUtah PPO |
$1,750.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,697.50
|
| Rate for Payer: Multiplan Medicare/VA |
$1,014.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,715.00
|
| Rate for Payer: PacificSource Commercial |
$1,575.00
|
| Rate for Payer: PHCS PPO |
$1,715.00
|
| Rate for Payer: Three Rivers PPO |
$1,312.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,067.50
|
| Rate for Payer: United Healthcare Commercial |
$1,671.25
|
| Rate for Payer: United Healthcare Medicare |
$1,067.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,662.50
|
|
