|
ANCHORS BONE 3 W/ DEL SYSTEM
|
Facility
|
OP
|
$3,325.00
|
|
| Hospital Charge Code |
3003002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.49 |
| Max. Negotiated Rate |
$3,325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,258.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,194.50
|
| Rate for Payer: Altius Commercial |
$3,192.00
|
| Rate for Payer: Beech Street Commercial |
$3,258.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,225.25
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,225.25
|
| Rate for Payer: Cigna of WY Commercial |
$3,258.50
|
| Rate for Payer: Entrust Commercial |
$3,158.75
|
| Rate for Payer: First Choice Health Commercial |
$3,158.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,158.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,895.25
|
| Rate for Payer: HealthUtah PPO |
$3,325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,225.25
|
| Rate for Payer: Multiplan Medicare/VA |
$1,800.49
|
| Rate for Payer: One Health Plan of WY PPO |
$3,258.50
|
| Rate for Payer: PacificSource Commercial |
$2,992.50
|
| Rate for Payer: PHCS PPO |
$3,258.50
|
| Rate for Payer: Three Rivers PPO |
$2,493.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,895.25
|
| Rate for Payer: United Healthcare Commercial |
$3,175.38
|
| Rate for Payer: United Healthcare Medicare |
$1,895.25
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,158.75
|
|
|
ANCHORS TENDON 8
|
Facility
|
OP
|
$2,498.26
|
|
| Hospital Charge Code |
3003003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,352.81 |
| Max. Negotiated Rate |
$2,498.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,448.29
|
| Rate for Payer: Aetna of WY Medicare |
$1,648.85
|
| Rate for Payer: Altius Commercial |
$2,398.33
|
| Rate for Payer: Beech Street Commercial |
$2,448.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,423.31
|
| Rate for Payer: Cash Price |
$1,748.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,423.31
|
| Rate for Payer: Cigna of WY Commercial |
$2,448.29
|
| Rate for Payer: Entrust Commercial |
$2,373.35
|
| Rate for Payer: First Choice Health Commercial |
$2,373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,424.01
|
| Rate for Payer: HealthUtah PPO |
$2,498.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,423.31
|
| Rate for Payer: Multiplan Medicare/VA |
$1,352.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,448.29
|
| Rate for Payer: PacificSource Commercial |
$2,248.43
|
| Rate for Payer: PHCS PPO |
$2,448.29
|
| Rate for Payer: Three Rivers PPO |
$1,873.70
|
| Rate for Payer: TriWest Veterans Administration |
$1,424.01
|
| Rate for Payer: United Healthcare Commercial |
$2,385.84
|
| Rate for Payer: United Healthcare Medicare |
$1,424.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,448.29
|
| Rate for Payer: Wise Provider Network Commercial |
$2,373.35
|
|
|
ANCHORS TENDON 8
|
Facility
|
IP
|
$2,498.26
|
|
| Hospital Charge Code |
3003003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,447.74 |
| Max. Negotiated Rate |
$2,498.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,448.29
|
| Rate for Payer: Aetna of WY Medicare |
$1,598.89
|
| Rate for Payer: Altius Commercial |
$2,398.33
|
| Rate for Payer: Beech Street Commercial |
$2,448.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,423.31
|
| Rate for Payer: Cash Price |
$1,748.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,423.31
|
| Rate for Payer: Cigna of WY Commercial |
$2,448.29
|
| Rate for Payer: Entrust Commercial |
$2,373.35
|
| Rate for Payer: First Choice Health Commercial |
$2,373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,373.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,523.94
|
| Rate for Payer: HealthUtah PPO |
$2,498.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,423.31
|
| Rate for Payer: Multiplan Medicare/VA |
$1,447.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,448.29
|
| Rate for Payer: PacificSource Commercial |
$2,248.43
|
| Rate for Payer: PHCS PPO |
$2,448.29
|
| Rate for Payer: Three Rivers PPO |
$1,873.70
|
| Rate for Payer: TriWest Veterans Administration |
$1,523.94
|
| Rate for Payer: United Healthcare Commercial |
$2,385.84
|
| Rate for Payer: United Healthcare Medicare |
$1,523.94
|
| Rate for Payer: WINHealth Partners Commercial |
$2,373.35
|
| Rate for Payer: Wise Provider Network Commercial |
$2,373.35
|
|
|
ANCHOR SUT FIBERTAK #1FW & NDL
|
Facility
|
OP
|
$1,487.50
|
|
| Hospital Charge Code |
3005564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$805.48 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,457.75
|
| Rate for Payer: Aetna of WY Medicare |
$981.75
|
| Rate for Payer: Altius Commercial |
$1,428.00
|
| Rate for Payer: Beech Street Commercial |
$1,457.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,442.88
|
| Rate for Payer: Cash Price |
$1,041.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,442.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,457.75
|
| Rate for Payer: Entrust Commercial |
$1,413.12
|
| Rate for Payer: First Choice Health Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$847.88
|
| Rate for Payer: HealthUtah PPO |
$1,487.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,442.88
|
| Rate for Payer: Multiplan Medicare/VA |
$805.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,457.75
|
| Rate for Payer: PacificSource Commercial |
$1,338.75
|
| Rate for Payer: PHCS PPO |
$1,457.75
|
| Rate for Payer: Three Rivers PPO |
$1,115.62
|
| Rate for Payer: TriWest Veterans Administration |
$847.88
|
| Rate for Payer: United Healthcare Commercial |
$1,420.56
|
| Rate for Payer: United Healthcare Medicare |
$847.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,457.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,413.12
|
|
|
ANCHOR SUT FIBERTAK #1FW & NDL
|
Facility
|
IP
|
$1,487.50
|
|
| Hospital Charge Code |
3005564
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.01 |
| Max. Negotiated Rate |
$1,487.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,457.75
|
| Rate for Payer: Aetna of WY Medicare |
$952.00
|
| Rate for Payer: Altius Commercial |
$1,428.00
|
| Rate for Payer: Beech Street Commercial |
$1,457.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,442.88
|
| Rate for Payer: Cash Price |
$1,041.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,442.88
|
| Rate for Payer: Cigna of WY Commercial |
$1,457.75
|
| Rate for Payer: Entrust Commercial |
$1,413.12
|
| Rate for Payer: First Choice Health Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,413.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$907.38
|
| Rate for Payer: HealthUtah PPO |
$1,487.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,442.88
|
| Rate for Payer: Multiplan Medicare/VA |
$862.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,457.75
|
| Rate for Payer: PacificSource Commercial |
$1,338.75
|
| Rate for Payer: PHCS PPO |
$1,457.75
|
| Rate for Payer: Three Rivers PPO |
$1,115.62
|
| Rate for Payer: TriWest Veterans Administration |
$907.38
|
| Rate for Payer: United Healthcare Commercial |
$1,420.56
|
| Rate for Payer: United Healthcare Medicare |
$907.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1,413.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,413.12
|
|
|
ANCHOR SUTURE FIBERTAK DX
|
Facility
|
IP
|
$1,627.50
|
|
| Hospital Charge Code |
3003426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$943.14 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,594.95
|
| Rate for Payer: Aetna of WY Medicare |
$1,041.60
|
| Rate for Payer: Altius Commercial |
$1,562.40
|
| Rate for Payer: Beech Street Commercial |
$1,594.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,578.68
|
| Rate for Payer: Cash Price |
$1,139.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,578.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,594.95
|
| Rate for Payer: Entrust Commercial |
$1,546.12
|
| Rate for Payer: First Choice Health Commercial |
$1,546.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,546.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$992.78
|
| Rate for Payer: HealthUtah PPO |
$1,627.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,578.68
|
| Rate for Payer: Multiplan Medicare/VA |
$943.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,594.95
|
| Rate for Payer: PacificSource Commercial |
$1,464.75
|
| Rate for Payer: PHCS PPO |
$1,594.95
|
| Rate for Payer: Three Rivers PPO |
$1,220.62
|
| Rate for Payer: TriWest Veterans Administration |
$992.78
|
| Rate for Payer: United Healthcare Commercial |
$1,554.26
|
| Rate for Payer: United Healthcare Medicare |
$992.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,546.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,546.12
|
|
|
ANCHOR SUTURE FIBERTAK DX
|
Facility
|
OP
|
$1,627.50
|
|
| Hospital Charge Code |
3003426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.29 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,594.95
|
| Rate for Payer: Aetna of WY Medicare |
$1,074.15
|
| Rate for Payer: Altius Commercial |
$1,562.40
|
| Rate for Payer: Beech Street Commercial |
$1,594.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,578.68
|
| Rate for Payer: Cash Price |
$1,139.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,578.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,594.95
|
| Rate for Payer: Entrust Commercial |
$1,546.12
|
| Rate for Payer: First Choice Health Commercial |
$1,546.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,546.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$927.68
|
| Rate for Payer: HealthUtah PPO |
$1,627.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,578.68
|
| Rate for Payer: Multiplan Medicare/VA |
$881.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,594.95
|
| Rate for Payer: PacificSource Commercial |
$1,464.75
|
| Rate for Payer: PHCS PPO |
$1,594.95
|
| Rate for Payer: Three Rivers PPO |
$1,220.62
|
| Rate for Payer: TriWest Veterans Administration |
$927.68
|
| Rate for Payer: United Healthcare Commercial |
$1,554.26
|
| Rate for Payer: United Healthcare Medicare |
$927.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,594.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,546.12
|
|
|
ANCHOR TISSUETAK TENDON
|
Facility
|
IP
|
$3,062.50
|
|
| Hospital Charge Code |
3004119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,774.72 |
| Max. Negotiated Rate |
$3,062.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,001.25
|
| Rate for Payer: Aetna of WY Medicare |
$1,960.00
|
| Rate for Payer: Altius Commercial |
$2,940.00
|
| Rate for Payer: Beech Street Commercial |
$3,001.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,970.62
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,970.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,001.25
|
| Rate for Payer: Entrust Commercial |
$2,909.38
|
| Rate for Payer: First Choice Health Commercial |
$2,909.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,909.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,868.12
|
| Rate for Payer: HealthUtah PPO |
$3,062.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,970.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,774.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3,001.25
|
| Rate for Payer: PacificSource Commercial |
$2,756.25
|
| Rate for Payer: PHCS PPO |
$3,001.25
|
| Rate for Payer: Three Rivers PPO |
$2,296.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,868.12
|
| Rate for Payer: United Healthcare Commercial |
$2,924.69
|
| Rate for Payer: United Healthcare Medicare |
$1,868.12
|
| Rate for Payer: WINHealth Partners Commercial |
$2,909.38
|
| Rate for Payer: Wise Provider Network Commercial |
$2,909.38
|
|
|
ANCHOR TISSUETAK TENDON
|
Facility
|
OP
|
$3,062.50
|
|
| Hospital Charge Code |
3004119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.34 |
| Max. Negotiated Rate |
$3,062.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,001.25
|
| Rate for Payer: Aetna of WY Medicare |
$2,021.25
|
| Rate for Payer: Altius Commercial |
$2,940.00
|
| Rate for Payer: Beech Street Commercial |
$3,001.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,970.62
|
| Rate for Payer: Cash Price |
$2,143.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,970.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,001.25
|
| Rate for Payer: Entrust Commercial |
$2,909.38
|
| Rate for Payer: First Choice Health Commercial |
$2,909.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,909.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,745.62
|
| Rate for Payer: HealthUtah PPO |
$3,062.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,970.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1,658.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,001.25
|
| Rate for Payer: PacificSource Commercial |
$2,756.25
|
| Rate for Payer: PHCS PPO |
$3,001.25
|
| Rate for Payer: Three Rivers PPO |
$2,296.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,745.62
|
| Rate for Payer: United Healthcare Commercial |
$2,924.69
|
| Rate for Payer: United Healthcare Medicare |
$1,745.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,001.25
|
| Rate for Payer: Wise Provider Network Commercial |
$2,909.38
|
|
|
ANES COMP BY EMERGENCY CONDITIONS SPECIFY
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 99140
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Beech Street Commercial |
$197.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: First Choice Health Commercial |
$187.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$197.60
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$197.60
|
| Rate for Payer: WINHealth Partners Commercial |
$197.60
|
|
|
ANESTHESIA EXTREME AGE PATIENT<1 YR&>70
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 99100
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Beech Street Commercial |
$197.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: First Choice Health Commercial |
$187.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$197.60
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: United Healthcare Commercial |
$197.60
|
| Rate for Payer: WINHealth Partners Commercial |
$197.60
|
|
|
ANEST SET SMALL BORE 11088483
|
Facility
|
OP
|
$6.20
|
|
| Hospital Charge Code |
2500023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.08
|
| Rate for Payer: Aetna of WY Medicare |
$4.09
|
| Rate for Payer: Altius Commercial |
$5.95
|
| Rate for Payer: Beech Street Commercial |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.01
|
| Rate for Payer: Cigna of WY Commercial |
$6.08
|
| Rate for Payer: Entrust Commercial |
$5.89
|
| Rate for Payer: First Choice Health Commercial |
$5.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.53
|
| Rate for Payer: HealthUtah PPO |
$6.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.01
|
| Rate for Payer: Multiplan Medicare/VA |
$3.36
|
| Rate for Payer: One Health Plan of WY PPO |
$6.08
|
| Rate for Payer: PacificSource Commercial |
$5.58
|
| Rate for Payer: PHCS PPO |
$6.08
|
| Rate for Payer: Three Rivers PPO |
$4.65
|
| Rate for Payer: TriWest Veterans Administration |
$3.53
|
| Rate for Payer: United Healthcare Commercial |
$5.92
|
| Rate for Payer: United Healthcare Medicare |
$3.53
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$5.89
|
|
|
ANEST SET SMALL BORE 11088483
|
Facility
|
IP
|
$6.20
|
|
| Hospital Charge Code |
2500023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$6.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.08
|
| Rate for Payer: Aetna of WY Medicare |
$3.97
|
| Rate for Payer: Altius Commercial |
$5.95
|
| Rate for Payer: Beech Street Commercial |
$6.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.01
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.01
|
| Rate for Payer: Cigna of WY Commercial |
$6.08
|
| Rate for Payer: Entrust Commercial |
$5.89
|
| Rate for Payer: First Choice Health Commercial |
$5.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.78
|
| Rate for Payer: HealthUtah PPO |
$6.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.01
|
| Rate for Payer: Multiplan Medicare/VA |
$3.59
|
| Rate for Payer: One Health Plan of WY PPO |
$6.08
|
| Rate for Payer: PacificSource Commercial |
$5.58
|
| Rate for Payer: PHCS PPO |
$6.08
|
| Rate for Payer: Three Rivers PPO |
$4.65
|
| Rate for Payer: TriWest Veterans Administration |
$3.78
|
| Rate for Payer: United Healthcare Commercial |
$5.92
|
| Rate for Payer: United Healthcare Medicare |
$3.78
|
| Rate for Payer: WINHealth Partners Commercial |
$5.89
|
| Rate for Payer: Wise Provider Network Commercial |
$5.89
|
|
|
ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION [162889]
|
Facility
|
IP
|
$2,553.53
|
|
|
Service Code
|
HCPCS J0491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,479.77 |
| Max. Negotiated Rate |
$2,553.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,502.46
|
| Rate for Payer: Aetna of WY Medicare |
$1,634.26
|
| Rate for Payer: Altius Commercial |
$2,451.39
|
| Rate for Payer: Beech Street Commercial |
$2,502.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,476.92
|
| Rate for Payer: Cash Price |
$1,787.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,476.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,502.46
|
| Rate for Payer: Entrust Commercial |
$2,425.85
|
| Rate for Payer: First Choice Health Commercial |
$2,425.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,425.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,557.65
|
| Rate for Payer: HealthUtah PPO |
$2,553.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,476.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1,479.77
|
| Rate for Payer: One Health Plan of WY PPO |
$2,502.46
|
| Rate for Payer: PacificSource Commercial |
$2,298.18
|
| Rate for Payer: PHCS PPO |
$2,502.46
|
| Rate for Payer: Three Rivers PPO |
$1,915.15
|
| Rate for Payer: TriWest Veterans Administration |
$1,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,438.62
|
| Rate for Payer: United Healthcare Medicare |
$1,557.65
|
| Rate for Payer: WINHealth Partners Commercial |
$2,425.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2,425.85
|
|
|
ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION [162889]
|
Facility
|
OP
|
$2,553.53
|
|
|
Service Code
|
HCPCS J0491
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,382.74 |
| Max. Negotiated Rate |
$2,553.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,502.46
|
| Rate for Payer: Aetna of WY Medicare |
$1,685.33
|
| Rate for Payer: Altius Commercial |
$2,451.39
|
| Rate for Payer: Beech Street Commercial |
$2,502.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,476.92
|
| Rate for Payer: Cash Price |
$1,787.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,476.92
|
| Rate for Payer: Cigna of WY Commercial |
$2,502.46
|
| Rate for Payer: Entrust Commercial |
$2,425.85
|
| Rate for Payer: First Choice Health Commercial |
$2,425.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,425.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,455.51
|
| Rate for Payer: HealthUtah PPO |
$2,553.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,476.92
|
| Rate for Payer: Multiplan Medicare/VA |
$1,382.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,502.46
|
| Rate for Payer: PacificSource Commercial |
$2,298.18
|
| Rate for Payer: PHCS PPO |
$2,502.46
|
| Rate for Payer: Three Rivers PPO |
$1,915.15
|
| Rate for Payer: TriWest Veterans Administration |
$1,455.51
|
| Rate for Payer: United Healthcare Commercial |
$2,438.62
|
| Rate for Payer: United Healthcare Medicare |
$1,455.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2,502.46
|
| Rate for Payer: Wise Provider Network Commercial |
$2,425.85
|
|
|
ANKLE CONTROL ORTHO PRE OTS
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS L4350
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.18
|
| Rate for Payer: Beech Street Commercial |
$38.95
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.77
|
| Rate for Payer: Cigna of WY Commercial |
$40.18
|
| Rate for Payer: First Choice Health Commercial |
$36.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.95
|
| Rate for Payer: HealthUtah PPO |
$41.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.77
|
| Rate for Payer: One Health Plan of WY PPO |
$40.18
|
| Rate for Payer: PacificSource Commercial |
$36.90
|
| Rate for Payer: PHCS PPO |
$38.95
|
| Rate for Payer: Three Rivers PPO |
$30.75
|
| Rate for Payer: United Healthcare Commercial |
$38.95
|
| Rate for Payer: WINHealth Partners Commercial |
$38.95
|
|
|
ANKLE DISTRACTOR AR-1712
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
2650520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.27 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$100.80
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.08
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$91.27
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$96.08
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$96.08
|
| Rate for Payer: WINHealth Partners Commercial |
$149.62
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
ANKLE DISTRACTOR AR-1712
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
2650520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.29 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$103.95
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.78
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$85.29
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$89.78
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$89.78
|
| Rate for Payer: WINHealth Partners Commercial |
$154.35
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
ANKLE FUSION PLATE ANTER TT RH
|
Facility
|
IP
|
$8,351.00
|
|
| Hospital Charge Code |
3002450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,839.40 |
| Max. Negotiated Rate |
$8,351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,183.98
|
| Rate for Payer: Aetna of WY Medicare |
$5,344.64
|
| Rate for Payer: Altius Commercial |
$8,016.96
|
| Rate for Payer: Beech Street Commercial |
$8,183.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,100.47
|
| Rate for Payer: Cash Price |
$5,845.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,100.47
|
| Rate for Payer: Cigna of WY Commercial |
$8,183.98
|
| Rate for Payer: Entrust Commercial |
$7,933.45
|
| Rate for Payer: First Choice Health Commercial |
$7,933.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,933.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,094.11
|
| Rate for Payer: HealthUtah PPO |
$8,351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,100.47
|
| Rate for Payer: Multiplan Medicare/VA |
$4,839.40
|
| Rate for Payer: One Health Plan of WY PPO |
$8,183.98
|
| Rate for Payer: PacificSource Commercial |
$7,515.90
|
| Rate for Payer: PHCS PPO |
$8,183.98
|
| Rate for Payer: Three Rivers PPO |
$6,263.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,094.11
|
| Rate for Payer: United Healthcare Commercial |
$7,975.20
|
| Rate for Payer: United Healthcare Medicare |
$5,094.11
|
| Rate for Payer: WINHealth Partners Commercial |
$7,933.45
|
| Rate for Payer: Wise Provider Network Commercial |
$7,933.45
|
|
|
ANKLE FUSION PLATE ANTER TT RH
|
Facility
|
OP
|
$8,351.00
|
|
| Hospital Charge Code |
3002450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,522.07 |
| Max. Negotiated Rate |
$8,351.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,183.98
|
| Rate for Payer: Aetna of WY Medicare |
$5,511.66
|
| Rate for Payer: Altius Commercial |
$8,016.96
|
| Rate for Payer: Beech Street Commercial |
$8,183.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,100.47
|
| Rate for Payer: Cash Price |
$5,845.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,100.47
|
| Rate for Payer: Cigna of WY Commercial |
$8,183.98
|
| Rate for Payer: Entrust Commercial |
$7,933.45
|
| Rate for Payer: First Choice Health Commercial |
$7,933.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,933.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,760.07
|
| Rate for Payer: HealthUtah PPO |
$8,351.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,100.47
|
| Rate for Payer: Multiplan Medicare/VA |
$4,522.07
|
| Rate for Payer: One Health Plan of WY PPO |
$8,183.98
|
| Rate for Payer: PacificSource Commercial |
$7,515.90
|
| Rate for Payer: PHCS PPO |
$8,183.98
|
| Rate for Payer: Three Rivers PPO |
$6,263.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,760.07
|
| Rate for Payer: United Healthcare Commercial |
$7,975.20
|
| Rate for Payer: United Healthcare Medicare |
$4,760.07
|
| Rate for Payer: WINHealth Partners Commercial |
$8,183.98
|
| Rate for Payer: Wise Provider Network Commercial |
$7,933.45
|
|
|
ANKLE KOOLAIR STIRRUP 11186
|
Facility
|
IP
|
$41.97
|
|
| Hospital Charge Code |
2200082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$41.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.13
|
| Rate for Payer: Aetna of WY Medicare |
$26.86
|
| Rate for Payer: Altius Commercial |
$40.29
|
| Rate for Payer: Beech Street Commercial |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.71
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.71
|
| Rate for Payer: Cigna of WY Commercial |
$41.13
|
| Rate for Payer: Entrust Commercial |
$39.87
|
| Rate for Payer: First Choice Health Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.60
|
| Rate for Payer: HealthUtah PPO |
$41.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.71
|
| Rate for Payer: Multiplan Medicare/VA |
$24.32
|
| Rate for Payer: One Health Plan of WY PPO |
$41.13
|
| Rate for Payer: PacificSource Commercial |
$37.77
|
| Rate for Payer: PHCS PPO |
$41.13
|
| Rate for Payer: Three Rivers PPO |
$31.48
|
| Rate for Payer: TriWest Veterans Administration |
$25.60
|
| Rate for Payer: United Healthcare Commercial |
$40.08
|
| Rate for Payer: United Healthcare Medicare |
$25.60
|
| Rate for Payer: WINHealth Partners Commercial |
$39.87
|
| Rate for Payer: Wise Provider Network Commercial |
$39.87
|
|
|
ANKLE KOOLAIR STIRRUP 11186
|
Facility
|
OP
|
$41.97
|
|
| Hospital Charge Code |
2200082
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$41.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.13
|
| Rate for Payer: Aetna of WY Medicare |
$27.70
|
| Rate for Payer: Altius Commercial |
$40.29
|
| Rate for Payer: Beech Street Commercial |
$41.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.71
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.71
|
| Rate for Payer: Cigna of WY Commercial |
$41.13
|
| Rate for Payer: Entrust Commercial |
$39.87
|
| Rate for Payer: First Choice Health Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.92
|
| Rate for Payer: HealthUtah PPO |
$41.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.71
|
| Rate for Payer: Multiplan Medicare/VA |
$22.73
|
| Rate for Payer: One Health Plan of WY PPO |
$41.13
|
| Rate for Payer: PacificSource Commercial |
$37.77
|
| Rate for Payer: PHCS PPO |
$41.13
|
| Rate for Payer: Three Rivers PPO |
$31.48
|
| Rate for Payer: TriWest Veterans Administration |
$23.92
|
| Rate for Payer: United Healthcare Commercial |
$40.08
|
| Rate for Payer: United Healthcare Medicare |
$23.92
|
| Rate for Payer: WINHealth Partners Commercial |
$41.13
|
| Rate for Payer: Wise Provider Network Commercial |
$39.87
|
|
|
ANKLE STAR POLY CORE 8MM
|
Facility
|
OP
|
$8,277.50
|
|
| Hospital Charge Code |
3002740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,482.27 |
| Max. Negotiated Rate |
$8,277.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,111.95
|
| Rate for Payer: Aetna of WY Medicare |
$5,463.15
|
| Rate for Payer: Altius Commercial |
$7,946.40
|
| Rate for Payer: Beech Street Commercial |
$8,111.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,029.18
|
| Rate for Payer: Cash Price |
$5,794.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,029.18
|
| Rate for Payer: Cigna of WY Commercial |
$8,111.95
|
| Rate for Payer: Entrust Commercial |
$7,863.62
|
| Rate for Payer: First Choice Health Commercial |
$7,863.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,863.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,718.18
|
| Rate for Payer: HealthUtah PPO |
$8,277.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,029.18
|
| Rate for Payer: Multiplan Medicare/VA |
$4,482.27
|
| Rate for Payer: One Health Plan of WY PPO |
$8,111.95
|
| Rate for Payer: PacificSource Commercial |
$7,449.75
|
| Rate for Payer: PHCS PPO |
$8,111.95
|
| Rate for Payer: Three Rivers PPO |
$6,208.12
|
| Rate for Payer: TriWest Veterans Administration |
$4,718.18
|
| Rate for Payer: United Healthcare Commercial |
$7,905.01
|
| Rate for Payer: United Healthcare Medicare |
$4,718.18
|
| Rate for Payer: WINHealth Partners Commercial |
$8,111.95
|
| Rate for Payer: Wise Provider Network Commercial |
$7,863.62
|
|
|
ANKLE STAR POLY CORE 8MM
|
Facility
|
IP
|
$8,277.50
|
|
| Hospital Charge Code |
3002740
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,796.81 |
| Max. Negotiated Rate |
$8,277.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,111.95
|
| Rate for Payer: Aetna of WY Medicare |
$5,297.60
|
| Rate for Payer: Altius Commercial |
$7,946.40
|
| Rate for Payer: Beech Street Commercial |
$8,111.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,029.18
|
| Rate for Payer: Cash Price |
$5,794.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,029.18
|
| Rate for Payer: Cigna of WY Commercial |
$8,111.95
|
| Rate for Payer: Entrust Commercial |
$7,863.62
|
| Rate for Payer: First Choice Health Commercial |
$7,863.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,863.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,049.28
|
| Rate for Payer: HealthUtah PPO |
$8,277.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,029.18
|
| Rate for Payer: Multiplan Medicare/VA |
$4,796.81
|
| Rate for Payer: One Health Plan of WY PPO |
$8,111.95
|
| Rate for Payer: PacificSource Commercial |
$7,449.75
|
| Rate for Payer: PHCS PPO |
$8,111.95
|
| Rate for Payer: Three Rivers PPO |
$6,208.12
|
| Rate for Payer: TriWest Veterans Administration |
$5,049.28
|
| Rate for Payer: United Healthcare Commercial |
$7,905.01
|
| Rate for Payer: United Healthcare Medicare |
$5,049.28
|
| Rate for Payer: WINHealth Partners Commercial |
$7,863.62
|
| Rate for Payer: Wise Provider Network Commercial |
$7,863.62
|
|
|
ANKLE STAR STERILE INSTRUMENTS
|
Facility
|
OP
|
$5,544.00
|
|
| Hospital Charge Code |
3002742
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,002.08 |
| Max. Negotiated Rate |
$5,544.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,433.12
|
| Rate for Payer: Aetna of WY Medicare |
$3,659.04
|
| Rate for Payer: Altius Commercial |
$5,322.24
|
| Rate for Payer: Beech Street Commercial |
$5,433.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,377.68
|
| Rate for Payer: Cash Price |
$3,880.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,377.68
|
| Rate for Payer: Cigna of WY Commercial |
$5,433.12
|
| Rate for Payer: Entrust Commercial |
$5,266.80
|
| Rate for Payer: First Choice Health Commercial |
$5,266.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,266.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,160.08
|
| Rate for Payer: HealthUtah PPO |
$5,544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,377.68
|
| Rate for Payer: Multiplan Medicare/VA |
$3,002.08
|
| Rate for Payer: One Health Plan of WY PPO |
$5,433.12
|
| Rate for Payer: PacificSource Commercial |
$4,989.60
|
| Rate for Payer: PHCS PPO |
$5,433.12
|
| Rate for Payer: Three Rivers PPO |
$4,158.00
|
| Rate for Payer: TriWest Veterans Administration |
$3,160.08
|
| Rate for Payer: United Healthcare Commercial |
$5,294.52
|
| Rate for Payer: United Healthcare Medicare |
$3,160.08
|
| Rate for Payer: WINHealth Partners Commercial |
$5,433.12
|
| Rate for Payer: Wise Provider Network Commercial |
$5,266.80
|
|
