|
HANA PERINEAL PAD SUPINE
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
2650731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.54 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Aetna of WY Medicare |
$201.60
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$305.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.15
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$182.54
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$192.15
|
| Rate for Payer: United Healthcare Commercial |
$300.82
|
| Rate for Payer: United Healthcare Medicare |
$192.15
|
| Rate for Payer: WINHealth Partners Commercial |
$299.25
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
HANA PERINEAL PAD SUPINE
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
2650731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.57 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Aetna of WY Medicare |
$207.90
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$305.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.55
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$170.57
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$179.55
|
| Rate for Payer: United Healthcare Commercial |
$300.82
|
| Rate for Payer: United Healthcare Medicare |
$179.55
|
| Rate for Payer: WINHealth Partners Commercial |
$308.70
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
HAND-HELD PEFR METER
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS A4614
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Beech Street Commercial |
$31.35
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: First Choice Health Commercial |
$29.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$31.35
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: United Healthcare Commercial |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
|
|
HAND/WRIST INTERNAL BRACE LGMNT REPAIR KIT
|
Facility
|
OP
|
$6,111.56
|
|
| Hospital Charge Code |
3004778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,309.41 |
| Max. Negotiated Rate |
$6,111.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,989.33
|
| Rate for Payer: Aetna of WY Medicare |
$4,033.63
|
| Rate for Payer: Altius Commercial |
$5,867.10
|
| Rate for Payer: Beech Street Commercial |
$5,989.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,928.21
|
| Rate for Payer: Cash Price |
$4,278.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,928.21
|
| Rate for Payer: Cigna of WY Commercial |
$5,989.33
|
| Rate for Payer: Entrust Commercial |
$5,805.98
|
| Rate for Payer: First Choice Health Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,483.59
|
| Rate for Payer: HealthUtah PPO |
$6,111.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,928.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3,309.41
|
| Rate for Payer: One Health Plan of WY PPO |
$5,989.33
|
| Rate for Payer: PacificSource Commercial |
$5,500.40
|
| Rate for Payer: PHCS PPO |
$5,989.33
|
| Rate for Payer: Three Rivers PPO |
$4,583.67
|
| Rate for Payer: TriWest Veterans Administration |
$3,483.59
|
| Rate for Payer: United Healthcare Commercial |
$5,836.54
|
| Rate for Payer: United Healthcare Medicare |
$3,483.59
|
| Rate for Payer: WINHealth Partners Commercial |
$5,989.33
|
| Rate for Payer: Wise Provider Network Commercial |
$5,805.98
|
|
|
HAND/WRIST INTERNAL BRACE LGMNT REPAIR KIT
|
Facility
|
IP
|
$6,111.56
|
|
| Hospital Charge Code |
3004778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,541.65 |
| Max. Negotiated Rate |
$6,111.56 |
| Rate for Payer: Three Rivers PPO |
$4,583.67
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,989.33
|
| Rate for Payer: Aetna of WY Medicare |
$3,911.40
|
| Rate for Payer: Altius Commercial |
$5,867.10
|
| Rate for Payer: Beech Street Commercial |
$5,989.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,928.21
|
| Rate for Payer: Cash Price |
$4,278.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,928.21
|
| Rate for Payer: Cigna of WY Commercial |
$5,989.33
|
| Rate for Payer: Entrust Commercial |
$5,805.98
|
| Rate for Payer: First Choice Health Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,728.05
|
| Rate for Payer: HealthUtah PPO |
$6,111.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,928.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3,541.65
|
| Rate for Payer: One Health Plan of WY PPO |
$5,989.33
|
| Rate for Payer: PacificSource Commercial |
$5,500.40
|
| Rate for Payer: PHCS PPO |
$5,989.33
|
| Rate for Payer: TriWest Veterans Administration |
$3,728.05
|
| Rate for Payer: United Healthcare Commercial |
$5,836.54
|
| Rate for Payer: United Healthcare Medicare |
$3,728.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,805.98
|
| Rate for Payer: Wise Provider Network Commercial |
$5,805.98
|
|
|
HANGING CAST SLING LARGE
|
Facility
|
OP
|
$21.67
|
|
| Hospital Charge Code |
2200464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.35
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$11.73
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$12.35
|
| Rate for Payer: WINHealth Partners Commercial |
$21.24
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING LARGE
|
Facility
|
IP
|
$21.67
|
|
| Hospital Charge Code |
2200464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$13.87
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.22
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$12.56
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.22
|
| Rate for Payer: United Healthcare Medicare |
$13.22
|
| Rate for Payer: WINHealth Partners Commercial |
$20.59
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING MEDIUM
|
Facility
|
IP
|
$21.67
|
|
| Hospital Charge Code |
2200463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$13.87
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.22
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$12.56
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.22
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$13.22
|
| Rate for Payer: WINHealth Partners Commercial |
$20.59
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING MEDIUM
|
Facility
|
OP
|
$21.67
|
|
| Hospital Charge Code |
2200463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.35
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$11.73
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$12.35
|
| Rate for Payer: WINHealth Partners Commercial |
$21.24
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING SMALL
|
Facility
|
IP
|
$21.67
|
|
| Hospital Charge Code |
2200462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$13.87
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.22
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$12.56
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.22
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$13.22
|
| Rate for Payer: WINHealth Partners Commercial |
$20.59
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING SMALL
|
Facility
|
OP
|
$21.67
|
|
| Hospital Charge Code |
2200462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.35
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$11.73
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$12.35
|
| Rate for Payer: WINHealth Partners Commercial |
$21.24
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING XLARGE
|
Facility
|
IP
|
$21.67
|
|
| Hospital Charge Code |
2200465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$13.87
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.22
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$12.56
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$13.22
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$13.22
|
| Rate for Payer: WINHealth Partners Commercial |
$20.59
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HANGING CAST SLING XLARGE
|
Facility
|
OP
|
$21.67
|
|
| Hospital Charge Code |
2200465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.02
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.35
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$11.73
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.35
|
| Rate for Payer: United Healthcare Commercial |
$20.69
|
| Rate for Payer: United Healthcare Medicare |
$12.35
|
| Rate for Payer: WINHealth Partners Commercial |
$21.24
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
HARMONIC COAG. SHEARS 5MM
|
Facility
|
OP
|
$515.93
|
|
| Hospital Charge Code |
2650157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.38 |
| Max. Negotiated Rate |
$515.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$505.61
|
| Rate for Payer: Aetna of WY Medicare |
$340.51
|
| Rate for Payer: Altius Commercial |
$495.29
|
| Rate for Payer: Beech Street Commercial |
$505.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$500.45
|
| Rate for Payer: Cash Price |
$361.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$500.45
|
| Rate for Payer: Cigna of WY Commercial |
$505.61
|
| Rate for Payer: Entrust Commercial |
$490.13
|
| Rate for Payer: First Choice Health Commercial |
$490.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$490.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.08
|
| Rate for Payer: HealthUtah PPO |
$515.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$500.45
|
| Rate for Payer: Multiplan Medicare/VA |
$279.38
|
| Rate for Payer: One Health Plan of WY PPO |
$505.61
|
| Rate for Payer: PacificSource Commercial |
$464.34
|
| Rate for Payer: PHCS PPO |
$505.61
|
| Rate for Payer: Three Rivers PPO |
$386.95
|
| Rate for Payer: TriWest Veterans Administration |
$294.08
|
| Rate for Payer: United Healthcare Commercial |
$492.71
|
| Rate for Payer: United Healthcare Medicare |
$294.08
|
| Rate for Payer: WINHealth Partners Commercial |
$505.61
|
| Rate for Payer: Wise Provider Network Commercial |
$490.13
|
|
|
HARMONIC COAG. SHEARS 5MM
|
Facility
|
IP
|
$515.93
|
|
| Hospital Charge Code |
2650157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.98 |
| Max. Negotiated Rate |
$515.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$505.61
|
| Rate for Payer: Aetna of WY Medicare |
$330.20
|
| Rate for Payer: Altius Commercial |
$495.29
|
| Rate for Payer: Beech Street Commercial |
$505.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$500.45
|
| Rate for Payer: Cash Price |
$361.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$500.45
|
| Rate for Payer: Cigna of WY Commercial |
$505.61
|
| Rate for Payer: Entrust Commercial |
$490.13
|
| Rate for Payer: First Choice Health Commercial |
$490.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$490.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$314.72
|
| Rate for Payer: HealthUtah PPO |
$515.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$500.45
|
| Rate for Payer: Multiplan Medicare/VA |
$298.98
|
| Rate for Payer: One Health Plan of WY PPO |
$505.61
|
| Rate for Payer: PacificSource Commercial |
$464.34
|
| Rate for Payer: PHCS PPO |
$505.61
|
| Rate for Payer: Three Rivers PPO |
$386.95
|
| Rate for Payer: TriWest Veterans Administration |
$314.72
|
| Rate for Payer: United Healthcare Commercial |
$492.71
|
| Rate for Payer: United Healthcare Medicare |
$314.72
|
| Rate for Payer: WINHealth Partners Commercial |
$490.13
|
| Rate for Payer: Wise Provider Network Commercial |
$490.13
|
|
|
HARMONIC WAVE18S
|
Facility
|
OP
|
$99.17
|
|
| Hospital Charge Code |
2650364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$99.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.19
|
| Rate for Payer: Aetna of WY Medicare |
$65.45
|
| Rate for Payer: Altius Commercial |
$95.20
|
| Rate for Payer: Beech Street Commercial |
$97.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.19
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.19
|
| Rate for Payer: Cigna of WY Commercial |
$97.19
|
| Rate for Payer: Entrust Commercial |
$94.21
|
| Rate for Payer: First Choice Health Commercial |
$94.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.53
|
| Rate for Payer: HealthUtah PPO |
$99.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.19
|
| Rate for Payer: Multiplan Medicare/VA |
$53.70
|
| Rate for Payer: One Health Plan of WY PPO |
$97.19
|
| Rate for Payer: PacificSource Commercial |
$89.25
|
| Rate for Payer: PHCS PPO |
$97.19
|
| Rate for Payer: Three Rivers PPO |
$74.38
|
| Rate for Payer: TriWest Veterans Administration |
$56.53
|
| Rate for Payer: United Healthcare Commercial |
$94.71
|
| Rate for Payer: United Healthcare Medicare |
$56.53
|
| Rate for Payer: WINHealth Partners Commercial |
$97.19
|
| Rate for Payer: Wise Provider Network Commercial |
$94.21
|
|
|
HARMONIC WAVE18S
|
Facility
|
IP
|
$99.17
|
|
| Hospital Charge Code |
2650364
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.47 |
| Max. Negotiated Rate |
$99.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.19
|
| Rate for Payer: Aetna of WY Medicare |
$63.47
|
| Rate for Payer: Altius Commercial |
$95.20
|
| Rate for Payer: Beech Street Commercial |
$97.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.19
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.19
|
| Rate for Payer: Cigna of WY Commercial |
$97.19
|
| Rate for Payer: Entrust Commercial |
$94.21
|
| Rate for Payer: First Choice Health Commercial |
$94.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.49
|
| Rate for Payer: HealthUtah PPO |
$99.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.19
|
| Rate for Payer: Multiplan Medicare/VA |
$57.47
|
| Rate for Payer: One Health Plan of WY PPO |
$97.19
|
| Rate for Payer: PacificSource Commercial |
$89.25
|
| Rate for Payer: PHCS PPO |
$97.19
|
| Rate for Payer: Three Rivers PPO |
$74.38
|
| Rate for Payer: TriWest Veterans Administration |
$60.49
|
| Rate for Payer: United Healthcare Commercial |
$94.71
|
| Rate for Payer: United Healthcare Medicare |
$60.49
|
| Rate for Payer: WINHealth Partners Commercial |
$94.21
|
| Rate for Payer: Wise Provider Network Commercial |
$94.21
|
|
|
HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 15040
|
| Min. Negotiated Rate |
$101.26 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$524.30
|
| Rate for Payer: Aetna of WY Medicare |
$119.13
|
| Rate for Payer: Beech Street Commercial |
$508.25
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: Cash Price |
$374.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$518.95
|
| Rate for Payer: Cigna of WY Commercial |
$524.30
|
| Rate for Payer: First Choice Health Commercial |
$481.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$508.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.13
|
| Rate for Payer: HealthUtah PPO |
$535.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$518.95
|
| Rate for Payer: Multiplan Medicare/VA |
$101.26
|
| Rate for Payer: One Health Plan of WY PPO |
$524.30
|
| Rate for Payer: PacificSource Commercial |
$481.50
|
| Rate for Payer: PHCS PPO |
$508.25
|
| Rate for Payer: Three Rivers PPO |
$401.25
|
| Rate for Payer: TriWest Veterans Administration |
$119.13
|
| Rate for Payer: United Healthcare Commercial |
$508.25
|
| Rate for Payer: WINHealth Partners Commercial |
$454.75
|
|
|
HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$217.14 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.98
|
| Rate for Payer: Aetna of WY Medicare |
$264.66
|
| Rate for Payer: Altius Commercial |
$384.96
|
| Rate for Payer: Beech Street Commercial |
$392.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$388.97
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.97
|
| Rate for Payer: Cigna of WY Commercial |
$392.98
|
| Rate for Payer: Entrust Commercial |
$380.95
|
| Rate for Payer: First Choice Health Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.57
|
| Rate for Payer: HealthUtah PPO |
$401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.97
|
| Rate for Payer: Multiplan Medicare/VA |
$217.14
|
| Rate for Payer: One Health Plan of WY PPO |
$392.98
|
| Rate for Payer: PacificSource Commercial |
$360.90
|
| Rate for Payer: PHCS PPO |
$392.98
|
| Rate for Payer: Three Rivers PPO |
$300.75
|
| Rate for Payer: TriWest Veterans Administration |
$228.57
|
| Rate for Payer: United Healthcare Commercial |
$382.96
|
| Rate for Payer: United Healthcare Medicare |
$228.57
|
| Rate for Payer: WINHealth Partners Commercial |
$392.98
|
| Rate for Payer: Wise Provider Network Commercial |
$380.95
|
|
|
HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION - CT 3D RECONSTRUCT
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637701
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.98
|
| Rate for Payer: Aetna of WY Medicare |
$256.64
|
| Rate for Payer: Altius Commercial |
$384.96
|
| Rate for Payer: Beech Street Commercial |
$392.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$388.97
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.97
|
| Rate for Payer: Cigna of WY Commercial |
$392.98
|
| Rate for Payer: Entrust Commercial |
$380.95
|
| Rate for Payer: First Choice Health Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.61
|
| Rate for Payer: HealthUtah PPO |
$401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.97
|
| Rate for Payer: Multiplan Medicare/VA |
$232.38
|
| Rate for Payer: One Health Plan of WY PPO |
$392.98
|
| Rate for Payer: PacificSource Commercial |
$360.90
|
| Rate for Payer: PHCS PPO |
$392.98
|
| Rate for Payer: Three Rivers PPO |
$300.75
|
| Rate for Payer: TriWest Veterans Administration |
$244.61
|
| Rate for Payer: United Healthcare Commercial |
$382.96
|
| Rate for Payer: United Healthcare Medicare |
$244.61
|
| Rate for Payer: WINHealth Partners Commercial |
$380.95
|
| Rate for Payer: Wise Provider Network Commercial |
$380.95
|
|
|
HC 3D RENDER W/INTRP POSTPROCES - 3D RENDERING ON AN INDEP WORKSTATION
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637702
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$217.14 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.98
|
| Rate for Payer: Aetna of WY Medicare |
$264.66
|
| Rate for Payer: Altius Commercial |
$384.96
|
| Rate for Payer: Beech Street Commercial |
$392.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$388.97
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.97
|
| Rate for Payer: Cigna of WY Commercial |
$392.98
|
| Rate for Payer: Entrust Commercial |
$380.95
|
| Rate for Payer: First Choice Health Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$228.57
|
| Rate for Payer: HealthUtah PPO |
$401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.97
|
| Rate for Payer: Multiplan Medicare/VA |
$217.14
|
| Rate for Payer: One Health Plan of WY PPO |
$392.98
|
| Rate for Payer: PacificSource Commercial |
$360.90
|
| Rate for Payer: PHCS PPO |
$392.98
|
| Rate for Payer: Three Rivers PPO |
$300.75
|
| Rate for Payer: TriWest Veterans Administration |
$228.57
|
| Rate for Payer: United Healthcare Commercial |
$382.96
|
| Rate for Payer: United Healthcare Medicare |
$228.57
|
| Rate for Payer: WINHealth Partners Commercial |
$392.98
|
| Rate for Payer: Wise Provider Network Commercial |
$380.95
|
|
|
HC 3D RENDER W/INTRP POSTPROCES - 3D RENDERING ON AN INDEP WORKSTATION
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 76377
|
| Hospital Charge Code |
3507637702
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: United Healthcare Commercial |
$382.96
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.98
|
| Rate for Payer: Aetna of WY Medicare |
$256.64
|
| Rate for Payer: Altius Commercial |
$384.96
|
| Rate for Payer: Beech Street Commercial |
$392.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$388.97
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.97
|
| Rate for Payer: Cigna of WY Commercial |
$392.98
|
| Rate for Payer: Entrust Commercial |
$380.95
|
| Rate for Payer: First Choice Health Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.61
|
| Rate for Payer: HealthUtah PPO |
$401.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.97
|
| Rate for Payer: Multiplan Medicare/VA |
$232.38
|
| Rate for Payer: One Health Plan of WY PPO |
$392.98
|
| Rate for Payer: PacificSource Commercial |
$360.90
|
| Rate for Payer: PHCS PPO |
$392.98
|
| Rate for Payer: Three Rivers PPO |
$300.75
|
| Rate for Payer: TriWest Veterans Administration |
$244.61
|
| Rate for Payer: United Healthcare Medicare |
$244.61
|
| Rate for Payer: WINHealth Partners Commercial |
$380.95
|
| Rate for Payer: Wise Provider Network Commercial |
$380.95
|
|
|
HC 4K SCORE PSA KALLIKREIN
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS 81539
|
| Hospital Charge Code |
3108153901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,187.61 |
| Max. Negotiated Rate |
$3,775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,699.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,416.00
|
| Rate for Payer: Altius Commercial |
$3,624.00
|
| Rate for Payer: Beech Street Commercial |
$3,699.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,661.75
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,661.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,699.50
|
| Rate for Payer: Entrust Commercial |
$3,586.25
|
| Rate for Payer: First Choice Health Commercial |
$3,586.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,586.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,302.75
|
| Rate for Payer: HealthUtah PPO |
$3,775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,661.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,187.61
|
| Rate for Payer: One Health Plan of WY PPO |
$3,699.50
|
| Rate for Payer: PacificSource Commercial |
$3,397.50
|
| Rate for Payer: PHCS PPO |
$3,699.50
|
| Rate for Payer: Three Rivers PPO |
$2,831.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,302.75
|
| Rate for Payer: United Healthcare Commercial |
$3,605.12
|
| Rate for Payer: United Healthcare Medicare |
$2,302.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,586.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3,586.25
|
|
|
HC 4K SCORE PSA KALLIKREIN
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS 81539
|
| Hospital Charge Code |
3108153901
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,044.16 |
| Max. Negotiated Rate |
$3,775.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,699.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,491.50
|
| Rate for Payer: Altius Commercial |
$3,624.00
|
| Rate for Payer: Beech Street Commercial |
$3,699.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,661.75
|
| Rate for Payer: Cash Price |
$2,642.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,661.75
|
| Rate for Payer: Cigna of WY Commercial |
$3,699.50
|
| Rate for Payer: Entrust Commercial |
$3,586.25
|
| Rate for Payer: First Choice Health Commercial |
$3,586.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,586.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,151.75
|
| Rate for Payer: HealthUtah PPO |
$3,775.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,661.75
|
| Rate for Payer: Multiplan Medicare/VA |
$2,044.16
|
| Rate for Payer: One Health Plan of WY PPO |
$3,699.50
|
| Rate for Payer: PacificSource Commercial |
$3,397.50
|
| Rate for Payer: PHCS PPO |
$3,699.50
|
| Rate for Payer: Three Rivers PPO |
$2,831.25
|
| Rate for Payer: TriWest Veterans Administration |
$2,151.75
|
| Rate for Payer: United Healthcare Commercial |
$3,605.12
|
| Rate for Payer: United Healthcare Medicare |
$2,151.75
|
| Rate for Payer: WINHealth Partners Commercial |
$3,699.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,586.25
|
|
|
HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE
|
Facility
|
OP
|
$2,222.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4024908301
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,203.21 |
| Max. Negotiated Rate |
$2,222.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,177.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,466.52
|
| Rate for Payer: Altius Commercial |
$2,133.12
|
| Rate for Payer: Beech Street Commercial |
$2,177.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,155.34
|
| Rate for Payer: Cash Price |
$1,555.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,155.34
|
| Rate for Payer: Cigna of WY Commercial |
$2,177.56
|
| Rate for Payer: Entrust Commercial |
$2,110.90
|
| Rate for Payer: First Choice Health Commercial |
$2,110.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,110.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,266.54
|
| Rate for Payer: HealthUtah PPO |
$2,222.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,155.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1,203.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2,177.56
|
| Rate for Payer: PacificSource Commercial |
$1,999.80
|
| Rate for Payer: PHCS PPO |
$2,177.56
|
| Rate for Payer: Three Rivers PPO |
$1,666.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,266.54
|
| Rate for Payer: United Healthcare Commercial |
$2,122.01
|
| Rate for Payer: United Healthcare Medicare |
$1,266.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2,177.56
|
| Rate for Payer: Wise Provider Network Commercial |
$2,110.90
|
|
