|
BITE GARD ORAL BITE BLOCK 1140
|
Facility
|
OP
|
$2.10
|
|
| Hospital Charge Code |
2500172
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Aetna of WY Medicare |
$1.39
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
BLADE BEAVER MYRINGOTOMY
|
Facility
|
IP
|
$46.89
|
|
| Hospital Charge Code |
2300001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$46.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.95
|
| Rate for Payer: Aetna of WY Medicare |
$30.01
|
| Rate for Payer: Altius Commercial |
$45.01
|
| Rate for Payer: Beech Street Commercial |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.48
|
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.48
|
| Rate for Payer: Cigna of WY Commercial |
$45.95
|
| Rate for Payer: Entrust Commercial |
$44.55
|
| Rate for Payer: First Choice Health Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.60
|
| Rate for Payer: HealthUtah PPO |
$46.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.48
|
| Rate for Payer: Multiplan Medicare/VA |
$27.17
|
| Rate for Payer: One Health Plan of WY PPO |
$45.95
|
| Rate for Payer: PacificSource Commercial |
$42.20
|
| Rate for Payer: PHCS PPO |
$45.95
|
| Rate for Payer: Three Rivers PPO |
$35.17
|
| Rate for Payer: TriWest Veterans Administration |
$28.60
|
| Rate for Payer: United Healthcare Commercial |
$44.78
|
| Rate for Payer: United Healthcare Medicare |
$28.60
|
| Rate for Payer: WINHealth Partners Commercial |
$44.55
|
| Rate for Payer: Wise Provider Network Commercial |
$44.55
|
|
|
BLADE BEAVER MYRINGOTOMY
|
Facility
|
OP
|
$46.89
|
|
| Hospital Charge Code |
2300001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.39 |
| Max. Negotiated Rate |
$46.89 |
| Rate for Payer: United Healthcare Commercial |
$44.78
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.95
|
| Rate for Payer: Aetna of WY Medicare |
$30.95
|
| Rate for Payer: Altius Commercial |
$45.01
|
| Rate for Payer: Beech Street Commercial |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.48
|
| Rate for Payer: Cash Price |
$32.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.48
|
| Rate for Payer: Cigna of WY Commercial |
$45.95
|
| Rate for Payer: Entrust Commercial |
$44.55
|
| Rate for Payer: First Choice Health Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.73
|
| Rate for Payer: HealthUtah PPO |
$46.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.48
|
| Rate for Payer: Multiplan Medicare/VA |
$25.39
|
| Rate for Payer: One Health Plan of WY PPO |
$45.95
|
| Rate for Payer: PacificSource Commercial |
$42.20
|
| Rate for Payer: PHCS PPO |
$45.95
|
| Rate for Payer: Three Rivers PPO |
$35.17
|
| Rate for Payer: TriWest Veterans Administration |
$26.73
|
| Rate for Payer: United Healthcare Medicare |
$26.73
|
| Rate for Payer: WINHealth Partners Commercial |
$45.95
|
| Rate for Payer: Wise Provider Network Commercial |
$44.55
|
|
|
BLADE BEAVER S-6900 STUCKI
|
Facility
|
OP
|
$29.16
|
|
| Hospital Charge Code |
2300006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.58
|
| Rate for Payer: Aetna of WY Medicare |
$19.25
|
| Rate for Payer: Altius Commercial |
$27.99
|
| Rate for Payer: Beech Street Commercial |
$28.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.29
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.29
|
| Rate for Payer: Cigna of WY Commercial |
$28.58
|
| Rate for Payer: Entrust Commercial |
$27.70
|
| Rate for Payer: First Choice Health Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.62
|
| Rate for Payer: HealthUtah PPO |
$29.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.29
|
| Rate for Payer: Multiplan Medicare/VA |
$15.79
|
| Rate for Payer: One Health Plan of WY PPO |
$28.58
|
| Rate for Payer: PacificSource Commercial |
$26.24
|
| Rate for Payer: PHCS PPO |
$28.58
|
| Rate for Payer: Three Rivers PPO |
$21.87
|
| Rate for Payer: TriWest Veterans Administration |
$16.62
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
| Rate for Payer: United Healthcare Medicare |
$16.62
|
| Rate for Payer: WINHealth Partners Commercial |
$28.58
|
| Rate for Payer: Wise Provider Network Commercial |
$27.70
|
|
|
BLADE BEAVER S-6900 STUCKI
|
Facility
|
IP
|
$29.16
|
|
| Hospital Charge Code |
2300006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.58
|
| Rate for Payer: Aetna of WY Medicare |
$18.66
|
| Rate for Payer: Altius Commercial |
$27.99
|
| Rate for Payer: Beech Street Commercial |
$28.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.29
|
| Rate for Payer: Cash Price |
$20.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.29
|
| Rate for Payer: Cigna of WY Commercial |
$28.58
|
| Rate for Payer: Entrust Commercial |
$27.70
|
| Rate for Payer: First Choice Health Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.79
|
| Rate for Payer: HealthUtah PPO |
$29.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.29
|
| Rate for Payer: Multiplan Medicare/VA |
$16.90
|
| Rate for Payer: One Health Plan of WY PPO |
$28.58
|
| Rate for Payer: PacificSource Commercial |
$26.24
|
| Rate for Payer: PHCS PPO |
$28.58
|
| Rate for Payer: Three Rivers PPO |
$21.87
|
| Rate for Payer: TriWest Veterans Administration |
$17.79
|
| Rate for Payer: United Healthcare Commercial |
$27.85
|
| Rate for Payer: United Healthcare Medicare |
$17.79
|
| Rate for Payer: WINHealth Partners Commercial |
$27.70
|
| Rate for Payer: Wise Provider Network Commercial |
$27.70
|
|
|
BLADE CAPSULOTOMY W/ HANDLE
|
Facility
|
OP
|
$682.50
|
|
| Hospital Charge Code |
3003274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.57 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$450.45
|
| Rate for Payer: Altius Commercial |
$655.20
|
| Rate for Payer: Beech Street Commercial |
$668.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$662.02
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.02
|
| Rate for Payer: Cigna of WY Commercial |
$668.85
|
| Rate for Payer: Entrust Commercial |
$648.38
|
| Rate for Payer: First Choice Health Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$389.02
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$369.57
|
| Rate for Payer: One Health Plan of WY PPO |
$668.85
|
| Rate for Payer: PacificSource Commercial |
$614.25
|
| Rate for Payer: PHCS PPO |
$668.85
|
| Rate for Payer: Three Rivers PPO |
$511.88
|
| Rate for Payer: TriWest Veterans Administration |
$389.02
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$389.02
|
| Rate for Payer: WINHealth Partners Commercial |
$668.85
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
BLADE CAPSULOTOMY W/ HANDLE
|
Facility
|
IP
|
$682.50
|
|
| Hospital Charge Code |
3003274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.51 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.85
|
| Rate for Payer: Aetna of WY Medicare |
$436.80
|
| Rate for Payer: Altius Commercial |
$655.20
|
| Rate for Payer: Beech Street Commercial |
$668.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$662.02
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.02
|
| Rate for Payer: Cigna of WY Commercial |
$668.85
|
| Rate for Payer: Entrust Commercial |
$648.38
|
| Rate for Payer: First Choice Health Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$416.32
|
| Rate for Payer: HealthUtah PPO |
$682.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.02
|
| Rate for Payer: Multiplan Medicare/VA |
$395.51
|
| Rate for Payer: One Health Plan of WY PPO |
$668.85
|
| Rate for Payer: PacificSource Commercial |
$614.25
|
| Rate for Payer: PHCS PPO |
$668.85
|
| Rate for Payer: Three Rivers PPO |
$511.88
|
| Rate for Payer: TriWest Veterans Administration |
$416.32
|
| Rate for Payer: United Healthcare Commercial |
$651.79
|
| Rate for Payer: United Healthcare Medicare |
$416.32
|
| Rate for Payer: WINHealth Partners Commercial |
$648.38
|
| Rate for Payer: Wise Provider Network Commercial |
$648.38
|
|
|
BLADE GRAFT KNIFE PARALLEL 09MM
|
Facility
|
OP
|
$164.50
|
|
| Hospital Charge Code |
3001986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.21
|
| Rate for Payer: Aetna of WY Medicare |
$108.57
|
| Rate for Payer: Altius Commercial |
$157.92
|
| Rate for Payer: Beech Street Commercial |
$161.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.56
|
| Rate for Payer: Cash Price |
$115.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.56
|
| Rate for Payer: Cigna of WY Commercial |
$161.21
|
| Rate for Payer: Entrust Commercial |
$156.28
|
| Rate for Payer: First Choice Health Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.76
|
| Rate for Payer: HealthUtah PPO |
$164.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.56
|
| Rate for Payer: Multiplan Medicare/VA |
$89.08
|
| Rate for Payer: One Health Plan of WY PPO |
$161.21
|
| Rate for Payer: PacificSource Commercial |
$148.05
|
| Rate for Payer: PHCS PPO |
$161.21
|
| Rate for Payer: Three Rivers PPO |
$123.38
|
| Rate for Payer: TriWest Veterans Administration |
$93.76
|
| Rate for Payer: United Healthcare Commercial |
$157.10
|
| Rate for Payer: United Healthcare Medicare |
$93.76
|
| Rate for Payer: WINHealth Partners Commercial |
$161.21
|
| Rate for Payer: Wise Provider Network Commercial |
$156.28
|
|
|
BLADE GRAFT KNIFE PARALLEL 09MM
|
Facility
|
IP
|
$164.50
|
|
| Hospital Charge Code |
3001986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.33 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.21
|
| Rate for Payer: Aetna of WY Medicare |
$105.28
|
| Rate for Payer: Altius Commercial |
$157.92
|
| Rate for Payer: Beech Street Commercial |
$161.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.56
|
| Rate for Payer: Cash Price |
$115.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.56
|
| Rate for Payer: Cigna of WY Commercial |
$161.21
|
| Rate for Payer: Entrust Commercial |
$156.28
|
| Rate for Payer: First Choice Health Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.34
|
| Rate for Payer: HealthUtah PPO |
$164.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.56
|
| Rate for Payer: Multiplan Medicare/VA |
$95.33
|
| Rate for Payer: One Health Plan of WY PPO |
$161.21
|
| Rate for Payer: PacificSource Commercial |
$148.05
|
| Rate for Payer: PHCS PPO |
$161.21
|
| Rate for Payer: Three Rivers PPO |
$123.38
|
| Rate for Payer: TriWest Veterans Administration |
$100.34
|
| Rate for Payer: United Healthcare Commercial |
$157.10
|
| Rate for Payer: United Healthcare Medicare |
$100.34
|
| Rate for Payer: WINHealth Partners Commercial |
$156.28
|
| Rate for Payer: Wise Provider Network Commercial |
$156.28
|
|
|
BLADE GRAFT KNIFE PARALLEL 10MM
|
Facility
|
IP
|
$192.15
|
|
| Hospital Charge Code |
3002029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Aetna of WY Medicare |
$122.98
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.39
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.21
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$111.35
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$117.21
|
| Rate for Payer: United Healthcare Commercial |
$183.50
|
| Rate for Payer: United Healthcare Medicare |
$117.21
|
| Rate for Payer: WINHealth Partners Commercial |
$182.54
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE GRAFT KNIFE PARALLEL 10MM
|
Facility
|
OP
|
$192.15
|
|
| Hospital Charge Code |
3002029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.05 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Aetna of WY Medicare |
$126.82
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.39
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.53
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$104.05
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$109.53
|
| Rate for Payer: United Healthcare Commercial |
$183.50
|
| Rate for Payer: United Healthcare Medicare |
$109.53
|
| Rate for Payer: WINHealth Partners Commercial |
$188.31
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE GRAFT KNIFE PARALLEL 11MM
|
Facility
|
OP
|
$192.15
|
|
| Hospital Charge Code |
3004500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.05 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Aetna of WY Medicare |
$126.82
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.39
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$109.53
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$104.05
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$109.53
|
| Rate for Payer: United Healthcare Commercial |
$183.50
|
| Rate for Payer: United Healthcare Medicare |
$109.53
|
| Rate for Payer: WINHealth Partners Commercial |
$188.31
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE GRAFT KNIFE PARALLEL 11MM
|
Facility
|
IP
|
$192.15
|
|
| Hospital Charge Code |
3004500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$192.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.31
|
| Rate for Payer: Aetna of WY Medicare |
$122.98
|
| Rate for Payer: Altius Commercial |
$184.46
|
| Rate for Payer: Beech Street Commercial |
$188.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.39
|
| Rate for Payer: Cash Price |
$134.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.39
|
| Rate for Payer: Cigna of WY Commercial |
$188.31
|
| Rate for Payer: Entrust Commercial |
$182.54
|
| Rate for Payer: First Choice Health Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.21
|
| Rate for Payer: HealthUtah PPO |
$192.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.39
|
| Rate for Payer: Multiplan Medicare/VA |
$111.35
|
| Rate for Payer: One Health Plan of WY PPO |
$188.31
|
| Rate for Payer: PacificSource Commercial |
$172.94
|
| Rate for Payer: PHCS PPO |
$188.31
|
| Rate for Payer: Three Rivers PPO |
$144.11
|
| Rate for Payer: TriWest Veterans Administration |
$117.21
|
| Rate for Payer: United Healthcare Commercial |
$183.50
|
| Rate for Payer: United Healthcare Medicare |
$117.21
|
| Rate for Payer: WINHealth Partners Commercial |
$182.54
|
| Rate for Payer: Wise Provider Network Commercial |
$182.54
|
|
|
BLADE, INF,TURB.2.9MM M4
|
Facility
|
IP
|
$895.82
|
|
| Hospital Charge Code |
2700006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.13 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$877.90
|
| Rate for Payer: Aetna of WY Medicare |
$573.32
|
| Rate for Payer: Altius Commercial |
$859.99
|
| Rate for Payer: Beech Street Commercial |
$877.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$868.95
|
| Rate for Payer: Cash Price |
$627.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$868.95
|
| Rate for Payer: Cigna of WY Commercial |
$877.90
|
| Rate for Payer: Entrust Commercial |
$851.03
|
| Rate for Payer: First Choice Health Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$546.45
|
| Rate for Payer: HealthUtah PPO |
$895.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$868.95
|
| Rate for Payer: Multiplan Medicare/VA |
$519.13
|
| Rate for Payer: One Health Plan of WY PPO |
$877.90
|
| Rate for Payer: PacificSource Commercial |
$806.24
|
| Rate for Payer: PHCS PPO |
$877.90
|
| Rate for Payer: Three Rivers PPO |
$671.86
|
| Rate for Payer: TriWest Veterans Administration |
$546.45
|
| Rate for Payer: United Healthcare Commercial |
$855.51
|
| Rate for Payer: United Healthcare Medicare |
$546.45
|
| Rate for Payer: WINHealth Partners Commercial |
$851.03
|
| Rate for Payer: Wise Provider Network Commercial |
$851.03
|
|
|
BLADE, INF,TURB.2.9MM M4
|
Facility
|
OP
|
$895.82
|
|
| Hospital Charge Code |
2700006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.09 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$877.90
|
| Rate for Payer: Aetna of WY Medicare |
$591.24
|
| Rate for Payer: Altius Commercial |
$859.99
|
| Rate for Payer: Beech Street Commercial |
$877.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$868.95
|
| Rate for Payer: Cash Price |
$627.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$868.95
|
| Rate for Payer: Cigna of WY Commercial |
$877.90
|
| Rate for Payer: Entrust Commercial |
$851.03
|
| Rate for Payer: First Choice Health Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$851.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$510.62
|
| Rate for Payer: HealthUtah PPO |
$895.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$868.95
|
| Rate for Payer: Multiplan Medicare/VA |
$485.09
|
| Rate for Payer: One Health Plan of WY PPO |
$877.90
|
| Rate for Payer: PacificSource Commercial |
$806.24
|
| Rate for Payer: PHCS PPO |
$877.90
|
| Rate for Payer: Three Rivers PPO |
$671.86
|
| Rate for Payer: TriWest Veterans Administration |
$510.62
|
| Rate for Payer: United Healthcare Commercial |
$855.51
|
| Rate for Payer: United Healthcare Medicare |
$510.62
|
| Rate for Payer: WINHealth Partners Commercial |
$877.90
|
| Rate for Payer: Wise Provider Network Commercial |
$851.03
|
|
|
BLADE LG BONE 90 X 25/1.37
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
2650723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
BLADE LG BONE 90 X 25/1.37
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
2650723
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
BLADE OSCILLATIN 90X13-21/1.19
|
Facility
|
IP
|
$598.50
|
|
| Hospital Charge Code |
2650766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.83 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$586.53
|
| Rate for Payer: Aetna of WY Medicare |
$383.04
|
| Rate for Payer: Altius Commercial |
$574.56
|
| Rate for Payer: Beech Street Commercial |
$586.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.54
|
| Rate for Payer: Cash Price |
$418.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$580.54
|
| Rate for Payer: Cigna of WY Commercial |
$586.53
|
| Rate for Payer: Entrust Commercial |
$568.58
|
| Rate for Payer: First Choice Health Commercial |
$568.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$568.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$365.08
|
| Rate for Payer: HealthUtah PPO |
$598.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$580.54
|
| Rate for Payer: Multiplan Medicare/VA |
$346.83
|
| Rate for Payer: One Health Plan of WY PPO |
$586.53
|
| Rate for Payer: PacificSource Commercial |
$538.65
|
| Rate for Payer: PHCS PPO |
$586.53
|
| Rate for Payer: Three Rivers PPO |
$448.88
|
| Rate for Payer: TriWest Veterans Administration |
$365.08
|
| Rate for Payer: United Healthcare Commercial |
$571.57
|
| Rate for Payer: United Healthcare Medicare |
$365.08
|
| Rate for Payer: WINHealth Partners Commercial |
$568.58
|
| Rate for Payer: Wise Provider Network Commercial |
$568.58
|
|
|
BLADE OSCILLATIN 90X13-21/1.19
|
Facility
|
OP
|
$598.50
|
|
| Hospital Charge Code |
2650766
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.09 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$586.53
|
| Rate for Payer: Aetna of WY Medicare |
$395.01
|
| Rate for Payer: Altius Commercial |
$574.56
|
| Rate for Payer: Beech Street Commercial |
$586.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$580.54
|
| Rate for Payer: Cash Price |
$418.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$580.54
|
| Rate for Payer: Cigna of WY Commercial |
$586.53
|
| Rate for Payer: Entrust Commercial |
$568.58
|
| Rate for Payer: First Choice Health Commercial |
$568.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$568.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.14
|
| Rate for Payer: HealthUtah PPO |
$598.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$580.54
|
| Rate for Payer: Multiplan Medicare/VA |
$324.09
|
| Rate for Payer: One Health Plan of WY PPO |
$586.53
|
| Rate for Payer: PacificSource Commercial |
$538.65
|
| Rate for Payer: PHCS PPO |
$586.53
|
| Rate for Payer: Three Rivers PPO |
$448.88
|
| Rate for Payer: TriWest Veterans Administration |
$341.14
|
| Rate for Payer: United Healthcare Commercial |
$571.57
|
| Rate for Payer: United Healthcare Medicare |
$341.14
|
| Rate for Payer: WINHealth Partners Commercial |
$586.53
|
| Rate for Payer: Wise Provider Network Commercial |
$568.58
|
|
|
BLADE OSCILLATING 100X17X1.37
|
Facility
|
OP
|
$87.50
|
|
| Hospital Charge Code |
3003599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Aetna of WY Medicare |
$57.75
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.88
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.88
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$47.38
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$49.88
|
| Rate for Payer: United Healthcare Commercial |
$83.56
|
| Rate for Payer: United Healthcare Medicare |
$49.88
|
| Rate for Payer: WINHealth Partners Commercial |
$85.75
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
BLADE OSCILLATING 100X17X1.37
|
Facility
|
IP
|
$87.50
|
|
| Hospital Charge Code |
3003599
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Aetna of WY Medicare |
$56.00
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.88
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.38
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$50.71
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$53.38
|
| Rate for Payer: United Healthcare Commercial |
$83.56
|
| Rate for Payer: United Healthcare Medicare |
$53.38
|
| Rate for Payer: WINHealth Partners Commercial |
$83.12
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
BLADE OSCILLATING 70X8X1.27MM
|
Facility
|
IP
|
$1,102.50
|
|
| Hospital Charge Code |
3002738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.90 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,080.45
|
| Rate for Payer: Aetna of WY Medicare |
$705.60
|
| Rate for Payer: Altius Commercial |
$1,058.40
|
| Rate for Payer: Beech Street Commercial |
$1,080.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,069.42
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,069.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,080.45
|
| Rate for Payer: Entrust Commercial |
$1,047.38
|
| Rate for Payer: First Choice Health Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$672.52
|
| Rate for Payer: HealthUtah PPO |
$1,102.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,069.42
|
| Rate for Payer: Multiplan Medicare/VA |
$638.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,080.45
|
| Rate for Payer: PacificSource Commercial |
$992.25
|
| Rate for Payer: PHCS PPO |
$1,080.45
|
| Rate for Payer: Three Rivers PPO |
$826.88
|
| Rate for Payer: TriWest Veterans Administration |
$672.52
|
| Rate for Payer: United Healthcare Commercial |
$1,052.89
|
| Rate for Payer: United Healthcare Medicare |
$672.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,047.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,047.38
|
|
|
BLADE OSCILLATING 70X8X1.27MM
|
Facility
|
OP
|
$1,102.50
|
|
| Hospital Charge Code |
3002738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$597.00 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,080.45
|
| Rate for Payer: Aetna of WY Medicare |
$727.65
|
| Rate for Payer: Altius Commercial |
$1,058.40
|
| Rate for Payer: Beech Street Commercial |
$1,080.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,069.42
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,069.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,080.45
|
| Rate for Payer: Entrust Commercial |
$1,047.38
|
| Rate for Payer: First Choice Health Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,047.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$628.42
|
| Rate for Payer: HealthUtah PPO |
$1,102.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,069.42
|
| Rate for Payer: Multiplan Medicare/VA |
$597.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1,080.45
|
| Rate for Payer: PacificSource Commercial |
$992.25
|
| Rate for Payer: PHCS PPO |
$1,080.45
|
| Rate for Payer: Three Rivers PPO |
$826.88
|
| Rate for Payer: TriWest Veterans Administration |
$628.42
|
| Rate for Payer: United Healthcare Commercial |
$1,052.89
|
| Rate for Payer: United Healthcare Medicare |
$628.42
|
| Rate for Payer: WINHealth Partners Commercial |
$1,080.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,047.38
|
|
|
BLADE OSTEOTOME AR-7000-01
|
Facility
|
IP
|
$437.50
|
|
| Hospital Charge Code |
3003296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.53 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.75
|
| Rate for Payer: Aetna of WY Medicare |
$280.00
|
| Rate for Payer: Altius Commercial |
$420.00
|
| Rate for Payer: Beech Street Commercial |
$428.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.38
|
| Rate for Payer: Cash Price |
$306.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.38
|
| Rate for Payer: Cigna of WY Commercial |
$428.75
|
| Rate for Payer: Entrust Commercial |
$415.62
|
| Rate for Payer: First Choice Health Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$266.88
|
| Rate for Payer: HealthUtah PPO |
$437.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.38
|
| Rate for Payer: Multiplan Medicare/VA |
$253.53
|
| Rate for Payer: One Health Plan of WY PPO |
$428.75
|
| Rate for Payer: PacificSource Commercial |
$393.75
|
| Rate for Payer: PHCS PPO |
$428.75
|
| Rate for Payer: Three Rivers PPO |
$328.12
|
| Rate for Payer: TriWest Veterans Administration |
$266.88
|
| Rate for Payer: United Healthcare Commercial |
$417.81
|
| Rate for Payer: United Healthcare Medicare |
$266.88
|
| Rate for Payer: WINHealth Partners Commercial |
$415.62
|
| Rate for Payer: Wise Provider Network Commercial |
$415.62
|
|
|
BLADE OSTEOTOME AR-7000-01
|
Facility
|
OP
|
$437.50
|
|
| Hospital Charge Code |
3003296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.91 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$428.75
|
| Rate for Payer: Aetna of WY Medicare |
$288.75
|
| Rate for Payer: Altius Commercial |
$420.00
|
| Rate for Payer: Beech Street Commercial |
$428.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$424.38
|
| Rate for Payer: Cash Price |
$306.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.38
|
| Rate for Payer: Cigna of WY Commercial |
$428.75
|
| Rate for Payer: Entrust Commercial |
$415.62
|
| Rate for Payer: First Choice Health Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$415.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.38
|
| Rate for Payer: HealthUtah PPO |
$437.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.38
|
| Rate for Payer: Multiplan Medicare/VA |
$236.91
|
| Rate for Payer: One Health Plan of WY PPO |
$428.75
|
| Rate for Payer: PacificSource Commercial |
$393.75
|
| Rate for Payer: PHCS PPO |
$428.75
|
| Rate for Payer: Three Rivers PPO |
$328.12
|
| Rate for Payer: TriWest Veterans Administration |
$249.38
|
| Rate for Payer: United Healthcare Commercial |
$417.81
|
| Rate for Payer: United Healthcare Medicare |
$249.38
|
| Rate for Payer: WINHealth Partners Commercial |
$428.75
|
| Rate for Payer: Wise Provider Network Commercial |
$415.62
|
|
