|
RESPIR PTHGN MULT REV TRANS& PRB TECH 14 TRGT
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 0098U
|
| Hospital Charge Code |
0098U
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: WINHealth Partners Commercial |
$385.70
|
|
|
RESP PEEP VALVE 22MM 2K8082
|
Facility
|
IP
|
$15.58
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$15.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.96
|
| Rate for Payer: Altius Commercial |
$14.96
|
| Rate for Payer: Beech Street Commercial |
$15.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.11
|
| Rate for Payer: Cigna of WY Commercial |
$15.27
|
| Rate for Payer: Entrust Commercial |
$14.80
|
| Rate for Payer: First Choice Health Commercial |
$14.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.28
|
| Rate for Payer: HealthUtah PPO |
$15.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.11
|
| Rate for Payer: Multiplan Medicare/VA |
$9.77
|
| Rate for Payer: One Health Plan of WY PPO |
$15.27
|
| Rate for Payer: PacificSource Commercial |
$14.02
|
| Rate for Payer: PHCS PPO |
$15.27
|
| Rate for Payer: Three Rivers PPO |
$11.68
|
| Rate for Payer: TriWest Veterans Administration |
$10.28
|
| Rate for Payer: United Healthcare Commercial |
$13.55
|
| Rate for Payer: United Healthcare Medicare |
$10.28
|
| Rate for Payer: WINHealth Partners Commercial |
$14.80
|
| Rate for Payer: Wise Provider Network Commercial |
$14.80
|
|
|
RESP PEEP VALVE 22MM 2K8082
|
Facility
|
OP
|
$15.58
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$15.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.27
|
| Rate for Payer: Aetna of WY Medicare |
$10.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.96
|
| Rate for Payer: Altius Commercial |
$14.96
|
| Rate for Payer: Beech Street Commercial |
$15.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.11
|
| Rate for Payer: Cigna of WY Commercial |
$15.27
|
| Rate for Payer: Entrust Commercial |
$14.80
|
| Rate for Payer: First Choice Health Commercial |
$14.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.04
|
| Rate for Payer: HealthUtah PPO |
$15.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.11
|
| Rate for Payer: Multiplan Medicare/VA |
$8.58
|
| Rate for Payer: One Health Plan of WY PPO |
$15.27
|
| Rate for Payer: PacificSource Commercial |
$14.02
|
| Rate for Payer: PHCS PPO |
$15.27
|
| Rate for Payer: Three Rivers PPO |
$11.68
|
| Rate for Payer: TriWest Veterans Administration |
$9.04
|
| Rate for Payer: United Healthcare Commercial |
$13.55
|
| Rate for Payer: United Healthcare Medicare |
$9.04
|
| Rate for Payer: WINHealth Partners Commercial |
$15.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.80
|
|
|
RESP SENSOR FLOW ADULT/PED
|
Facility
|
IP
|
$64.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$64.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.15
|
| Rate for Payer: Altius Commercial |
$62.15
|
| Rate for Payer: Beech Street Commercial |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.15
|
| Rate for Payer: Cash Price |
$45.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.80
|
| Rate for Payer: Cigna of WY Commercial |
$63.45
|
| Rate for Payer: Entrust Commercial |
$61.50
|
| Rate for Payer: First Choice Health Commercial |
$61.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.73
|
| Rate for Payer: HealthUtah PPO |
$64.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.80
|
| Rate for Payer: Multiplan Medicare/VA |
$40.59
|
| Rate for Payer: One Health Plan of WY PPO |
$63.45
|
| Rate for Payer: PacificSource Commercial |
$58.27
|
| Rate for Payer: PHCS PPO |
$63.45
|
| Rate for Payer: Three Rivers PPO |
$48.56
|
| Rate for Payer: TriWest Veterans Administration |
$42.73
|
| Rate for Payer: United Healthcare Commercial |
$56.32
|
| Rate for Payer: United Healthcare Medicare |
$42.73
|
| Rate for Payer: WINHealth Partners Commercial |
$61.50
|
| Rate for Payer: Wise Provider Network Commercial |
$61.50
|
|
|
RESP SENSOR FLOW ADULT/PED
|
Facility
|
OP
|
$64.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$64.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.45
|
| Rate for Payer: Aetna of WY Medicare |
$42.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$62.15
|
| Rate for Payer: Altius Commercial |
$62.15
|
| Rate for Payer: Beech Street Commercial |
$63.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.15
|
| Rate for Payer: Cash Price |
$45.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.80
|
| Rate for Payer: Cigna of WY Commercial |
$63.45
|
| Rate for Payer: Entrust Commercial |
$61.50
|
| Rate for Payer: First Choice Health Commercial |
$61.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.55
|
| Rate for Payer: HealthUtah PPO |
$64.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.80
|
| Rate for Payer: Multiplan Medicare/VA |
$35.67
|
| Rate for Payer: One Health Plan of WY PPO |
$63.45
|
| Rate for Payer: PacificSource Commercial |
$58.27
|
| Rate for Payer: PHCS PPO |
$63.45
|
| Rate for Payer: Three Rivers PPO |
$48.56
|
| Rate for Payer: TriWest Veterans Administration |
$37.55
|
| Rate for Payer: United Healthcare Commercial |
$56.32
|
| Rate for Payer: United Healthcare Medicare |
$37.55
|
| Rate for Payer: WINHealth Partners Commercial |
$63.45
|
| Rate for Payer: Wise Provider Network Commercial |
$61.50
|
|
|
RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [182791]
|
Facility
|
OP
|
$306.80
|
|
|
Service Code
|
NDC 0069034405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.66
|
| Rate for Payer: Aetna of WY Medicare |
$202.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.53
|
| Rate for Payer: Altius Commercial |
$294.53
|
| Rate for Payer: Beech Street Commercial |
$300.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$214.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.60
|
| Rate for Payer: Cigna of WY Commercial |
$300.66
|
| Rate for Payer: Entrust Commercial |
$291.46
|
| Rate for Payer: First Choice Health Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.94
|
| Rate for Payer: HealthUtah PPO |
$306.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.60
|
| Rate for Payer: Multiplan Medicare/VA |
$169.05
|
| Rate for Payer: One Health Plan of WY PPO |
$300.66
|
| Rate for Payer: PacificSource Commercial |
$276.12
|
| Rate for Payer: PHCS PPO |
$300.66
|
| Rate for Payer: Three Rivers PPO |
$230.10
|
| Rate for Payer: TriWest Veterans Administration |
$177.94
|
| Rate for Payer: United Healthcare Commercial |
$266.92
|
| Rate for Payer: United Healthcare Medicare |
$177.94
|
| Rate for Payer: WINHealth Partners Commercial |
$300.66
|
| Rate for Payer: Wise Provider Network Commercial |
$291.46
|
|
|
RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [182791]
|
Facility
|
IP
|
$306.80
|
|
|
Service Code
|
NDC 0069020701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.53
|
| Rate for Payer: Altius Commercial |
$294.53
|
| Rate for Payer: Beech Street Commercial |
$300.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$214.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.60
|
| Rate for Payer: Cigna of WY Commercial |
$300.66
|
| Rate for Payer: Entrust Commercial |
$291.46
|
| Rate for Payer: First Choice Health Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.49
|
| Rate for Payer: HealthUtah PPO |
$306.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.60
|
| Rate for Payer: Multiplan Medicare/VA |
$192.36
|
| Rate for Payer: One Health Plan of WY PPO |
$300.66
|
| Rate for Payer: PacificSource Commercial |
$276.12
|
| Rate for Payer: PHCS PPO |
$300.66
|
| Rate for Payer: Three Rivers PPO |
$230.10
|
| Rate for Payer: TriWest Veterans Administration |
$202.49
|
| Rate for Payer: United Healthcare Commercial |
$266.92
|
| Rate for Payer: United Healthcare Medicare |
$202.49
|
| Rate for Payer: WINHealth Partners Commercial |
$291.46
|
| Rate for Payer: Wise Provider Network Commercial |
$291.46
|
|
|
RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [182791]
|
Facility
|
IP
|
$306.80
|
|
|
Service Code
|
NDC 0069034401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.53
|
| Rate for Payer: Altius Commercial |
$294.53
|
| Rate for Payer: Beech Street Commercial |
$300.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$214.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.60
|
| Rate for Payer: Cigna of WY Commercial |
$300.66
|
| Rate for Payer: Entrust Commercial |
$291.46
|
| Rate for Payer: First Choice Health Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.49
|
| Rate for Payer: HealthUtah PPO |
$306.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.60
|
| Rate for Payer: Multiplan Medicare/VA |
$192.36
|
| Rate for Payer: One Health Plan of WY PPO |
$300.66
|
| Rate for Payer: PacificSource Commercial |
$276.12
|
| Rate for Payer: PHCS PPO |
$300.66
|
| Rate for Payer: Three Rivers PPO |
$230.10
|
| Rate for Payer: TriWest Veterans Administration |
$202.49
|
| Rate for Payer: United Healthcare Commercial |
$266.92
|
| Rate for Payer: United Healthcare Medicare |
$202.49
|
| Rate for Payer: WINHealth Partners Commercial |
$291.46
|
| Rate for Payer: Wise Provider Network Commercial |
$291.46
|
|
|
RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [182791]
|
Facility
|
IP
|
$306.80
|
|
|
Service Code
|
NDC 0069034405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.53
|
| Rate for Payer: Altius Commercial |
$294.53
|
| Rate for Payer: Beech Street Commercial |
$300.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$214.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.60
|
| Rate for Payer: Cigna of WY Commercial |
$300.66
|
| Rate for Payer: Entrust Commercial |
$291.46
|
| Rate for Payer: First Choice Health Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.49
|
| Rate for Payer: HealthUtah PPO |
$306.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.60
|
| Rate for Payer: Multiplan Medicare/VA |
$192.36
|
| Rate for Payer: One Health Plan of WY PPO |
$300.66
|
| Rate for Payer: PacificSource Commercial |
$276.12
|
| Rate for Payer: PHCS PPO |
$300.66
|
| Rate for Payer: Three Rivers PPO |
$230.10
|
| Rate for Payer: TriWest Veterans Administration |
$202.49
|
| Rate for Payer: United Healthcare Commercial |
$266.92
|
| Rate for Payer: United Healthcare Medicare |
$202.49
|
| Rate for Payer: WINHealth Partners Commercial |
$291.46
|
| Rate for Payer: Wise Provider Network Commercial |
$291.46
|
|
|
RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [182791]
|
Facility
|
OP
|
$306.80
|
|
|
Service Code
|
NDC 0069020701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.66
|
| Rate for Payer: Aetna of WY Medicare |
$202.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.53
|
| Rate for Payer: Altius Commercial |
$294.53
|
| Rate for Payer: Beech Street Commercial |
$300.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$214.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.60
|
| Rate for Payer: Cigna of WY Commercial |
$300.66
|
| Rate for Payer: Entrust Commercial |
$291.46
|
| Rate for Payer: First Choice Health Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.94
|
| Rate for Payer: HealthUtah PPO |
$306.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.60
|
| Rate for Payer: Multiplan Medicare/VA |
$169.05
|
| Rate for Payer: One Health Plan of WY PPO |
$300.66
|
| Rate for Payer: PacificSource Commercial |
$276.12
|
| Rate for Payer: PHCS PPO |
$300.66
|
| Rate for Payer: Three Rivers PPO |
$230.10
|
| Rate for Payer: TriWest Veterans Administration |
$177.94
|
| Rate for Payer: United Healthcare Commercial |
$266.92
|
| Rate for Payer: United Healthcare Medicare |
$177.94
|
| Rate for Payer: WINHealth Partners Commercial |
$300.66
|
| Rate for Payer: Wise Provider Network Commercial |
$291.46
|
|
|
RESP SYNCYTIAL VIRUS VAC, PREF A AND B (PF) 120 MCG/0.5 ML IM SOLUTION [182791]
|
Facility
|
OP
|
$306.80
|
|
|
Service Code
|
NDC 0069034401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$306.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$300.66
|
| Rate for Payer: Aetna of WY Medicare |
$202.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$294.53
|
| Rate for Payer: Altius Commercial |
$294.53
|
| Rate for Payer: Beech Street Commercial |
$300.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$214.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$297.60
|
| Rate for Payer: Cigna of WY Commercial |
$300.66
|
| Rate for Payer: Entrust Commercial |
$291.46
|
| Rate for Payer: First Choice Health Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$291.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$177.94
|
| Rate for Payer: HealthUtah PPO |
$306.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$297.60
|
| Rate for Payer: Multiplan Medicare/VA |
$169.05
|
| Rate for Payer: One Health Plan of WY PPO |
$300.66
|
| Rate for Payer: PacificSource Commercial |
$276.12
|
| Rate for Payer: PHCS PPO |
$300.66
|
| Rate for Payer: Three Rivers PPO |
$230.10
|
| Rate for Payer: TriWest Veterans Administration |
$177.94
|
| Rate for Payer: United Healthcare Commercial |
$266.92
|
| Rate for Payer: United Healthcare Medicare |
$177.94
|
| Rate for Payer: WINHealth Partners Commercial |
$300.66
|
| Rate for Payer: Wise Provider Network Commercial |
$291.46
|
|
|
RESTRAINT LIMB 1 STRAP 2532
|
Facility
|
IP
|
$11.23
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.78
|
| Rate for Payer: Altius Commercial |
$10.78
|
| Rate for Payer: Beech Street Commercial |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.89
|
| Rate for Payer: Cigna of WY Commercial |
$11.01
|
| Rate for Payer: Entrust Commercial |
$10.67
|
| Rate for Payer: First Choice Health Commercial |
$10.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.41
|
| Rate for Payer: HealthUtah PPO |
$11.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.89
|
| Rate for Payer: Multiplan Medicare/VA |
$7.04
|
| Rate for Payer: One Health Plan of WY PPO |
$11.01
|
| Rate for Payer: PacificSource Commercial |
$10.11
|
| Rate for Payer: PHCS PPO |
$11.01
|
| Rate for Payer: Three Rivers PPO |
$8.42
|
| Rate for Payer: TriWest Veterans Administration |
$7.41
|
| Rate for Payer: United Healthcare Commercial |
$9.77
|
| Rate for Payer: United Healthcare Medicare |
$7.41
|
| Rate for Payer: WINHealth Partners Commercial |
$10.67
|
| Rate for Payer: Wise Provider Network Commercial |
$10.67
|
|
|
RESTRAINT LIMB 1 STRAP 2532
|
Facility
|
OP
|
$11.23
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.01
|
| Rate for Payer: Aetna of WY Medicare |
$7.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.78
|
| Rate for Payer: Altius Commercial |
$10.78
|
| Rate for Payer: Beech Street Commercial |
$11.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.89
|
| Rate for Payer: Cigna of WY Commercial |
$11.01
|
| Rate for Payer: Entrust Commercial |
$10.67
|
| Rate for Payer: First Choice Health Commercial |
$10.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.51
|
| Rate for Payer: HealthUtah PPO |
$11.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.89
|
| Rate for Payer: Multiplan Medicare/VA |
$6.19
|
| Rate for Payer: One Health Plan of WY PPO |
$11.01
|
| Rate for Payer: PacificSource Commercial |
$10.11
|
| Rate for Payer: PHCS PPO |
$11.01
|
| Rate for Payer: Three Rivers PPO |
$8.42
|
| Rate for Payer: TriWest Veterans Administration |
$6.51
|
| Rate for Payer: United Healthcare Commercial |
$9.77
|
| Rate for Payer: United Healthcare Medicare |
$6.51
|
| Rate for Payer: WINHealth Partners Commercial |
$11.01
|
| Rate for Payer: Wise Provider Network Commercial |
$10.67
|
|
|
REVEFENACIN 175 MCG/3 ML SOLUTION FOR NEBULIZATION [154640]
|
Facility
|
OP
|
$39.41
|
|
|
Service Code
|
HCPCS J7677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$39.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.62
|
| Rate for Payer: Aetna of WY Medicare |
$26.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.83
|
| Rate for Payer: Altius Commercial |
$37.83
|
| Rate for Payer: Beech Street Commercial |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.36
|
| Rate for Payer: Cash Price |
$27.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.23
|
| Rate for Payer: Cigna of WY Commercial |
$38.62
|
| Rate for Payer: Entrust Commercial |
$37.44
|
| Rate for Payer: First Choice Health Commercial |
$37.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.86
|
| Rate for Payer: HealthUtah PPO |
$39.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.23
|
| Rate for Payer: Multiplan Medicare/VA |
$21.71
|
| Rate for Payer: One Health Plan of WY PPO |
$38.62
|
| Rate for Payer: PacificSource Commercial |
$35.47
|
| Rate for Payer: PHCS PPO |
$38.62
|
| Rate for Payer: Three Rivers PPO |
$29.56
|
| Rate for Payer: TriWest Veterans Administration |
$22.86
|
| Rate for Payer: United Healthcare Commercial |
$34.29
|
| Rate for Payer: United Healthcare Medicare |
$22.86
|
| Rate for Payer: WINHealth Partners Commercial |
$38.62
|
| Rate for Payer: Wise Provider Network Commercial |
$37.44
|
|
|
REVEFENACIN 175 MCG/3 ML SOLUTION FOR NEBULIZATION [154640]
|
Facility
|
IP
|
$39.41
|
|
|
Service Code
|
HCPCS J7677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$39.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.83
|
| Rate for Payer: Altius Commercial |
$37.83
|
| Rate for Payer: Beech Street Commercial |
$38.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.36
|
| Rate for Payer: Cash Price |
$27.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.23
|
| Rate for Payer: Cigna of WY Commercial |
$38.62
|
| Rate for Payer: Entrust Commercial |
$37.44
|
| Rate for Payer: First Choice Health Commercial |
$37.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.01
|
| Rate for Payer: HealthUtah PPO |
$39.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.23
|
| Rate for Payer: Multiplan Medicare/VA |
$24.71
|
| Rate for Payer: One Health Plan of WY PPO |
$38.62
|
| Rate for Payer: PacificSource Commercial |
$35.47
|
| Rate for Payer: PHCS PPO |
$38.62
|
| Rate for Payer: Three Rivers PPO |
$29.56
|
| Rate for Payer: TriWest Veterans Administration |
$26.01
|
| Rate for Payer: United Healthcare Commercial |
$34.29
|
| Rate for Payer: United Healthcare Medicare |
$26.01
|
| Rate for Payer: WINHealth Partners Commercial |
$37.44
|
| Rate for Payer: Wise Provider Network Commercial |
$37.44
|
|
|
REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$5,926.00
|
|
|
Service Code
|
HCPCS 23474 80
|
| Hospital Charge Code |
23474
|
| Min. Negotiated Rate |
$1,411.55 |
| Max. Negotiated Rate |
$5,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,807.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,660.65
|
| Rate for Payer: Beech Street Commercial |
$5,629.70
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,748.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,807.48
|
| Rate for Payer: First Choice Health Commercial |
$5,333.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,629.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,660.65
|
| Rate for Payer: HealthUtah PPO |
$5,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,748.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1,411.55
|
| Rate for Payer: One Health Plan of WY PPO |
$5,807.48
|
| Rate for Payer: PacificSource Commercial |
$5,333.40
|
| Rate for Payer: PHCS PPO |
$5,629.70
|
| Rate for Payer: Three Rivers PPO |
$4,444.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,660.65
|
| Rate for Payer: United Healthcare Commercial |
$5,155.62
|
| Rate for Payer: United Healthcare Medicare |
$1,660.65
|
| Rate for Payer: WINHealth Partners Commercial |
$5,037.10
|
|
|
REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$5,926.00
|
|
|
Service Code
|
HCPCS 23474 AS
|
| Hospital Charge Code |
23474
|
| Min. Negotiated Rate |
$1,411.55 |
| Max. Negotiated Rate |
$5,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,807.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,660.65
|
| Rate for Payer: Beech Street Commercial |
$5,629.70
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,748.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,807.48
|
| Rate for Payer: First Choice Health Commercial |
$5,333.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,629.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,660.65
|
| Rate for Payer: HealthUtah PPO |
$5,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,748.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1,411.55
|
| Rate for Payer: One Health Plan of WY PPO |
$5,807.48
|
| Rate for Payer: PacificSource Commercial |
$5,333.40
|
| Rate for Payer: PHCS PPO |
$5,629.70
|
| Rate for Payer: Three Rivers PPO |
$4,444.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,660.65
|
| Rate for Payer: United Healthcare Commercial |
$5,155.62
|
| Rate for Payer: United Healthcare Medicare |
$1,660.65
|
| Rate for Payer: WINHealth Partners Commercial |
$5,037.10
|
|
|
REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$5,926.00
|
|
|
Service Code
|
HCPCS 23474
|
| Hospital Charge Code |
23474
|
| Min. Negotiated Rate |
$1,411.55 |
| Max. Negotiated Rate |
$5,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,807.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,660.65
|
| Rate for Payer: Beech Street Commercial |
$5,629.70
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: Cash Price |
$4,148.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,748.22
|
| Rate for Payer: Cigna of WY Commercial |
$5,807.48
|
| Rate for Payer: First Choice Health Commercial |
$5,333.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,629.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,660.65
|
| Rate for Payer: HealthUtah PPO |
$5,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,748.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1,411.55
|
| Rate for Payer: One Health Plan of WY PPO |
$5,807.48
|
| Rate for Payer: PacificSource Commercial |
$5,333.40
|
| Rate for Payer: PHCS PPO |
$5,629.70
|
| Rate for Payer: Three Rivers PPO |
$4,444.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,660.65
|
| Rate for Payer: United Healthcare Commercial |
$5,155.62
|
| Rate for Payer: United Healthcare Medicare |
$1,660.65
|
| Rate for Payer: WINHealth Partners Commercial |
$5,037.10
|
|
|
REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$5,492.00
|
|
|
Service Code
|
HCPCS 23473 AS
|
| Hospital Charge Code |
23473
|
| Min. Negotiated Rate |
$1,308.29 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,382.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,539.17
|
| Rate for Payer: Beech Street Commercial |
$5,217.40
|
| Rate for Payer: Cash Price |
$3,844.40
|
| Rate for Payer: Cash Price |
$3,844.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,327.24
|
| Rate for Payer: Cigna of WY Commercial |
$5,382.16
|
| Rate for Payer: First Choice Health Commercial |
$4,942.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,217.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,539.17
|
| Rate for Payer: HealthUtah PPO |
$5,492.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,327.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,308.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5,382.16
|
| Rate for Payer: PacificSource Commercial |
$4,942.80
|
| Rate for Payer: PHCS PPO |
$5,217.40
|
| Rate for Payer: Three Rivers PPO |
$4,119.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,539.17
|
| Rate for Payer: United Healthcare Commercial |
$4,778.04
|
| Rate for Payer: United Healthcare Medicare |
$1,539.17
|
| Rate for Payer: WINHealth Partners Commercial |
$4,668.20
|
|
|
REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$5,492.00
|
|
|
Service Code
|
HCPCS 23473
|
| Hospital Charge Code |
23473
|
| Min. Negotiated Rate |
$1,308.29 |
| Max. Negotiated Rate |
$5,492.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,382.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,539.17
|
| Rate for Payer: Beech Street Commercial |
$5,217.40
|
| Rate for Payer: Cash Price |
$3,844.40
|
| Rate for Payer: Cash Price |
$3,844.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,327.24
|
| Rate for Payer: Cigna of WY Commercial |
$5,382.16
|
| Rate for Payer: First Choice Health Commercial |
$4,942.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,217.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,539.17
|
| Rate for Payer: HealthUtah PPO |
$5,492.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,327.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1,308.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5,382.16
|
| Rate for Payer: PacificSource Commercial |
$4,942.80
|
| Rate for Payer: PHCS PPO |
$5,217.40
|
| Rate for Payer: Three Rivers PPO |
$4,119.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,539.17
|
| Rate for Payer: United Healthcare Commercial |
$4,778.04
|
| Rate for Payer: United Healthcare Medicare |
$1,539.17
|
| Rate for Payer: WINHealth Partners Commercial |
$4,668.20
|
|
|
REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
63663
|
| Min. Negotiated Rate |
$369.13 |
| Max. Negotiated Rate |
$2,329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,282.42
|
| Rate for Payer: Aetna of WY Medicare |
$434.27
|
| Rate for Payer: Beech Street Commercial |
$2,212.55
|
| Rate for Payer: Cash Price |
$1,630.30
|
| Rate for Payer: Cash Price |
$1,630.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,259.13
|
| Rate for Payer: Cigna of WY Commercial |
$2,282.42
|
| Rate for Payer: First Choice Health Commercial |
$2,096.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,212.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$434.27
|
| Rate for Payer: HealthUtah PPO |
$2,329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,259.13
|
| Rate for Payer: Multiplan Medicare/VA |
$369.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,282.42
|
| Rate for Payer: PacificSource Commercial |
$2,096.10
|
| Rate for Payer: PHCS PPO |
$2,212.55
|
| Rate for Payer: Three Rivers PPO |
$1,746.75
|
| Rate for Payer: TriWest Veterans Administration |
$434.27
|
| Rate for Payer: United Healthcare Commercial |
$2,026.23
|
| Rate for Payer: United Healthcare Medicare |
$434.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,979.65
|
|
|
REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
63688
|
| Min. Negotiated Rate |
$245.66 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,872.78
|
| Rate for Payer: Aetna of WY Medicare |
$289.01
|
| Rate for Payer: Beech Street Commercial |
$1,815.45
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: Cash Price |
$1,337.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,853.67
|
| Rate for Payer: Cigna of WY Commercial |
$1,872.78
|
| Rate for Payer: First Choice Health Commercial |
$1,719.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,815.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$289.01
|
| Rate for Payer: HealthUtah PPO |
$1,911.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,853.67
|
| Rate for Payer: Multiplan Medicare/VA |
$245.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1,872.78
|
| Rate for Payer: PacificSource Commercial |
$1,719.90
|
| Rate for Payer: PHCS PPO |
$1,815.45
|
| Rate for Payer: Three Rivers PPO |
$1,433.25
|
| Rate for Payer: TriWest Veterans Administration |
$289.01
|
| Rate for Payer: United Healthcare Commercial |
$1,662.57
|
| Rate for Payer: United Healthcare Medicare |
$289.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,624.35
|
|
|
REVJ/RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
64585
|
| Min. Negotiated Rate |
$118.34 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$728.14
|
| Rate for Payer: Aetna of WY Medicare |
$139.22
|
| Rate for Payer: Beech Street Commercial |
$705.85
|
| Rate for Payer: Cash Price |
$520.10
|
| Rate for Payer: Cash Price |
$520.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$720.71
|
| Rate for Payer: Cigna of WY Commercial |
$728.14
|
| Rate for Payer: First Choice Health Commercial |
$668.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$705.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.22
|
| Rate for Payer: HealthUtah PPO |
$743.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$720.71
|
| Rate for Payer: Multiplan Medicare/VA |
$118.34
|
| Rate for Payer: One Health Plan of WY PPO |
$728.14
|
| Rate for Payer: PacificSource Commercial |
$668.70
|
| Rate for Payer: PHCS PPO |
$705.85
|
| Rate for Payer: Three Rivers PPO |
$557.25
|
| Rate for Payer: TriWest Veterans Administration |
$139.22
|
| Rate for Payer: United Healthcare Commercial |
$646.41
|
| Rate for Payer: United Healthcare Medicare |
$139.22
|
| Rate for Payer: WINHealth Partners Commercial |
$631.55
|
|
|
REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$7,263.00
|
|
|
Service Code
|
HCPCS 27486 AS
|
| Hospital Charge Code |
27486
|
| Min. Negotiated Rate |
$1,144.19 |
| Max. Negotiated Rate |
$7,263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,117.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,346.11
|
| Rate for Payer: Beech Street Commercial |
$6,899.85
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: Cash Price |
$5,084.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,045.11
|
| Rate for Payer: Cigna of WY Commercial |
$7,117.74
|
| Rate for Payer: First Choice Health Commercial |
$6,536.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,899.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,346.11
|
| Rate for Payer: HealthUtah PPO |
$7,263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,045.11
|
| Rate for Payer: Multiplan Medicare/VA |
$1,144.19
|
| Rate for Payer: One Health Plan of WY PPO |
$7,117.74
|
| Rate for Payer: PacificSource Commercial |
$6,536.70
|
| Rate for Payer: PHCS PPO |
$6,899.85
|
| Rate for Payer: Three Rivers PPO |
$5,447.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,346.11
|
| Rate for Payer: United Healthcare Commercial |
$6,318.81
|
| Rate for Payer: United Healthcare Medicare |
$1,346.11
|
| Rate for Payer: WINHealth Partners Commercial |
$6,173.55
|
|
|
REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT
|
Professional
|
Both
|
$14,527.00
|
|
|
Service Code
|
HCPCS 27486 50
|
| Hospital Charge Code |
27486
|
| Min. Negotiated Rate |
$1,144.19 |
| Max. Negotiated Rate |
$14,527.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14,236.46
|
| Rate for Payer: Aetna of WY Medicare |
$1,346.11
|
| Rate for Payer: Beech Street Commercial |
$13,800.65
|
| Rate for Payer: Cash Price |
$10,168.90
|
| Rate for Payer: Cash Price |
$10,168.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$14,091.19
|
| Rate for Payer: Cigna of WY Commercial |
$14,236.46
|
| Rate for Payer: First Choice Health Commercial |
$13,074.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13,800.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,346.11
|
| Rate for Payer: HealthUtah PPO |
$14,527.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14,091.19
|
| Rate for Payer: Multiplan Medicare/VA |
$1,144.19
|
| Rate for Payer: One Health Plan of WY PPO |
$14,236.46
|
| Rate for Payer: PacificSource Commercial |
$13,074.30
|
| Rate for Payer: PHCS PPO |
$13,800.65
|
| Rate for Payer: Three Rivers PPO |
$10,895.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,346.11
|
| Rate for Payer: United Healthcare Commercial |
$12,638.49
|
| Rate for Payer: United Healthcare Medicare |
$1,346.11
|
| Rate for Payer: WINHealth Partners Commercial |
$12,347.95
|
|
