|
BRACE ANKLE XLARGE SA702509
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
2200400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$30.94
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.49
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$28.01
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$29.49
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare |
$29.49
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XLARGE SA702509
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
2200400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.18
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XSMALL SA702501
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
2200396
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.18
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XSMALL SA702501
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
2200396
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$30.94
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.49
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$28.01
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$29.49
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare |
$29.49
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XXLARGE SA702511
|
Facility
|
OP
|
$48.34
|
|
| Hospital Charge Code |
2200401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$31.90
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$26.18
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$47.37
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANKLE XXLARGE SA702511
|
Facility
|
IP
|
$48.34
|
|
| Hospital Charge Code |
2200401
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.01 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.37
|
| Rate for Payer: Aetna of WY Medicare |
$30.94
|
| Rate for Payer: Altius Commercial |
$46.41
|
| Rate for Payer: Beech Street Commercial |
$47.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.89
|
| Rate for Payer: Cigna of WY Commercial |
$47.37
|
| Rate for Payer: Entrust Commercial |
$45.92
|
| Rate for Payer: First Choice Health Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.49
|
| Rate for Payer: HealthUtah PPO |
$48.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.89
|
| Rate for Payer: Multiplan Medicare/VA |
$28.01
|
| Rate for Payer: One Health Plan of WY PPO |
$47.37
|
| Rate for Payer: PacificSource Commercial |
$43.51
|
| Rate for Payer: PHCS PPO |
$47.37
|
| Rate for Payer: Three Rivers PPO |
$36.26
|
| Rate for Payer: TriWest Veterans Administration |
$29.49
|
| Rate for Payer: United Healthcare Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicare |
$29.49
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$45.92
|
|
|
BRACE ANK VISCO FIGURE 8 LT LG
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200413
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT LG
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200413
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT MD
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200412
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT MD
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200412
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT SM
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200411
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT SM
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200411
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT XL
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200414
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT XL
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200414
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT XS
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 LT XS
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200422
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE8 LT XXL
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200415
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE8 LT XXL
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200415
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT LG
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200408
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT LG
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200408
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT MD
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT MD
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT SM
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200406
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT SM
|
Facility
|
IP
|
$138.46
|
|
| Hospital Charge Code |
2200406
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.24 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$88.61
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.46
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$80.24
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$84.46
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$84.46
|
| Rate for Payer: WINHealth Partners Commercial |
$131.54
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
|
BRACE ANK VISCO FIGURE 8 RT XL
|
Facility
|
OP
|
$138.46
|
|
| Hospital Charge Code |
2200409
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$138.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$135.69
|
| Rate for Payer: Aetna of WY Medicare |
$91.38
|
| Rate for Payer: Altius Commercial |
$132.92
|
| Rate for Payer: Beech Street Commercial |
$135.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.31
|
| Rate for Payer: Cash Price |
$96.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.31
|
| Rate for Payer: Cigna of WY Commercial |
$135.69
|
| Rate for Payer: Entrust Commercial |
$131.54
|
| Rate for Payer: First Choice Health Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.92
|
| Rate for Payer: HealthUtah PPO |
$138.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.31
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$135.69
|
| Rate for Payer: PacificSource Commercial |
$124.61
|
| Rate for Payer: PHCS PPO |
$135.69
|
| Rate for Payer: Three Rivers PPO |
$103.84
|
| Rate for Payer: TriWest Veterans Administration |
$78.92
|
| Rate for Payer: United Healthcare Commercial |
$132.23
|
| Rate for Payer: United Healthcare Medicare |
$78.92
|
| Rate for Payer: WINHealth Partners Commercial |
$135.69
|
| Rate for Payer: Wise Provider Network Commercial |
$131.54
|
|
