|
SHILEY TRACH TUBE SZ 60
|
Facility
|
OP
|
$187.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.50
|
| Rate for Payer: Aetna of WY Medicare |
$123.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$179.76
|
| Rate for Payer: Altius Commercial |
$179.76
|
| Rate for Payer: Beech Street Commercial |
$183.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.73
|
| Rate for Payer: Cash Price |
$131.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.63
|
| Rate for Payer: Cigna of WY Commercial |
$183.50
|
| Rate for Payer: Entrust Commercial |
$177.89
|
| Rate for Payer: First Choice Health Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.60
|
| Rate for Payer: HealthUtah PPO |
$187.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.63
|
| Rate for Payer: Multiplan Medicare/VA |
$103.17
|
| Rate for Payer: One Health Plan of WY PPO |
$183.50
|
| Rate for Payer: PacificSource Commercial |
$168.52
|
| Rate for Payer: PHCS PPO |
$183.50
|
| Rate for Payer: Three Rivers PPO |
$140.44
|
| Rate for Payer: TriWest Veterans Administration |
$108.60
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$108.60
|
| Rate for Payer: WINHealth Partners Commercial |
$183.50
|
| Rate for Payer: Wise Provider Network Commercial |
$177.89
|
|
|
SHILEY TRACH TUBE SZ 70
|
Facility
|
IP
|
$187.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.41 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$179.76
|
| Rate for Payer: Altius Commercial |
$179.76
|
| Rate for Payer: Beech Street Commercial |
$183.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.73
|
| Rate for Payer: Cash Price |
$131.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.63
|
| Rate for Payer: Cigna of WY Commercial |
$183.50
|
| Rate for Payer: Entrust Commercial |
$177.89
|
| Rate for Payer: First Choice Health Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.58
|
| Rate for Payer: HealthUtah PPO |
$187.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.63
|
| Rate for Payer: Multiplan Medicare/VA |
$117.41
|
| Rate for Payer: One Health Plan of WY PPO |
$183.50
|
| Rate for Payer: PacificSource Commercial |
$168.52
|
| Rate for Payer: PHCS PPO |
$183.50
|
| Rate for Payer: Three Rivers PPO |
$140.44
|
| Rate for Payer: TriWest Veterans Administration |
$123.58
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
| Rate for Payer: WINHealth Partners Commercial |
$177.89
|
| Rate for Payer: Wise Provider Network Commercial |
$177.89
|
|
|
SHILEY TRACH TUBE SZ 70
|
Facility
|
OP
|
$187.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.50
|
| Rate for Payer: Aetna of WY Medicare |
$123.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$179.76
|
| Rate for Payer: Altius Commercial |
$179.76
|
| Rate for Payer: Beech Street Commercial |
$183.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.73
|
| Rate for Payer: Cash Price |
$131.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.63
|
| Rate for Payer: Cigna of WY Commercial |
$183.50
|
| Rate for Payer: Entrust Commercial |
$177.89
|
| Rate for Payer: First Choice Health Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.60
|
| Rate for Payer: HealthUtah PPO |
$187.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.63
|
| Rate for Payer: Multiplan Medicare/VA |
$103.17
|
| Rate for Payer: One Health Plan of WY PPO |
$183.50
|
| Rate for Payer: PacificSource Commercial |
$168.52
|
| Rate for Payer: PHCS PPO |
$183.50
|
| Rate for Payer: Three Rivers PPO |
$140.44
|
| Rate for Payer: TriWest Veterans Administration |
$108.60
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$108.60
|
| Rate for Payer: WINHealth Partners Commercial |
$183.50
|
| Rate for Payer: Wise Provider Network Commercial |
$177.89
|
|
|
SHILEY TRACH TUBE SZ 80
|
Facility
|
OP
|
$187.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.50
|
| Rate for Payer: Aetna of WY Medicare |
$123.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$179.76
|
| Rate for Payer: Altius Commercial |
$179.76
|
| Rate for Payer: Beech Street Commercial |
$183.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.73
|
| Rate for Payer: Cash Price |
$131.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.63
|
| Rate for Payer: Cigna of WY Commercial |
$183.50
|
| Rate for Payer: Entrust Commercial |
$177.89
|
| Rate for Payer: First Choice Health Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$108.60
|
| Rate for Payer: HealthUtah PPO |
$187.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.63
|
| Rate for Payer: Multiplan Medicare/VA |
$103.17
|
| Rate for Payer: One Health Plan of WY PPO |
$183.50
|
| Rate for Payer: PacificSource Commercial |
$168.52
|
| Rate for Payer: PHCS PPO |
$183.50
|
| Rate for Payer: Three Rivers PPO |
$140.44
|
| Rate for Payer: TriWest Veterans Administration |
$108.60
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$108.60
|
| Rate for Payer: WINHealth Partners Commercial |
$183.50
|
| Rate for Payer: Wise Provider Network Commercial |
$177.89
|
|
|
SHILEY TRACH TUBE SZ 80
|
Facility
|
IP
|
$187.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.41 |
| Max. Negotiated Rate |
$187.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$183.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$179.76
|
| Rate for Payer: Altius Commercial |
$179.76
|
| Rate for Payer: Beech Street Commercial |
$183.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$153.73
|
| Rate for Payer: Cash Price |
$131.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$181.63
|
| Rate for Payer: Cigna of WY Commercial |
$183.50
|
| Rate for Payer: Entrust Commercial |
$177.89
|
| Rate for Payer: First Choice Health Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$177.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.58
|
| Rate for Payer: HealthUtah PPO |
$187.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$181.63
|
| Rate for Payer: Multiplan Medicare/VA |
$117.41
|
| Rate for Payer: One Health Plan of WY PPO |
$183.50
|
| Rate for Payer: PacificSource Commercial |
$168.52
|
| Rate for Payer: PHCS PPO |
$183.50
|
| Rate for Payer: Three Rivers PPO |
$140.44
|
| Rate for Payer: TriWest Veterans Administration |
$123.58
|
| Rate for Payer: United Healthcare Commercial |
$162.91
|
| Rate for Payer: United Healthcare Medicare |
$123.58
|
| Rate for Payer: WINHealth Partners Commercial |
$177.89
|
| Rate for Payer: Wise Provider Network Commercial |
$177.89
|
|
|
SHOE CAST OPE TOE M/L 11394
|
Facility
|
IP
|
$23.27
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.34
|
| Rate for Payer: Altius Commercial |
$22.34
|
| Rate for Payer: Beech Street Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.10
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.57
|
| Rate for Payer: Cigna of WY Commercial |
$22.80
|
| Rate for Payer: Entrust Commercial |
$22.11
|
| Rate for Payer: First Choice Health Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.36
|
| Rate for Payer: HealthUtah PPO |
$23.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.57
|
| Rate for Payer: Multiplan Medicare/VA |
$14.59
|
| Rate for Payer: One Health Plan of WY PPO |
$22.80
|
| Rate for Payer: PacificSource Commercial |
$20.94
|
| Rate for Payer: PHCS PPO |
$22.80
|
| Rate for Payer: Three Rivers PPO |
$17.45
|
| Rate for Payer: TriWest Veterans Administration |
$15.36
|
| Rate for Payer: United Healthcare Commercial |
$20.24
|
| Rate for Payer: United Healthcare Medicare |
$15.36
|
| Rate for Payer: WINHealth Partners Commercial |
$22.11
|
| Rate for Payer: Wise Provider Network Commercial |
$22.11
|
|
|
SHOE CAST OPE TOE M/L 11394
|
Facility
|
OP
|
$23.27
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.80
|
| Rate for Payer: Aetna of WY Medicare |
$15.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.34
|
| Rate for Payer: Altius Commercial |
$22.34
|
| Rate for Payer: Beech Street Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.10
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.57
|
| Rate for Payer: Cigna of WY Commercial |
$22.80
|
| Rate for Payer: Entrust Commercial |
$22.11
|
| Rate for Payer: First Choice Health Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$23.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.57
|
| Rate for Payer: Multiplan Medicare/VA |
$12.82
|
| Rate for Payer: One Health Plan of WY PPO |
$22.80
|
| Rate for Payer: PacificSource Commercial |
$20.94
|
| Rate for Payer: PHCS PPO |
$22.80
|
| Rate for Payer: Three Rivers PPO |
$17.45
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$20.24
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
| Rate for Payer: WINHealth Partners Commercial |
$22.80
|
| Rate for Payer: Wise Provider Network Commercial |
$22.11
|
|
|
SHOE CAST OPE TOE S/M 11393
|
Facility
|
IP
|
$23.27
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.34
|
| Rate for Payer: Altius Commercial |
$22.34
|
| Rate for Payer: Beech Street Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.10
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.57
|
| Rate for Payer: Cigna of WY Commercial |
$22.80
|
| Rate for Payer: Entrust Commercial |
$22.11
|
| Rate for Payer: First Choice Health Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.36
|
| Rate for Payer: HealthUtah PPO |
$23.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.57
|
| Rate for Payer: Multiplan Medicare/VA |
$14.59
|
| Rate for Payer: One Health Plan of WY PPO |
$22.80
|
| Rate for Payer: PacificSource Commercial |
$20.94
|
| Rate for Payer: PHCS PPO |
$22.80
|
| Rate for Payer: Three Rivers PPO |
$17.45
|
| Rate for Payer: TriWest Veterans Administration |
$15.36
|
| Rate for Payer: United Healthcare Commercial |
$20.24
|
| Rate for Payer: United Healthcare Medicare |
$15.36
|
| Rate for Payer: WINHealth Partners Commercial |
$22.11
|
| Rate for Payer: Wise Provider Network Commercial |
$22.11
|
|
|
SHOE CAST OPE TOE S/M 11393
|
Facility
|
OP
|
$23.27
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.80
|
| Rate for Payer: Aetna of WY Medicare |
$15.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.34
|
| Rate for Payer: Altius Commercial |
$22.34
|
| Rate for Payer: Beech Street Commercial |
$22.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.10
|
| Rate for Payer: Cash Price |
$16.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.57
|
| Rate for Payer: Cigna of WY Commercial |
$22.80
|
| Rate for Payer: Entrust Commercial |
$22.11
|
| Rate for Payer: First Choice Health Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.50
|
| Rate for Payer: HealthUtah PPO |
$23.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.57
|
| Rate for Payer: Multiplan Medicare/VA |
$12.82
|
| Rate for Payer: One Health Plan of WY PPO |
$22.80
|
| Rate for Payer: PacificSource Commercial |
$20.94
|
| Rate for Payer: PHCS PPO |
$22.80
|
| Rate for Payer: Three Rivers PPO |
$17.45
|
| Rate for Payer: TriWest Veterans Administration |
$13.50
|
| Rate for Payer: United Healthcare Commercial |
$20.24
|
| Rate for Payer: United Healthcare Medicare |
$13.50
|
| Rate for Payer: WINHealth Partners Commercial |
$22.80
|
| Rate for Payer: Wise Provider Network Commercial |
$22.11
|
|
|
SHOE CAST PED OPEN XS 11397
|
Facility
|
OP
|
$17.92
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.56
|
| Rate for Payer: Aetna of WY Medicare |
$11.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.20
|
| Rate for Payer: Altius Commercial |
$17.20
|
| Rate for Payer: Beech Street Commercial |
$17.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.38
|
| Rate for Payer: Cigna of WY Commercial |
$17.56
|
| Rate for Payer: Entrust Commercial |
$17.02
|
| Rate for Payer: First Choice Health Commercial |
$17.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.39
|
| Rate for Payer: HealthUtah PPO |
$17.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.38
|
| Rate for Payer: Multiplan Medicare/VA |
$9.87
|
| Rate for Payer: One Health Plan of WY PPO |
$17.56
|
| Rate for Payer: PacificSource Commercial |
$16.13
|
| Rate for Payer: PHCS PPO |
$17.56
|
| Rate for Payer: Three Rivers PPO |
$13.44
|
| Rate for Payer: TriWest Veterans Administration |
$10.39
|
| Rate for Payer: United Healthcare Commercial |
$15.59
|
| Rate for Payer: United Healthcare Medicare |
$10.39
|
| Rate for Payer: WINHealth Partners Commercial |
$17.56
|
| Rate for Payer: Wise Provider Network Commercial |
$17.02
|
|
|
SHOE CAST PED OPEN XS 11397
|
Facility
|
IP
|
$17.92
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.20
|
| Rate for Payer: Altius Commercial |
$17.20
|
| Rate for Payer: Beech Street Commercial |
$17.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.38
|
| Rate for Payer: Cigna of WY Commercial |
$17.56
|
| Rate for Payer: Entrust Commercial |
$17.02
|
| Rate for Payer: First Choice Health Commercial |
$17.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.83
|
| Rate for Payer: HealthUtah PPO |
$17.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.38
|
| Rate for Payer: Multiplan Medicare/VA |
$11.24
|
| Rate for Payer: One Health Plan of WY PPO |
$17.56
|
| Rate for Payer: PacificSource Commercial |
$16.13
|
| Rate for Payer: PHCS PPO |
$17.56
|
| Rate for Payer: Three Rivers PPO |
$13.44
|
| Rate for Payer: TriWest Veterans Administration |
$11.83
|
| Rate for Payer: United Healthcare Commercial |
$15.59
|
| Rate for Payer: United Healthcare Medicare |
$11.83
|
| Rate for Payer: WINHealth Partners Commercial |
$17.02
|
| Rate for Payer: Wise Provider Network Commercial |
$17.02
|
|
|
SHOE CAST XLG OPE BREG 11395
|
Facility
|
IP
|
$13.96
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.40
|
| Rate for Payer: Altius Commercial |
$13.40
|
| Rate for Payer: Beech Street Commercial |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.46
|
| Rate for Payer: Cash Price |
$9.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.54
|
| Rate for Payer: Cigna of WY Commercial |
$13.68
|
| Rate for Payer: Entrust Commercial |
$13.26
|
| Rate for Payer: First Choice Health Commercial |
$13.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.21
|
| Rate for Payer: HealthUtah PPO |
$13.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.54
|
| Rate for Payer: Multiplan Medicare/VA |
$8.75
|
| Rate for Payer: One Health Plan of WY PPO |
$13.68
|
| Rate for Payer: PacificSource Commercial |
$12.56
|
| Rate for Payer: PHCS PPO |
$13.68
|
| Rate for Payer: Three Rivers PPO |
$10.47
|
| Rate for Payer: TriWest Veterans Administration |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$12.15
|
| Rate for Payer: United Healthcare Medicare |
$9.21
|
| Rate for Payer: WINHealth Partners Commercial |
$13.26
|
| Rate for Payer: Wise Provider Network Commercial |
$13.26
|
|
|
SHOE CAST XLG OPE BREG 11395
|
Facility
|
OP
|
$13.96
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$13.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.68
|
| Rate for Payer: Aetna of WY Medicare |
$9.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.40
|
| Rate for Payer: Altius Commercial |
$13.40
|
| Rate for Payer: Beech Street Commercial |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.46
|
| Rate for Payer: Cash Price |
$9.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.54
|
| Rate for Payer: Cigna of WY Commercial |
$13.68
|
| Rate for Payer: Entrust Commercial |
$13.26
|
| Rate for Payer: First Choice Health Commercial |
$13.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.10
|
| Rate for Payer: HealthUtah PPO |
$13.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.54
|
| Rate for Payer: Multiplan Medicare/VA |
$7.69
|
| Rate for Payer: One Health Plan of WY PPO |
$13.68
|
| Rate for Payer: PacificSource Commercial |
$12.56
|
| Rate for Payer: PHCS PPO |
$13.68
|
| Rate for Payer: Three Rivers PPO |
$10.47
|
| Rate for Payer: TriWest Veterans Administration |
$8.10
|
| Rate for Payer: United Healthcare Commercial |
$12.15
|
| Rate for Payer: United Healthcare Medicare |
$8.10
|
| Rate for Payer: WINHealth Partners Commercial |
$13.68
|
| Rate for Payer: Wise Provider Network Commercial |
$13.26
|
|
|
SHOE HEEL WEDGE
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS L3350
|
| Hospital Charge Code |
L3350
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$27.19
|
| Rate for Payer: Beech Street Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: First Choice Health Commercial |
$104.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.19
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$23.11
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$110.20
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$27.19
|
| Rate for Payer: United Healthcare Commercial |
$100.92
|
| Rate for Payer: United Healthcare Medicare |
$27.19
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
|
|
SHOE LG SQUARE TOE POST OP
|
Facility
|
IP
|
$19.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.95
|
| Rate for Payer: Altius Commercial |
$18.95
|
| Rate for Payer: Beech Street Commercial |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.21
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.35
|
| Rate for Payer: Entrust Commercial |
$18.75
|
| Rate for Payer: First Choice Health Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.03
|
| Rate for Payer: HealthUtah PPO |
$19.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.15
|
| Rate for Payer: Multiplan Medicare/VA |
$12.38
|
| Rate for Payer: One Health Plan of WY PPO |
$19.35
|
| Rate for Payer: PacificSource Commercial |
$17.77
|
| Rate for Payer: PHCS PPO |
$19.35
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare |
$13.03
|
| Rate for Payer: WINHealth Partners Commercial |
$18.75
|
| Rate for Payer: Wise Provider Network Commercial |
$18.75
|
|
|
SHOE LG SQUARE TOE POST OP
|
Facility
|
OP
|
$19.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.35
|
| Rate for Payer: Aetna of WY Medicare |
$13.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.95
|
| Rate for Payer: Altius Commercial |
$18.95
|
| Rate for Payer: Beech Street Commercial |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.21
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.35
|
| Rate for Payer: Entrust Commercial |
$18.75
|
| Rate for Payer: First Choice Health Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.45
|
| Rate for Payer: HealthUtah PPO |
$19.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.15
|
| Rate for Payer: Multiplan Medicare/VA |
$10.88
|
| Rate for Payer: One Health Plan of WY PPO |
$19.35
|
| Rate for Payer: PacificSource Commercial |
$17.77
|
| Rate for Payer: PHCS PPO |
$19.35
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare |
$11.45
|
| Rate for Payer: WINHealth Partners Commercial |
$19.35
|
| Rate for Payer: Wise Provider Network Commercial |
$18.75
|
|
|
SHOE LIFTS TAPERED TO ONE-HA
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3332
|
| Hospital Charge Code |
L3332
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Aetna of WY Medicare |
$87.75
|
| Rate for Payer: Beech Street Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: First Choice Health Commercial |
$25.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.75
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$74.59
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$26.60
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$24.36
|
| Rate for Payer: United Healthcare Medicare |
$87.75
|
| Rate for Payer: WINHealth Partners Commercial |
$26.60
|
|
|
SHOE MD SQUARE TOE POST OP
|
Facility
|
IP
|
$18.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$11.52
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.46
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
SHOE MD SQUARE TOE POST OP
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
SHOE SM SQUARE TOE POST OP
|
Facility
|
IP
|
$18.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$11.52
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.46
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
SHOE SM SQUARE TOE POST OP
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
SHOE XL SQUARE TOE POST OP
|
Facility
|
OP
|
$19.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.35
|
| Rate for Payer: Aetna of WY Medicare |
$13.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.95
|
| Rate for Payer: Altius Commercial |
$18.95
|
| Rate for Payer: Beech Street Commercial |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.21
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.35
|
| Rate for Payer: Entrust Commercial |
$18.75
|
| Rate for Payer: First Choice Health Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.45
|
| Rate for Payer: HealthUtah PPO |
$19.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.15
|
| Rate for Payer: Multiplan Medicare/VA |
$10.88
|
| Rate for Payer: One Health Plan of WY PPO |
$19.35
|
| Rate for Payer: PacificSource Commercial |
$17.77
|
| Rate for Payer: PHCS PPO |
$19.35
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare |
$11.45
|
| Rate for Payer: WINHealth Partners Commercial |
$19.35
|
| Rate for Payer: Wise Provider Network Commercial |
$18.75
|
|
|
SHOE XL SQUARE TOE POST OP
|
Facility
|
IP
|
$19.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.95
|
| Rate for Payer: Altius Commercial |
$18.95
|
| Rate for Payer: Beech Street Commercial |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.21
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.35
|
| Rate for Payer: Entrust Commercial |
$18.75
|
| Rate for Payer: First Choice Health Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.03
|
| Rate for Payer: HealthUtah PPO |
$19.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.15
|
| Rate for Payer: Multiplan Medicare/VA |
$12.38
|
| Rate for Payer: One Health Plan of WY PPO |
$19.35
|
| Rate for Payer: PacificSource Commercial |
$17.77
|
| Rate for Payer: PHCS PPO |
$19.35
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare |
$13.03
|
| Rate for Payer: WINHealth Partners Commercial |
$18.75
|
| Rate for Payer: Wise Provider Network Commercial |
$18.75
|
|
|
SHOE XS SQUARE TOE POST OP
|
Facility
|
IP
|
$19.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.95
|
| Rate for Payer: Altius Commercial |
$18.95
|
| Rate for Payer: Beech Street Commercial |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.21
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.35
|
| Rate for Payer: Entrust Commercial |
$18.75
|
| Rate for Payer: First Choice Health Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.03
|
| Rate for Payer: HealthUtah PPO |
$19.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.15
|
| Rate for Payer: Multiplan Medicare/VA |
$12.38
|
| Rate for Payer: One Health Plan of WY PPO |
$19.35
|
| Rate for Payer: PacificSource Commercial |
$17.77
|
| Rate for Payer: PHCS PPO |
$19.35
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare |
$13.03
|
| Rate for Payer: WINHealth Partners Commercial |
$18.75
|
| Rate for Payer: Wise Provider Network Commercial |
$18.75
|
|
|
SHOE XS SQUARE TOE POST OP
|
Facility
|
OP
|
$19.74
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.35
|
| Rate for Payer: Aetna of WY Medicare |
$13.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.95
|
| Rate for Payer: Altius Commercial |
$18.95
|
| Rate for Payer: Beech Street Commercial |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.21
|
| Rate for Payer: Cash Price |
$13.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.15
|
| Rate for Payer: Cigna of WY Commercial |
$19.35
|
| Rate for Payer: Entrust Commercial |
$18.75
|
| Rate for Payer: First Choice Health Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.45
|
| Rate for Payer: HealthUtah PPO |
$19.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.15
|
| Rate for Payer: Multiplan Medicare/VA |
$10.88
|
| Rate for Payer: One Health Plan of WY PPO |
$19.35
|
| Rate for Payer: PacificSource Commercial |
$17.77
|
| Rate for Payer: PHCS PPO |
$19.35
|
| Rate for Payer: Three Rivers PPO |
$14.80
|
| Rate for Payer: TriWest Veterans Administration |
$11.45
|
| Rate for Payer: United Healthcare Commercial |
$17.17
|
| Rate for Payer: United Healthcare Medicare |
$11.45
|
| Rate for Payer: WINHealth Partners Commercial |
$19.35
|
| Rate for Payer: Wise Provider Network Commercial |
$18.75
|
|
