|
SLING ARM 2XSMALL VP20101-005
|
Facility
|
IP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.97
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.72
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.97
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.97
|
| Rate for Payer: WINHealth Partners Commercial |
$7.15
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM 2XSMALL VP20101-005
|
Facility
|
OP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.37
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.15
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.37
|
| Rate for Payer: WINHealth Partners Commercial |
$7.38
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM LRG VP20101-040
|
Facility
|
IP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.97
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.72
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.97
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.97
|
| Rate for Payer: WINHealth Partners Commercial |
$7.15
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM LRG VP20101-040
|
Facility
|
OP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.37
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.15
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.37
|
| Rate for Payer: WINHealth Partners Commercial |
$7.38
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM MED VP20101-030
|
Facility
|
IP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.97
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.72
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.97
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.97
|
| Rate for Payer: WINHealth Partners Commercial |
$7.15
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM MED VP20101-030
|
Facility
|
OP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.37
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.15
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.37
|
| Rate for Payer: WINHealth Partners Commercial |
$7.38
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM SM VP20101-020
|
Facility
|
OP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.37
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.15
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.37
|
| Rate for Payer: WINHealth Partners Commercial |
$7.38
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM SM VP20101-020
|
Facility
|
IP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.97
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.72
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.97
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.97
|
| Rate for Payer: WINHealth Partners Commercial |
$7.15
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM XLG VP20101-050
|
Facility
|
IP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.97
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.72
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.97
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.97
|
| Rate for Payer: WINHealth Partners Commercial |
$7.15
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM XLG VP20101-050
|
Facility
|
OP
|
$7.53
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.23
|
| Rate for Payer: Altius Commercial |
$7.23
|
| Rate for Payer: Beech Street Commercial |
$7.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$5.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.30
|
| Rate for Payer: Cigna of WY Commercial |
$7.38
|
| Rate for Payer: Entrust Commercial |
$7.15
|
| Rate for Payer: First Choice Health Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.37
|
| Rate for Payer: HealthUtah PPO |
$7.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.30
|
| Rate for Payer: Multiplan Medicare/VA |
$4.15
|
| Rate for Payer: One Health Plan of WY PPO |
$7.38
|
| Rate for Payer: PacificSource Commercial |
$6.78
|
| Rate for Payer: PHCS PPO |
$7.38
|
| Rate for Payer: Three Rivers PPO |
$5.65
|
| Rate for Payer: TriWest Veterans Administration |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare |
$4.37
|
| Rate for Payer: WINHealth Partners Commercial |
$7.38
|
| Rate for Payer: Wise Provider Network Commercial |
$7.15
|
|
|
SLING ARM XSM VP20101-010
|
Facility
|
OP
|
$10.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.29
|
| Rate for Payer: Aetna of WY Medicare |
$6.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.08
|
| Rate for Payer: Altius Commercial |
$10.08
|
| Rate for Payer: Beech Street Commercial |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.18
|
| Rate for Payer: Cigna of WY Commercial |
$10.29
|
| Rate for Payer: Entrust Commercial |
$9.98
|
| Rate for Payer: First Choice Health Commercial |
$9.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.09
|
| Rate for Payer: HealthUtah PPO |
$10.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.18
|
| Rate for Payer: Multiplan Medicare/VA |
$5.79
|
| Rate for Payer: One Health Plan of WY PPO |
$10.29
|
| Rate for Payer: PacificSource Commercial |
$9.45
|
| Rate for Payer: PHCS PPO |
$10.29
|
| Rate for Payer: Three Rivers PPO |
$7.88
|
| Rate for Payer: TriWest Veterans Administration |
$6.09
|
| Rate for Payer: United Healthcare Commercial |
$9.14
|
| Rate for Payer: United Healthcare Medicare |
$6.09
|
| Rate for Payer: WINHealth Partners Commercial |
$10.29
|
| Rate for Payer: Wise Provider Network Commercial |
$9.98
|
|
|
SLING ARM XSM VP20101-010
|
Facility
|
IP
|
$10.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.08
|
| Rate for Payer: Altius Commercial |
$10.08
|
| Rate for Payer: Beech Street Commercial |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$7.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.18
|
| Rate for Payer: Cigna of WY Commercial |
$10.29
|
| Rate for Payer: Entrust Commercial |
$9.98
|
| Rate for Payer: First Choice Health Commercial |
$9.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.93
|
| Rate for Payer: HealthUtah PPO |
$10.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.18
|
| Rate for Payer: Multiplan Medicare/VA |
$6.58
|
| Rate for Payer: One Health Plan of WY PPO |
$10.29
|
| Rate for Payer: PacificSource Commercial |
$9.45
|
| Rate for Payer: PHCS PPO |
$10.29
|
| Rate for Payer: Three Rivers PPO |
$7.88
|
| Rate for Payer: TriWest Veterans Administration |
$6.93
|
| Rate for Payer: United Healthcare Commercial |
$9.14
|
| Rate for Payer: United Healthcare Medicare |
$6.93
|
| Rate for Payer: WINHealth Partners Commercial |
$9.98
|
| Rate for Payer: Wise Provider Network Commercial |
$9.98
|
|
|
SLING DESARA BLUE
|
Facility
|
OP
|
$3,041.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.87 |
| Max. Negotiated Rate |
$3,041.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,980.67
|
| Rate for Payer: Aetna of WY Medicare |
$2,007.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,919.84
|
| Rate for Payer: Altius Commercial |
$2,919.84
|
| Rate for Payer: Beech Street Commercial |
$2,980.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,497.07
|
| Rate for Payer: Cash Price |
$2,129.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,950.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,980.67
|
| Rate for Payer: Entrust Commercial |
$2,889.42
|
| Rate for Payer: First Choice Health Commercial |
$2,889.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,889.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,764.07
|
| Rate for Payer: HealthUtah PPO |
$3,041.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,950.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,675.87
|
| Rate for Payer: One Health Plan of WY PPO |
$2,980.67
|
| Rate for Payer: PacificSource Commercial |
$2,737.35
|
| Rate for Payer: PHCS PPO |
$2,980.67
|
| Rate for Payer: Three Rivers PPO |
$2,281.12
|
| Rate for Payer: TriWest Veterans Administration |
$1,764.07
|
| Rate for Payer: United Healthcare Commercial |
$2,646.10
|
| Rate for Payer: United Healthcare Medicare |
$1,764.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,980.67
|
| Rate for Payer: Wise Provider Network Commercial |
$2,889.42
|
|
|
SLING DESARA BLUE
|
Facility
|
IP
|
$3,041.50
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,907.02 |
| Max. Negotiated Rate |
$3,041.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,980.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,919.84
|
| Rate for Payer: Altius Commercial |
$2,919.84
|
| Rate for Payer: Beech Street Commercial |
$2,980.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,497.07
|
| Rate for Payer: Cash Price |
$2,129.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,950.26
|
| Rate for Payer: Cigna of WY Commercial |
$2,980.67
|
| Rate for Payer: Entrust Commercial |
$2,889.42
|
| Rate for Payer: First Choice Health Commercial |
$2,889.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,889.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,007.39
|
| Rate for Payer: HealthUtah PPO |
$3,041.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,950.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1,907.02
|
| Rate for Payer: One Health Plan of WY PPO |
$2,980.67
|
| Rate for Payer: PacificSource Commercial |
$2,737.35
|
| Rate for Payer: PHCS PPO |
$2,980.67
|
| Rate for Payer: Three Rivers PPO |
$2,281.12
|
| Rate for Payer: TriWest Veterans Administration |
$2,007.39
|
| Rate for Payer: United Healthcare Commercial |
$2,646.10
|
| Rate for Payer: United Healthcare Medicare |
$2,007.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,889.42
|
| Rate for Payer: Wise Provider Network Commercial |
$2,889.42
|
|
|
SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$5,018.00
|
|
|
Service Code
|
HCPCS 57288 80
|
| Hospital Charge Code |
57288
|
| Min. Negotiated Rate |
$610.56 |
| Max. Negotiated Rate |
$5,018.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,917.64
|
| Rate for Payer: Aetna of WY Medicare |
$718.31
|
| Rate for Payer: Beech Street Commercial |
$4,767.10
|
| Rate for Payer: Cash Price |
$3,512.60
|
| Rate for Payer: Cash Price |
$3,512.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,867.46
|
| Rate for Payer: Cigna of WY Commercial |
$4,917.64
|
| Rate for Payer: First Choice Health Commercial |
$4,516.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,767.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$718.31
|
| Rate for Payer: HealthUtah PPO |
$5,018.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,867.46
|
| Rate for Payer: Multiplan Medicare/VA |
$610.56
|
| Rate for Payer: One Health Plan of WY PPO |
$4,917.64
|
| Rate for Payer: PacificSource Commercial |
$4,516.20
|
| Rate for Payer: PHCS PPO |
$4,767.10
|
| Rate for Payer: Three Rivers PPO |
$3,763.50
|
| Rate for Payer: TriWest Veterans Administration |
$718.31
|
| Rate for Payer: United Healthcare Commercial |
$4,365.66
|
| Rate for Payer: United Healthcare Medicare |
$718.31
|
| Rate for Payer: WINHealth Partners Commercial |
$4,265.30
|
|
|
SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$5,018.00
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
57288
|
| Min. Negotiated Rate |
$610.56 |
| Max. Negotiated Rate |
$5,018.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,917.64
|
| Rate for Payer: Aetna of WY Medicare |
$718.31
|
| Rate for Payer: Beech Street Commercial |
$4,767.10
|
| Rate for Payer: Cash Price |
$3,512.60
|
| Rate for Payer: Cash Price |
$3,512.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,867.46
|
| Rate for Payer: Cigna of WY Commercial |
$4,917.64
|
| Rate for Payer: First Choice Health Commercial |
$4,516.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,767.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$718.31
|
| Rate for Payer: HealthUtah PPO |
$5,018.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,867.46
|
| Rate for Payer: Multiplan Medicare/VA |
$610.56
|
| Rate for Payer: One Health Plan of WY PPO |
$4,917.64
|
| Rate for Payer: PacificSource Commercial |
$4,516.20
|
| Rate for Payer: PHCS PPO |
$4,767.10
|
| Rate for Payer: Three Rivers PPO |
$3,763.50
|
| Rate for Payer: TriWest Veterans Administration |
$718.31
|
| Rate for Payer: United Healthcare Commercial |
$4,365.66
|
| Rate for Payer: United Healthcare Medicare |
$718.31
|
| Rate for Payer: WINHealth Partners Commercial |
$4,265.30
|
|
|
SLINGS
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
A4565
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.32
|
| Rate for Payer: Beech Street Commercial |
$32.30
|
| Rate for Payer: Cash Price |
$23.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.98
|
| Rate for Payer: Cigna of WY Commercial |
$33.32
|
| Rate for Payer: First Choice Health Commercial |
$30.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.30
|
| Rate for Payer: HealthUtah PPO |
$34.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.98
|
| Rate for Payer: One Health Plan of WY PPO |
$33.32
|
| Rate for Payer: PacificSource Commercial |
$30.60
|
| Rate for Payer: PHCS PPO |
$32.30
|
| Rate for Payer: Three Rivers PPO |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$29.58
|
| Rate for Payer: WINHealth Partners Commercial |
$32.30
|
|
|
SLING SHOULDER ATLAS MINOR
|
Facility
|
IP
|
$87.99
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$87.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.47
|
| Rate for Payer: Altius Commercial |
$84.47
|
| Rate for Payer: Beech Street Commercial |
$86.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.24
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.35
|
| Rate for Payer: Cigna of WY Commercial |
$86.23
|
| Rate for Payer: Entrust Commercial |
$83.59
|
| Rate for Payer: First Choice Health Commercial |
$83.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.07
|
| Rate for Payer: HealthUtah PPO |
$87.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.35
|
| Rate for Payer: Multiplan Medicare/VA |
$55.17
|
| Rate for Payer: One Health Plan of WY PPO |
$86.23
|
| Rate for Payer: PacificSource Commercial |
$79.19
|
| Rate for Payer: PHCS PPO |
$86.23
|
| Rate for Payer: Three Rivers PPO |
$65.99
|
| Rate for Payer: TriWest Veterans Administration |
$58.07
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
| Rate for Payer: United Healthcare Medicare |
$58.07
|
| Rate for Payer: WINHealth Partners Commercial |
$83.59
|
| Rate for Payer: Wise Provider Network Commercial |
$83.59
|
|
|
SLING SHOULDER ATLAS MINOR
|
Facility
|
OP
|
$87.99
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$87.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.23
|
| Rate for Payer: Aetna of WY Medicare |
$58.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.47
|
| Rate for Payer: Altius Commercial |
$84.47
|
| Rate for Payer: Beech Street Commercial |
$86.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$72.24
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.35
|
| Rate for Payer: Cigna of WY Commercial |
$86.23
|
| Rate for Payer: Entrust Commercial |
$83.59
|
| Rate for Payer: First Choice Health Commercial |
$83.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.03
|
| Rate for Payer: HealthUtah PPO |
$87.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.35
|
| Rate for Payer: Multiplan Medicare/VA |
$48.48
|
| Rate for Payer: One Health Plan of WY PPO |
$86.23
|
| Rate for Payer: PacificSource Commercial |
$79.19
|
| Rate for Payer: PHCS PPO |
$86.23
|
| Rate for Payer: Three Rivers PPO |
$65.99
|
| Rate for Payer: TriWest Veterans Administration |
$51.03
|
| Rate for Payer: United Healthcare Commercial |
$76.55
|
| Rate for Payer: United Healthcare Medicare |
$51.03
|
| Rate for Payer: WINHealth Partners Commercial |
$86.23
|
| Rate for Payer: Wise Provider Network Commercial |
$83.59
|
|
|
SLING SHOULDER SLINGSHOT 3 LRG
|
Facility
|
OP
|
$122.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.05
|
| Rate for Payer: Aetna of WY Medicare |
$80.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.60
|
| Rate for Payer: Altius Commercial |
$117.60
|
| Rate for Payer: Beech Street Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.57
|
| Rate for Payer: Cash Price |
$85.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.82
|
| Rate for Payer: Cigna of WY Commercial |
$120.05
|
| Rate for Payer: Entrust Commercial |
$116.38
|
| Rate for Payer: First Choice Health Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.05
|
| Rate for Payer: HealthUtah PPO |
$122.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.82
|
| Rate for Payer: Multiplan Medicare/VA |
$67.50
|
| Rate for Payer: One Health Plan of WY PPO |
$120.05
|
| Rate for Payer: PacificSource Commercial |
$110.25
|
| Rate for Payer: PHCS PPO |
$120.05
|
| Rate for Payer: Three Rivers PPO |
$91.88
|
| Rate for Payer: TriWest Veterans Administration |
$71.05
|
| Rate for Payer: United Healthcare Commercial |
$106.58
|
| Rate for Payer: United Healthcare Medicare |
$71.05
|
| Rate for Payer: WINHealth Partners Commercial |
$120.05
|
| Rate for Payer: Wise Provider Network Commercial |
$116.38
|
|
|
SLING SHOULDER SLINGSHOT 3 LRG
|
Facility
|
IP
|
$122.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.81 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.60
|
| Rate for Payer: Altius Commercial |
$117.60
|
| Rate for Payer: Beech Street Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.57
|
| Rate for Payer: Cash Price |
$85.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.82
|
| Rate for Payer: Cigna of WY Commercial |
$120.05
|
| Rate for Payer: Entrust Commercial |
$116.38
|
| Rate for Payer: First Choice Health Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.85
|
| Rate for Payer: HealthUtah PPO |
$122.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.82
|
| Rate for Payer: Multiplan Medicare/VA |
$76.81
|
| Rate for Payer: One Health Plan of WY PPO |
$120.05
|
| Rate for Payer: PacificSource Commercial |
$110.25
|
| Rate for Payer: PHCS PPO |
$120.05
|
| Rate for Payer: Three Rivers PPO |
$91.88
|
| Rate for Payer: TriWest Veterans Administration |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$106.58
|
| Rate for Payer: United Healthcare Medicare |
$80.85
|
| Rate for Payer: WINHealth Partners Commercial |
$116.38
|
| Rate for Payer: Wise Provider Network Commercial |
$116.38
|
|
|
SLING SHOULDER SLINGSHOT 3 MED
|
Facility
|
IP
|
$122.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.81 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.60
|
| Rate for Payer: Altius Commercial |
$117.60
|
| Rate for Payer: Beech Street Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.57
|
| Rate for Payer: Cash Price |
$85.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.82
|
| Rate for Payer: Cigna of WY Commercial |
$120.05
|
| Rate for Payer: Entrust Commercial |
$116.38
|
| Rate for Payer: First Choice Health Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.85
|
| Rate for Payer: HealthUtah PPO |
$122.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.82
|
| Rate for Payer: Multiplan Medicare/VA |
$76.81
|
| Rate for Payer: One Health Plan of WY PPO |
$120.05
|
| Rate for Payer: PacificSource Commercial |
$110.25
|
| Rate for Payer: PHCS PPO |
$120.05
|
| Rate for Payer: Three Rivers PPO |
$91.88
|
| Rate for Payer: TriWest Veterans Administration |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$106.58
|
| Rate for Payer: United Healthcare Medicare |
$80.85
|
| Rate for Payer: WINHealth Partners Commercial |
$116.38
|
| Rate for Payer: Wise Provider Network Commercial |
$116.38
|
|
|
SLING SHOULDER SLINGSHOT 3 MED
|
Facility
|
OP
|
$122.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.05
|
| Rate for Payer: Aetna of WY Medicare |
$80.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.60
|
| Rate for Payer: Altius Commercial |
$117.60
|
| Rate for Payer: Beech Street Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.57
|
| Rate for Payer: Cash Price |
$85.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.82
|
| Rate for Payer: Cigna of WY Commercial |
$120.05
|
| Rate for Payer: Entrust Commercial |
$116.38
|
| Rate for Payer: First Choice Health Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.05
|
| Rate for Payer: HealthUtah PPO |
$122.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.82
|
| Rate for Payer: Multiplan Medicare/VA |
$67.50
|
| Rate for Payer: One Health Plan of WY PPO |
$120.05
|
| Rate for Payer: PacificSource Commercial |
$110.25
|
| Rate for Payer: PHCS PPO |
$120.05
|
| Rate for Payer: Three Rivers PPO |
$91.88
|
| Rate for Payer: TriWest Veterans Administration |
$71.05
|
| Rate for Payer: United Healthcare Commercial |
$106.58
|
| Rate for Payer: United Healthcare Medicare |
$71.05
|
| Rate for Payer: WINHealth Partners Commercial |
$120.05
|
| Rate for Payer: Wise Provider Network Commercial |
$116.38
|
|
|
SLING SHOULDER SLINGSHOT 3 SM
|
Facility
|
IP
|
$143.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.40
|
| Rate for Payer: Altius Commercial |
$137.40
|
| Rate for Payer: Beech Street Commercial |
$140.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.50
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.83
|
| Rate for Payer: Cigna of WY Commercial |
$140.26
|
| Rate for Payer: Entrust Commercial |
$135.96
|
| Rate for Payer: First Choice Health Commercial |
$135.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.46
|
| Rate for Payer: HealthUtah PPO |
$143.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.83
|
| Rate for Payer: Multiplan Medicare/VA |
$89.74
|
| Rate for Payer: One Health Plan of WY PPO |
$140.26
|
| Rate for Payer: PacificSource Commercial |
$128.81
|
| Rate for Payer: PHCS PPO |
$140.26
|
| Rate for Payer: Three Rivers PPO |
$107.34
|
| Rate for Payer: TriWest Veterans Administration |
$94.46
|
| Rate for Payer: United Healthcare Commercial |
$124.51
|
| Rate for Payer: United Healthcare Medicare |
$94.46
|
| Rate for Payer: WINHealth Partners Commercial |
$135.96
|
| Rate for Payer: Wise Provider Network Commercial |
$135.96
|
|
|
SLING SHOULDER SLINGSHOT 3 SM
|
Facility
|
OP
|
$143.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.86 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.26
|
| Rate for Payer: Aetna of WY Medicare |
$94.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.40
|
| Rate for Payer: Altius Commercial |
$137.40
|
| Rate for Payer: Beech Street Commercial |
$140.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.50
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.83
|
| Rate for Payer: Cigna of WY Commercial |
$140.26
|
| Rate for Payer: Entrust Commercial |
$135.96
|
| Rate for Payer: First Choice Health Commercial |
$135.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.01
|
| Rate for Payer: HealthUtah PPO |
$143.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.83
|
| Rate for Payer: Multiplan Medicare/VA |
$78.86
|
| Rate for Payer: One Health Plan of WY PPO |
$140.26
|
| Rate for Payer: PacificSource Commercial |
$128.81
|
| Rate for Payer: PHCS PPO |
$140.26
|
| Rate for Payer: Three Rivers PPO |
$107.34
|
| Rate for Payer: TriWest Veterans Administration |
$83.01
|
| Rate for Payer: United Healthcare Commercial |
$124.51
|
| Rate for Payer: United Healthcare Medicare |
$83.01
|
| Rate for Payer: WINHealth Partners Commercial |
$140.26
|
| Rate for Payer: Wise Provider Network Commercial |
$135.96
|
|
