|
BRACE BREG ROADRUNNER KNEE LG
|
Facility
|
IP
|
$249.62
|
|
| Hospital Charge Code |
2200200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$249.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.63
|
| Rate for Payer: Aetna of WY Medicare |
$159.76
|
| Rate for Payer: Altius Commercial |
$239.64
|
| Rate for Payer: Beech Street Commercial |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.13
|
| Rate for Payer: Cash Price |
$174.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.13
|
| Rate for Payer: Cigna of WY Commercial |
$244.63
|
| Rate for Payer: Entrust Commercial |
$237.14
|
| Rate for Payer: First Choice Health Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.27
|
| Rate for Payer: HealthUtah PPO |
$249.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.13
|
| Rate for Payer: Multiplan Medicare/VA |
$144.65
|
| Rate for Payer: One Health Plan of WY PPO |
$244.63
|
| Rate for Payer: PacificSource Commercial |
$224.66
|
| Rate for Payer: PHCS PPO |
$244.63
|
| Rate for Payer: Three Rivers PPO |
$187.22
|
| Rate for Payer: TriWest Veterans Administration |
$152.27
|
| Rate for Payer: United Healthcare Commercial |
$238.39
|
| Rate for Payer: United Healthcare Medicare |
$152.27
|
| Rate for Payer: WINHealth Partners Commercial |
$237.14
|
| Rate for Payer: Wise Provider Network Commercial |
$237.14
|
|
|
BRACE BREG ROADRUNNER KNEE LG
|
Facility
|
OP
|
$249.62
|
|
| Hospital Charge Code |
2200200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.17 |
| Max. Negotiated Rate |
$249.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.63
|
| Rate for Payer: Aetna of WY Medicare |
$164.75
|
| Rate for Payer: Altius Commercial |
$239.64
|
| Rate for Payer: Beech Street Commercial |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.13
|
| Rate for Payer: Cash Price |
$174.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.13
|
| Rate for Payer: Cigna of WY Commercial |
$244.63
|
| Rate for Payer: Entrust Commercial |
$237.14
|
| Rate for Payer: First Choice Health Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.28
|
| Rate for Payer: HealthUtah PPO |
$249.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.13
|
| Rate for Payer: Multiplan Medicare/VA |
$135.17
|
| Rate for Payer: One Health Plan of WY PPO |
$244.63
|
| Rate for Payer: PacificSource Commercial |
$224.66
|
| Rate for Payer: PHCS PPO |
$244.63
|
| Rate for Payer: Three Rivers PPO |
$187.22
|
| Rate for Payer: TriWest Veterans Administration |
$142.28
|
| Rate for Payer: United Healthcare Commercial |
$238.39
|
| Rate for Payer: United Healthcare Medicare |
$142.28
|
| Rate for Payer: WINHealth Partners Commercial |
$244.63
|
| Rate for Payer: Wise Provider Network Commercial |
$237.14
|
|
|
BRACE BREG ROADRUNNER KNEE MED
|
Facility
|
OP
|
$249.62
|
|
| Hospital Charge Code |
2200199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.17 |
| Max. Negotiated Rate |
$249.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.63
|
| Rate for Payer: Aetna of WY Medicare |
$164.75
|
| Rate for Payer: Altius Commercial |
$239.64
|
| Rate for Payer: Beech Street Commercial |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.13
|
| Rate for Payer: Cash Price |
$174.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.13
|
| Rate for Payer: Cigna of WY Commercial |
$244.63
|
| Rate for Payer: Entrust Commercial |
$237.14
|
| Rate for Payer: First Choice Health Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.28
|
| Rate for Payer: HealthUtah PPO |
$249.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.13
|
| Rate for Payer: Multiplan Medicare/VA |
$135.17
|
| Rate for Payer: One Health Plan of WY PPO |
$244.63
|
| Rate for Payer: PacificSource Commercial |
$224.66
|
| Rate for Payer: PHCS PPO |
$244.63
|
| Rate for Payer: Three Rivers PPO |
$187.22
|
| Rate for Payer: TriWest Veterans Administration |
$142.28
|
| Rate for Payer: United Healthcare Commercial |
$238.39
|
| Rate for Payer: United Healthcare Medicare |
$142.28
|
| Rate for Payer: WINHealth Partners Commercial |
$244.63
|
| Rate for Payer: Wise Provider Network Commercial |
$237.14
|
|
|
BRACE BREG ROADRUNNER KNEE MED
|
Facility
|
IP
|
$249.62
|
|
| Hospital Charge Code |
2200199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$249.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.63
|
| Rate for Payer: Aetna of WY Medicare |
$159.76
|
| Rate for Payer: Altius Commercial |
$239.64
|
| Rate for Payer: Beech Street Commercial |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.13
|
| Rate for Payer: Cash Price |
$174.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.13
|
| Rate for Payer: Cigna of WY Commercial |
$244.63
|
| Rate for Payer: Entrust Commercial |
$237.14
|
| Rate for Payer: First Choice Health Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.27
|
| Rate for Payer: HealthUtah PPO |
$249.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.13
|
| Rate for Payer: Multiplan Medicare/VA |
$144.65
|
| Rate for Payer: One Health Plan of WY PPO |
$244.63
|
| Rate for Payer: PacificSource Commercial |
$224.66
|
| Rate for Payer: PHCS PPO |
$244.63
|
| Rate for Payer: Three Rivers PPO |
$187.22
|
| Rate for Payer: TriWest Veterans Administration |
$152.27
|
| Rate for Payer: United Healthcare Commercial |
$238.39
|
| Rate for Payer: United Healthcare Medicare |
$152.27
|
| Rate for Payer: WINHealth Partners Commercial |
$237.14
|
| Rate for Payer: Wise Provider Network Commercial |
$237.14
|
|
|
BRACE BREG ROADRUNNER SM
|
Facility
|
OP
|
$249.62
|
|
| Hospital Charge Code |
2200198
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$135.17 |
| Max. Negotiated Rate |
$249.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.63
|
| Rate for Payer: Aetna of WY Medicare |
$164.75
|
| Rate for Payer: Altius Commercial |
$239.64
|
| Rate for Payer: Beech Street Commercial |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.13
|
| Rate for Payer: Cash Price |
$174.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.13
|
| Rate for Payer: Cigna of WY Commercial |
$244.63
|
| Rate for Payer: Entrust Commercial |
$237.14
|
| Rate for Payer: First Choice Health Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.28
|
| Rate for Payer: HealthUtah PPO |
$249.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.13
|
| Rate for Payer: Multiplan Medicare/VA |
$135.17
|
| Rate for Payer: One Health Plan of WY PPO |
$244.63
|
| Rate for Payer: PacificSource Commercial |
$224.66
|
| Rate for Payer: PHCS PPO |
$244.63
|
| Rate for Payer: Three Rivers PPO |
$187.22
|
| Rate for Payer: TriWest Veterans Administration |
$142.28
|
| Rate for Payer: United Healthcare Commercial |
$238.39
|
| Rate for Payer: United Healthcare Medicare |
$142.28
|
| Rate for Payer: WINHealth Partners Commercial |
$244.63
|
| Rate for Payer: Wise Provider Network Commercial |
$237.14
|
|
|
BRACE BREG ROADRUNNER SM
|
Facility
|
IP
|
$249.62
|
|
| Hospital Charge Code |
2200198
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$249.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$244.63
|
| Rate for Payer: Aetna of WY Medicare |
$159.76
|
| Rate for Payer: Altius Commercial |
$239.64
|
| Rate for Payer: Beech Street Commercial |
$244.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$242.13
|
| Rate for Payer: Cash Price |
$174.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$242.13
|
| Rate for Payer: Cigna of WY Commercial |
$244.63
|
| Rate for Payer: Entrust Commercial |
$237.14
|
| Rate for Payer: First Choice Health Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$237.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.27
|
| Rate for Payer: HealthUtah PPO |
$249.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$242.13
|
| Rate for Payer: Multiplan Medicare/VA |
$144.65
|
| Rate for Payer: One Health Plan of WY PPO |
$244.63
|
| Rate for Payer: PacificSource Commercial |
$224.66
|
| Rate for Payer: PHCS PPO |
$244.63
|
| Rate for Payer: Three Rivers PPO |
$187.22
|
| Rate for Payer: TriWest Veterans Administration |
$152.27
|
| Rate for Payer: United Healthcare Commercial |
$238.39
|
| Rate for Payer: United Healthcare Medicare |
$152.27
|
| Rate for Payer: WINHealth Partners Commercial |
$237.14
|
| Rate for Payer: Wise Provider Network Commercial |
$237.14
|
|
|
BRACE HUM FRACTURE EXTEND MED
|
Facility
|
OP
|
$193.38
|
|
| Hospital Charge Code |
2200264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.51
|
| Rate for Payer: Aetna of WY Medicare |
$127.63
|
| Rate for Payer: Altius Commercial |
$185.64
|
| Rate for Payer: Beech Street Commercial |
$189.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.58
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.58
|
| Rate for Payer: Cigna of WY Commercial |
$189.51
|
| Rate for Payer: Entrust Commercial |
$183.71
|
| Rate for Payer: First Choice Health Commercial |
$183.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.23
|
| Rate for Payer: HealthUtah PPO |
$193.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.58
|
| Rate for Payer: Multiplan Medicare/VA |
$104.72
|
| Rate for Payer: One Health Plan of WY PPO |
$189.51
|
| Rate for Payer: PacificSource Commercial |
$174.04
|
| Rate for Payer: PHCS PPO |
$189.51
|
| Rate for Payer: Three Rivers PPO |
$145.04
|
| Rate for Payer: TriWest Veterans Administration |
$110.23
|
| Rate for Payer: United Healthcare Commercial |
$184.68
|
| Rate for Payer: United Healthcare Medicare |
$110.23
|
| Rate for Payer: WINHealth Partners Commercial |
$189.51
|
| Rate for Payer: Wise Provider Network Commercial |
$183.71
|
|
|
BRACE HUM FRACTURE EXTEND MED
|
Facility
|
IP
|
$193.38
|
|
| Hospital Charge Code |
2200264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$189.51
|
| Rate for Payer: Aetna of WY Medicare |
$123.76
|
| Rate for Payer: Altius Commercial |
$185.64
|
| Rate for Payer: Beech Street Commercial |
$189.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$187.58
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$187.58
|
| Rate for Payer: Cigna of WY Commercial |
$189.51
|
| Rate for Payer: Entrust Commercial |
$183.71
|
| Rate for Payer: First Choice Health Commercial |
$183.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$183.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.96
|
| Rate for Payer: HealthUtah PPO |
$193.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$187.58
|
| Rate for Payer: Multiplan Medicare/VA |
$112.06
|
| Rate for Payer: One Health Plan of WY PPO |
$189.51
|
| Rate for Payer: PacificSource Commercial |
$174.04
|
| Rate for Payer: PHCS PPO |
$189.51
|
| Rate for Payer: Three Rivers PPO |
$145.04
|
| Rate for Payer: TriWest Veterans Administration |
$117.96
|
| Rate for Payer: United Healthcare Commercial |
$184.68
|
| Rate for Payer: United Healthcare Medicare |
$117.96
|
| Rate for Payer: WINHealth Partners Commercial |
$183.71
|
| Rate for Payer: Wise Provider Network Commercial |
$183.71
|
|
|
BRACE HUM FRACTURE XLG
|
Facility
|
OP
|
$308.80
|
|
| Hospital Charge Code |
2200104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.22 |
| Max. Negotiated Rate |
$308.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.62
|
| Rate for Payer: Aetna of WY Medicare |
$203.81
|
| Rate for Payer: Altius Commercial |
$296.45
|
| Rate for Payer: Beech Street Commercial |
$302.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$216.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.54
|
| Rate for Payer: Cigna of WY Commercial |
$302.62
|
| Rate for Payer: Entrust Commercial |
$293.36
|
| Rate for Payer: First Choice Health Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$176.02
|
| Rate for Payer: HealthUtah PPO |
$308.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.54
|
| Rate for Payer: Multiplan Medicare/VA |
$167.22
|
| Rate for Payer: One Health Plan of WY PPO |
$302.62
|
| Rate for Payer: PacificSource Commercial |
$277.92
|
| Rate for Payer: PHCS PPO |
$302.62
|
| Rate for Payer: Three Rivers PPO |
$231.60
|
| Rate for Payer: TriWest Veterans Administration |
$176.02
|
| Rate for Payer: United Healthcare Commercial |
$294.90
|
| Rate for Payer: United Healthcare Medicare |
$176.02
|
| Rate for Payer: WINHealth Partners Commercial |
$302.62
|
| Rate for Payer: Wise Provider Network Commercial |
$293.36
|
|
|
BRACE HUM FRACTURE XLG
|
Facility
|
IP
|
$308.80
|
|
| Hospital Charge Code |
2200104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.95 |
| Max. Negotiated Rate |
$308.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.62
|
| Rate for Payer: Aetna of WY Medicare |
$197.63
|
| Rate for Payer: Altius Commercial |
$296.45
|
| Rate for Payer: Beech Street Commercial |
$302.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$216.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.54
|
| Rate for Payer: Cigna of WY Commercial |
$302.62
|
| Rate for Payer: Entrust Commercial |
$293.36
|
| Rate for Payer: First Choice Health Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$188.37
|
| Rate for Payer: HealthUtah PPO |
$308.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.54
|
| Rate for Payer: Multiplan Medicare/VA |
$178.95
|
| Rate for Payer: One Health Plan of WY PPO |
$302.62
|
| Rate for Payer: PacificSource Commercial |
$277.92
|
| Rate for Payer: PHCS PPO |
$302.62
|
| Rate for Payer: Three Rivers PPO |
$231.60
|
| Rate for Payer: TriWest Veterans Administration |
$188.37
|
| Rate for Payer: United Healthcare Commercial |
$294.90
|
| Rate for Payer: United Healthcare Medicare |
$188.37
|
| Rate for Payer: WINHealth Partners Commercial |
$293.36
|
| Rate for Payer: Wise Provider Network Commercial |
$293.36
|
|
|
BRACE KNEE DELUX HING XSM
|
Facility
|
OP
|
$70.07
|
|
| Hospital Charge Code |
2200187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.94 |
| Max. Negotiated Rate |
$70.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.67
|
| Rate for Payer: Aetna of WY Medicare |
$46.25
|
| Rate for Payer: Altius Commercial |
$67.27
|
| Rate for Payer: Beech Street Commercial |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.97
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.97
|
| Rate for Payer: Cigna of WY Commercial |
$68.67
|
| Rate for Payer: Entrust Commercial |
$66.57
|
| Rate for Payer: First Choice Health Commercial |
$66.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.94
|
| Rate for Payer: HealthUtah PPO |
$70.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.97
|
| Rate for Payer: Multiplan Medicare/VA |
$37.94
|
| Rate for Payer: One Health Plan of WY PPO |
$68.67
|
| Rate for Payer: PacificSource Commercial |
$63.06
|
| Rate for Payer: PHCS PPO |
$68.67
|
| Rate for Payer: Three Rivers PPO |
$52.55
|
| Rate for Payer: TriWest Veterans Administration |
$39.94
|
| Rate for Payer: United Healthcare Commercial |
$66.92
|
| Rate for Payer: United Healthcare Medicare |
$39.94
|
| Rate for Payer: WINHealth Partners Commercial |
$68.67
|
| Rate for Payer: Wise Provider Network Commercial |
$66.57
|
|
|
BRACE KNEE DELUX HING XSM
|
Facility
|
IP
|
$70.07
|
|
| Hospital Charge Code |
2200187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$70.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.67
|
| Rate for Payer: Aetna of WY Medicare |
$44.84
|
| Rate for Payer: Altius Commercial |
$67.27
|
| Rate for Payer: Beech Street Commercial |
$68.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$67.97
|
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.97
|
| Rate for Payer: Cigna of WY Commercial |
$68.67
|
| Rate for Payer: Entrust Commercial |
$66.57
|
| Rate for Payer: First Choice Health Commercial |
$66.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.74
|
| Rate for Payer: HealthUtah PPO |
$70.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.97
|
| Rate for Payer: Multiplan Medicare/VA |
$40.61
|
| Rate for Payer: One Health Plan of WY PPO |
$68.67
|
| Rate for Payer: PacificSource Commercial |
$63.06
|
| Rate for Payer: PHCS PPO |
$68.67
|
| Rate for Payer: Three Rivers PPO |
$52.55
|
| Rate for Payer: TriWest Veterans Administration |
$42.74
|
| Rate for Payer: United Healthcare Commercial |
$66.92
|
| Rate for Payer: United Healthcare Medicare |
$42.74
|
| Rate for Payer: WINHealth Partners Commercial |
$66.57
|
| Rate for Payer: Wise Provider Network Commercial |
$66.57
|
|
|
BRACE KNEE HINGED LARGE
|
Facility
|
OP
|
$132.58
|
|
| Hospital Charge Code |
2200218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$71.79 |
| Max. Negotiated Rate |
$132.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.93
|
| Rate for Payer: Aetna of WY Medicare |
$87.50
|
| Rate for Payer: Altius Commercial |
$127.28
|
| Rate for Payer: Beech Street Commercial |
$129.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.60
|
| Rate for Payer: Cigna of WY Commercial |
$129.93
|
| Rate for Payer: Entrust Commercial |
$125.95
|
| Rate for Payer: First Choice Health Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.57
|
| Rate for Payer: HealthUtah PPO |
$132.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.60
|
| Rate for Payer: Multiplan Medicare/VA |
$71.79
|
| Rate for Payer: One Health Plan of WY PPO |
$129.93
|
| Rate for Payer: PacificSource Commercial |
$119.32
|
| Rate for Payer: PHCS PPO |
$129.93
|
| Rate for Payer: Three Rivers PPO |
$99.44
|
| Rate for Payer: TriWest Veterans Administration |
$75.57
|
| Rate for Payer: United Healthcare Commercial |
$126.61
|
| Rate for Payer: United Healthcare Medicare |
$75.57
|
| Rate for Payer: WINHealth Partners Commercial |
$129.93
|
| Rate for Payer: Wise Provider Network Commercial |
$125.95
|
|
|
BRACE KNEE HINGED LARGE
|
Facility
|
IP
|
$132.58
|
|
| Hospital Charge Code |
2200218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$132.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.93
|
| Rate for Payer: Aetna of WY Medicare |
$84.85
|
| Rate for Payer: Altius Commercial |
$127.28
|
| Rate for Payer: Beech Street Commercial |
$129.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.60
|
| Rate for Payer: Cigna of WY Commercial |
$129.93
|
| Rate for Payer: Entrust Commercial |
$125.95
|
| Rate for Payer: First Choice Health Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.87
|
| Rate for Payer: HealthUtah PPO |
$132.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.60
|
| Rate for Payer: Multiplan Medicare/VA |
$76.83
|
| Rate for Payer: One Health Plan of WY PPO |
$129.93
|
| Rate for Payer: PacificSource Commercial |
$119.32
|
| Rate for Payer: PHCS PPO |
$129.93
|
| Rate for Payer: Three Rivers PPO |
$99.44
|
| Rate for Payer: TriWest Veterans Administration |
$80.87
|
| Rate for Payer: United Healthcare Commercial |
$126.61
|
| Rate for Payer: United Healthcare Medicare |
$80.87
|
| Rate for Payer: WINHealth Partners Commercial |
$125.95
|
| Rate for Payer: Wise Provider Network Commercial |
$125.95
|
|
|
BRACE KNEE HINGED MEDIUM
|
Facility
|
OP
|
$58.83
|
|
| Hospital Charge Code |
2200217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.53
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$31.86
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$33.53
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$33.53
|
| Rate for Payer: WINHealth Partners Commercial |
$57.65
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED MEDIUM
|
Facility
|
IP
|
$58.83
|
|
| Hospital Charge Code |
2200217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$37.65
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$55.89
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED SMALL
|
Facility
|
OP
|
$58.83
|
|
| Hospital Charge Code |
2200216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.53
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$31.86
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$33.53
|
| Rate for Payer: United Healthcare Medicare |
$33.53
|
| Rate for Payer: WINHealth Partners Commercial |
$57.65
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED SMALL
|
Facility
|
IP
|
$58.83
|
|
| Hospital Charge Code |
2200216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$37.65
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$55.89
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED XL
|
Facility
|
IP
|
$58.83
|
|
| Hospital Charge Code |
2200222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$37.65
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$55.89
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED XL
|
Facility
|
OP
|
$58.83
|
|
| Hospital Charge Code |
2200222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.53
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$31.86
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$33.53
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$33.53
|
| Rate for Payer: WINHealth Partners Commercial |
$57.65
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED XXL
|
Facility
|
IP
|
$58.83
|
|
| Hospital Charge Code |
2200444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$37.65
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$55.89
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE HINGED XXL
|
Facility
|
OP
|
$58.83
|
|
| Hospital Charge Code |
2200444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$58.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.65
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Commercial |
$56.48
|
| Rate for Payer: Beech Street Commercial |
$57.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.65
|
| Rate for Payer: Entrust Commercial |
$55.89
|
| Rate for Payer: First Choice Health Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.53
|
| Rate for Payer: HealthUtah PPO |
$58.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$31.86
|
| Rate for Payer: One Health Plan of WY PPO |
$57.65
|
| Rate for Payer: PacificSource Commercial |
$52.95
|
| Rate for Payer: PHCS PPO |
$57.65
|
| Rate for Payer: Three Rivers PPO |
$44.12
|
| Rate for Payer: TriWest Veterans Administration |
$33.53
|
| Rate for Payer: United Healthcare Commercial |
$56.18
|
| Rate for Payer: United Healthcare Medicare |
$33.53
|
| Rate for Payer: WINHealth Partners Commercial |
$57.65
|
| Rate for Payer: Wise Provider Network Commercial |
$55.89
|
|
|
BRACE KNEE IMMOB ADJ 222000C
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
2200135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$41.58
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.91
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$34.11
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$35.91
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
| Rate for Payer: United Healthcare Medicare |
$35.91
|
| Rate for Payer: WINHealth Partners Commercial |
$61.74
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
BRACE KNEE IMMOB ADJ 222000C
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
2200135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.74
|
| Rate for Payer: Aetna of WY Medicare |
$40.32
|
| Rate for Payer: Altius Commercial |
$60.48
|
| Rate for Payer: Beech Street Commercial |
$61.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.11
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.11
|
| Rate for Payer: Cigna of WY Commercial |
$61.74
|
| Rate for Payer: Entrust Commercial |
$59.85
|
| Rate for Payer: First Choice Health Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.43
|
| Rate for Payer: HealthUtah PPO |
$63.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.11
|
| Rate for Payer: Multiplan Medicare/VA |
$36.51
|
| Rate for Payer: One Health Plan of WY PPO |
$61.74
|
| Rate for Payer: PacificSource Commercial |
$56.70
|
| Rate for Payer: PHCS PPO |
$61.74
|
| Rate for Payer: Three Rivers PPO |
$47.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.43
|
| Rate for Payer: United Healthcare Commercial |
$60.16
|
| Rate for Payer: United Healthcare Medicare |
$38.43
|
| Rate for Payer: WINHealth Partners Commercial |
$59.85
|
| Rate for Payer: Wise Provider Network Commercial |
$59.85
|
|
|
BRACE KNEE TRIPANEL IMMOB 16"
|
Facility
|
OP
|
$88.73
|
|
| Hospital Charge Code |
2200131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$88.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.96
|
| Rate for Payer: Aetna of WY Medicare |
$58.56
|
| Rate for Payer: Altius Commercial |
$85.18
|
| Rate for Payer: Beech Street Commercial |
$86.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$86.07
|
| Rate for Payer: Cash Price |
$62.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.07
|
| Rate for Payer: Cigna of WY Commercial |
$86.96
|
| Rate for Payer: Entrust Commercial |
$84.29
|
| Rate for Payer: First Choice Health Commercial |
$84.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.58
|
| Rate for Payer: HealthUtah PPO |
$88.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.07
|
| Rate for Payer: Multiplan Medicare/VA |
$48.05
|
| Rate for Payer: One Health Plan of WY PPO |
$86.96
|
| Rate for Payer: PacificSource Commercial |
$79.86
|
| Rate for Payer: PHCS PPO |
$86.96
|
| Rate for Payer: Three Rivers PPO |
$66.55
|
| Rate for Payer: TriWest Veterans Administration |
$50.58
|
| Rate for Payer: United Healthcare Commercial |
$84.74
|
| Rate for Payer: United Healthcare Medicare |
$50.58
|
| Rate for Payer: WINHealth Partners Commercial |
$86.96
|
| Rate for Payer: Wise Provider Network Commercial |
$84.29
|
|
