|
SPONGE TONSIL LG
|
Facility
|
OP
|
$10.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$10.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.67
|
| Rate for Payer: Aetna of WY Medicare |
$7.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.45
|
| Rate for Payer: Altius Commercial |
$10.45
|
| Rate for Payer: Beech Street Commercial |
$10.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$7.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.56
|
| Rate for Payer: Cigna of WY Commercial |
$10.67
|
| Rate for Payer: Entrust Commercial |
$10.35
|
| Rate for Payer: First Choice Health Commercial |
$10.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.32
|
| Rate for Payer: HealthUtah PPO |
$10.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.56
|
| Rate for Payer: Multiplan Medicare/VA |
$6.00
|
| Rate for Payer: One Health Plan of WY PPO |
$10.67
|
| Rate for Payer: PacificSource Commercial |
$9.80
|
| Rate for Payer: PHCS PPO |
$10.67
|
| Rate for Payer: Three Rivers PPO |
$8.17
|
| Rate for Payer: TriWest Veterans Administration |
$6.32
|
| Rate for Payer: United Healthcare Commercial |
$9.47
|
| Rate for Payer: United Healthcare Medicare |
$6.32
|
| Rate for Payer: WINHealth Partners Commercial |
$10.67
|
| Rate for Payer: Wise Provider Network Commercial |
$10.35
|
|
|
SPONGE TONSIL MED 7/8"
|
Facility
|
IP
|
$2.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.22
|
| Rate for Payer: Altius Commercial |
$2.22
|
| Rate for Payer: Beech Street Commercial |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.24
|
| Rate for Payer: Cigna of WY Commercial |
$2.26
|
| Rate for Payer: Entrust Commercial |
$2.19
|
| Rate for Payer: First Choice Health Commercial |
$2.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.52
|
| Rate for Payer: HealthUtah PPO |
$2.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2.26
|
| Rate for Payer: PacificSource Commercial |
$2.08
|
| Rate for Payer: PHCS PPO |
$2.26
|
| Rate for Payer: Three Rivers PPO |
$1.73
|
| Rate for Payer: TriWest Veterans Administration |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$1.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2.19
|
| Rate for Payer: Wise Provider Network Commercial |
$2.19
|
|
|
SPONGE TONSIL MED 7/8"
|
Facility
|
OP
|
$2.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.26
|
| Rate for Payer: Aetna of WY Medicare |
$1.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.22
|
| Rate for Payer: Altius Commercial |
$2.22
|
| Rate for Payer: Beech Street Commercial |
$2.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.24
|
| Rate for Payer: Cigna of WY Commercial |
$2.26
|
| Rate for Payer: Entrust Commercial |
$2.19
|
| Rate for Payer: First Choice Health Commercial |
$2.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.34
|
| Rate for Payer: HealthUtah PPO |
$2.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1.27
|
| Rate for Payer: One Health Plan of WY PPO |
$2.26
|
| Rate for Payer: PacificSource Commercial |
$2.08
|
| Rate for Payer: PHCS PPO |
$2.26
|
| Rate for Payer: Three Rivers PPO |
$1.73
|
| Rate for Payer: TriWest Veterans Administration |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$2.01
|
| Rate for Payer: United Healthcare Medicare |
$1.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2.26
|
| Rate for Payer: Wise Provider Network Commercial |
$2.19
|
|
|
SPONGE TONSIL SM 5/8
|
Facility
|
IP
|
$10.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.91
|
| Rate for Payer: Altius Commercial |
$9.91
|
| Rate for Payer: Beech Street Commercial |
$10.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.01
|
| Rate for Payer: Cigna of WY Commercial |
$10.11
|
| Rate for Payer: Entrust Commercial |
$9.80
|
| Rate for Payer: First Choice Health Commercial |
$9.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.81
|
| Rate for Payer: HealthUtah PPO |
$10.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.01
|
| Rate for Payer: Multiplan Medicare/VA |
$6.47
|
| Rate for Payer: One Health Plan of WY PPO |
$10.11
|
| Rate for Payer: PacificSource Commercial |
$9.29
|
| Rate for Payer: PHCS PPO |
$10.11
|
| Rate for Payer: Three Rivers PPO |
$7.74
|
| Rate for Payer: TriWest Veterans Administration |
$6.81
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
| Rate for Payer: United Healthcare Medicare |
$6.81
|
| Rate for Payer: WINHealth Partners Commercial |
$9.80
|
| Rate for Payer: Wise Provider Network Commercial |
$9.80
|
|
|
SPONGE TONSIL SM 5/8
|
Facility
|
OP
|
$10.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$10.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.11
|
| Rate for Payer: Aetna of WY Medicare |
$6.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.91
|
| Rate for Payer: Altius Commercial |
$9.91
|
| Rate for Payer: Beech Street Commercial |
$10.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.47
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.01
|
| Rate for Payer: Cigna of WY Commercial |
$10.11
|
| Rate for Payer: Entrust Commercial |
$9.80
|
| Rate for Payer: First Choice Health Commercial |
$9.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.99
|
| Rate for Payer: HealthUtah PPO |
$10.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.01
|
| Rate for Payer: Multiplan Medicare/VA |
$5.69
|
| Rate for Payer: One Health Plan of WY PPO |
$10.11
|
| Rate for Payer: PacificSource Commercial |
$9.29
|
| Rate for Payer: PHCS PPO |
$10.11
|
| Rate for Payer: Three Rivers PPO |
$7.74
|
| Rate for Payer: TriWest Veterans Administration |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
| Rate for Payer: United Healthcare Medicare |
$5.99
|
| Rate for Payer: WINHealth Partners Commercial |
$10.11
|
| Rate for Payer: Wise Provider Network Commercial |
$9.80
|
|
|
SPORTS/CAMP PHYSICAL < 18 YEARS OF AGE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS TY009
|
| Hospital Charge Code |
TY009
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Beech Street Commercial |
$23.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: First Choice Health Commercial |
$22.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$23.75
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
|
|
SPORTS PHYSICAL 99213
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS TY042
|
| Hospital Charge Code |
TY042
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.50
|
| Rate for Payer: Beech Street Commercial |
$23.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.25
|
| Rate for Payer: Cigna of WY Commercial |
$24.50
|
| Rate for Payer: First Choice Health Commercial |
$22.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.75
|
| Rate for Payer: HealthUtah PPO |
$25.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.25
|
| Rate for Payer: One Health Plan of WY PPO |
$24.50
|
| Rate for Payer: PacificSource Commercial |
$22.50
|
| Rate for Payer: PHCS PPO |
$23.75
|
| Rate for Payer: Three Rivers PPO |
$18.75
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: WINHealth Partners Commercial |
$23.75
|
|
|
SPOT EX INK ENDOSCOPIC TATTOO
|
Facility
|
OP
|
$94.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$92.61
|
| Rate for Payer: Aetna of WY Medicare |
$62.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$90.72
|
| Rate for Payer: Altius Commercial |
$90.72
|
| Rate for Payer: Beech Street Commercial |
$92.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.58
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$91.66
|
| Rate for Payer: Cigna of WY Commercial |
$92.61
|
| Rate for Payer: Entrust Commercial |
$89.78
|
| Rate for Payer: First Choice Health Commercial |
$89.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.81
|
| Rate for Payer: HealthUtah PPO |
$94.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$91.66
|
| Rate for Payer: Multiplan Medicare/VA |
$52.07
|
| Rate for Payer: One Health Plan of WY PPO |
$92.61
|
| Rate for Payer: PacificSource Commercial |
$85.05
|
| Rate for Payer: PHCS PPO |
$92.61
|
| Rate for Payer: Three Rivers PPO |
$70.88
|
| Rate for Payer: TriWest Veterans Administration |
$54.81
|
| Rate for Payer: United Healthcare Commercial |
$82.22
|
| Rate for Payer: United Healthcare Medicare |
$54.81
|
| Rate for Payer: WINHealth Partners Commercial |
$92.61
|
| Rate for Payer: Wise Provider Network Commercial |
$89.78
|
|
|
SPOT EX INK ENDOSCOPIC TATTOO
|
Facility
|
IP
|
$94.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$92.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$90.72
|
| Rate for Payer: Altius Commercial |
$90.72
|
| Rate for Payer: Beech Street Commercial |
$92.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.58
|
| Rate for Payer: Cash Price |
$66.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$91.66
|
| Rate for Payer: Cigna of WY Commercial |
$92.61
|
| Rate for Payer: Entrust Commercial |
$89.78
|
| Rate for Payer: First Choice Health Commercial |
$89.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.37
|
| Rate for Payer: HealthUtah PPO |
$94.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$91.66
|
| Rate for Payer: Multiplan Medicare/VA |
$59.25
|
| Rate for Payer: One Health Plan of WY PPO |
$92.61
|
| Rate for Payer: PacificSource Commercial |
$85.05
|
| Rate for Payer: PHCS PPO |
$92.61
|
| Rate for Payer: Three Rivers PPO |
$70.88
|
| Rate for Payer: TriWest Veterans Administration |
$62.37
|
| Rate for Payer: United Healthcare Commercial |
$82.22
|
| Rate for Payer: United Healthcare Medicare |
$62.37
|
| Rate for Payer: WINHealth Partners Commercial |
$89.78
|
| Rate for Payer: Wise Provider Network Commercial |
$89.78
|
|
|
STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,433.00
|
|
|
Service Code
|
HCPCS 37765
|
| Hospital Charge Code |
37765
|
| Min. Negotiated Rate |
$1,074.75 |
| Max. Negotiated Rate |
$1,433.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,404.34
|
| Rate for Payer: Beech Street Commercial |
$1,361.35
|
| Rate for Payer: Cash Price |
$1,003.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,390.01
|
| Rate for Payer: Cigna of WY Commercial |
$1,404.34
|
| Rate for Payer: First Choice Health Commercial |
$1,289.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,361.35
|
| Rate for Payer: HealthUtah PPO |
$1,433.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,390.01
|
| Rate for Payer: One Health Plan of WY PPO |
$1,404.34
|
| Rate for Payer: PacificSource Commercial |
$1,289.70
|
| Rate for Payer: PHCS PPO |
$1,361.35
|
| Rate for Payer: Three Rivers PPO |
$1,074.75
|
| Rate for Payer: United Healthcare Commercial |
$1,246.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,218.05
|
|
|
STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
HCPCS 37766
|
| Hospital Charge Code |
37766
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$1,684.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,650.32
|
| Rate for Payer: Aetna of WY Medicare |
$308.70
|
| Rate for Payer: Beech Street Commercial |
$1,599.80
|
| Rate for Payer: Cash Price |
$1,178.80
|
| Rate for Payer: Cash Price |
$1,178.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,633.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,650.32
|
| Rate for Payer: First Choice Health Commercial |
$1,515.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,599.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.70
|
| Rate for Payer: HealthUtah PPO |
$1,684.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,633.48
|
| Rate for Payer: Multiplan Medicare/VA |
$262.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,650.32
|
| Rate for Payer: PacificSource Commercial |
$1,515.60
|
| Rate for Payer: PHCS PPO |
$1,599.80
|
| Rate for Payer: Three Rivers PPO |
$1,263.00
|
| Rate for Payer: TriWest Veterans Administration |
$308.70
|
| Rate for Payer: United Healthcare Commercial |
$1,465.08
|
| Rate for Payer: United Healthcare Medicare |
$308.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1,431.40
|
|
|
STAPLER CONTOUR CURVED 40MM
|
Facility
|
OP
|
$1,003.62
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.99 |
| Max. Negotiated Rate |
$1,003.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$983.55
|
| Rate for Payer: Aetna of WY Medicare |
$662.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$963.48
|
| Rate for Payer: Altius Commercial |
$963.48
|
| Rate for Payer: Beech Street Commercial |
$983.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$823.97
|
| Rate for Payer: Cash Price |
$702.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$973.51
|
| Rate for Payer: Cigna of WY Commercial |
$983.55
|
| Rate for Payer: Entrust Commercial |
$953.44
|
| Rate for Payer: First Choice Health Commercial |
$953.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$953.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$582.10
|
| Rate for Payer: HealthUtah PPO |
$1,003.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$973.51
|
| Rate for Payer: Multiplan Medicare/VA |
$552.99
|
| Rate for Payer: One Health Plan of WY PPO |
$983.55
|
| Rate for Payer: PacificSource Commercial |
$903.26
|
| Rate for Payer: PHCS PPO |
$983.55
|
| Rate for Payer: Three Rivers PPO |
$752.72
|
| Rate for Payer: TriWest Veterans Administration |
$582.10
|
| Rate for Payer: United Healthcare Commercial |
$873.15
|
| Rate for Payer: United Healthcare Medicare |
$582.10
|
| Rate for Payer: WINHealth Partners Commercial |
$983.55
|
| Rate for Payer: Wise Provider Network Commercial |
$953.44
|
|
|
STAPLER CONTOUR CURVED 40MM
|
Facility
|
IP
|
$1,003.62
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.27 |
| Max. Negotiated Rate |
$1,003.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$983.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$963.48
|
| Rate for Payer: Altius Commercial |
$963.48
|
| Rate for Payer: Beech Street Commercial |
$983.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$823.97
|
| Rate for Payer: Cash Price |
$702.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$973.51
|
| Rate for Payer: Cigna of WY Commercial |
$983.55
|
| Rate for Payer: Entrust Commercial |
$953.44
|
| Rate for Payer: First Choice Health Commercial |
$953.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$953.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$662.39
|
| Rate for Payer: HealthUtah PPO |
$1,003.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$973.51
|
| Rate for Payer: Multiplan Medicare/VA |
$629.27
|
| Rate for Payer: One Health Plan of WY PPO |
$983.55
|
| Rate for Payer: PacificSource Commercial |
$903.26
|
| Rate for Payer: PHCS PPO |
$983.55
|
| Rate for Payer: Three Rivers PPO |
$752.72
|
| Rate for Payer: TriWest Veterans Administration |
$662.39
|
| Rate for Payer: United Healthcare Commercial |
$873.15
|
| Rate for Payer: United Healthcare Medicare |
$662.39
|
| Rate for Payer: WINHealth Partners Commercial |
$953.44
|
| Rate for Payer: Wise Provider Network Commercial |
$953.44
|
|
|
STAPLER ENDO GIA ULTRA 12MM
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
STAPLER ENDO GIA ULTRA 12MM
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.12 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$482.12
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
STAPLER ENDO GIA ULTRA 12MM XL
|
Facility
|
IP
|
$2,043.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,281.13 |
| Max. Negotiated Rate |
$2,043.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,002.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,961.54
|
| Rate for Payer: Altius Commercial |
$1,961.54
|
| Rate for Payer: Beech Street Commercial |
$2,002.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,677.52
|
| Rate for Payer: Cash Price |
$1,430.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,981.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,002.40
|
| Rate for Payer: Entrust Commercial |
$1,941.11
|
| Rate for Payer: First Choice Health Commercial |
$1,941.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,348.56
|
| Rate for Payer: HealthUtah PPO |
$2,043.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,981.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,281.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,002.40
|
| Rate for Payer: PacificSource Commercial |
$1,838.94
|
| Rate for Payer: PHCS PPO |
$2,002.40
|
| Rate for Payer: Three Rivers PPO |
$1,532.45
|
| Rate for Payer: TriWest Veterans Administration |
$1,348.56
|
| Rate for Payer: United Healthcare Commercial |
$1,777.64
|
| Rate for Payer: United Healthcare Medicare |
$1,348.56
|
| Rate for Payer: WINHealth Partners Commercial |
$1,941.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1,941.11
|
|
|
STAPLER ENDO GIA ULTRA 12MM XL
|
Facility
|
OP
|
$2,043.27
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,125.84 |
| Max. Negotiated Rate |
$2,043.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,002.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,348.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,961.54
|
| Rate for Payer: Altius Commercial |
$1,961.54
|
| Rate for Payer: Beech Street Commercial |
$2,002.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,677.52
|
| Rate for Payer: Cash Price |
$1,430.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,981.97
|
| Rate for Payer: Cigna of WY Commercial |
$2,002.40
|
| Rate for Payer: Entrust Commercial |
$1,941.11
|
| Rate for Payer: First Choice Health Commercial |
$1,941.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,941.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,185.10
|
| Rate for Payer: HealthUtah PPO |
$2,043.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,981.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,125.84
|
| Rate for Payer: One Health Plan of WY PPO |
$2,002.40
|
| Rate for Payer: PacificSource Commercial |
$1,838.94
|
| Rate for Payer: PHCS PPO |
$2,002.40
|
| Rate for Payer: Three Rivers PPO |
$1,532.45
|
| Rate for Payer: TriWest Veterans Administration |
$1,185.10
|
| Rate for Payer: United Healthcare Commercial |
$1,777.64
|
| Rate for Payer: United Healthcare Medicare |
$1,185.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,002.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,941.11
|
|
|
STAPLER GIA 80MM 3.8MM BLUE
|
Facility
|
OP
|
$522.13
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.69 |
| Max. Negotiated Rate |
$522.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.69
|
| Rate for Payer: Aetna of WY Medicare |
$344.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$501.24
|
| Rate for Payer: Altius Commercial |
$501.24
|
| Rate for Payer: Beech Street Commercial |
$511.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$428.67
|
| Rate for Payer: Cash Price |
$365.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.47
|
| Rate for Payer: Cigna of WY Commercial |
$511.69
|
| Rate for Payer: Entrust Commercial |
$496.02
|
| Rate for Payer: First Choice Health Commercial |
$496.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$496.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$302.84
|
| Rate for Payer: HealthUtah PPO |
$522.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.47
|
| Rate for Payer: Multiplan Medicare/VA |
$287.69
|
| Rate for Payer: One Health Plan of WY PPO |
$511.69
|
| Rate for Payer: PacificSource Commercial |
$469.92
|
| Rate for Payer: PHCS PPO |
$511.69
|
| Rate for Payer: Three Rivers PPO |
$391.60
|
| Rate for Payer: TriWest Veterans Administration |
$302.84
|
| Rate for Payer: United Healthcare Commercial |
$454.25
|
| Rate for Payer: United Healthcare Medicare |
$302.84
|
| Rate for Payer: WINHealth Partners Commercial |
$511.69
|
| Rate for Payer: Wise Provider Network Commercial |
$496.02
|
|
|
STAPLER GIA 80MM 3.8MM BLUE
|
Facility
|
IP
|
$522.13
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$327.38 |
| Max. Negotiated Rate |
$522.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$501.24
|
| Rate for Payer: Altius Commercial |
$501.24
|
| Rate for Payer: Beech Street Commercial |
$511.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$428.67
|
| Rate for Payer: Cash Price |
$365.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.47
|
| Rate for Payer: Cigna of WY Commercial |
$511.69
|
| Rate for Payer: Entrust Commercial |
$496.02
|
| Rate for Payer: First Choice Health Commercial |
$496.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$496.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$344.61
|
| Rate for Payer: HealthUtah PPO |
$522.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.47
|
| Rate for Payer: Multiplan Medicare/VA |
$327.38
|
| Rate for Payer: One Health Plan of WY PPO |
$511.69
|
| Rate for Payer: PacificSource Commercial |
$469.92
|
| Rate for Payer: PHCS PPO |
$511.69
|
| Rate for Payer: Three Rivers PPO |
$391.60
|
| Rate for Payer: TriWest Veterans Administration |
$344.61
|
| Rate for Payer: United Healthcare Commercial |
$454.25
|
| Rate for Payer: United Healthcare Medicare |
$344.61
|
| Rate for Payer: WINHealth Partners Commercial |
$496.02
|
| Rate for Payer: Wise Provider Network Commercial |
$496.02
|
|
|
STAPLER POWER CIRCULAR 25MM
|
Facility
|
OP
|
$1,224.99
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.97 |
| Max. Negotiated Rate |
$1,224.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.49
|
| Rate for Payer: Aetna of WY Medicare |
$808.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,175.99
|
| Rate for Payer: Altius Commercial |
$1,175.99
|
| Rate for Payer: Beech Street Commercial |
$1,200.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,005.72
|
| Rate for Payer: Cash Price |
$857.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.49
|
| Rate for Payer: Entrust Commercial |
$1,163.74
|
| Rate for Payer: First Choice Health Commercial |
$1,163.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,163.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$710.49
|
| Rate for Payer: HealthUtah PPO |
$1,224.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.24
|
| Rate for Payer: Multiplan Medicare/VA |
$674.97
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.49
|
| Rate for Payer: PacificSource Commercial |
$1,102.49
|
| Rate for Payer: PHCS PPO |
$1,200.49
|
| Rate for Payer: Three Rivers PPO |
$918.74
|
| Rate for Payer: TriWest Veterans Administration |
$710.49
|
| Rate for Payer: United Healthcare Commercial |
$1,065.74
|
| Rate for Payer: United Healthcare Medicare |
$710.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,200.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1,163.74
|
|
|
STAPLER POWER CIRCULAR 25MM
|
Facility
|
IP
|
$1,224.99
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.07 |
| Max. Negotiated Rate |
$1,224.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,175.99
|
| Rate for Payer: Altius Commercial |
$1,175.99
|
| Rate for Payer: Beech Street Commercial |
$1,200.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,005.72
|
| Rate for Payer: Cash Price |
$857.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.49
|
| Rate for Payer: Entrust Commercial |
$1,163.74
|
| Rate for Payer: First Choice Health Commercial |
$1,163.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,163.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$808.49
|
| Rate for Payer: HealthUtah PPO |
$1,224.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.24
|
| Rate for Payer: Multiplan Medicare/VA |
$768.07
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.49
|
| Rate for Payer: PacificSource Commercial |
$1,102.49
|
| Rate for Payer: PHCS PPO |
$1,200.49
|
| Rate for Payer: Three Rivers PPO |
$918.74
|
| Rate for Payer: TriWest Veterans Administration |
$808.49
|
| Rate for Payer: United Healthcare Commercial |
$1,065.74
|
| Rate for Payer: United Healthcare Medicare |
$808.49
|
| Rate for Payer: WINHealth Partners Commercial |
$1,163.74
|
| Rate for Payer: Wise Provider Network Commercial |
$1,163.74
|
|
|
STAPLER POWER CIRCULAR 29MM
|
Facility
|
OP
|
$1,225.28
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.13 |
| Max. Negotiated Rate |
$1,225.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.77
|
| Rate for Payer: Aetna of WY Medicare |
$808.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,176.27
|
| Rate for Payer: Altius Commercial |
$1,176.27
|
| Rate for Payer: Beech Street Commercial |
$1,200.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,005.95
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.77
|
| Rate for Payer: Entrust Commercial |
$1,164.02
|
| Rate for Payer: First Choice Health Commercial |
$1,164.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,164.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$710.66
|
| Rate for Payer: HealthUtah PPO |
$1,225.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.52
|
| Rate for Payer: Multiplan Medicare/VA |
$675.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.77
|
| Rate for Payer: PacificSource Commercial |
$1,102.75
|
| Rate for Payer: PHCS PPO |
$1,200.77
|
| Rate for Payer: Three Rivers PPO |
$918.96
|
| Rate for Payer: TriWest Veterans Administration |
$710.66
|
| Rate for Payer: United Healthcare Commercial |
$1,065.99
|
| Rate for Payer: United Healthcare Medicare |
$710.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1,200.77
|
| Rate for Payer: Wise Provider Network Commercial |
$1,164.02
|
|
|
STAPLER POWER CIRCULAR 29MM
|
Facility
|
IP
|
$1,225.28
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$768.25 |
| Max. Negotiated Rate |
$1,225.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,200.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,176.27
|
| Rate for Payer: Altius Commercial |
$1,176.27
|
| Rate for Payer: Beech Street Commercial |
$1,200.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,005.95
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,188.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,200.77
|
| Rate for Payer: Entrust Commercial |
$1,164.02
|
| Rate for Payer: First Choice Health Commercial |
$1,164.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,164.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$808.68
|
| Rate for Payer: HealthUtah PPO |
$1,225.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,188.52
|
| Rate for Payer: Multiplan Medicare/VA |
$768.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,200.77
|
| Rate for Payer: PacificSource Commercial |
$1,102.75
|
| Rate for Payer: PHCS PPO |
$1,200.77
|
| Rate for Payer: Three Rivers PPO |
$918.96
|
| Rate for Payer: TriWest Veterans Administration |
$808.68
|
| Rate for Payer: United Healthcare Commercial |
$1,065.99
|
| Rate for Payer: United Healthcare Medicare |
$808.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,164.02
|
| Rate for Payer: Wise Provider Network Commercial |
$1,164.02
|
|
|
STAPLER POWER CIRCULAR 31MM
|
Facility
|
OP
|
$1,217.84
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.03 |
| Max. Negotiated Rate |
$1,217.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.48
|
| Rate for Payer: Aetna of WY Medicare |
$803.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,169.13
|
| Rate for Payer: Altius Commercial |
$1,169.13
|
| Rate for Payer: Beech Street Commercial |
$1,193.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$999.85
|
| Rate for Payer: Cash Price |
$852.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.48
|
| Rate for Payer: Entrust Commercial |
$1,156.95
|
| Rate for Payer: First Choice Health Commercial |
$1,156.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,156.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$706.35
|
| Rate for Payer: HealthUtah PPO |
$1,217.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.30
|
| Rate for Payer: Multiplan Medicare/VA |
$671.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.48
|
| Rate for Payer: PacificSource Commercial |
$1,096.06
|
| Rate for Payer: PHCS PPO |
$1,193.48
|
| Rate for Payer: Three Rivers PPO |
$913.38
|
| Rate for Payer: TriWest Veterans Administration |
$706.35
|
| Rate for Payer: United Healthcare Commercial |
$1,059.52
|
| Rate for Payer: United Healthcare Medicare |
$706.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,193.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1,156.95
|
|
|
STAPLER POWER CIRCULAR 31MM
|
Facility
|
IP
|
$1,217.84
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.59 |
| Max. Negotiated Rate |
$1,217.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,169.13
|
| Rate for Payer: Altius Commercial |
$1,169.13
|
| Rate for Payer: Beech Street Commercial |
$1,193.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$999.85
|
| Rate for Payer: Cash Price |
$852.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.48
|
| Rate for Payer: Entrust Commercial |
$1,156.95
|
| Rate for Payer: First Choice Health Commercial |
$1,156.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,156.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$803.77
|
| Rate for Payer: HealthUtah PPO |
$1,217.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.30
|
| Rate for Payer: Multiplan Medicare/VA |
$763.59
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.48
|
| Rate for Payer: PacificSource Commercial |
$1,096.06
|
| Rate for Payer: PHCS PPO |
$1,193.48
|
| Rate for Payer: Three Rivers PPO |
$913.38
|
| Rate for Payer: TriWest Veterans Administration |
$803.77
|
| Rate for Payer: United Healthcare Commercial |
$1,059.52
|
| Rate for Payer: United Healthcare Medicare |
$803.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1,156.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1,156.95
|
|
