|
BRACE WRIST 8" RH XL 79-87288
|
Facility
|
OP
|
$16.34
|
|
| Hospital Charge Code |
2200356
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.85
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
BRACE WRIST/THUMB L UNIV SZ
|
Facility
|
OP
|
$17.32
|
|
| Hospital Charge Code |
2200439
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Aetna of WY Medicare |
$11.43
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.87
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.38
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$9.87
|
| Rate for Payer: United Healthcare Commercial |
$16.54
|
| Rate for Payer: United Healthcare Medicare |
$9.87
|
| Rate for Payer: WINHealth Partners Commercial |
$16.97
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST/THUMB L UNIV SZ
|
Facility
|
IP
|
$17.32
|
|
| Hospital Charge Code |
2200439
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Aetna of WY Medicare |
$11.08
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.57
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.04
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$10.57
|
| Rate for Payer: United Healthcare Commercial |
$16.54
|
| Rate for Payer: United Healthcare Medicare |
$10.57
|
| Rate for Payer: WINHealth Partners Commercial |
$16.45
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST/THUMB R UNIV SZ
|
Facility
|
OP
|
$17.32
|
|
| Hospital Charge Code |
2200438
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Aetna of WY Medicare |
$11.43
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.87
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.38
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$9.87
|
| Rate for Payer: United Healthcare Commercial |
$16.54
|
| Rate for Payer: United Healthcare Medicare |
$9.87
|
| Rate for Payer: WINHealth Partners Commercial |
$16.97
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST/THUMB R UNIV SZ
|
Facility
|
IP
|
$17.32
|
|
| Hospital Charge Code |
2200438
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.97
|
| Rate for Payer: Aetna of WY Medicare |
$11.08
|
| Rate for Payer: Altius Commercial |
$16.63
|
| Rate for Payer: Beech Street Commercial |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.80
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.80
|
| Rate for Payer: Cigna of WY Commercial |
$16.97
|
| Rate for Payer: Entrust Commercial |
$16.45
|
| Rate for Payer: First Choice Health Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.57
|
| Rate for Payer: HealthUtah PPO |
$17.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.80
|
| Rate for Payer: Multiplan Medicare/VA |
$10.04
|
| Rate for Payer: One Health Plan of WY PPO |
$16.97
|
| Rate for Payer: PacificSource Commercial |
$15.59
|
| Rate for Payer: PHCS PPO |
$16.97
|
| Rate for Payer: Three Rivers PPO |
$12.99
|
| Rate for Payer: TriWest Veterans Administration |
$10.57
|
| Rate for Payer: United Healthcare Commercial |
$16.54
|
| Rate for Payer: United Healthcare Medicare |
$10.57
|
| Rate for Payer: WINHealth Partners Commercial |
$16.45
|
| Rate for Payer: Wise Provider Network Commercial |
$16.45
|
|
|
BRACE WRIST THUMB SUPPORT LARGE
|
Facility
|
IP
|
$31.81
|
|
| Hospital Charge Code |
2200461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.17
|
| Rate for Payer: Aetna of WY Medicare |
$20.36
|
| Rate for Payer: Altius Commercial |
$30.54
|
| Rate for Payer: Beech Street Commercial |
$31.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.86
|
| Rate for Payer: Cigna of WY Commercial |
$31.17
|
| Rate for Payer: Entrust Commercial |
$30.22
|
| Rate for Payer: First Choice Health Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.40
|
| Rate for Payer: HealthUtah PPO |
$31.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.86
|
| Rate for Payer: Multiplan Medicare/VA |
$18.43
|
| Rate for Payer: One Health Plan of WY PPO |
$31.17
|
| Rate for Payer: PacificSource Commercial |
$28.63
|
| Rate for Payer: PHCS PPO |
$31.17
|
| Rate for Payer: Three Rivers PPO |
$23.86
|
| Rate for Payer: TriWest Veterans Administration |
$19.40
|
| Rate for Payer: United Healthcare Commercial |
$30.38
|
| Rate for Payer: United Healthcare Medicare |
$19.40
|
| Rate for Payer: WINHealth Partners Commercial |
$30.22
|
| Rate for Payer: Wise Provider Network Commercial |
$30.22
|
|
|
BRACE WRIST THUMB SUPPORT LARGE
|
Facility
|
OP
|
$31.81
|
|
| Hospital Charge Code |
2200461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.17
|
| Rate for Payer: Aetna of WY Medicare |
$20.99
|
| Rate for Payer: Altius Commercial |
$30.54
|
| Rate for Payer: Beech Street Commercial |
$31.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.86
|
| Rate for Payer: Cigna of WY Commercial |
$31.17
|
| Rate for Payer: Entrust Commercial |
$30.22
|
| Rate for Payer: First Choice Health Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.13
|
| Rate for Payer: HealthUtah PPO |
$31.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.86
|
| Rate for Payer: Multiplan Medicare/VA |
$17.23
|
| Rate for Payer: One Health Plan of WY PPO |
$31.17
|
| Rate for Payer: PacificSource Commercial |
$28.63
|
| Rate for Payer: PHCS PPO |
$31.17
|
| Rate for Payer: Three Rivers PPO |
$23.86
|
| Rate for Payer: TriWest Veterans Administration |
$18.13
|
| Rate for Payer: United Healthcare Commercial |
$30.38
|
| Rate for Payer: United Healthcare Medicare |
$18.13
|
| Rate for Payer: WINHealth Partners Commercial |
$31.17
|
| Rate for Payer: Wise Provider Network Commercial |
$30.22
|
|
|
BRACE WRIST THUMB SUPPORT MEDIUM
|
Facility
|
OP
|
$31.81
|
|
| Hospital Charge Code |
2200460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.17
|
| Rate for Payer: Aetna of WY Medicare |
$20.99
|
| Rate for Payer: Altius Commercial |
$30.54
|
| Rate for Payer: Beech Street Commercial |
$31.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.86
|
| Rate for Payer: Cigna of WY Commercial |
$31.17
|
| Rate for Payer: Entrust Commercial |
$30.22
|
| Rate for Payer: First Choice Health Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.13
|
| Rate for Payer: HealthUtah PPO |
$31.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.86
|
| Rate for Payer: Multiplan Medicare/VA |
$17.23
|
| Rate for Payer: One Health Plan of WY PPO |
$31.17
|
| Rate for Payer: PacificSource Commercial |
$28.63
|
| Rate for Payer: PHCS PPO |
$31.17
|
| Rate for Payer: Three Rivers PPO |
$23.86
|
| Rate for Payer: TriWest Veterans Administration |
$18.13
|
| Rate for Payer: United Healthcare Commercial |
$30.38
|
| Rate for Payer: United Healthcare Medicare |
$18.13
|
| Rate for Payer: WINHealth Partners Commercial |
$31.17
|
| Rate for Payer: Wise Provider Network Commercial |
$30.22
|
|
|
BRACE WRIST THUMB SUPPORT MEDIUM
|
Facility
|
IP
|
$31.81
|
|
| Hospital Charge Code |
2200460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.17
|
| Rate for Payer: Aetna of WY Medicare |
$20.36
|
| Rate for Payer: Altius Commercial |
$30.54
|
| Rate for Payer: Beech Street Commercial |
$31.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.86
|
| Rate for Payer: Cigna of WY Commercial |
$31.17
|
| Rate for Payer: Entrust Commercial |
$30.22
|
| Rate for Payer: First Choice Health Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.40
|
| Rate for Payer: HealthUtah PPO |
$31.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.86
|
| Rate for Payer: Multiplan Medicare/VA |
$18.43
|
| Rate for Payer: One Health Plan of WY PPO |
$31.17
|
| Rate for Payer: PacificSource Commercial |
$28.63
|
| Rate for Payer: PHCS PPO |
$31.17
|
| Rate for Payer: Three Rivers PPO |
$23.86
|
| Rate for Payer: TriWest Veterans Administration |
$19.40
|
| Rate for Payer: United Healthcare Commercial |
$30.38
|
| Rate for Payer: United Healthcare Medicare |
$19.40
|
| Rate for Payer: WINHealth Partners Commercial |
$30.22
|
| Rate for Payer: Wise Provider Network Commercial |
$30.22
|
|
|
BRACE WRIST THUMB SUPPORT SMALL
|
Facility
|
IP
|
$31.81
|
|
| Hospital Charge Code |
2200459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.17
|
| Rate for Payer: Aetna of WY Medicare |
$20.36
|
| Rate for Payer: Altius Commercial |
$30.54
|
| Rate for Payer: Beech Street Commercial |
$31.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.86
|
| Rate for Payer: Cigna of WY Commercial |
$31.17
|
| Rate for Payer: Entrust Commercial |
$30.22
|
| Rate for Payer: First Choice Health Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.40
|
| Rate for Payer: HealthUtah PPO |
$31.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.86
|
| Rate for Payer: Multiplan Medicare/VA |
$18.43
|
| Rate for Payer: One Health Plan of WY PPO |
$31.17
|
| Rate for Payer: PacificSource Commercial |
$28.63
|
| Rate for Payer: PHCS PPO |
$31.17
|
| Rate for Payer: Three Rivers PPO |
$23.86
|
| Rate for Payer: TriWest Veterans Administration |
$19.40
|
| Rate for Payer: United Healthcare Commercial |
$30.38
|
| Rate for Payer: United Healthcare Medicare |
$19.40
|
| Rate for Payer: WINHealth Partners Commercial |
$30.22
|
| Rate for Payer: Wise Provider Network Commercial |
$30.22
|
|
|
BRACE WRIST THUMB SUPPORT SMALL
|
Facility
|
OP
|
$31.81
|
|
| Hospital Charge Code |
2200459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.23 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.17
|
| Rate for Payer: Aetna of WY Medicare |
$20.99
|
| Rate for Payer: Altius Commercial |
$30.54
|
| Rate for Payer: Beech Street Commercial |
$31.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.86
|
| Rate for Payer: Cigna of WY Commercial |
$31.17
|
| Rate for Payer: Entrust Commercial |
$30.22
|
| Rate for Payer: First Choice Health Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.13
|
| Rate for Payer: HealthUtah PPO |
$31.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.86
|
| Rate for Payer: Multiplan Medicare/VA |
$17.23
|
| Rate for Payer: One Health Plan of WY PPO |
$31.17
|
| Rate for Payer: PacificSource Commercial |
$28.63
|
| Rate for Payer: PHCS PPO |
$31.17
|
| Rate for Payer: Three Rivers PPO |
$23.86
|
| Rate for Payer: TriWest Veterans Administration |
$18.13
|
| Rate for Payer: United Healthcare Commercial |
$30.38
|
| Rate for Payer: United Healthcare Medicare |
$18.13
|
| Rate for Payer: WINHealth Partners Commercial |
$31.17
|
| Rate for Payer: Wise Provider Network Commercial |
$30.22
|
|
|
BREAST MILK STORAGE BAG 68062
|
Facility
|
OP
|
$0.34
|
|
| Hospital Charge Code |
2450025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
BREAST MILK STORAGE BAG 68062
|
Facility
|
IP
|
$0.34
|
|
| Hospital Charge Code |
2450025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.21
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.20
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.21
|
| Rate for Payer: United Healthcare Commercial |
$0.32
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
BREAST PUMP CONNECTOR 87076
|
Facility
|
OP
|
$3.51
|
|
| Hospital Charge Code |
2450004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.44
|
| Rate for Payer: Aetna of WY Medicare |
$2.32
|
| Rate for Payer: Altius Commercial |
$3.37
|
| Rate for Payer: Beech Street Commercial |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.44
|
| Rate for Payer: Entrust Commercial |
$3.33
|
| Rate for Payer: First Choice Health Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.00
|
| Rate for Payer: HealthUtah PPO |
$3.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3.44
|
| Rate for Payer: PacificSource Commercial |
$3.16
|
| Rate for Payer: PHCS PPO |
$3.44
|
| Rate for Payer: Three Rivers PPO |
$2.63
|
| Rate for Payer: TriWest Veterans Administration |
$2.00
|
| Rate for Payer: United Healthcare Commercial |
$3.35
|
| Rate for Payer: United Healthcare Medicare |
$2.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3.44
|
| Rate for Payer: Wise Provider Network Commercial |
$3.33
|
|
|
BREAST PUMP CONNECTOR 87076
|
Facility
|
IP
|
$3.51
|
|
| Hospital Charge Code |
2450004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.44
|
| Rate for Payer: Aetna of WY Medicare |
$2.25
|
| Rate for Payer: Altius Commercial |
$3.37
|
| Rate for Payer: Beech Street Commercial |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.44
|
| Rate for Payer: Entrust Commercial |
$3.33
|
| Rate for Payer: First Choice Health Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.14
|
| Rate for Payer: HealthUtah PPO |
$3.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$2.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3.44
|
| Rate for Payer: PacificSource Commercial |
$3.16
|
| Rate for Payer: PHCS PPO |
$3.44
|
| Rate for Payer: Three Rivers PPO |
$2.63
|
| Rate for Payer: TriWest Veterans Administration |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$3.35
|
| Rate for Payer: United Healthcare Medicare |
$2.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3.33
|
| Rate for Payer: Wise Provider Network Commercial |
$3.33
|
|
|
BRIDLE NASAL TUBE SYS 16-18F
|
Facility
|
OP
|
$450.80
|
|
| Hospital Charge Code |
2400286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.11 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$297.53
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.28
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.96
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$244.11
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$256.96
|
| Rate for Payer: United Healthcare Commercial |
$430.51
|
| Rate for Payer: United Healthcare Medicare |
$256.96
|
| Rate for Payer: WINHealth Partners Commercial |
$441.78
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIDLE NASAL TUBE SYS 16-18F
|
Facility
|
IP
|
$450.80
|
|
| Hospital Charge Code |
2400286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.24 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$288.51
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.28
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$274.99
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$261.24
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$274.99
|
| Rate for Payer: United Healthcare Commercial |
$430.51
|
| Rate for Payer: United Healthcare Medicare |
$274.99
|
| Rate for Payer: WINHealth Partners Commercial |
$428.26
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIDLE NASAL TUBE SYS 8-10F
|
Facility
|
IP
|
$450.80
|
|
| Hospital Charge Code |
2400285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.24 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$288.51
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.28
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$274.99
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$261.24
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$274.99
|
| Rate for Payer: United Healthcare Commercial |
$430.51
|
| Rate for Payer: United Healthcare Medicare |
$274.99
|
| Rate for Payer: WINHealth Partners Commercial |
$428.26
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIDLE NASAL TUBE SYS 8-10F
|
Facility
|
OP
|
$450.80
|
|
| Hospital Charge Code |
2400285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.11 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$441.78
|
| Rate for Payer: Aetna of WY Medicare |
$297.53
|
| Rate for Payer: Altius Commercial |
$432.77
|
| Rate for Payer: Beech Street Commercial |
$441.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$437.28
|
| Rate for Payer: Cash Price |
$315.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$437.28
|
| Rate for Payer: Cigna of WY Commercial |
$441.78
|
| Rate for Payer: Entrust Commercial |
$428.26
|
| Rate for Payer: First Choice Health Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$428.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$256.96
|
| Rate for Payer: HealthUtah PPO |
$450.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$437.28
|
| Rate for Payer: Multiplan Medicare/VA |
$244.11
|
| Rate for Payer: One Health Plan of WY PPO |
$441.78
|
| Rate for Payer: PacificSource Commercial |
$405.72
|
| Rate for Payer: PHCS PPO |
$441.78
|
| Rate for Payer: Three Rivers PPO |
$338.10
|
| Rate for Payer: TriWest Veterans Administration |
$256.96
|
| Rate for Payer: United Healthcare Commercial |
$430.51
|
| Rate for Payer: United Healthcare Medicare |
$256.96
|
| Rate for Payer: WINHealth Partners Commercial |
$441.78
|
| Rate for Payer: Wise Provider Network Commercial |
$428.26
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
OP
|
$26.77
|
|
|
Service Code
|
NDC 2420853708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.23
|
| Rate for Payer: Aetna of WY Medicare |
$17.67
|
| Rate for Payer: Altius Commercial |
$25.70
|
| Rate for Payer: Beech Street Commercial |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.97
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.97
|
| Rate for Payer: Cigna of WY Commercial |
$26.23
|
| Rate for Payer: Entrust Commercial |
$25.43
|
| Rate for Payer: First Choice Health Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.26
|
| Rate for Payer: HealthUtah PPO |
$26.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.97
|
| Rate for Payer: Multiplan Medicare/VA |
$14.50
|
| Rate for Payer: One Health Plan of WY PPO |
$26.23
|
| Rate for Payer: PacificSource Commercial |
$24.09
|
| Rate for Payer: PHCS PPO |
$26.23
|
| Rate for Payer: Three Rivers PPO |
$20.08
|
| Rate for Payer: TriWest Veterans Administration |
$15.26
|
| Rate for Payer: United Healthcare Commercial |
$25.57
|
| Rate for Payer: United Healthcare Medicare |
$15.26
|
| Rate for Payer: WINHealth Partners Commercial |
$26.23
|
| Rate for Payer: Wise Provider Network Commercial |
$25.43
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
IP
|
$26.77
|
|
|
Service Code
|
NDC 2420853708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.23
|
| Rate for Payer: Aetna of WY Medicare |
$17.13
|
| Rate for Payer: Altius Commercial |
$25.70
|
| Rate for Payer: Beech Street Commercial |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.97
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.97
|
| Rate for Payer: Cigna of WY Commercial |
$26.23
|
| Rate for Payer: Entrust Commercial |
$25.43
|
| Rate for Payer: First Choice Health Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.33
|
| Rate for Payer: HealthUtah PPO |
$26.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.97
|
| Rate for Payer: Multiplan Medicare/VA |
$15.51
|
| Rate for Payer: One Health Plan of WY PPO |
$26.23
|
| Rate for Payer: PacificSource Commercial |
$24.09
|
| Rate for Payer: PHCS PPO |
$26.23
|
| Rate for Payer: Three Rivers PPO |
$20.08
|
| Rate for Payer: TriWest Veterans Administration |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.57
|
| Rate for Payer: United Healthcare Medicare |
$16.33
|
| Rate for Payer: WINHealth Partners Commercial |
$25.43
|
| Rate for Payer: Wise Provider Network Commercial |
$25.43
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
OP
|
$26.77
|
|
|
Service Code
|
NDC 1011953708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.23
|
| Rate for Payer: Aetna of WY Medicare |
$17.67
|
| Rate for Payer: Altius Commercial |
$25.70
|
| Rate for Payer: Beech Street Commercial |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.97
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.97
|
| Rate for Payer: Cigna of WY Commercial |
$26.23
|
| Rate for Payer: Entrust Commercial |
$25.43
|
| Rate for Payer: First Choice Health Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.26
|
| Rate for Payer: HealthUtah PPO |
$26.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.97
|
| Rate for Payer: Multiplan Medicare/VA |
$14.50
|
| Rate for Payer: One Health Plan of WY PPO |
$26.23
|
| Rate for Payer: PacificSource Commercial |
$24.09
|
| Rate for Payer: PHCS PPO |
$26.23
|
| Rate for Payer: Three Rivers PPO |
$20.08
|
| Rate for Payer: TriWest Veterans Administration |
$15.26
|
| Rate for Payer: United Healthcare Commercial |
$25.57
|
| Rate for Payer: United Healthcare Medicare |
$15.26
|
| Rate for Payer: WINHealth Partners Commercial |
$26.23
|
| Rate for Payer: Wise Provider Network Commercial |
$25.43
|
|
|
BRIMONIDINE 0.025 % EYE DROPS [151430]
|
Facility
|
IP
|
$26.77
|
|
|
Service Code
|
NDC 1011953708
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.23
|
| Rate for Payer: Aetna of WY Medicare |
$17.13
|
| Rate for Payer: Altius Commercial |
$25.70
|
| Rate for Payer: Beech Street Commercial |
$26.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.97
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.97
|
| Rate for Payer: Cigna of WY Commercial |
$26.23
|
| Rate for Payer: Entrust Commercial |
$25.43
|
| Rate for Payer: First Choice Health Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.33
|
| Rate for Payer: HealthUtah PPO |
$26.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.97
|
| Rate for Payer: Multiplan Medicare/VA |
$15.51
|
| Rate for Payer: One Health Plan of WY PPO |
$26.23
|
| Rate for Payer: PacificSource Commercial |
$24.09
|
| Rate for Payer: PHCS PPO |
$26.23
|
| Rate for Payer: Three Rivers PPO |
$20.08
|
| Rate for Payer: TriWest Veterans Administration |
$16.33
|
| Rate for Payer: United Healthcare Commercial |
$25.57
|
| Rate for Payer: United Healthcare Medicare |
$16.33
|
| Rate for Payer: WINHealth Partners Commercial |
$25.43
|
| Rate for Payer: Wise Provider Network Commercial |
$25.43
|
|
|
BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 94060 26
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$70.56
|
| Rate for Payer: Aetna of WY Medicare |
$9.74
|
| Rate for Payer: Beech Street Commercial |
$68.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.84
|
| Rate for Payer: Cigna of WY Commercial |
$70.56
|
| Rate for Payer: First Choice Health Commercial |
$64.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.74
|
| Rate for Payer: HealthUtah PPO |
$72.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$70.56
|
| Rate for Payer: PacificSource Commercial |
$64.80
|
| Rate for Payer: PHCS PPO |
$68.40
|
| Rate for Payer: Three Rivers PPO |
$54.00
|
| Rate for Payer: TriWest Veterans Administration |
$9.74
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: WINHealth Partners Commercial |
$68.40
|
|
|
BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$1,041.00
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,020.18
|
| Rate for Payer: Aetna of WY Medicare |
$125.05
|
| Rate for Payer: Beech Street Commercial |
$988.95
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: Cash Price |
$728.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,009.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,020.18
|
| Rate for Payer: First Choice Health Commercial |
$936.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$988.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.05
|
| Rate for Payer: HealthUtah PPO |
$1,041.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,009.77
|
| Rate for Payer: Multiplan Medicare/VA |
$106.29
|
| Rate for Payer: One Health Plan of WY PPO |
$1,020.18
|
| Rate for Payer: PacificSource Commercial |
$936.90
|
| Rate for Payer: PHCS PPO |
$988.95
|
| Rate for Payer: Three Rivers PPO |
$780.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.05
|
| Rate for Payer: United Healthcare Commercial |
$988.95
|
| Rate for Payer: WINHealth Partners Commercial |
$884.85
|
|
