|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 12MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 12MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 15MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 15MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 20MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 20MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 8MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 4.5 X 8MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 12MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 12MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 15MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 15MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 20MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 20MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 8MM
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.48
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$237.01
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$249.48
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$249.48
|
| Rate for Payer: WINHealth Partners Commercial |
$359.10
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGE MONORAIL BALLOON CATHETER 5.0 X 8MM
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.28 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$370.44
|
| Rate for Payer: Aetna of WY Medicare |
$249.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$362.88
|
| Rate for Payer: Altius Commercial |
$362.88
|
| Rate for Payer: Beech Street Commercial |
$370.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.34
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$366.66
|
| Rate for Payer: Cigna of WY Commercial |
$370.44
|
| Rate for Payer: Entrust Commercial |
$359.10
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.24
|
| Rate for Payer: HealthUtah PPO |
$378.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$366.66
|
| Rate for Payer: Multiplan Medicare/VA |
$208.28
|
| Rate for Payer: One Health Plan of WY PPO |
$370.44
|
| Rate for Payer: PacificSource Commercial |
$340.20
|
| Rate for Payer: PHCS PPO |
$370.44
|
| Rate for Payer: Three Rivers PPO |
$283.50
|
| Rate for Payer: TriWest Veterans Administration |
$219.24
|
| Rate for Payer: United Healthcare Commercial |
$328.86
|
| Rate for Payer: United Healthcare Medicare |
$219.24
|
| Rate for Payer: WINHealth Partners Commercial |
$370.44
|
| Rate for Payer: Wise Provider Network Commercial |
$359.10
|
|
|
EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
99285
|
| Min. Negotiated Rate |
$141.68 |
| Max. Negotiated Rate |
$2,072.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,072.70
|
| Rate for Payer: Aetna of WY Medicare |
$166.68
|
| Rate for Payer: Beech Street Commercial |
$2,009.25
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,480.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,051.55
|
| Rate for Payer: Cigna of WY Commercial |
$2,072.70
|
| Rate for Payer: First Choice Health Commercial |
$1,903.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,009.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.68
|
| Rate for Payer: HealthUtah PPO |
$291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,051.55
|
| Rate for Payer: Multiplan Medicare/VA |
$141.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,072.70
|
| Rate for Payer: PacificSource Commercial |
$1,903.50
|
| Rate for Payer: PHCS PPO |
$2,009.25
|
| Rate for Payer: Three Rivers PPO |
$1,586.25
|
| Rate for Payer: TriWest Veterans Administration |
$166.68
|
| Rate for Payer: United Healthcare Commercial |
$1,840.05
|
| Rate for Payer: United Healthcare Medicare |
$166.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2,009.25
|
|
|
EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
99283
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$835.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$835.94
|
| Rate for Payer: Aetna of WY Medicare |
$67.64
|
| Rate for Payer: Beech Street Commercial |
$810.35
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: Cash Price |
$597.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$827.41
|
| Rate for Payer: Cigna of WY Commercial |
$835.94
|
| Rate for Payer: First Choice Health Commercial |
$767.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$810.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.64
|
| Rate for Payer: HealthUtah PPO |
$130.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$827.41
|
| Rate for Payer: Multiplan Medicare/VA |
$57.49
|
| Rate for Payer: One Health Plan of WY PPO |
$835.94
|
| Rate for Payer: PacificSource Commercial |
$767.70
|
| Rate for Payer: PHCS PPO |
$810.35
|
| Rate for Payer: Three Rivers PPO |
$639.75
|
| Rate for Payer: TriWest Veterans Administration |
$67.64
|
| Rate for Payer: United Healthcare Commercial |
$742.11
|
| Rate for Payer: United Healthcare Medicare |
$67.64
|
| Rate for Payer: WINHealth Partners Commercial |
$810.35
|
|
|
EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
99281
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$256.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$256.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.88
|
| Rate for Payer: Beech Street Commercial |
$248.90
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: Cash Price |
$183.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$254.14
|
| Rate for Payer: Cigna of WY Commercial |
$256.76
|
| Rate for Payer: First Choice Health Commercial |
$235.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$248.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.88
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$254.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.25
|
| Rate for Payer: One Health Plan of WY PPO |
$256.76
|
| Rate for Payer: PacificSource Commercial |
$235.80
|
| Rate for Payer: PHCS PPO |
$248.90
|
| Rate for Payer: Three Rivers PPO |
$196.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$227.94
|
| Rate for Payer: United Healthcare Medicare |
$10.88
|
| Rate for Payer: WINHealth Partners Commercial |
$248.90
|
|
|
EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
99284
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$1,422.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,422.96
|
| Rate for Payer: Aetna of WY Medicare |
$115.07
|
| Rate for Payer: Beech Street Commercial |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,408.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,422.96
|
| Rate for Payer: First Choice Health Commercial |
$1,306.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,379.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.07
|
| Rate for Payer: HealthUtah PPO |
$197.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,408.44
|
| Rate for Payer: Multiplan Medicare/VA |
$97.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,422.96
|
| Rate for Payer: PacificSource Commercial |
$1,306.80
|
| Rate for Payer: PHCS PPO |
$1,379.40
|
| Rate for Payer: Three Rivers PPO |
$1,089.00
|
| Rate for Payer: TriWest Veterans Administration |
$115.07
|
| Rate for Payer: United Healthcare Commercial |
$1,263.24
|
| Rate for Payer: United Healthcare Medicare |
$115.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,379.40
|
|
|
EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
99282
|
| Min. Negotiated Rate |
$33.79 |
| Max. Negotiated Rate |
$545.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$545.86
|
| Rate for Payer: Aetna of WY Medicare |
$39.75
|
| Rate for Payer: Beech Street Commercial |
$529.15
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: Cash Price |
$389.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$540.29
|
| Rate for Payer: Cigna of WY Commercial |
$545.86
|
| Rate for Payer: First Choice Health Commercial |
$501.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$529.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.75
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$540.29
|
| Rate for Payer: Multiplan Medicare/VA |
$33.79
|
| Rate for Payer: One Health Plan of WY PPO |
$545.86
|
| Rate for Payer: PacificSource Commercial |
$501.30
|
| Rate for Payer: PHCS PPO |
$529.15
|
| Rate for Payer: Three Rivers PPO |
$417.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.75
|
| Rate for Payer: United Healthcare Commercial |
$484.59
|
| Rate for Payer: United Healthcare Medicare |
$39.75
|
| Rate for Payer: WINHealth Partners Commercial |
$529.15
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
51784
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$253.82
|
| Rate for Payer: Aetna of WY Medicare |
$62.51
|
| Rate for Payer: Beech Street Commercial |
$246.05
|
| Rate for Payer: Cash Price |
$181.30
|
| Rate for Payer: Cash Price |
$181.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$251.23
|
| Rate for Payer: Cigna of WY Commercial |
$253.82
|
| Rate for Payer: First Choice Health Commercial |
$233.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$246.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.51
|
| Rate for Payer: HealthUtah PPO |
$259.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$251.23
|
| Rate for Payer: Multiplan Medicare/VA |
$53.13
|
| Rate for Payer: One Health Plan of WY PPO |
$253.82
|
| Rate for Payer: PacificSource Commercial |
$233.10
|
| Rate for Payer: PHCS PPO |
$246.05
|
| Rate for Payer: Three Rivers PPO |
$194.25
|
| Rate for Payer: TriWest Veterans Administration |
$62.51
|
| Rate for Payer: United Healthcare Commercial |
$225.33
|
| Rate for Payer: United Healthcare Medicare |
$62.51
|
| Rate for Payer: WINHealth Partners Commercial |
$220.15
|
|
|
EMPAGLIFLOZIN 25 MG TABLET [137121]
|
Facility
|
OP
|
$41.96
|
|
|
Service Code
|
NDC 0597015337
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$41.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.12
|
| Rate for Payer: Aetna of WY Medicare |
$27.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.28
|
| Rate for Payer: Altius Commercial |
$40.28
|
| Rate for Payer: Beech Street Commercial |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.45
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.70
|
| Rate for Payer: Cigna of WY Commercial |
$41.12
|
| Rate for Payer: Entrust Commercial |
$39.86
|
| Rate for Payer: First Choice Health Commercial |
$39.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.34
|
| Rate for Payer: HealthUtah PPO |
$41.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.70
|
| Rate for Payer: Multiplan Medicare/VA |
$23.12
|
| Rate for Payer: One Health Plan of WY PPO |
$41.12
|
| Rate for Payer: PacificSource Commercial |
$37.76
|
| Rate for Payer: PHCS PPO |
$41.12
|
| Rate for Payer: Three Rivers PPO |
$31.47
|
| Rate for Payer: TriWest Veterans Administration |
$24.34
|
| Rate for Payer: United Healthcare Commercial |
$36.51
|
| Rate for Payer: United Healthcare Medicare |
$24.34
|
| Rate for Payer: WINHealth Partners Commercial |
$41.12
|
| Rate for Payer: Wise Provider Network Commercial |
$39.86
|
|
|
EMPAGLIFLOZIN 25 MG TABLET [137121]
|
Facility
|
IP
|
$41.96
|
|
|
Service Code
|
NDC 0597015337
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$41.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.28
|
| Rate for Payer: Altius Commercial |
$40.28
|
| Rate for Payer: Beech Street Commercial |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.45
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.70
|
| Rate for Payer: Cigna of WY Commercial |
$41.12
|
| Rate for Payer: Entrust Commercial |
$39.86
|
| Rate for Payer: First Choice Health Commercial |
$39.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.69
|
| Rate for Payer: HealthUtah PPO |
$41.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.70
|
| Rate for Payer: Multiplan Medicare/VA |
$26.31
|
| Rate for Payer: One Health Plan of WY PPO |
$41.12
|
| Rate for Payer: PacificSource Commercial |
$37.76
|
| Rate for Payer: PHCS PPO |
$41.12
|
| Rate for Payer: Three Rivers PPO |
$31.47
|
| Rate for Payer: TriWest Veterans Administration |
$27.69
|
| Rate for Payer: United Healthcare Commercial |
$36.51
|
| Rate for Payer: United Healthcare Medicare |
$27.69
|
| Rate for Payer: WINHealth Partners Commercial |
$39.86
|
| Rate for Payer: Wise Provider Network Commercial |
$39.86
|
|
|
EMTRICITABINE 200 MG CAPSULE [28956]
|
Facility
|
IP
|
$40.24
|
|
|
Service Code
|
NDC 6195806011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.23 |
| Max. Negotiated Rate |
$40.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.63
|
| Rate for Payer: Altius Commercial |
$38.63
|
| Rate for Payer: Beech Street Commercial |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.04
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.03
|
| Rate for Payer: Cigna of WY Commercial |
$39.44
|
| Rate for Payer: Entrust Commercial |
$38.23
|
| Rate for Payer: First Choice Health Commercial |
$38.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.56
|
| Rate for Payer: HealthUtah PPO |
$40.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.03
|
| Rate for Payer: Multiplan Medicare/VA |
$25.23
|
| Rate for Payer: One Health Plan of WY PPO |
$39.44
|
| Rate for Payer: PacificSource Commercial |
$36.22
|
| Rate for Payer: PHCS PPO |
$39.44
|
| Rate for Payer: Three Rivers PPO |
$30.18
|
| Rate for Payer: TriWest Veterans Administration |
$26.56
|
| Rate for Payer: United Healthcare Commercial |
$35.01
|
| Rate for Payer: United Healthcare Medicare |
$26.56
|
| Rate for Payer: WINHealth Partners Commercial |
$38.23
|
| Rate for Payer: Wise Provider Network Commercial |
$38.23
|
|
