|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [6641]
|
Facility
|
OP
|
$174.87
|
|
|
Service Code
|
HCPCS J0834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.69 |
| Max. Negotiated Rate |
$174.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.37
|
| Rate for Payer: Aetna of WY Medicare |
$115.41
|
| Rate for Payer: Altius Commercial |
$167.88
|
| Rate for Payer: Beech Street Commercial |
$171.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.62
|
| Rate for Payer: Cash Price |
$122.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.62
|
| Rate for Payer: Cigna of WY Commercial |
$171.37
|
| Rate for Payer: Entrust Commercial |
$166.13
|
| Rate for Payer: First Choice Health Commercial |
$166.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.68
|
| Rate for Payer: HealthUtah PPO |
$174.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.62
|
| Rate for Payer: Multiplan Medicare/VA |
$94.69
|
| Rate for Payer: One Health Plan of WY PPO |
$171.37
|
| Rate for Payer: PacificSource Commercial |
$157.38
|
| Rate for Payer: PHCS PPO |
$171.37
|
| Rate for Payer: Three Rivers PPO |
$131.15
|
| Rate for Payer: TriWest Veterans Administration |
$99.68
|
| Rate for Payer: United Healthcare Commercial |
$167.00
|
| Rate for Payer: United Healthcare Medicare |
$99.68
|
| Rate for Payer: WINHealth Partners Commercial |
$171.37
|
| Rate for Payer: Wise Provider Network Commercial |
$166.13
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION [6641]
|
Facility
|
IP
|
$174.87
|
|
|
Service Code
|
HCPCS J0834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.34 |
| Max. Negotiated Rate |
$174.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.37
|
| Rate for Payer: Aetna of WY Medicare |
$111.92
|
| Rate for Payer: Altius Commercial |
$167.88
|
| Rate for Payer: Beech Street Commercial |
$171.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$169.62
|
| Rate for Payer: Cash Price |
$122.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.62
|
| Rate for Payer: Cigna of WY Commercial |
$171.37
|
| Rate for Payer: Entrust Commercial |
$166.13
|
| Rate for Payer: First Choice Health Commercial |
$166.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.67
|
| Rate for Payer: HealthUtah PPO |
$174.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.62
|
| Rate for Payer: Multiplan Medicare/VA |
$101.34
|
| Rate for Payer: One Health Plan of WY PPO |
$171.37
|
| Rate for Payer: PacificSource Commercial |
$157.38
|
| Rate for Payer: PHCS PPO |
$171.37
|
| Rate for Payer: Three Rivers PPO |
$131.15
|
| Rate for Payer: TriWest Veterans Administration |
$106.67
|
| Rate for Payer: United Healthcare Commercial |
$167.00
|
| Rate for Payer: United Healthcare Medicare |
$106.67
|
| Rate for Payer: WINHealth Partners Commercial |
$166.13
|
| Rate for Payer: Wise Provider Network Commercial |
$166.13
|
|
|
COTTON ROLL 1 LB NON6027
|
Facility
|
OP
|
$14.16
|
|
| Hospital Charge Code |
2400032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.88
|
| Rate for Payer: Aetna of WY Medicare |
$9.35
|
| Rate for Payer: Altius Commercial |
$13.59
|
| Rate for Payer: Beech Street Commercial |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.74
|
| Rate for Payer: Cigna of WY Commercial |
$13.88
|
| Rate for Payer: Entrust Commercial |
$13.45
|
| Rate for Payer: First Choice Health Commercial |
$13.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.07
|
| Rate for Payer: HealthUtah PPO |
$14.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.74
|
| Rate for Payer: Multiplan Medicare/VA |
$7.67
|
| Rate for Payer: One Health Plan of WY PPO |
$13.88
|
| Rate for Payer: PacificSource Commercial |
$12.74
|
| Rate for Payer: PHCS PPO |
$13.88
|
| Rate for Payer: Three Rivers PPO |
$10.62
|
| Rate for Payer: TriWest Veterans Administration |
$8.07
|
| Rate for Payer: United Healthcare Commercial |
$13.52
|
| Rate for Payer: United Healthcare Medicare |
$8.07
|
| Rate for Payer: WINHealth Partners Commercial |
$13.88
|
| Rate for Payer: Wise Provider Network Commercial |
$13.45
|
|
|
COTTON ROLL 1 LB NON6027
|
Facility
|
IP
|
$14.16
|
|
| Hospital Charge Code |
2400032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.88
|
| Rate for Payer: Aetna of WY Medicare |
$9.06
|
| Rate for Payer: Altius Commercial |
$13.59
|
| Rate for Payer: Beech Street Commercial |
$13.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.74
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.74
|
| Rate for Payer: Cigna of WY Commercial |
$13.88
|
| Rate for Payer: Entrust Commercial |
$13.45
|
| Rate for Payer: First Choice Health Commercial |
$13.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$14.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$13.88
|
| Rate for Payer: PacificSource Commercial |
$12.74
|
| Rate for Payer: PHCS PPO |
$13.88
|
| Rate for Payer: Three Rivers PPO |
$10.62
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$13.52
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$13.45
|
| Rate for Payer: Wise Provider Network Commercial |
$13.45
|
|
|
COUNTERSINK FOR 2.7/3.5
|
Facility
|
IP
|
$315.84
|
|
| Hospital Charge Code |
3100199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.52
|
| Rate for Payer: Aetna of WY Medicare |
$202.14
|
| Rate for Payer: Altius Commercial |
$303.21
|
| Rate for Payer: Beech Street Commercial |
$309.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$306.36
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$306.36
|
| Rate for Payer: Cigna of WY Commercial |
$309.52
|
| Rate for Payer: Entrust Commercial |
$300.05
|
| Rate for Payer: First Choice Health Commercial |
$300.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$300.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.66
|
| Rate for Payer: HealthUtah PPO |
$315.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$306.36
|
| Rate for Payer: Multiplan Medicare/VA |
$183.03
|
| Rate for Payer: One Health Plan of WY PPO |
$309.52
|
| Rate for Payer: PacificSource Commercial |
$284.26
|
| Rate for Payer: PHCS PPO |
$309.52
|
| Rate for Payer: Three Rivers PPO |
$236.88
|
| Rate for Payer: TriWest Veterans Administration |
$192.66
|
| Rate for Payer: United Healthcare Commercial |
$301.63
|
| Rate for Payer: United Healthcare Medicare |
$192.66
|
| Rate for Payer: WINHealth Partners Commercial |
$300.05
|
| Rate for Payer: Wise Provider Network Commercial |
$300.05
|
|
|
COUNTERSINK FOR 2.7/3.5
|
Facility
|
OP
|
$315.84
|
|
| Hospital Charge Code |
3100199
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.03 |
| Max. Negotiated Rate |
$315.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$309.52
|
| Rate for Payer: Aetna of WY Medicare |
$208.45
|
| Rate for Payer: Altius Commercial |
$303.21
|
| Rate for Payer: Beech Street Commercial |
$309.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$306.36
|
| Rate for Payer: Cash Price |
$221.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$306.36
|
| Rate for Payer: Cigna of WY Commercial |
$309.52
|
| Rate for Payer: Entrust Commercial |
$300.05
|
| Rate for Payer: First Choice Health Commercial |
$300.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$300.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.03
|
| Rate for Payer: HealthUtah PPO |
$315.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$306.36
|
| Rate for Payer: Multiplan Medicare/VA |
$171.03
|
| Rate for Payer: One Health Plan of WY PPO |
$309.52
|
| Rate for Payer: PacificSource Commercial |
$284.26
|
| Rate for Payer: PHCS PPO |
$309.52
|
| Rate for Payer: Three Rivers PPO |
$236.88
|
| Rate for Payer: TriWest Veterans Administration |
$180.03
|
| Rate for Payer: United Healthcare Commercial |
$301.63
|
| Rate for Payer: United Healthcare Medicare |
$180.03
|
| Rate for Payer: WINHealth Partners Commercial |
$309.52
|
| Rate for Payer: Wise Provider Network Commercial |
$300.05
|
|
|
COV-19 AMP PRB HGH THRUPUT
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS U0003
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Beech Street Commercial |
$164.35
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: First Choice Health Commercial |
$155.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: HealthUtah PPO |
$173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PHCS PPO |
$164.35
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: WINHealth Partners Commercial |
$164.35
|
|
|
COVADERM 4X4 DRESS MSC3244
|
Facility
|
OP
|
$1.40
|
|
| Hospital Charge Code |
2000097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.92
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.80
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
| Rate for Payer: United Healthcare Medicare |
$0.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1.37
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
COVADERM 4X4 DRESS MSC3244
|
Facility
|
IP
|
$1.40
|
|
| Hospital Charge Code |
2000097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.90
|
| Rate for Payer: Altius Commercial |
$1.34
|
| Rate for Payer: Beech Street Commercial |
$1.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.36
|
| Rate for Payer: Cigna of WY Commercial |
$1.37
|
| Rate for Payer: Entrust Commercial |
$1.33
|
| Rate for Payer: First Choice Health Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
| Rate for Payer: HealthUtah PPO |
$1.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.36
|
| Rate for Payer: Multiplan Medicare/VA |
$0.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1.37
|
| Rate for Payer: PacificSource Commercial |
$1.26
|
| Rate for Payer: PHCS PPO |
$1.37
|
| Rate for Payer: Three Rivers PPO |
$1.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
| Rate for Payer: United Healthcare Medicare |
$0.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1.33
|
| Rate for Payer: Wise Provider Network Commercial |
$1.33
|
|
|
COVADERM DRESSING 4"X10"
|
Facility
|
OP
|
$2.87
|
|
| Hospital Charge Code |
2000062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.81
|
| Rate for Payer: Aetna of WY Medicare |
$1.89
|
| Rate for Payer: Altius Commercial |
$2.76
|
| Rate for Payer: Beech Street Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.78
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.78
|
| Rate for Payer: Cigna of WY Commercial |
$2.81
|
| Rate for Payer: Entrust Commercial |
$2.73
|
| Rate for Payer: First Choice Health Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.64
|
| Rate for Payer: HealthUtah PPO |
$2.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2.81
|
| Rate for Payer: PacificSource Commercial |
$2.58
|
| Rate for Payer: PHCS PPO |
$2.81
|
| Rate for Payer: Three Rivers PPO |
$2.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$2.74
|
| Rate for Payer: United Healthcare Medicare |
$1.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2.81
|
| Rate for Payer: Wise Provider Network Commercial |
$2.73
|
|
|
COVADERM DRESSING 4"X10"
|
Facility
|
IP
|
$2.87
|
|
| Hospital Charge Code |
2000062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.81
|
| Rate for Payer: Aetna of WY Medicare |
$1.84
|
| Rate for Payer: Altius Commercial |
$2.76
|
| Rate for Payer: Beech Street Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.78
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.78
|
| Rate for Payer: Cigna of WY Commercial |
$2.81
|
| Rate for Payer: Entrust Commercial |
$2.73
|
| Rate for Payer: First Choice Health Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.75
|
| Rate for Payer: HealthUtah PPO |
$2.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2.81
|
| Rate for Payer: PacificSource Commercial |
$2.58
|
| Rate for Payer: PHCS PPO |
$2.81
|
| Rate for Payer: Three Rivers PPO |
$2.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.75
|
| Rate for Payer: United Healthcare Commercial |
$2.74
|
| Rate for Payer: United Healthcare Medicare |
$1.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2.73
|
| Rate for Payer: Wise Provider Network Commercial |
$2.73
|
|
|
COVER CAMERA STERIS
|
Facility
|
IP
|
$14.33
|
|
| Hospital Charge Code |
4650072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.04
|
| Rate for Payer: Aetna of WY Medicare |
$9.17
|
| Rate for Payer: Altius Commercial |
$13.76
|
| Rate for Payer: Beech Street Commercial |
$14.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.90
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.90
|
| Rate for Payer: Cigna of WY Commercial |
$14.04
|
| Rate for Payer: Entrust Commercial |
$13.61
|
| Rate for Payer: First Choice Health Commercial |
$13.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.74
|
| Rate for Payer: HealthUtah PPO |
$14.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.90
|
| Rate for Payer: Multiplan Medicare/VA |
$8.30
|
| Rate for Payer: One Health Plan of WY PPO |
$14.04
|
| Rate for Payer: PacificSource Commercial |
$12.90
|
| Rate for Payer: PHCS PPO |
$14.04
|
| Rate for Payer: Three Rivers PPO |
$10.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare |
$8.74
|
| Rate for Payer: WINHealth Partners Commercial |
$13.61
|
| Rate for Payer: Wise Provider Network Commercial |
$13.61
|
|
|
COVER CAMERA STERIS
|
Facility
|
OP
|
$14.33
|
|
| Hospital Charge Code |
4650072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.04
|
| Rate for Payer: Aetna of WY Medicare |
$9.46
|
| Rate for Payer: Altius Commercial |
$13.76
|
| Rate for Payer: Beech Street Commercial |
$14.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.90
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.90
|
| Rate for Payer: Cigna of WY Commercial |
$14.04
|
| Rate for Payer: Entrust Commercial |
$13.61
|
| Rate for Payer: First Choice Health Commercial |
$13.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.17
|
| Rate for Payer: HealthUtah PPO |
$14.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.90
|
| Rate for Payer: Multiplan Medicare/VA |
$7.76
|
| Rate for Payer: One Health Plan of WY PPO |
$14.04
|
| Rate for Payer: PacificSource Commercial |
$12.90
|
| Rate for Payer: PHCS PPO |
$14.04
|
| Rate for Payer: Three Rivers PPO |
$10.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.17
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare |
$8.17
|
| Rate for Payer: WINHealth Partners Commercial |
$14.04
|
| Rate for Payer: Wise Provider Network Commercial |
$13.61
|
|
|
COVID-19 LAB TEST NON-CDC
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS U0002
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$173.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.54
|
| Rate for Payer: Aetna of WY Medicare |
$51.31
|
| Rate for Payer: Beech Street Commercial |
$164.35
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: Cash Price |
$121.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.81
|
| Rate for Payer: Cigna of WY Commercial |
$169.54
|
| Rate for Payer: First Choice Health Commercial |
$155.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.31
|
| Rate for Payer: HealthUtah PPO |
$173.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.81
|
| Rate for Payer: Multiplan Medicare/VA |
$43.61
|
| Rate for Payer: One Health Plan of WY PPO |
$169.54
|
| Rate for Payer: PacificSource Commercial |
$155.70
|
| Rate for Payer: PHCS PPO |
$164.35
|
| Rate for Payer: Three Rivers PPO |
$129.75
|
| Rate for Payer: TriWest Veterans Administration |
$51.31
|
| Rate for Payer: United Healthcare Commercial |
$164.35
|
| Rate for Payer: WINHealth Partners Commercial |
$164.35
|
|
|
COVID-19 VACC,BV(ORIG,BA.4/5)(MODERNA)(PF) 50 MCG/0.5 ML IM SUSP (EUA) [176928]
|
Facility
|
IP
|
$15.02
|
|
|
Service Code
|
HCPCS 91313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.27
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
COVID-19 VACC,BV(ORIG,BA.4/5)(MODERNA)(PF) 50 MCG/0.5 ML IM SUSP (EUA) [176928]
|
Facility
|
OP
|
$15.02
|
|
|
Service Code
|
HCPCS 91313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.72
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Commercial |
$14.42
|
| Rate for Payer: Beech Street Commercial |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.57
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.57
|
| Rate for Payer: Cigna of WY Commercial |
$14.72
|
| Rate for Payer: Entrust Commercial |
$14.27
|
| Rate for Payer: First Choice Health Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: HealthUtah PPO |
$15.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.57
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: One Health Plan of WY PPO |
$14.72
|
| Rate for Payer: PacificSource Commercial |
$13.52
|
| Rate for Payer: PHCS PPO |
$14.72
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$14.34
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.27
|
|
|
COVID-19 VACCINE,MRNA,CX024414(MODERNA)(PF)100 MCG/0.5 ML IM SUSP [160551]
|
Facility
|
IP
|
$15.01
|
|
|
Service Code
|
NDC 8077727310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.61
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.16
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.70
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.16
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$9.16
|
| Rate for Payer: WINHealth Partners Commercial |
$14.26
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
COVID-19 VACCINE,MRNA,CX024414(MODERNA)(PF)100 MCG/0.5 ML IM SUSP [160551]
|
Facility
|
OP
|
$15.01
|
|
|
Service Code
|
NDC 8077727310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$15.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.91
|
| Rate for Payer: Altius Commercial |
$14.41
|
| Rate for Payer: Beech Street Commercial |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.56
|
| Rate for Payer: Cash Price |
$10.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.56
|
| Rate for Payer: Cigna of WY Commercial |
$14.71
|
| Rate for Payer: Entrust Commercial |
$14.26
|
| Rate for Payer: First Choice Health Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.56
|
| Rate for Payer: HealthUtah PPO |
$15.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.56
|
| Rate for Payer: Multiplan Medicare/VA |
$8.13
|
| Rate for Payer: One Health Plan of WY PPO |
$14.71
|
| Rate for Payer: PacificSource Commercial |
$13.51
|
| Rate for Payer: PHCS PPO |
$14.71
|
| Rate for Payer: Three Rivers PPO |
$11.26
|
| Rate for Payer: TriWest Veterans Administration |
$8.56
|
| Rate for Payer: United Healthcare Commercial |
$14.33
|
| Rate for Payer: United Healthcare Medicare |
$8.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.26
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
NDC 8077710295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Aetna of WY Medicare |
$221.10
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.95
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.95
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$181.40
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$190.95
|
| Rate for Payer: United Healthcare Commercial |
$319.92
|
| Rate for Payer: United Healthcare Medicare |
$190.95
|
| Rate for Payer: WINHealth Partners Commercial |
$328.30
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
NDC 8077710204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.13 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.95
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.35
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$194.13
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$204.35
|
| Rate for Payer: United Healthcare Commercial |
$319.92
|
| Rate for Payer: United Healthcare Medicare |
$204.35
|
| Rate for Payer: WINHealth Partners Commercial |
$318.25
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
NDC 8077710204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Aetna of WY Medicare |
$221.10
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.95
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$190.95
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$181.40
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$190.95
|
| Rate for Payer: United Healthcare Commercial |
$319.92
|
| Rate for Payer: United Healthcare Medicare |
$190.95
|
| Rate for Payer: WINHealth Partners Commercial |
$328.30
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
COVID VAC 2023-24 (12YR AND UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SUSP [183904]
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
NDC 8077710295
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$194.13 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$328.30
|
| Rate for Payer: Aetna of WY Medicare |
$214.40
|
| Rate for Payer: Altius Commercial |
$321.60
|
| Rate for Payer: Beech Street Commercial |
$328.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.95
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$324.95
|
| Rate for Payer: Cigna of WY Commercial |
$328.30
|
| Rate for Payer: Entrust Commercial |
$318.25
|
| Rate for Payer: First Choice Health Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$318.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$204.35
|
| Rate for Payer: HealthUtah PPO |
$335.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$324.95
|
| Rate for Payer: Multiplan Medicare/VA |
$194.13
|
| Rate for Payer: One Health Plan of WY PPO |
$328.30
|
| Rate for Payer: PacificSource Commercial |
$301.50
|
| Rate for Payer: PHCS PPO |
$328.30
|
| Rate for Payer: Three Rivers PPO |
$251.25
|
| Rate for Payer: TriWest Veterans Administration |
$204.35
|
| Rate for Payer: United Healthcare Commercial |
$319.92
|
| Rate for Payer: United Healthcare Medicare |
$204.35
|
| Rate for Payer: WINHealth Partners Commercial |
$318.25
|
| Rate for Payer: Wise Provider Network Commercial |
$318.25
|
|
|
COVID VAC 2023-24 (12 YR UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SYRINGE [183899]
|
Facility
|
IP
|
$338.75
|
|
|
Service Code
|
NDC 8077710201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$338.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.98
|
| Rate for Payer: Aetna of WY Medicare |
$216.80
|
| Rate for Payer: Altius Commercial |
$325.20
|
| Rate for Payer: Beech Street Commercial |
$331.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.59
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.59
|
| Rate for Payer: Cigna of WY Commercial |
$331.98
|
| Rate for Payer: Entrust Commercial |
$321.81
|
| Rate for Payer: First Choice Health Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.64
|
| Rate for Payer: HealthUtah PPO |
$338.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.59
|
| Rate for Payer: Multiplan Medicare/VA |
$196.31
|
| Rate for Payer: One Health Plan of WY PPO |
$331.98
|
| Rate for Payer: PacificSource Commercial |
$304.88
|
| Rate for Payer: PHCS PPO |
$331.98
|
| Rate for Payer: Three Rivers PPO |
$254.06
|
| Rate for Payer: TriWest Veterans Administration |
$206.64
|
| Rate for Payer: United Healthcare Commercial |
$323.51
|
| Rate for Payer: United Healthcare Medicare |
$206.64
|
| Rate for Payer: WINHealth Partners Commercial |
$321.81
|
| Rate for Payer: Wise Provider Network Commercial |
$321.81
|
|
|
COVID VAC 2023-24 (12 YR UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SYRINGE [183899]
|
Facility
|
IP
|
$338.75
|
|
|
Service Code
|
NDC 8077710296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$338.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.98
|
| Rate for Payer: Aetna of WY Medicare |
$216.80
|
| Rate for Payer: Altius Commercial |
$325.20
|
| Rate for Payer: Beech Street Commercial |
$331.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.59
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.59
|
| Rate for Payer: Cigna of WY Commercial |
$331.98
|
| Rate for Payer: Entrust Commercial |
$321.81
|
| Rate for Payer: First Choice Health Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.64
|
| Rate for Payer: HealthUtah PPO |
$338.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.59
|
| Rate for Payer: Multiplan Medicare/VA |
$196.31
|
| Rate for Payer: One Health Plan of WY PPO |
$331.98
|
| Rate for Payer: PacificSource Commercial |
$304.88
|
| Rate for Payer: PHCS PPO |
$331.98
|
| Rate for Payer: Three Rivers PPO |
$254.06
|
| Rate for Payer: TriWest Veterans Administration |
$206.64
|
| Rate for Payer: United Healthcare Commercial |
$323.51
|
| Rate for Payer: United Healthcare Medicare |
$206.64
|
| Rate for Payer: WINHealth Partners Commercial |
$321.81
|
| Rate for Payer: Wise Provider Network Commercial |
$321.81
|
|
|
COVID VAC 2023-24 (12 YR UP)(ANDUSOMERAN)(PF) 50 MCG/0.5 ML IM SYRINGE [183899]
|
Facility
|
OP
|
$338.75
|
|
|
Service Code
|
NDC 8077710296
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$183.43 |
| Max. Negotiated Rate |
$338.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$331.98
|
| Rate for Payer: Aetna of WY Medicare |
$223.58
|
| Rate for Payer: Altius Commercial |
$325.20
|
| Rate for Payer: Beech Street Commercial |
$331.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$328.59
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$328.59
|
| Rate for Payer: Cigna of WY Commercial |
$331.98
|
| Rate for Payer: Entrust Commercial |
$321.81
|
| Rate for Payer: First Choice Health Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$321.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$193.09
|
| Rate for Payer: HealthUtah PPO |
$338.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$328.59
|
| Rate for Payer: Multiplan Medicare/VA |
$183.43
|
| Rate for Payer: One Health Plan of WY PPO |
$331.98
|
| Rate for Payer: PacificSource Commercial |
$304.88
|
| Rate for Payer: PHCS PPO |
$331.98
|
| Rate for Payer: Three Rivers PPO |
$254.06
|
| Rate for Payer: TriWest Veterans Administration |
$193.09
|
| Rate for Payer: United Healthcare Commercial |
$323.51
|
| Rate for Payer: United Healthcare Medicare |
$193.09
|
| Rate for Payer: WINHealth Partners Commercial |
$331.98
|
| Rate for Payer: Wise Provider Network Commercial |
$321.81
|
|
