|
AIRWAY 90MM BERMAN
|
Facility
|
IP
|
$0.65
|
|
| Hospital Charge Code |
2500158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.64
|
| Rate for Payer: Aetna of WY Medicare |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.62
|
| Rate for Payer: Beech Street Commercial |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.63
|
| Rate for Payer: Cigna of WY Commercial |
$0.64
|
| Rate for Payer: Entrust Commercial |
$0.62
|
| Rate for Payer: First Choice Health Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.40
|
| Rate for Payer: HealthUtah PPO |
$0.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.63
|
| Rate for Payer: Multiplan Medicare/VA |
$0.38
|
| Rate for Payer: One Health Plan of WY PPO |
$0.64
|
| Rate for Payer: PacificSource Commercial |
$0.59
|
| Rate for Payer: PHCS PPO |
$0.64
|
| Rate for Payer: Three Rivers PPO |
$0.49
|
| Rate for Payer: TriWest Veterans Administration |
$0.40
|
| Rate for Payer: United Healthcare Commercial |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
| Rate for Payer: WINHealth Partners Commercial |
$0.62
|
| Rate for Payer: Wise Provider Network Commercial |
$0.62
|
|
|
AIRWAY 90MM BERMAN
|
Facility
|
OP
|
$0.65
|
|
| Hospital Charge Code |
2500158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.64
|
| Rate for Payer: Aetna of WY Medicare |
$0.43
|
| Rate for Payer: Altius Commercial |
$0.62
|
| Rate for Payer: Beech Street Commercial |
$0.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.63
|
| Rate for Payer: Cigna of WY Commercial |
$0.64
|
| Rate for Payer: Entrust Commercial |
$0.62
|
| Rate for Payer: First Choice Health Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.37
|
| Rate for Payer: HealthUtah PPO |
$0.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.63
|
| Rate for Payer: Multiplan Medicare/VA |
$0.35
|
| Rate for Payer: One Health Plan of WY PPO |
$0.64
|
| Rate for Payer: PacificSource Commercial |
$0.59
|
| Rate for Payer: PHCS PPO |
$0.64
|
| Rate for Payer: Three Rivers PPO |
$0.49
|
| Rate for Payer: TriWest Veterans Administration |
$0.37
|
| Rate for Payer: United Healthcare Commercial |
$0.62
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WINHealth Partners Commercial |
$0.64
|
| Rate for Payer: Wise Provider Network Commercial |
$0.62
|
|
|
AIRWAY EXCHANGE CATH 14FR
|
Facility
|
IP
|
$200.20
|
|
| Hospital Charge Code |
2500181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.20
|
| Rate for Payer: Aetna of WY Medicare |
$128.13
|
| Rate for Payer: Altius Commercial |
$192.19
|
| Rate for Payer: Beech Street Commercial |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$194.19
|
| Rate for Payer: Cash Price |
$140.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.19
|
| Rate for Payer: Cigna of WY Commercial |
$196.20
|
| Rate for Payer: Entrust Commercial |
$190.19
|
| Rate for Payer: First Choice Health Commercial |
$190.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.12
|
| Rate for Payer: HealthUtah PPO |
$200.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.19
|
| Rate for Payer: Multiplan Medicare/VA |
$116.02
|
| Rate for Payer: One Health Plan of WY PPO |
$196.20
|
| Rate for Payer: PacificSource Commercial |
$180.18
|
| Rate for Payer: PHCS PPO |
$196.20
|
| Rate for Payer: Three Rivers PPO |
$150.15
|
| Rate for Payer: TriWest Veterans Administration |
$122.12
|
| Rate for Payer: United Healthcare Commercial |
$191.19
|
| Rate for Payer: United Healthcare Medicare |
$122.12
|
| Rate for Payer: WINHealth Partners Commercial |
$190.19
|
| Rate for Payer: Wise Provider Network Commercial |
$190.19
|
|
|
AIRWAY EXCHANGE CATH 14FR
|
Facility
|
OP
|
$200.20
|
|
| Hospital Charge Code |
2500181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.20
|
| Rate for Payer: Aetna of WY Medicare |
$132.13
|
| Rate for Payer: Altius Commercial |
$192.19
|
| Rate for Payer: Beech Street Commercial |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$194.19
|
| Rate for Payer: Cash Price |
$140.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.19
|
| Rate for Payer: Cigna of WY Commercial |
$196.20
|
| Rate for Payer: Entrust Commercial |
$190.19
|
| Rate for Payer: First Choice Health Commercial |
$190.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.11
|
| Rate for Payer: HealthUtah PPO |
$200.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.19
|
| Rate for Payer: Multiplan Medicare/VA |
$108.41
|
| Rate for Payer: One Health Plan of WY PPO |
$196.20
|
| Rate for Payer: PacificSource Commercial |
$180.18
|
| Rate for Payer: PHCS PPO |
$196.20
|
| Rate for Payer: Three Rivers PPO |
$150.15
|
| Rate for Payer: TriWest Veterans Administration |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$191.19
|
| Rate for Payer: United Healthcare Medicare |
$114.11
|
| Rate for Payer: WINHealth Partners Commercial |
$196.20
|
| Rate for Payer: Wise Provider Network Commercial |
$190.19
|
|
|
AIRWAY EXCHANGE CATH 19FR
|
Facility
|
IP
|
$213.85
|
|
| Hospital Charge Code |
2500182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.93 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.57
|
| Rate for Payer: Aetna of WY Medicare |
$136.86
|
| Rate for Payer: Altius Commercial |
$205.30
|
| Rate for Payer: Beech Street Commercial |
$209.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$207.43
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$207.43
|
| Rate for Payer: Cigna of WY Commercial |
$209.57
|
| Rate for Payer: Entrust Commercial |
$203.16
|
| Rate for Payer: First Choice Health Commercial |
$203.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$203.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.45
|
| Rate for Payer: HealthUtah PPO |
$213.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.43
|
| Rate for Payer: Multiplan Medicare/VA |
$123.93
|
| Rate for Payer: One Health Plan of WY PPO |
$209.57
|
| Rate for Payer: PacificSource Commercial |
$192.46
|
| Rate for Payer: PHCS PPO |
$209.57
|
| Rate for Payer: Three Rivers PPO |
$160.39
|
| Rate for Payer: TriWest Veterans Administration |
$130.45
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
| Rate for Payer: United Healthcare Medicare |
$130.45
|
| Rate for Payer: WINHealth Partners Commercial |
$203.16
|
| Rate for Payer: Wise Provider Network Commercial |
$203.16
|
|
|
AIRWAY EXCHANGE CATH 19FR
|
Facility
|
OP
|
$213.85
|
|
| Hospital Charge Code |
2500182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.80 |
| Max. Negotiated Rate |
$213.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$209.57
|
| Rate for Payer: Aetna of WY Medicare |
$141.14
|
| Rate for Payer: Altius Commercial |
$205.30
|
| Rate for Payer: Beech Street Commercial |
$209.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$207.43
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$207.43
|
| Rate for Payer: Cigna of WY Commercial |
$209.57
|
| Rate for Payer: Entrust Commercial |
$203.16
|
| Rate for Payer: First Choice Health Commercial |
$203.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$203.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.89
|
| Rate for Payer: HealthUtah PPO |
$213.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$207.43
|
| Rate for Payer: Multiplan Medicare/VA |
$115.80
|
| Rate for Payer: One Health Plan of WY PPO |
$209.57
|
| Rate for Payer: PacificSource Commercial |
$192.46
|
| Rate for Payer: PHCS PPO |
$209.57
|
| Rate for Payer: Three Rivers PPO |
$160.39
|
| Rate for Payer: TriWest Veterans Administration |
$121.89
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
| Rate for Payer: United Healthcare Medicare |
$121.89
|
| Rate for Payer: WINHealth Partners Commercial |
$209.57
|
| Rate for Payer: Wise Provider Network Commercial |
$203.16
|
|
|
AIRWAY EXCHANGE CATH 8FR
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2500180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.72 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.70
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$113.72
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$119.70
|
| Rate for Payer: United Healthcare Commercial |
$200.55
|
| Rate for Payer: United Healthcare Medicare |
$119.70
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
AIRWAY EXCHANGE CATH 8FR
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2500180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.70 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$134.40
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$203.70
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.10
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$121.70
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$128.10
|
| Rate for Payer: United Healthcare Commercial |
$200.55
|
| Rate for Payer: United Healthcare Medicare |
$128.10
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ALARIS BLOOD SET 2477-0007
|
Facility
|
OP
|
$21.22
|
|
| Hospital Charge Code |
2050074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.80
|
| Rate for Payer: Aetna of WY Medicare |
$14.01
|
| Rate for Payer: Altius Commercial |
$20.37
|
| Rate for Payer: Beech Street Commercial |
$20.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.58
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.58
|
| Rate for Payer: Cigna of WY Commercial |
$20.80
|
| Rate for Payer: Entrust Commercial |
$20.16
|
| Rate for Payer: First Choice Health Commercial |
$20.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.10
|
| Rate for Payer: HealthUtah PPO |
$21.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.58
|
| Rate for Payer: Multiplan Medicare/VA |
$11.49
|
| Rate for Payer: One Health Plan of WY PPO |
$20.80
|
| Rate for Payer: PacificSource Commercial |
$19.10
|
| Rate for Payer: PHCS PPO |
$20.80
|
| Rate for Payer: Three Rivers PPO |
$15.92
|
| Rate for Payer: TriWest Veterans Administration |
$12.10
|
| Rate for Payer: United Healthcare Commercial |
$20.27
|
| Rate for Payer: United Healthcare Medicare |
$12.10
|
| Rate for Payer: WINHealth Partners Commercial |
$20.80
|
| Rate for Payer: Wise Provider Network Commercial |
$20.16
|
|
|
ALARIS BLOOD SET 2477-0007
|
Facility
|
IP
|
$21.22
|
|
| Hospital Charge Code |
2050074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.80
|
| Rate for Payer: Aetna of WY Medicare |
$13.58
|
| Rate for Payer: Altius Commercial |
$20.37
|
| Rate for Payer: Beech Street Commercial |
$20.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.58
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.58
|
| Rate for Payer: Cigna of WY Commercial |
$20.80
|
| Rate for Payer: Entrust Commercial |
$20.16
|
| Rate for Payer: First Choice Health Commercial |
$20.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.94
|
| Rate for Payer: HealthUtah PPO |
$21.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.58
|
| Rate for Payer: Multiplan Medicare/VA |
$12.30
|
| Rate for Payer: One Health Plan of WY PPO |
$20.80
|
| Rate for Payer: PacificSource Commercial |
$19.10
|
| Rate for Payer: PHCS PPO |
$20.80
|
| Rate for Payer: Three Rivers PPO |
$15.92
|
| Rate for Payer: TriWest Veterans Administration |
$12.94
|
| Rate for Payer: United Healthcare Commercial |
$20.27
|
| Rate for Payer: United Healthcare Medicare |
$12.94
|
| Rate for Payer: WINHealth Partners Commercial |
$20.16
|
| Rate for Payer: Wise Provider Network Commercial |
$20.16
|
|
|
ALARIS IVAC SET 20 DROP (NEW)
|
Facility
|
OP
|
$13.67
|
|
| Hospital Charge Code |
2050073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.40
|
| Rate for Payer: Aetna of WY Medicare |
$9.02
|
| Rate for Payer: Altius Commercial |
$13.12
|
| Rate for Payer: Beech Street Commercial |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.26
|
| Rate for Payer: Cigna of WY Commercial |
$13.40
|
| Rate for Payer: Entrust Commercial |
$12.99
|
| Rate for Payer: First Choice Health Commercial |
$12.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.79
|
| Rate for Payer: HealthUtah PPO |
$13.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.26
|
| Rate for Payer: Multiplan Medicare/VA |
$7.40
|
| Rate for Payer: One Health Plan of WY PPO |
$13.40
|
| Rate for Payer: PacificSource Commercial |
$12.30
|
| Rate for Payer: PHCS PPO |
$13.40
|
| Rate for Payer: Three Rivers PPO |
$10.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.79
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$7.79
|
| Rate for Payer: WINHealth Partners Commercial |
$13.40
|
| Rate for Payer: Wise Provider Network Commercial |
$12.99
|
|
|
ALARIS IVAC SET 20 DROP (NEW)
|
Facility
|
IP
|
$13.67
|
|
| Hospital Charge Code |
2050073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$13.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.40
|
| Rate for Payer: Aetna of WY Medicare |
$8.75
|
| Rate for Payer: Altius Commercial |
$13.12
|
| Rate for Payer: Beech Street Commercial |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.26
|
| Rate for Payer: Cigna of WY Commercial |
$13.40
|
| Rate for Payer: Entrust Commercial |
$12.99
|
| Rate for Payer: First Choice Health Commercial |
$12.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.34
|
| Rate for Payer: HealthUtah PPO |
$13.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.26
|
| Rate for Payer: Multiplan Medicare/VA |
$7.92
|
| Rate for Payer: One Health Plan of WY PPO |
$13.40
|
| Rate for Payer: PacificSource Commercial |
$12.30
|
| Rate for Payer: PHCS PPO |
$13.40
|
| Rate for Payer: Three Rivers PPO |
$10.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.34
|
| Rate for Payer: United Healthcare Commercial |
$13.05
|
| Rate for Payer: United Healthcare Medicare |
$8.34
|
| Rate for Payer: WINHealth Partners Commercial |
$12.99
|
| Rate for Payer: Wise Provider Network Commercial |
$12.99
|
|
|
ALARIS PCA SET 10800176
|
Facility
|
IP
|
$10.77
|
|
| Hospital Charge Code |
2050075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.55
|
| Rate for Payer: Aetna of WY Medicare |
$6.89
|
| Rate for Payer: Altius Commercial |
$10.34
|
| Rate for Payer: Beech Street Commercial |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.45
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.45
|
| Rate for Payer: Cigna of WY Commercial |
$10.55
|
| Rate for Payer: Entrust Commercial |
$10.23
|
| Rate for Payer: First Choice Health Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.57
|
| Rate for Payer: HealthUtah PPO |
$10.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.45
|
| Rate for Payer: Multiplan Medicare/VA |
$6.24
|
| Rate for Payer: One Health Plan of WY PPO |
$10.55
|
| Rate for Payer: PacificSource Commercial |
$9.69
|
| Rate for Payer: PHCS PPO |
$10.55
|
| Rate for Payer: Three Rivers PPO |
$8.08
|
| Rate for Payer: TriWest Veterans Administration |
$6.57
|
| Rate for Payer: United Healthcare Commercial |
$10.29
|
| Rate for Payer: United Healthcare Medicare |
$6.57
|
| Rate for Payer: WINHealth Partners Commercial |
$10.23
|
| Rate for Payer: Wise Provider Network Commercial |
$10.23
|
|
|
ALARIS PCA SET 10800176
|
Facility
|
OP
|
$10.77
|
|
| Hospital Charge Code |
2050075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.55
|
| Rate for Payer: Aetna of WY Medicare |
$7.11
|
| Rate for Payer: Altius Commercial |
$10.34
|
| Rate for Payer: Beech Street Commercial |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.45
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.45
|
| Rate for Payer: Cigna of WY Commercial |
$10.55
|
| Rate for Payer: Entrust Commercial |
$10.23
|
| Rate for Payer: First Choice Health Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.14
|
| Rate for Payer: HealthUtah PPO |
$10.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.45
|
| Rate for Payer: Multiplan Medicare/VA |
$5.83
|
| Rate for Payer: One Health Plan of WY PPO |
$10.55
|
| Rate for Payer: PacificSource Commercial |
$9.69
|
| Rate for Payer: PHCS PPO |
$10.55
|
| Rate for Payer: Three Rivers PPO |
$8.08
|
| Rate for Payer: TriWest Veterans Administration |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$10.29
|
| Rate for Payer: United Healthcare Medicare |
$6.14
|
| Rate for Payer: WINHealth Partners Commercial |
$10.55
|
| Rate for Payer: Wise Provider Network Commercial |
$10.23
|
|
|
ALBUMIN 5% BOLUS FROM BAG [4090000107]
|
Facility
|
OP
|
$15.74
|
|
|
Service Code
|
NDC 6851652141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.39
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.43
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
ALBUMIN 5% BOLUS FROM BAG [4090000107]
|
Facility
|
IP
|
$15.74
|
|
|
Service Code
|
NDC 6851652141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.60
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.12
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [9676]
|
Facility
|
OP
|
$19.59
|
|
|
Service Code
|
NDC 6898264302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.93
|
| Rate for Payer: Altius Commercial |
$18.81
|
| Rate for Payer: Beech Street Commercial |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.00
|
| Rate for Payer: Cigna of WY Commercial |
$19.20
|
| Rate for Payer: Entrust Commercial |
$18.61
|
| Rate for Payer: First Choice Health Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.17
|
| Rate for Payer: HealthUtah PPO |
$19.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.00
|
| Rate for Payer: Multiplan Medicare/VA |
$10.61
|
| Rate for Payer: One Health Plan of WY PPO |
$19.20
|
| Rate for Payer: PacificSource Commercial |
$17.63
|
| Rate for Payer: PHCS PPO |
$19.20
|
| Rate for Payer: Three Rivers PPO |
$14.69
|
| Rate for Payer: TriWest Veterans Administration |
$11.17
|
| Rate for Payer: United Healthcare Commercial |
$18.71
|
| Rate for Payer: United Healthcare Medicare |
$11.17
|
| Rate for Payer: WINHealth Partners Commercial |
$19.20
|
| Rate for Payer: Wise Provider Network Commercial |
$18.61
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [9676]
|
Facility
|
IP
|
$19.59
|
|
|
Service Code
|
NDC 6898264302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Commercial |
$18.81
|
| Rate for Payer: Beech Street Commercial |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.00
|
| Rate for Payer: Cigna of WY Commercial |
$19.20
|
| Rate for Payer: Entrust Commercial |
$18.61
|
| Rate for Payer: First Choice Health Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.95
|
| Rate for Payer: HealthUtah PPO |
$19.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.00
|
| Rate for Payer: Multiplan Medicare/VA |
$11.35
|
| Rate for Payer: One Health Plan of WY PPO |
$19.20
|
| Rate for Payer: PacificSource Commercial |
$17.63
|
| Rate for Payer: PHCS PPO |
$19.20
|
| Rate for Payer: Three Rivers PPO |
$14.69
|
| Rate for Payer: TriWest Veterans Administration |
$11.95
|
| Rate for Payer: United Healthcare Commercial |
$18.71
|
| Rate for Payer: United Healthcare Medicare |
$11.95
|
| Rate for Payer: WINHealth Partners Commercial |
$18.61
|
| Rate for Payer: Wise Provider Network Commercial |
$18.61
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
OP
|
$15.74
|
|
|
Service Code
|
NDC 6851652141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.39
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.43
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
IP
|
$16.11
|
|
|
Service Code
|
NDC 6898262302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.79
|
| Rate for Payer: Aetna of WY Medicare |
$10.31
|
| Rate for Payer: Altius Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.63
|
| Rate for Payer: Cigna of WY Commercial |
$15.79
|
| Rate for Payer: Entrust Commercial |
$15.30
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.83
|
| Rate for Payer: HealthUtah PPO |
$16.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.63
|
| Rate for Payer: Multiplan Medicare/VA |
$9.34
|
| Rate for Payer: One Health Plan of WY PPO |
$15.79
|
| Rate for Payer: PacificSource Commercial |
$14.50
|
| Rate for Payer: PHCS PPO |
$15.79
|
| Rate for Payer: Three Rivers PPO |
$12.08
|
| Rate for Payer: TriWest Veterans Administration |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$15.39
|
| Rate for Payer: United Healthcare Medicare |
$9.83
|
| Rate for Payer: WINHealth Partners Commercial |
$15.30
|
| Rate for Payer: Wise Provider Network Commercial |
$15.30
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
OP
|
$16.11
|
|
|
Service Code
|
NDC 6898262302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.79
|
| Rate for Payer: Aetna of WY Medicare |
$10.63
|
| Rate for Payer: Altius Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.63
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.63
|
| Rate for Payer: Cigna of WY Commercial |
$15.79
|
| Rate for Payer: Entrust Commercial |
$15.30
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.18
|
| Rate for Payer: HealthUtah PPO |
$16.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.63
|
| Rate for Payer: Multiplan Medicare/VA |
$8.72
|
| Rate for Payer: One Health Plan of WY PPO |
$15.79
|
| Rate for Payer: PacificSource Commercial |
$14.50
|
| Rate for Payer: PHCS PPO |
$15.79
|
| Rate for Payer: Three Rivers PPO |
$12.08
|
| Rate for Payer: TriWest Veterans Administration |
$9.18
|
| Rate for Payer: United Healthcare Commercial |
$15.39
|
| Rate for Payer: United Healthcare Medicare |
$9.18
|
| Rate for Payer: WINHealth Partners Commercial |
$15.79
|
| Rate for Payer: Wise Provider Network Commercial |
$15.30
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
IP
|
$15.74
|
|
|
Service Code
|
NDC 6851652141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.60
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.12
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$9.60
|
| Rate for Payer: United Healthcare Commercial |
$15.03
|
| Rate for Payer: United Healthcare Medicare |
$9.60
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.66
|
| Rate for Payer: Aetna of WY Medicare |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: Cash Price |
$11.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.49
|
| Rate for Payer: Cigna of WY Commercial |
$16.66
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$17.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.49
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$16.66
|
| Rate for Payer: PacificSource Commercial |
$15.30
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$16.15
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [3850]
|
Facility
|
IP
|
$16.77
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.73
|
| Rate for Payer: Altius Commercial |
$16.10
|
| Rate for Payer: Beech Street Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.27
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.27
|
| Rate for Payer: Cigna of WY Commercial |
$16.43
|
| Rate for Payer: Entrust Commercial |
$15.93
|
| Rate for Payer: First Choice Health Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.23
|
| Rate for Payer: HealthUtah PPO |
$16.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.72
|
| Rate for Payer: One Health Plan of WY PPO |
$16.43
|
| Rate for Payer: PacificSource Commercial |
$15.09
|
| Rate for Payer: PHCS PPO |
$16.43
|
| Rate for Payer: Three Rivers PPO |
$12.58
|
| Rate for Payer: TriWest Veterans Administration |
$10.23
|
| Rate for Payer: United Healthcare Commercial |
$16.02
|
| Rate for Payer: United Healthcare Medicare |
$10.23
|
| Rate for Payer: WINHealth Partners Commercial |
$15.93
|
| Rate for Payer: Wise Provider Network Commercial |
$15.93
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [3850]
|
Facility
|
OP
|
$16.77
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.43
|
| Rate for Payer: Aetna of WY Medicare |
$11.07
|
| Rate for Payer: Altius Commercial |
$16.10
|
| Rate for Payer: Beech Street Commercial |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.27
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.27
|
| Rate for Payer: Cigna of WY Commercial |
$16.43
|
| Rate for Payer: Entrust Commercial |
$15.93
|
| Rate for Payer: First Choice Health Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.56
|
| Rate for Payer: HealthUtah PPO |
$16.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.08
|
| Rate for Payer: One Health Plan of WY PPO |
$16.43
|
| Rate for Payer: PacificSource Commercial |
$15.09
|
| Rate for Payer: PHCS PPO |
$16.43
|
| Rate for Payer: Three Rivers PPO |
$12.58
|
| Rate for Payer: TriWest Veterans Administration |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$16.02
|
| Rate for Payer: United Healthcare Medicare |
$9.56
|
| Rate for Payer: WINHealth Partners Commercial |
$16.43
|
| Rate for Payer: Wise Provider Network Commercial |
$15.93
|
|
