|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [140403]
|
Facility
|
OP
|
$563.72
|
|
|
Service Code
|
HCPCS Q5101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$310.61 |
| Max. Negotiated Rate |
$563.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.45
|
| Rate for Payer: Aetna of WY Medicare |
$372.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$541.17
|
| Rate for Payer: Altius Commercial |
$541.17
|
| Rate for Payer: Beech Street Commercial |
$552.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$462.81
|
| Rate for Payer: Cash Price |
$394.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$546.81
|
| Rate for Payer: Cigna of WY Commercial |
$552.45
|
| Rate for Payer: Entrust Commercial |
$535.53
|
| Rate for Payer: First Choice Health Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.96
|
| Rate for Payer: HealthUtah PPO |
$563.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$546.81
|
| Rate for Payer: Multiplan Medicare/VA |
$310.61
|
| Rate for Payer: One Health Plan of WY PPO |
$552.45
|
| Rate for Payer: PacificSource Commercial |
$507.35
|
| Rate for Payer: PHCS PPO |
$552.45
|
| Rate for Payer: Three Rivers PPO |
$422.79
|
| Rate for Payer: TriWest Veterans Administration |
$326.96
|
| Rate for Payer: United Healthcare Commercial |
$490.44
|
| Rate for Payer: United Healthcare Medicare |
$326.96
|
| Rate for Payer: WINHealth Partners Commercial |
$552.45
|
| Rate for Payer: Wise Provider Network Commercial |
$535.53
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [140403]
|
Facility
|
IP
|
$563.72
|
|
|
Service Code
|
HCPCS Q5101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$353.45 |
| Max. Negotiated Rate |
$563.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$541.17
|
| Rate for Payer: Altius Commercial |
$541.17
|
| Rate for Payer: Beech Street Commercial |
$552.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$462.81
|
| Rate for Payer: Cash Price |
$394.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$546.81
|
| Rate for Payer: Cigna of WY Commercial |
$552.45
|
| Rate for Payer: Entrust Commercial |
$535.53
|
| Rate for Payer: First Choice Health Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.06
|
| Rate for Payer: HealthUtah PPO |
$563.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$546.81
|
| Rate for Payer: Multiplan Medicare/VA |
$353.45
|
| Rate for Payer: One Health Plan of WY PPO |
$552.45
|
| Rate for Payer: PacificSource Commercial |
$507.35
|
| Rate for Payer: PHCS PPO |
$552.45
|
| Rate for Payer: Three Rivers PPO |
$422.79
|
| Rate for Payer: TriWest Veterans Administration |
$372.06
|
| Rate for Payer: United Healthcare Commercial |
$490.44
|
| Rate for Payer: United Healthcare Medicare |
$372.06
|
| Rate for Payer: WINHealth Partners Commercial |
$535.53
|
| Rate for Payer: Wise Provider Network Commercial |
$535.53
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [140402]
|
Facility
|
IP
|
$563.72
|
|
|
Service Code
|
HCPCS Q5101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$353.45 |
| Max. Negotiated Rate |
$563.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$541.17
|
| Rate for Payer: Altius Commercial |
$541.17
|
| Rate for Payer: Beech Street Commercial |
$552.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$462.81
|
| Rate for Payer: Cash Price |
$394.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$546.81
|
| Rate for Payer: Cigna of WY Commercial |
$552.45
|
| Rate for Payer: Entrust Commercial |
$535.53
|
| Rate for Payer: First Choice Health Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$372.06
|
| Rate for Payer: HealthUtah PPO |
$563.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$546.81
|
| Rate for Payer: Multiplan Medicare/VA |
$353.45
|
| Rate for Payer: One Health Plan of WY PPO |
$552.45
|
| Rate for Payer: PacificSource Commercial |
$507.35
|
| Rate for Payer: PHCS PPO |
$552.45
|
| Rate for Payer: Three Rivers PPO |
$422.79
|
| Rate for Payer: TriWest Veterans Administration |
$372.06
|
| Rate for Payer: United Healthcare Commercial |
$490.44
|
| Rate for Payer: United Healthcare Medicare |
$372.06
|
| Rate for Payer: WINHealth Partners Commercial |
$535.53
|
| Rate for Payer: Wise Provider Network Commercial |
$535.53
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [140402]
|
Facility
|
OP
|
$563.72
|
|
|
Service Code
|
HCPCS Q5101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$310.61 |
| Max. Negotiated Rate |
$563.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$552.45
|
| Rate for Payer: Aetna of WY Medicare |
$372.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$541.17
|
| Rate for Payer: Altius Commercial |
$541.17
|
| Rate for Payer: Beech Street Commercial |
$552.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$462.81
|
| Rate for Payer: Cash Price |
$394.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$546.81
|
| Rate for Payer: Cigna of WY Commercial |
$552.45
|
| Rate for Payer: Entrust Commercial |
$535.53
|
| Rate for Payer: First Choice Health Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$535.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.96
|
| Rate for Payer: HealthUtah PPO |
$563.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$546.81
|
| Rate for Payer: Multiplan Medicare/VA |
$310.61
|
| Rate for Payer: One Health Plan of WY PPO |
$552.45
|
| Rate for Payer: PacificSource Commercial |
$507.35
|
| Rate for Payer: PHCS PPO |
$552.45
|
| Rate for Payer: Three Rivers PPO |
$422.79
|
| Rate for Payer: TriWest Veterans Administration |
$326.96
|
| Rate for Payer: United Healthcare Commercial |
$490.44
|
| Rate for Payer: United Healthcare Medicare |
$326.96
|
| Rate for Payer: WINHealth Partners Commercial |
$552.45
|
| Rate for Payer: Wise Provider Network Commercial |
$535.53
|
|
|
FILTER BLOOD PALL GELSQ40S
|
Facility
|
OP
|
$27.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.89
|
| Rate for Payer: Aetna of WY Medicare |
$18.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.34
|
| Rate for Payer: Altius Commercial |
$26.34
|
| Rate for Payer: Beech Street Commercial |
$26.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.53
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.62
|
| Rate for Payer: Cigna of WY Commercial |
$26.89
|
| Rate for Payer: Entrust Commercial |
$26.07
|
| Rate for Payer: First Choice Health Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.92
|
| Rate for Payer: HealthUtah PPO |
$27.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.62
|
| Rate for Payer: Multiplan Medicare/VA |
$15.12
|
| Rate for Payer: One Health Plan of WY PPO |
$26.89
|
| Rate for Payer: PacificSource Commercial |
$24.70
|
| Rate for Payer: PHCS PPO |
$26.89
|
| Rate for Payer: Three Rivers PPO |
$20.58
|
| Rate for Payer: TriWest Veterans Administration |
$15.92
|
| Rate for Payer: United Healthcare Commercial |
$23.87
|
| Rate for Payer: United Healthcare Medicare |
$15.92
|
| Rate for Payer: WINHealth Partners Commercial |
$26.89
|
| Rate for Payer: Wise Provider Network Commercial |
$26.07
|
|
|
FILTER BLOOD PALL GELSQ40S
|
Facility
|
IP
|
$27.44
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$27.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.34
|
| Rate for Payer: Altius Commercial |
$26.34
|
| Rate for Payer: Beech Street Commercial |
$26.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.53
|
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.62
|
| Rate for Payer: Cigna of WY Commercial |
$26.89
|
| Rate for Payer: Entrust Commercial |
$26.07
|
| Rate for Payer: First Choice Health Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.11
|
| Rate for Payer: HealthUtah PPO |
$27.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.62
|
| Rate for Payer: Multiplan Medicare/VA |
$17.20
|
| Rate for Payer: One Health Plan of WY PPO |
$26.89
|
| Rate for Payer: PacificSource Commercial |
$24.70
|
| Rate for Payer: PHCS PPO |
$26.89
|
| Rate for Payer: Three Rivers PPO |
$20.58
|
| Rate for Payer: TriWest Veterans Administration |
$18.11
|
| Rate for Payer: United Healthcare Commercial |
$23.87
|
| Rate for Payer: United Healthcare Medicare |
$18.11
|
| Rate for Payer: WINHealth Partners Commercial |
$26.07
|
| Rate for Payer: Wise Provider Network Commercial |
$26.07
|
|
|
FIMBRIOPLASTY
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 58760
|
| Hospital Charge Code |
58760
|
| Min. Negotiated Rate |
$671.79 |
| Max. Negotiated Rate |
$3,414.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,345.72
|
| Rate for Payer: Aetna of WY Medicare |
$790.34
|
| Rate for Payer: Beech Street Commercial |
$3,243.30
|
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: Cash Price |
$2,389.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,311.58
|
| Rate for Payer: Cigna of WY Commercial |
$3,345.72
|
| Rate for Payer: First Choice Health Commercial |
$3,072.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,243.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$790.34
|
| Rate for Payer: HealthUtah PPO |
$3,414.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,311.58
|
| Rate for Payer: Multiplan Medicare/VA |
$671.79
|
| Rate for Payer: One Health Plan of WY PPO |
$3,345.72
|
| Rate for Payer: PacificSource Commercial |
$3,072.60
|
| Rate for Payer: PHCS PPO |
$3,243.30
|
| Rate for Payer: Three Rivers PPO |
$2,560.50
|
| Rate for Payer: TriWest Veterans Administration |
$790.34
|
| Rate for Payer: United Healthcare Commercial |
$2,970.18
|
| Rate for Payer: United Healthcare Medicare |
$790.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2,901.90
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
NDC 6068742865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.07
|
| Rate for Payer: Altius Commercial |
$3.07
|
| Rate for Payer: Beech Street Commercial |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.10
|
| Rate for Payer: Cigna of WY Commercial |
$3.14
|
| Rate for Payer: Entrust Commercial |
$3.04
|
| Rate for Payer: First Choice Health Commercial |
$3.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.11
|
| Rate for Payer: HealthUtah PPO |
$3.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.10
|
| Rate for Payer: Multiplan Medicare/VA |
$2.01
|
| Rate for Payer: One Health Plan of WY PPO |
$3.14
|
| Rate for Payer: PacificSource Commercial |
$2.88
|
| Rate for Payer: PHCS PPO |
$3.14
|
| Rate for Payer: Three Rivers PPO |
$2.40
|
| Rate for Payer: TriWest Veterans Administration |
$2.11
|
| Rate for Payer: United Healthcare Commercial |
$2.78
|
| Rate for Payer: United Healthcare Medicare |
$2.11
|
| Rate for Payer: WINHealth Partners Commercial |
$3.04
|
| Rate for Payer: Wise Provider Network Commercial |
$3.04
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 6068742811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.46
|
| Rate for Payer: Altius Commercial |
$3.46
|
| Rate for Payer: Beech Street Commercial |
$3.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.49
|
| Rate for Payer: Cigna of WY Commercial |
$3.53
|
| Rate for Payer: Entrust Commercial |
$3.42
|
| Rate for Payer: First Choice Health Commercial |
$3.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.38
|
| Rate for Payer: HealthUtah PPO |
$3.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.49
|
| Rate for Payer: Multiplan Medicare/VA |
$2.26
|
| Rate for Payer: One Health Plan of WY PPO |
$3.53
|
| Rate for Payer: PacificSource Commercial |
$3.24
|
| Rate for Payer: PHCS PPO |
$3.53
|
| Rate for Payer: Three Rivers PPO |
$2.70
|
| Rate for Payer: TriWest Veterans Administration |
$2.38
|
| Rate for Payer: United Healthcare Commercial |
$3.13
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3.42
|
| Rate for Payer: Wise Provider Network Commercial |
$3.42
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
NDC 6068742865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.14
|
| Rate for Payer: Aetna of WY Medicare |
$2.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.07
|
| Rate for Payer: Altius Commercial |
$3.07
|
| Rate for Payer: Beech Street Commercial |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.10
|
| Rate for Payer: Cigna of WY Commercial |
$3.14
|
| Rate for Payer: Entrust Commercial |
$3.04
|
| Rate for Payer: First Choice Health Commercial |
$3.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.86
|
| Rate for Payer: HealthUtah PPO |
$3.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3.14
|
| Rate for Payer: PacificSource Commercial |
$2.88
|
| Rate for Payer: PHCS PPO |
$3.14
|
| Rate for Payer: Three Rivers PPO |
$2.40
|
| Rate for Payer: TriWest Veterans Administration |
$1.86
|
| Rate for Payer: United Healthcare Commercial |
$2.78
|
| Rate for Payer: United Healthcare Medicare |
$1.86
|
| Rate for Payer: WINHealth Partners Commercial |
$3.14
|
| Rate for Payer: Wise Provider Network Commercial |
$3.04
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 6068742811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.53
|
| Rate for Payer: Aetna of WY Medicare |
$2.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.46
|
| Rate for Payer: Altius Commercial |
$3.46
|
| Rate for Payer: Beech Street Commercial |
$3.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.49
|
| Rate for Payer: Cigna of WY Commercial |
$3.53
|
| Rate for Payer: Entrust Commercial |
$3.42
|
| Rate for Payer: First Choice Health Commercial |
$3.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.09
|
| Rate for Payer: HealthUtah PPO |
$3.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.49
|
| Rate for Payer: Multiplan Medicare/VA |
$1.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3.53
|
| Rate for Payer: PacificSource Commercial |
$3.24
|
| Rate for Payer: PHCS PPO |
$3.53
|
| Rate for Payer: Three Rivers PPO |
$2.70
|
| Rate for Payer: TriWest Veterans Administration |
$2.09
|
| Rate for Payer: United Healthcare Commercial |
$3.13
|
| Rate for Payer: United Healthcare Medicare |
$2.09
|
| Rate for Payer: WINHealth Partners Commercial |
$3.53
|
| Rate for Payer: Wise Provider Network Commercial |
$3.42
|
|
|
FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
10021
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Aetna of WY Medicare |
$52.18
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.18
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: Multiplan Medicare/VA |
$44.35
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: TriWest Veterans Administration |
$52.18
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: United Healthcare Medicare |
$52.18
|
| Rate for Payer: WINHealth Partners Commercial |
$235.45
|
|
|
FINGERSHIELDS AR-7199
|
Facility
|
IP
|
$143.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.71 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.36
|
| Rate for Payer: Altius Commercial |
$137.36
|
| Rate for Payer: Beech Street Commercial |
$140.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.47
|
| Rate for Payer: Cash Price |
$100.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.79
|
| Rate for Payer: Cigna of WY Commercial |
$140.22
|
| Rate for Payer: Entrust Commercial |
$135.93
|
| Rate for Payer: First Choice Health Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.43
|
| Rate for Payer: HealthUtah PPO |
$143.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.79
|
| Rate for Payer: Multiplan Medicare/VA |
$89.71
|
| Rate for Payer: One Health Plan of WY PPO |
$140.22
|
| Rate for Payer: PacificSource Commercial |
$128.77
|
| Rate for Payer: PHCS PPO |
$140.22
|
| Rate for Payer: Three Rivers PPO |
$107.31
|
| Rate for Payer: TriWest Veterans Administration |
$94.43
|
| Rate for Payer: United Healthcare Commercial |
$124.48
|
| Rate for Payer: United Healthcare Medicare |
$94.43
|
| Rate for Payer: WINHealth Partners Commercial |
$135.93
|
| Rate for Payer: Wise Provider Network Commercial |
$135.93
|
|
|
FINGERSHIELDS AR-7199
|
Facility
|
OP
|
$143.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.84 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.22
|
| Rate for Payer: Aetna of WY Medicare |
$94.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$137.36
|
| Rate for Payer: Altius Commercial |
$137.36
|
| Rate for Payer: Beech Street Commercial |
$140.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$117.47
|
| Rate for Payer: Cash Price |
$100.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.79
|
| Rate for Payer: Cigna of WY Commercial |
$140.22
|
| Rate for Payer: Entrust Commercial |
$135.93
|
| Rate for Payer: First Choice Health Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.99
|
| Rate for Payer: HealthUtah PPO |
$143.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.79
|
| Rate for Payer: Multiplan Medicare/VA |
$78.84
|
| Rate for Payer: One Health Plan of WY PPO |
$140.22
|
| Rate for Payer: PacificSource Commercial |
$128.77
|
| Rate for Payer: PHCS PPO |
$140.22
|
| Rate for Payer: Three Rivers PPO |
$107.31
|
| Rate for Payer: TriWest Veterans Administration |
$82.99
|
| Rate for Payer: United Healthcare Commercial |
$124.48
|
| Rate for Payer: United Healthcare Medicare |
$82.99
|
| Rate for Payer: WINHealth Partners Commercial |
$140.22
|
| Rate for Payer: Wise Provider Network Commercial |
$135.93
|
|
|
FINGER SPLINT, STATIC
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Hospital Charge Code |
Q4049
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.84
|
| Rate for Payer: Beech Street Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.76
|
| Rate for Payer: Cigna of WY Commercial |
$7.84
|
| Rate for Payer: First Choice Health Commercial |
$7.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.60
|
| Rate for Payer: HealthUtah PPO |
$8.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.76
|
| Rate for Payer: One Health Plan of WY PPO |
$7.84
|
| Rate for Payer: PacificSource Commercial |
$7.20
|
| Rate for Payer: PHCS PPO |
$7.60
|
| Rate for Payer: Three Rivers PPO |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$6.96
|
| Rate for Payer: WINHealth Partners Commercial |
$7.60
|
|
|
FINGER/TOE GEL 6" TUBE NARROW
|
Facility
|
IP
|
$18.15
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.42
|
| Rate for Payer: Altius Commercial |
$17.42
|
| Rate for Payer: Beech Street Commercial |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.90
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.61
|
| Rate for Payer: Cigna of WY Commercial |
$17.79
|
| Rate for Payer: Entrust Commercial |
$17.24
|
| Rate for Payer: First Choice Health Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.98
|
| Rate for Payer: HealthUtah PPO |
$18.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.61
|
| Rate for Payer: Multiplan Medicare/VA |
$11.38
|
| Rate for Payer: One Health Plan of WY PPO |
$17.79
|
| Rate for Payer: PacificSource Commercial |
$16.34
|
| Rate for Payer: PHCS PPO |
$17.79
|
| Rate for Payer: Three Rivers PPO |
$13.61
|
| Rate for Payer: TriWest Veterans Administration |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.79
|
| Rate for Payer: United Healthcare Medicare |
$11.98
|
| Rate for Payer: WINHealth Partners Commercial |
$17.24
|
| Rate for Payer: Wise Provider Network Commercial |
$17.24
|
|
|
FINGER/TOE GEL 6" TUBE NARROW
|
Facility
|
OP
|
$18.15
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.79
|
| Rate for Payer: Aetna of WY Medicare |
$11.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.42
|
| Rate for Payer: Altius Commercial |
$17.42
|
| Rate for Payer: Beech Street Commercial |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.90
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.61
|
| Rate for Payer: Cigna of WY Commercial |
$17.79
|
| Rate for Payer: Entrust Commercial |
$17.24
|
| Rate for Payer: First Choice Health Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$18.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.61
|
| Rate for Payer: Multiplan Medicare/VA |
$10.00
|
| Rate for Payer: One Health Plan of WY PPO |
$17.79
|
| Rate for Payer: PacificSource Commercial |
$16.34
|
| Rate for Payer: PHCS PPO |
$17.79
|
| Rate for Payer: Three Rivers PPO |
$13.61
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$15.79
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$17.79
|
| Rate for Payer: Wise Provider Network Commercial |
$17.24
|
|
|
FINGER/TOE GEL 6" TUBE WIDE
|
Facility
|
OP
|
$18.15
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.79
|
| Rate for Payer: Aetna of WY Medicare |
$11.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.42
|
| Rate for Payer: Altius Commercial |
$17.42
|
| Rate for Payer: Beech Street Commercial |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.90
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.61
|
| Rate for Payer: Cigna of WY Commercial |
$17.79
|
| Rate for Payer: Entrust Commercial |
$17.24
|
| Rate for Payer: First Choice Health Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$18.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.61
|
| Rate for Payer: Multiplan Medicare/VA |
$10.00
|
| Rate for Payer: One Health Plan of WY PPO |
$17.79
|
| Rate for Payer: PacificSource Commercial |
$16.34
|
| Rate for Payer: PHCS PPO |
$17.79
|
| Rate for Payer: Three Rivers PPO |
$13.61
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$15.79
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$17.79
|
| Rate for Payer: Wise Provider Network Commercial |
$17.24
|
|
|
FINGER/TOE GEL 6" TUBE WIDE
|
Facility
|
IP
|
$18.15
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$18.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.42
|
| Rate for Payer: Altius Commercial |
$17.42
|
| Rate for Payer: Beech Street Commercial |
$17.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.90
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.61
|
| Rate for Payer: Cigna of WY Commercial |
$17.79
|
| Rate for Payer: Entrust Commercial |
$17.24
|
| Rate for Payer: First Choice Health Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.98
|
| Rate for Payer: HealthUtah PPO |
$18.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.61
|
| Rate for Payer: Multiplan Medicare/VA |
$11.38
|
| Rate for Payer: One Health Plan of WY PPO |
$17.79
|
| Rate for Payer: PacificSource Commercial |
$16.34
|
| Rate for Payer: PHCS PPO |
$17.79
|
| Rate for Payer: Three Rivers PPO |
$13.61
|
| Rate for Payer: TriWest Veterans Administration |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.79
|
| Rate for Payer: United Healthcare Medicare |
$11.98
|
| Rate for Payer: WINHealth Partners Commercial |
$17.24
|
| Rate for Payer: Wise Provider Network Commercial |
$17.24
|
|
|
FINGER/TOE GEL CAP L/XL
|
Facility
|
IP
|
$12.85
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.34
|
| Rate for Payer: Altius Commercial |
$12.34
|
| Rate for Payer: Beech Street Commercial |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.55
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.46
|
| Rate for Payer: Cigna of WY Commercial |
$12.59
|
| Rate for Payer: Entrust Commercial |
$12.21
|
| Rate for Payer: First Choice Health Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.48
|
| Rate for Payer: HealthUtah PPO |
$12.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.46
|
| Rate for Payer: Multiplan Medicare/VA |
$8.06
|
| Rate for Payer: One Health Plan of WY PPO |
$12.59
|
| Rate for Payer: PacificSource Commercial |
$11.56
|
| Rate for Payer: PHCS PPO |
$12.59
|
| Rate for Payer: Three Rivers PPO |
$9.64
|
| Rate for Payer: TriWest Veterans Administration |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare |
$8.48
|
| Rate for Payer: WINHealth Partners Commercial |
$12.21
|
| Rate for Payer: Wise Provider Network Commercial |
$12.21
|
|
|
FINGER/TOE GEL CAP L/XL
|
Facility
|
OP
|
$12.85
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.59
|
| Rate for Payer: Aetna of WY Medicare |
$8.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.34
|
| Rate for Payer: Altius Commercial |
$12.34
|
| Rate for Payer: Beech Street Commercial |
$12.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.55
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.46
|
| Rate for Payer: Cigna of WY Commercial |
$12.59
|
| Rate for Payer: Entrust Commercial |
$12.21
|
| Rate for Payer: First Choice Health Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.45
|
| Rate for Payer: HealthUtah PPO |
$12.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.46
|
| Rate for Payer: Multiplan Medicare/VA |
$7.08
|
| Rate for Payer: One Health Plan of WY PPO |
$12.59
|
| Rate for Payer: PacificSource Commercial |
$11.56
|
| Rate for Payer: PHCS PPO |
$12.59
|
| Rate for Payer: Three Rivers PPO |
$9.64
|
| Rate for Payer: TriWest Veterans Administration |
$7.45
|
| Rate for Payer: United Healthcare Commercial |
$11.18
|
| Rate for Payer: United Healthcare Medicare |
$7.45
|
| Rate for Payer: WINHealth Partners Commercial |
$12.59
|
| Rate for Payer: Wise Provider Network Commercial |
$12.21
|
|
|
FINGER/TOE GEL CAP S/M
|
Facility
|
OP
|
$11.63
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.40
|
| Rate for Payer: Aetna of WY Medicare |
$7.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.16
|
| Rate for Payer: Altius Commercial |
$11.16
|
| Rate for Payer: Beech Street Commercial |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.55
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.28
|
| Rate for Payer: Cigna of WY Commercial |
$11.40
|
| Rate for Payer: Entrust Commercial |
$11.05
|
| Rate for Payer: First Choice Health Commercial |
$11.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.75
|
| Rate for Payer: HealthUtah PPO |
$11.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.28
|
| Rate for Payer: Multiplan Medicare/VA |
$6.41
|
| Rate for Payer: One Health Plan of WY PPO |
$11.40
|
| Rate for Payer: PacificSource Commercial |
$10.47
|
| Rate for Payer: PHCS PPO |
$11.40
|
| Rate for Payer: Three Rivers PPO |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$6.75
|
| Rate for Payer: United Healthcare Commercial |
$10.12
|
| Rate for Payer: United Healthcare Medicare |
$6.75
|
| Rate for Payer: WINHealth Partners Commercial |
$11.40
|
| Rate for Payer: Wise Provider Network Commercial |
$11.05
|
|
|
FINGER/TOE GEL CAP S/M
|
Facility
|
IP
|
$11.63
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$11.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.16
|
| Rate for Payer: Altius Commercial |
$11.16
|
| Rate for Payer: Beech Street Commercial |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.55
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.28
|
| Rate for Payer: Cigna of WY Commercial |
$11.40
|
| Rate for Payer: Entrust Commercial |
$11.05
|
| Rate for Payer: First Choice Health Commercial |
$11.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.68
|
| Rate for Payer: HealthUtah PPO |
$11.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.28
|
| Rate for Payer: Multiplan Medicare/VA |
$7.29
|
| Rate for Payer: One Health Plan of WY PPO |
$11.40
|
| Rate for Payer: PacificSource Commercial |
$10.47
|
| Rate for Payer: PHCS PPO |
$11.40
|
| Rate for Payer: Three Rivers PPO |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$7.68
|
| Rate for Payer: United Healthcare Commercial |
$10.12
|
| Rate for Payer: United Healthcare Medicare |
$7.68
|
| Rate for Payer: WINHealth Partners Commercial |
$11.05
|
| Rate for Payer: Wise Provider Network Commercial |
$11.05
|
|
|
FINGER/TOE GEL CAP XXL
|
Facility
|
OP
|
$13.77
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.49
|
| Rate for Payer: Aetna of WY Medicare |
$9.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.22
|
| Rate for Payer: Altius Commercial |
$13.22
|
| Rate for Payer: Beech Street Commercial |
$13.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.31
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.36
|
| Rate for Payer: Cigna of WY Commercial |
$13.49
|
| Rate for Payer: Entrust Commercial |
$13.08
|
| Rate for Payer: First Choice Health Commercial |
$13.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.99
|
| Rate for Payer: HealthUtah PPO |
$13.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.36
|
| Rate for Payer: Multiplan Medicare/VA |
$7.59
|
| Rate for Payer: One Health Plan of WY PPO |
$13.49
|
| Rate for Payer: PacificSource Commercial |
$12.39
|
| Rate for Payer: PHCS PPO |
$13.49
|
| Rate for Payer: Three Rivers PPO |
$10.33
|
| Rate for Payer: TriWest Veterans Administration |
$7.99
|
| Rate for Payer: United Healthcare Commercial |
$11.98
|
| Rate for Payer: United Healthcare Medicare |
$7.99
|
| Rate for Payer: WINHealth Partners Commercial |
$13.49
|
| Rate for Payer: Wise Provider Network Commercial |
$13.08
|
|
|
FINGER/TOE GEL CAP XXL
|
Facility
|
IP
|
$13.77
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.22
|
| Rate for Payer: Altius Commercial |
$13.22
|
| Rate for Payer: Beech Street Commercial |
$13.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.31
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.36
|
| Rate for Payer: Cigna of WY Commercial |
$13.49
|
| Rate for Payer: Entrust Commercial |
$13.08
|
| Rate for Payer: First Choice Health Commercial |
$13.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$13.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.36
|
| Rate for Payer: Multiplan Medicare/VA |
$8.63
|
| Rate for Payer: One Health Plan of WY PPO |
$13.49
|
| Rate for Payer: PacificSource Commercial |
$12.39
|
| Rate for Payer: PHCS PPO |
$13.49
|
| Rate for Payer: Three Rivers PPO |
$10.33
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$11.98
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$13.08
|
| Rate for Payer: Wise Provider Network Commercial |
$13.08
|
|
