|
DRAPE LITHOTOMY W/FLUID
|
Facility
|
IP
|
$32.76
|
|
| Hospital Charge Code |
2650178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.10
|
| Rate for Payer: Aetna of WY Medicare |
$20.97
|
| Rate for Payer: Altius Commercial |
$31.45
|
| Rate for Payer: Beech Street Commercial |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.78
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.78
|
| Rate for Payer: Cigna of WY Commercial |
$32.10
|
| Rate for Payer: Entrust Commercial |
$31.12
|
| Rate for Payer: First Choice Health Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.98
|
| Rate for Payer: HealthUtah PPO |
$32.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.78
|
| Rate for Payer: Multiplan Medicare/VA |
$18.98
|
| Rate for Payer: One Health Plan of WY PPO |
$32.10
|
| Rate for Payer: PacificSource Commercial |
$29.48
|
| Rate for Payer: PHCS PPO |
$32.10
|
| Rate for Payer: Three Rivers PPO |
$24.57
|
| Rate for Payer: TriWest Veterans Administration |
$19.98
|
| Rate for Payer: United Healthcare Commercial |
$31.29
|
| Rate for Payer: United Healthcare Medicare |
$19.98
|
| Rate for Payer: WINHealth Partners Commercial |
$31.12
|
| Rate for Payer: Wise Provider Network Commercial |
$31.12
|
|
|
DRAPE LITHOTOMY W/FLUID
|
Facility
|
OP
|
$32.76
|
|
| Hospital Charge Code |
2650178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$32.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.10
|
| Rate for Payer: Aetna of WY Medicare |
$21.62
|
| Rate for Payer: Altius Commercial |
$31.45
|
| Rate for Payer: Beech Street Commercial |
$32.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.78
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.78
|
| Rate for Payer: Cigna of WY Commercial |
$32.10
|
| Rate for Payer: Entrust Commercial |
$31.12
|
| Rate for Payer: First Choice Health Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.67
|
| Rate for Payer: HealthUtah PPO |
$32.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.78
|
| Rate for Payer: Multiplan Medicare/VA |
$17.74
|
| Rate for Payer: One Health Plan of WY PPO |
$32.10
|
| Rate for Payer: PacificSource Commercial |
$29.48
|
| Rate for Payer: PHCS PPO |
$32.10
|
| Rate for Payer: Three Rivers PPO |
$24.57
|
| Rate for Payer: TriWest Veterans Administration |
$18.67
|
| Rate for Payer: United Healthcare Commercial |
$31.29
|
| Rate for Payer: United Healthcare Medicare |
$18.67
|
| Rate for Payer: WINHealth Partners Commercial |
$32.10
|
| Rate for Payer: Wise Provider Network Commercial |
$31.12
|
|
|
DRAPE MAYO STAND
|
Facility
|
OP
|
$3.04
|
|
| Hospital Charge Code |
2650103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.98
|
| Rate for Payer: Aetna of WY Medicare |
$2.01
|
| Rate for Payer: Altius Commercial |
$2.92
|
| Rate for Payer: Beech Street Commercial |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.95
|
| Rate for Payer: Cigna of WY Commercial |
$2.98
|
| Rate for Payer: Entrust Commercial |
$2.89
|
| Rate for Payer: First Choice Health Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.73
|
| Rate for Payer: HealthUtah PPO |
$3.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2.98
|
| Rate for Payer: PacificSource Commercial |
$2.74
|
| Rate for Payer: PHCS PPO |
$2.98
|
| Rate for Payer: Three Rivers PPO |
$2.28
|
| Rate for Payer: TriWest Veterans Administration |
$1.73
|
| Rate for Payer: United Healthcare Commercial |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$1.73
|
| Rate for Payer: WINHealth Partners Commercial |
$2.98
|
| Rate for Payer: Wise Provider Network Commercial |
$2.89
|
|
|
DRAPE MAYO STAND
|
Facility
|
IP
|
$3.04
|
|
| Hospital Charge Code |
2650103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.98
|
| Rate for Payer: Aetna of WY Medicare |
$1.95
|
| Rate for Payer: Altius Commercial |
$2.92
|
| Rate for Payer: Beech Street Commercial |
$2.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.95
|
| Rate for Payer: Cigna of WY Commercial |
$2.98
|
| Rate for Payer: Entrust Commercial |
$2.89
|
| Rate for Payer: First Choice Health Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.85
|
| Rate for Payer: HealthUtah PPO |
$3.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.95
|
| Rate for Payer: Multiplan Medicare/VA |
$1.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2.98
|
| Rate for Payer: PacificSource Commercial |
$2.74
|
| Rate for Payer: PHCS PPO |
$2.98
|
| Rate for Payer: Three Rivers PPO |
$2.28
|
| Rate for Payer: TriWest Veterans Administration |
$1.85
|
| Rate for Payer: United Healthcare Commercial |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$1.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2.89
|
| Rate for Payer: Wise Provider Network Commercial |
$2.89
|
|
|
DRAPE MAYO XL 30X57
|
Facility
|
IP
|
$5.68
|
|
| Hospital Charge Code |
2650831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.57
|
| Rate for Payer: Aetna of WY Medicare |
$3.64
|
| Rate for Payer: Altius Commercial |
$5.45
|
| Rate for Payer: Beech Street Commercial |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$3.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.51
|
| Rate for Payer: Cigna of WY Commercial |
$5.57
|
| Rate for Payer: Entrust Commercial |
$5.40
|
| Rate for Payer: First Choice Health Commercial |
$5.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.46
|
| Rate for Payer: HealthUtah PPO |
$5.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.51
|
| Rate for Payer: Multiplan Medicare/VA |
$3.29
|
| Rate for Payer: One Health Plan of WY PPO |
$5.57
|
| Rate for Payer: PacificSource Commercial |
$5.11
|
| Rate for Payer: PHCS PPO |
$5.57
|
| Rate for Payer: Three Rivers PPO |
$4.26
|
| Rate for Payer: TriWest Veterans Administration |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$5.42
|
| Rate for Payer: United Healthcare Medicare |
$3.46
|
| Rate for Payer: WINHealth Partners Commercial |
$5.40
|
| Rate for Payer: Wise Provider Network Commercial |
$5.40
|
|
|
DRAPE MAYO XL 30X57
|
Facility
|
OP
|
$5.68
|
|
| Hospital Charge Code |
2650831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.57
|
| Rate for Payer: Aetna of WY Medicare |
$3.75
|
| Rate for Payer: Altius Commercial |
$5.45
|
| Rate for Payer: Beech Street Commercial |
$5.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$3.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.51
|
| Rate for Payer: Cigna of WY Commercial |
$5.57
|
| Rate for Payer: Entrust Commercial |
$5.40
|
| Rate for Payer: First Choice Health Commercial |
$5.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.24
|
| Rate for Payer: HealthUtah PPO |
$5.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.51
|
| Rate for Payer: Multiplan Medicare/VA |
$3.08
|
| Rate for Payer: One Health Plan of WY PPO |
$5.57
|
| Rate for Payer: PacificSource Commercial |
$5.11
|
| Rate for Payer: PHCS PPO |
$5.57
|
| Rate for Payer: Three Rivers PPO |
$4.26
|
| Rate for Payer: TriWest Veterans Administration |
$3.24
|
| Rate for Payer: United Healthcare Commercial |
$5.42
|
| Rate for Payer: United Healthcare Medicare |
$3.24
|
| Rate for Payer: WINHealth Partners Commercial |
$5.57
|
| Rate for Payer: Wise Provider Network Commercial |
$5.40
|
|
|
DRAPE MICROSCOPE ZEISS NC33
|
Facility
|
OP
|
$42.36
|
|
| Hospital Charge Code |
2650446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.51
|
| Rate for Payer: Aetna of WY Medicare |
$27.96
|
| Rate for Payer: Altius Commercial |
$40.67
|
| Rate for Payer: Beech Street Commercial |
$41.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.09
|
| Rate for Payer: Cash Price |
$29.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.09
|
| Rate for Payer: Cigna of WY Commercial |
$41.51
|
| Rate for Payer: Entrust Commercial |
$40.24
|
| Rate for Payer: First Choice Health Commercial |
$40.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.15
|
| Rate for Payer: HealthUtah PPO |
$42.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.09
|
| Rate for Payer: Multiplan Medicare/VA |
$22.94
|
| Rate for Payer: One Health Plan of WY PPO |
$41.51
|
| Rate for Payer: PacificSource Commercial |
$38.12
|
| Rate for Payer: PHCS PPO |
$41.51
|
| Rate for Payer: Three Rivers PPO |
$31.77
|
| Rate for Payer: TriWest Veterans Administration |
$24.15
|
| Rate for Payer: United Healthcare Commercial |
$40.45
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: WINHealth Partners Commercial |
$41.51
|
| Rate for Payer: Wise Provider Network Commercial |
$40.24
|
|
|
DRAPE MICROSCOPE ZEISS NC33
|
Facility
|
IP
|
$42.36
|
|
| Hospital Charge Code |
2650446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.51
|
| Rate for Payer: Aetna of WY Medicare |
$27.11
|
| Rate for Payer: Altius Commercial |
$40.67
|
| Rate for Payer: Beech Street Commercial |
$41.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.09
|
| Rate for Payer: Cash Price |
$29.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.09
|
| Rate for Payer: Cigna of WY Commercial |
$41.51
|
| Rate for Payer: Entrust Commercial |
$40.24
|
| Rate for Payer: First Choice Health Commercial |
$40.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.84
|
| Rate for Payer: HealthUtah PPO |
$42.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.09
|
| Rate for Payer: Multiplan Medicare/VA |
$24.55
|
| Rate for Payer: One Health Plan of WY PPO |
$41.51
|
| Rate for Payer: PacificSource Commercial |
$38.12
|
| Rate for Payer: PHCS PPO |
$41.51
|
| Rate for Payer: Three Rivers PPO |
$31.77
|
| Rate for Payer: TriWest Veterans Administration |
$25.84
|
| Rate for Payer: United Healthcare Commercial |
$40.45
|
| Rate for Payer: United Healthcare Medicare |
$25.84
|
| Rate for Payer: WINHealth Partners Commercial |
$40.24
|
| Rate for Payer: Wise Provider Network Commercial |
$40.24
|
|
|
DRAPE MICROSCOPE ZEISS OPMI
|
Facility
|
OP
|
$41.36
|
|
| Hospital Charge Code |
2650447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$41.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.53
|
| Rate for Payer: Aetna of WY Medicare |
$27.30
|
| Rate for Payer: Altius Commercial |
$39.71
|
| Rate for Payer: Beech Street Commercial |
$40.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.12
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.12
|
| Rate for Payer: Cigna of WY Commercial |
$40.53
|
| Rate for Payer: Entrust Commercial |
$39.29
|
| Rate for Payer: First Choice Health Commercial |
$39.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.58
|
| Rate for Payer: HealthUtah PPO |
$41.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.12
|
| Rate for Payer: Multiplan Medicare/VA |
$22.40
|
| Rate for Payer: One Health Plan of WY PPO |
$40.53
|
| Rate for Payer: PacificSource Commercial |
$37.22
|
| Rate for Payer: PHCS PPO |
$40.53
|
| Rate for Payer: Three Rivers PPO |
$31.02
|
| Rate for Payer: TriWest Veterans Administration |
$23.58
|
| Rate for Payer: United Healthcare Commercial |
$39.50
|
| Rate for Payer: United Healthcare Medicare |
$23.58
|
| Rate for Payer: WINHealth Partners Commercial |
$40.53
|
| Rate for Payer: Wise Provider Network Commercial |
$39.29
|
|
|
DRAPE MICROSCOPE ZEISS OPMI
|
Facility
|
IP
|
$41.36
|
|
| Hospital Charge Code |
2650447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$41.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.53
|
| Rate for Payer: Aetna of WY Medicare |
$26.47
|
| Rate for Payer: Altius Commercial |
$39.71
|
| Rate for Payer: Beech Street Commercial |
$40.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.12
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.12
|
| Rate for Payer: Cigna of WY Commercial |
$40.53
|
| Rate for Payer: Entrust Commercial |
$39.29
|
| Rate for Payer: First Choice Health Commercial |
$39.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.23
|
| Rate for Payer: HealthUtah PPO |
$41.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.12
|
| Rate for Payer: Multiplan Medicare/VA |
$23.97
|
| Rate for Payer: One Health Plan of WY PPO |
$40.53
|
| Rate for Payer: PacificSource Commercial |
$37.22
|
| Rate for Payer: PHCS PPO |
$40.53
|
| Rate for Payer: Three Rivers PPO |
$31.02
|
| Rate for Payer: TriWest Veterans Administration |
$25.23
|
| Rate for Payer: United Healthcare Commercial |
$39.50
|
| Rate for Payer: United Healthcare Medicare |
$25.23
|
| Rate for Payer: WINHealth Partners Commercial |
$39.29
|
| Rate for Payer: Wise Provider Network Commercial |
$39.29
|
|
|
DRAPE MICROSCOPE ZEISS TIVATO
|
Facility
|
IP
|
$135.10
|
|
| Hospital Charge Code |
2650961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$135.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.40
|
| Rate for Payer: Aetna of WY Medicare |
$86.46
|
| Rate for Payer: Altius Commercial |
$129.70
|
| Rate for Payer: Beech Street Commercial |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.05
|
| Rate for Payer: Cash Price |
$94.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.05
|
| Rate for Payer: Cigna of WY Commercial |
$132.40
|
| Rate for Payer: Entrust Commercial |
$128.34
|
| Rate for Payer: First Choice Health Commercial |
$128.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.41
|
| Rate for Payer: HealthUtah PPO |
$135.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.05
|
| Rate for Payer: Multiplan Medicare/VA |
$78.29
|
| Rate for Payer: One Health Plan of WY PPO |
$132.40
|
| Rate for Payer: PacificSource Commercial |
$121.59
|
| Rate for Payer: PHCS PPO |
$132.40
|
| Rate for Payer: Three Rivers PPO |
$101.32
|
| Rate for Payer: TriWest Veterans Administration |
$82.41
|
| Rate for Payer: United Healthcare Commercial |
$129.02
|
| Rate for Payer: United Healthcare Medicare |
$82.41
|
| Rate for Payer: WINHealth Partners Commercial |
$128.34
|
| Rate for Payer: Wise Provider Network Commercial |
$128.34
|
|
|
DRAPE MICROSCOPE ZEISS TIVATO
|
Facility
|
OP
|
$135.10
|
|
| Hospital Charge Code |
2650961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.16 |
| Max. Negotiated Rate |
$135.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.40
|
| Rate for Payer: Aetna of WY Medicare |
$89.17
|
| Rate for Payer: Altius Commercial |
$129.70
|
| Rate for Payer: Beech Street Commercial |
$132.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$131.05
|
| Rate for Payer: Cash Price |
$94.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$131.05
|
| Rate for Payer: Cigna of WY Commercial |
$132.40
|
| Rate for Payer: Entrust Commercial |
$128.34
|
| Rate for Payer: First Choice Health Commercial |
$128.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.01
|
| Rate for Payer: HealthUtah PPO |
$135.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$131.05
|
| Rate for Payer: Multiplan Medicare/VA |
$73.16
|
| Rate for Payer: One Health Plan of WY PPO |
$132.40
|
| Rate for Payer: PacificSource Commercial |
$121.59
|
| Rate for Payer: PHCS PPO |
$132.40
|
| Rate for Payer: Three Rivers PPO |
$101.32
|
| Rate for Payer: TriWest Veterans Administration |
$77.01
|
| Rate for Payer: United Healthcare Commercial |
$129.02
|
| Rate for Payer: United Healthcare Medicare |
$77.01
|
| Rate for Payer: WINHealth Partners Commercial |
$132.40
|
| Rate for Payer: Wise Provider Network Commercial |
$128.34
|
|
|
DRAPE MINOR PROCEDURE CERVICAL
|
Facility
|
OP
|
$18.61
|
|
| Hospital Charge Code |
2650959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.24
|
| Rate for Payer: Aetna of WY Medicare |
$12.28
|
| Rate for Payer: Altius Commercial |
$17.87
|
| Rate for Payer: Beech Street Commercial |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.05
|
| Rate for Payer: Cigna of WY Commercial |
$18.24
|
| Rate for Payer: Entrust Commercial |
$17.68
|
| Rate for Payer: First Choice Health Commercial |
$17.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.61
|
| Rate for Payer: HealthUtah PPO |
$18.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.05
|
| Rate for Payer: Multiplan Medicare/VA |
$10.08
|
| Rate for Payer: One Health Plan of WY PPO |
$18.24
|
| Rate for Payer: PacificSource Commercial |
$16.75
|
| Rate for Payer: PHCS PPO |
$18.24
|
| Rate for Payer: Three Rivers PPO |
$13.96
|
| Rate for Payer: TriWest Veterans Administration |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$17.77
|
| Rate for Payer: United Healthcare Medicare |
$10.61
|
| Rate for Payer: WINHealth Partners Commercial |
$18.24
|
| Rate for Payer: Wise Provider Network Commercial |
$17.68
|
|
|
DRAPE MINOR PROCEDURE CERVICAL
|
Facility
|
IP
|
$18.61
|
|
| Hospital Charge Code |
2650959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.24
|
| Rate for Payer: Aetna of WY Medicare |
$11.91
|
| Rate for Payer: Altius Commercial |
$17.87
|
| Rate for Payer: Beech Street Commercial |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.05
|
| Rate for Payer: Cigna of WY Commercial |
$18.24
|
| Rate for Payer: Entrust Commercial |
$17.68
|
| Rate for Payer: First Choice Health Commercial |
$17.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.35
|
| Rate for Payer: HealthUtah PPO |
$18.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.05
|
| Rate for Payer: Multiplan Medicare/VA |
$10.78
|
| Rate for Payer: One Health Plan of WY PPO |
$18.24
|
| Rate for Payer: PacificSource Commercial |
$16.75
|
| Rate for Payer: PHCS PPO |
$18.24
|
| Rate for Payer: Three Rivers PPO |
$13.96
|
| Rate for Payer: TriWest Veterans Administration |
$11.35
|
| Rate for Payer: United Healthcare Commercial |
$17.77
|
| Rate for Payer: United Healthcare Medicare |
$11.35
|
| Rate for Payer: WINHealth Partners Commercial |
$17.68
|
| Rate for Payer: Wise Provider Network Commercial |
$17.68
|
|
|
DRAPE OVERHEAD TABLE COVER
|
Facility
|
OP
|
$14.92
|
|
| Hospital Charge Code |
2650958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.62
|
| Rate for Payer: Aetna of WY Medicare |
$9.85
|
| Rate for Payer: Altius Commercial |
$14.32
|
| Rate for Payer: Beech Street Commercial |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.47
|
| Rate for Payer: Cigna of WY Commercial |
$14.62
|
| Rate for Payer: Entrust Commercial |
$14.17
|
| Rate for Payer: First Choice Health Commercial |
$14.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.50
|
| Rate for Payer: HealthUtah PPO |
$14.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.08
|
| Rate for Payer: One Health Plan of WY PPO |
$14.62
|
| Rate for Payer: PacificSource Commercial |
$13.43
|
| Rate for Payer: PHCS PPO |
$14.62
|
| Rate for Payer: Three Rivers PPO |
$11.19
|
| Rate for Payer: TriWest Veterans Administration |
$8.50
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$8.50
|
| Rate for Payer: WINHealth Partners Commercial |
$14.62
|
| Rate for Payer: Wise Provider Network Commercial |
$14.17
|
|
|
DRAPE OVERHEAD TABLE COVER
|
Facility
|
IP
|
$14.92
|
|
| Hospital Charge Code |
2650958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.62
|
| Rate for Payer: Aetna of WY Medicare |
$9.55
|
| Rate for Payer: Altius Commercial |
$14.32
|
| Rate for Payer: Beech Street Commercial |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.47
|
| Rate for Payer: Cigna of WY Commercial |
$14.62
|
| Rate for Payer: Entrust Commercial |
$14.17
|
| Rate for Payer: First Choice Health Commercial |
$14.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.10
|
| Rate for Payer: HealthUtah PPO |
$14.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.47
|
| Rate for Payer: Multiplan Medicare/VA |
$8.65
|
| Rate for Payer: One Health Plan of WY PPO |
$14.62
|
| Rate for Payer: PacificSource Commercial |
$13.43
|
| Rate for Payer: PHCS PPO |
$14.62
|
| Rate for Payer: Three Rivers PPO |
$11.19
|
| Rate for Payer: TriWest Veterans Administration |
$9.10
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$9.10
|
| Rate for Payer: WINHealth Partners Commercial |
$14.17
|
| Rate for Payer: Wise Provider Network Commercial |
$14.17
|
|
|
DRAPE POLY LINED TOWEL 18"X26"
|
Facility
|
IP
|
$0.69
|
|
| Hospital Charge Code |
2650916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.68
|
| Rate for Payer: Aetna of WY Medicare |
$0.44
|
| Rate for Payer: Altius Commercial |
$0.66
|
| Rate for Payer: Beech Street Commercial |
$0.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.67
|
| Rate for Payer: Cigna of WY Commercial |
$0.68
|
| Rate for Payer: Entrust Commercial |
$0.66
|
| Rate for Payer: First Choice Health Commercial |
$0.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.67
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.68
|
| Rate for Payer: PacificSource Commercial |
$0.62
|
| Rate for Payer: PHCS PPO |
$0.68
|
| Rate for Payer: Three Rivers PPO |
$0.52
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.66
|
| Rate for Payer: Wise Provider Network Commercial |
$0.66
|
|
|
DRAPE POLY LINED TOWEL 18"X26"
|
Facility
|
OP
|
$0.69
|
|
| Hospital Charge Code |
2650916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.68
|
| Rate for Payer: Aetna of WY Medicare |
$0.46
|
| Rate for Payer: Altius Commercial |
$0.66
|
| Rate for Payer: Beech Street Commercial |
$0.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.67
|
| Rate for Payer: Cigna of WY Commercial |
$0.68
|
| Rate for Payer: Entrust Commercial |
$0.66
|
| Rate for Payer: First Choice Health Commercial |
$0.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.69
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.67
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.68
|
| Rate for Payer: PacificSource Commercial |
$0.62
|
| Rate for Payer: PHCS PPO |
$0.68
|
| Rate for Payer: Three Rivers PPO |
$0.52
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.68
|
| Rate for Payer: Wise Provider Network Commercial |
$0.66
|
|
|
DRAPE SHOULDER BEACH CHAIR
|
Facility
|
OP
|
$68.99
|
|
| Hospital Charge Code |
2650356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.36 |
| Max. Negotiated Rate |
$68.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.61
|
| Rate for Payer: Aetna of WY Medicare |
$45.53
|
| Rate for Payer: Altius Commercial |
$66.23
|
| Rate for Payer: Beech Street Commercial |
$67.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.92
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.92
|
| Rate for Payer: Cigna of WY Commercial |
$67.61
|
| Rate for Payer: Entrust Commercial |
$65.54
|
| Rate for Payer: First Choice Health Commercial |
$65.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.32
|
| Rate for Payer: HealthUtah PPO |
$68.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.92
|
| Rate for Payer: Multiplan Medicare/VA |
$37.36
|
| Rate for Payer: One Health Plan of WY PPO |
$67.61
|
| Rate for Payer: PacificSource Commercial |
$62.09
|
| Rate for Payer: PHCS PPO |
$67.61
|
| Rate for Payer: Three Rivers PPO |
$51.74
|
| Rate for Payer: TriWest Veterans Administration |
$39.32
|
| Rate for Payer: United Healthcare Commercial |
$65.89
|
| Rate for Payer: United Healthcare Medicare |
$39.32
|
| Rate for Payer: WINHealth Partners Commercial |
$67.61
|
| Rate for Payer: Wise Provider Network Commercial |
$65.54
|
|
|
DRAPE SHOULDER BEACH CHAIR
|
Facility
|
IP
|
$68.99
|
|
| Hospital Charge Code |
2650356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$68.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.61
|
| Rate for Payer: Aetna of WY Medicare |
$44.15
|
| Rate for Payer: Altius Commercial |
$66.23
|
| Rate for Payer: Beech Street Commercial |
$67.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.92
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.92
|
| Rate for Payer: Cigna of WY Commercial |
$67.61
|
| Rate for Payer: Entrust Commercial |
$65.54
|
| Rate for Payer: First Choice Health Commercial |
$65.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.08
|
| Rate for Payer: HealthUtah PPO |
$68.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.92
|
| Rate for Payer: Multiplan Medicare/VA |
$39.98
|
| Rate for Payer: One Health Plan of WY PPO |
$67.61
|
| Rate for Payer: PacificSource Commercial |
$62.09
|
| Rate for Payer: PHCS PPO |
$67.61
|
| Rate for Payer: Three Rivers PPO |
$51.74
|
| Rate for Payer: TriWest Veterans Administration |
$42.08
|
| Rate for Payer: United Healthcare Commercial |
$65.89
|
| Rate for Payer: United Healthcare Medicare |
$42.08
|
| Rate for Payer: WINHealth Partners Commercial |
$65.54
|
| Rate for Payer: Wise Provider Network Commercial |
$65.54
|
|
|
DRAPE SPLIT SHEET EENT
|
Facility
|
IP
|
$16.13
|
|
| Hospital Charge Code |
2650105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$16.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.81
|
| Rate for Payer: Aetna of WY Medicare |
$10.32
|
| Rate for Payer: Altius Commercial |
$15.48
|
| Rate for Payer: Beech Street Commercial |
$15.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.65
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.65
|
| Rate for Payer: Cigna of WY Commercial |
$15.81
|
| Rate for Payer: Entrust Commercial |
$15.32
|
| Rate for Payer: First Choice Health Commercial |
$15.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.84
|
| Rate for Payer: HealthUtah PPO |
$16.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.35
|
| Rate for Payer: One Health Plan of WY PPO |
$15.81
|
| Rate for Payer: PacificSource Commercial |
$14.52
|
| Rate for Payer: PHCS PPO |
$15.81
|
| Rate for Payer: Three Rivers PPO |
$12.10
|
| Rate for Payer: TriWest Veterans Administration |
$9.84
|
| Rate for Payer: United Healthcare Commercial |
$15.40
|
| Rate for Payer: United Healthcare Medicare |
$9.84
|
| Rate for Payer: WINHealth Partners Commercial |
$15.32
|
| Rate for Payer: Wise Provider Network Commercial |
$15.32
|
|
|
DRAPE SPLIT SHEET EENT
|
Facility
|
OP
|
$16.13
|
|
| Hospital Charge Code |
2650105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$16.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.81
|
| Rate for Payer: Aetna of WY Medicare |
$10.65
|
| Rate for Payer: Altius Commercial |
$15.48
|
| Rate for Payer: Beech Street Commercial |
$15.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.65
|
| Rate for Payer: Cash Price |
$11.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.65
|
| Rate for Payer: Cigna of WY Commercial |
$15.81
|
| Rate for Payer: Entrust Commercial |
$15.32
|
| Rate for Payer: First Choice Health Commercial |
$15.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.19
|
| Rate for Payer: HealthUtah PPO |
$16.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.65
|
| Rate for Payer: Multiplan Medicare/VA |
$8.73
|
| Rate for Payer: One Health Plan of WY PPO |
$15.81
|
| Rate for Payer: PacificSource Commercial |
$14.52
|
| Rate for Payer: PHCS PPO |
$15.81
|
| Rate for Payer: Three Rivers PPO |
$12.10
|
| Rate for Payer: TriWest Veterans Administration |
$9.19
|
| Rate for Payer: United Healthcare Commercial |
$15.40
|
| Rate for Payer: United Healthcare Medicare |
$9.19
|
| Rate for Payer: WINHealth Partners Commercial |
$15.81
|
| Rate for Payer: Wise Provider Network Commercial |
$15.32
|
|
|
DRAPE SURG IOBAN 6617 3M
|
Facility
|
IP
|
$58.84
|
|
| Hospital Charge Code |
2650106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.66
|
| Rate for Payer: Aetna of WY Medicare |
$37.66
|
| Rate for Payer: Altius Commercial |
$56.49
|
| Rate for Payer: Beech Street Commercial |
$57.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.66
|
| Rate for Payer: Entrust Commercial |
$55.90
|
| Rate for Payer: First Choice Health Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$58.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.10
|
| Rate for Payer: One Health Plan of WY PPO |
$57.66
|
| Rate for Payer: PacificSource Commercial |
$52.96
|
| Rate for Payer: PHCS PPO |
$57.66
|
| Rate for Payer: Three Rivers PPO |
$44.13
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$56.19
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$55.90
|
| Rate for Payer: Wise Provider Network Commercial |
$55.90
|
|
|
DRAPE SURG IOBAN 6617 3M
|
Facility
|
OP
|
$58.84
|
|
| Hospital Charge Code |
2650106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$58.84 |
| Rate for Payer: United Healthcare Commercial |
$56.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.66
|
| Rate for Payer: Aetna of WY Medicare |
$38.83
|
| Rate for Payer: Altius Commercial |
$56.49
|
| Rate for Payer: Beech Street Commercial |
$57.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.07
|
| Rate for Payer: Cash Price |
$41.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.07
|
| Rate for Payer: Cigna of WY Commercial |
$57.66
|
| Rate for Payer: Entrust Commercial |
$55.90
|
| Rate for Payer: First Choice Health Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.54
|
| Rate for Payer: HealthUtah PPO |
$58.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.07
|
| Rate for Payer: Multiplan Medicare/VA |
$31.86
|
| Rate for Payer: One Health Plan of WY PPO |
$57.66
|
| Rate for Payer: PacificSource Commercial |
$52.96
|
| Rate for Payer: PHCS PPO |
$57.66
|
| Rate for Payer: Three Rivers PPO |
$44.13
|
| Rate for Payer: TriWest Veterans Administration |
$33.54
|
| Rate for Payer: United Healthcare Medicare |
$33.54
|
| Rate for Payer: WINHealth Partners Commercial |
$57.66
|
| Rate for Payer: Wise Provider Network Commercial |
$55.90
|
|
|
DRAPE SWITCH SPIDER2 ARM
|
Facility
|
OP
|
$132.30
|
|
| Hospital Charge Code |
3002184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.65
|
| Rate for Payer: Aetna of WY Medicare |
$87.32
|
| Rate for Payer: Altius Commercial |
$127.01
|
| Rate for Payer: Beech Street Commercial |
$129.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.33
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.33
|
| Rate for Payer: Cigna of WY Commercial |
$129.65
|
| Rate for Payer: Entrust Commercial |
$125.68
|
| Rate for Payer: First Choice Health Commercial |
$125.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.41
|
| Rate for Payer: HealthUtah PPO |
$132.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.33
|
| Rate for Payer: Multiplan Medicare/VA |
$71.64
|
| Rate for Payer: One Health Plan of WY PPO |
$129.65
|
| Rate for Payer: PacificSource Commercial |
$119.07
|
| Rate for Payer: PHCS PPO |
$129.65
|
| Rate for Payer: Three Rivers PPO |
$99.22
|
| Rate for Payer: TriWest Veterans Administration |
$75.41
|
| Rate for Payer: United Healthcare Commercial |
$126.35
|
| Rate for Payer: United Healthcare Medicare |
$75.41
|
| Rate for Payer: WINHealth Partners Commercial |
$129.65
|
| Rate for Payer: Wise Provider Network Commercial |
$125.68
|
|
