|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [46141]
|
Facility
|
IP
|
$34.81
|
|
|
Service Code
|
NDC 4928154758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.42
|
| Rate for Payer: Altius Commercial |
$33.42
|
| Rate for Payer: Beech Street Commercial |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.58
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.77
|
| Rate for Payer: Cigna of WY Commercial |
$34.11
|
| Rate for Payer: Entrust Commercial |
$33.07
|
| Rate for Payer: First Choice Health Commercial |
$33.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.97
|
| Rate for Payer: HealthUtah PPO |
$34.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.77
|
| Rate for Payer: Multiplan Medicare/VA |
$21.83
|
| Rate for Payer: One Health Plan of WY PPO |
$34.11
|
| Rate for Payer: PacificSource Commercial |
$31.33
|
| Rate for Payer: PHCS PPO |
$34.11
|
| Rate for Payer: Three Rivers PPO |
$26.11
|
| Rate for Payer: TriWest Veterans Administration |
$22.97
|
| Rate for Payer: United Healthcare Commercial |
$30.28
|
| Rate for Payer: United Healthcare Medicare |
$22.97
|
| Rate for Payer: WINHealth Partners Commercial |
$33.07
|
| Rate for Payer: Wise Provider Network Commercial |
$33.07
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [46141]
|
Facility
|
OP
|
$37.24
|
|
|
Service Code
|
NDC 5816081603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.50
|
| Rate for Payer: Aetna of WY Medicare |
$24.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.75
|
| Rate for Payer: Altius Commercial |
$35.75
|
| Rate for Payer: Beech Street Commercial |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.57
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.12
|
| Rate for Payer: Cigna of WY Commercial |
$36.50
|
| Rate for Payer: Entrust Commercial |
$35.38
|
| Rate for Payer: First Choice Health Commercial |
$35.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.60
|
| Rate for Payer: HealthUtah PPO |
$37.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.12
|
| Rate for Payer: Multiplan Medicare/VA |
$20.52
|
| Rate for Payer: One Health Plan of WY PPO |
$36.50
|
| Rate for Payer: PacificSource Commercial |
$33.52
|
| Rate for Payer: PHCS PPO |
$36.50
|
| Rate for Payer: Three Rivers PPO |
$27.93
|
| Rate for Payer: TriWest Veterans Administration |
$21.60
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Medicare |
$21.60
|
| Rate for Payer: WINHealth Partners Commercial |
$36.50
|
| Rate for Payer: Wise Provider Network Commercial |
$35.38
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [46141]
|
Facility
|
OP
|
$34.81
|
|
|
Service Code
|
NDC 4928154758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$34.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.11
|
| Rate for Payer: Aetna of WY Medicare |
$22.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.42
|
| Rate for Payer: Altius Commercial |
$33.42
|
| Rate for Payer: Beech Street Commercial |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.58
|
| Rate for Payer: Cash Price |
$24.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.77
|
| Rate for Payer: Cigna of WY Commercial |
$34.11
|
| Rate for Payer: Entrust Commercial |
$33.07
|
| Rate for Payer: First Choice Health Commercial |
$33.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.19
|
| Rate for Payer: HealthUtah PPO |
$34.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.77
|
| Rate for Payer: Multiplan Medicare/VA |
$19.18
|
| Rate for Payer: One Health Plan of WY PPO |
$34.11
|
| Rate for Payer: PacificSource Commercial |
$31.33
|
| Rate for Payer: PHCS PPO |
$34.11
|
| Rate for Payer: Three Rivers PPO |
$26.11
|
| Rate for Payer: TriWest Veterans Administration |
$20.19
|
| Rate for Payer: United Healthcare Commercial |
$30.28
|
| Rate for Payer: United Healthcare Medicare |
$20.19
|
| Rate for Payer: WINHealth Partners Commercial |
$34.11
|
| Rate for Payer: Wise Provider Network Commercial |
$33.07
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [46141]
|
Facility
|
IP
|
$37.24
|
|
|
Service Code
|
NDC 5816081603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$35.75
|
| Rate for Payer: Altius Commercial |
$35.75
|
| Rate for Payer: Beech Street Commercial |
$36.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.57
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.12
|
| Rate for Payer: Cigna of WY Commercial |
$36.50
|
| Rate for Payer: Entrust Commercial |
$35.38
|
| Rate for Payer: First Choice Health Commercial |
$35.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.58
|
| Rate for Payer: HealthUtah PPO |
$37.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.12
|
| Rate for Payer: Multiplan Medicare/VA |
$23.35
|
| Rate for Payer: One Health Plan of WY PPO |
$36.50
|
| Rate for Payer: PacificSource Commercial |
$33.52
|
| Rate for Payer: PHCS PPO |
$36.50
|
| Rate for Payer: Three Rivers PPO |
$27.93
|
| Rate for Payer: TriWest Veterans Administration |
$24.58
|
| Rate for Payer: United Healthcare Commercial |
$32.40
|
| Rate for Payer: United Healthcare Medicare |
$24.58
|
| Rate for Payer: WINHealth Partners Commercial |
$35.38
|
| Rate for Payer: Wise Provider Network Commercial |
$35.38
|
|
|
HALLUS-VALGUS NT DYN PRE OTS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS L3100
|
| Hospital Charge Code |
L3100
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$51.42
|
| Rate for Payer: Beech Street Commercial |
$71.25
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: First Choice Health Commercial |
$67.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.42
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$43.71
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$71.25
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$51.42
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$51.42
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
|
|
HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 28289 80
|
| Hospital Charge Code |
28289
|
| Min. Negotiated Rate |
$383.29 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,327.50
|
| Rate for Payer: Aetna of WY Medicare |
$450.93
|
| Rate for Payer: Beech Street Commercial |
$2,256.25
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,303.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,327.50
|
| Rate for Payer: First Choice Health Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,256.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.93
|
| Rate for Payer: HealthUtah PPO |
$2,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,303.75
|
| Rate for Payer: Multiplan Medicare/VA |
$383.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,327.50
|
| Rate for Payer: PacificSource Commercial |
$2,137.50
|
| Rate for Payer: PHCS PPO |
$2,256.25
|
| Rate for Payer: Three Rivers PPO |
$1,781.25
|
| Rate for Payer: TriWest Veterans Administration |
$450.93
|
| Rate for Payer: United Healthcare Commercial |
$2,066.25
|
| Rate for Payer: United Healthcare Medicare |
$450.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,018.75
|
|
|
HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
28289
|
| Min. Negotiated Rate |
$383.29 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,327.50
|
| Rate for Payer: Aetna of WY Medicare |
$450.93
|
| Rate for Payer: Beech Street Commercial |
$2,256.25
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,303.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,327.50
|
| Rate for Payer: First Choice Health Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,256.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.93
|
| Rate for Payer: HealthUtah PPO |
$2,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,303.75
|
| Rate for Payer: Multiplan Medicare/VA |
$383.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,327.50
|
| Rate for Payer: PacificSource Commercial |
$2,137.50
|
| Rate for Payer: PHCS PPO |
$2,256.25
|
| Rate for Payer: Three Rivers PPO |
$1,781.25
|
| Rate for Payer: TriWest Veterans Administration |
$450.93
|
| Rate for Payer: United Healthcare Commercial |
$2,066.25
|
| Rate for Payer: United Healthcare Medicare |
$450.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,018.75
|
|
|
HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 28289 AS
|
| Hospital Charge Code |
28289
|
| Min. Negotiated Rate |
$383.29 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,327.50
|
| Rate for Payer: Aetna of WY Medicare |
$450.93
|
| Rate for Payer: Beech Street Commercial |
$2,256.25
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: Cash Price |
$1,662.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,303.75
|
| Rate for Payer: Cigna of WY Commercial |
$2,327.50
|
| Rate for Payer: First Choice Health Commercial |
$2,137.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,256.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.93
|
| Rate for Payer: HealthUtah PPO |
$2,375.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,303.75
|
| Rate for Payer: Multiplan Medicare/VA |
$383.29
|
| Rate for Payer: One Health Plan of WY PPO |
$2,327.50
|
| Rate for Payer: PacificSource Commercial |
$2,137.50
|
| Rate for Payer: PHCS PPO |
$2,256.25
|
| Rate for Payer: Three Rivers PPO |
$1,781.25
|
| Rate for Payer: TriWest Veterans Administration |
$450.93
|
| Rate for Payer: United Healthcare Commercial |
$2,066.25
|
| Rate for Payer: United Healthcare Medicare |
$450.93
|
| Rate for Payer: WINHealth Partners Commercial |
$2,018.75
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [16079]
|
Facility
|
OP
|
$18.52
|
|
|
Service Code
|
HCPCS J1630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.15
|
| Rate for Payer: Aetna of WY Medicare |
$12.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.78
|
| Rate for Payer: Altius Commercial |
$17.78
|
| Rate for Payer: Beech Street Commercial |
$18.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.96
|
| Rate for Payer: Cigna of WY Commercial |
$18.15
|
| Rate for Payer: Entrust Commercial |
$17.59
|
| Rate for Payer: First Choice Health Commercial |
$17.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.74
|
| Rate for Payer: HealthUtah PPO |
$18.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.96
|
| Rate for Payer: Multiplan Medicare/VA |
$10.20
|
| Rate for Payer: One Health Plan of WY PPO |
$18.15
|
| Rate for Payer: PacificSource Commercial |
$16.67
|
| Rate for Payer: PHCS PPO |
$18.15
|
| Rate for Payer: Three Rivers PPO |
$13.89
|
| Rate for Payer: TriWest Veterans Administration |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$16.11
|
| Rate for Payer: United Healthcare Medicare |
$10.74
|
| Rate for Payer: WINHealth Partners Commercial |
$18.15
|
| Rate for Payer: Wise Provider Network Commercial |
$17.59
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [16079]
|
Facility
|
IP
|
$18.52
|
|
|
Service Code
|
HCPCS J1630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.78
|
| Rate for Payer: Altius Commercial |
$17.78
|
| Rate for Payer: Beech Street Commercial |
$18.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.96
|
| Rate for Payer: Cigna of WY Commercial |
$18.15
|
| Rate for Payer: Entrust Commercial |
$17.59
|
| Rate for Payer: First Choice Health Commercial |
$17.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.22
|
| Rate for Payer: HealthUtah PPO |
$18.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.96
|
| Rate for Payer: Multiplan Medicare/VA |
$11.61
|
| Rate for Payer: One Health Plan of WY PPO |
$18.15
|
| Rate for Payer: PacificSource Commercial |
$16.67
|
| Rate for Payer: PHCS PPO |
$18.15
|
| Rate for Payer: Three Rivers PPO |
$13.89
|
| Rate for Payer: TriWest Veterans Administration |
$12.22
|
| Rate for Payer: United Healthcare Commercial |
$16.11
|
| Rate for Payer: United Healthcare Medicare |
$12.22
|
| Rate for Payer: WINHealth Partners Commercial |
$17.59
|
| Rate for Payer: Wise Provider Network Commercial |
$17.59
|
|
|
HAMILTON G5 ADULT CIRCUIT ER
|
Facility
|
IP
|
$18.51
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.77
|
| Rate for Payer: Altius Commercial |
$17.77
|
| Rate for Payer: Beech Street Commercial |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.95
|
| Rate for Payer: Cigna of WY Commercial |
$18.14
|
| Rate for Payer: Entrust Commercial |
$17.58
|
| Rate for Payer: First Choice Health Commercial |
$17.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.22
|
| Rate for Payer: HealthUtah PPO |
$18.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.95
|
| Rate for Payer: Multiplan Medicare/VA |
$11.61
|
| Rate for Payer: One Health Plan of WY PPO |
$18.14
|
| Rate for Payer: PacificSource Commercial |
$16.66
|
| Rate for Payer: PHCS PPO |
$18.14
|
| Rate for Payer: Three Rivers PPO |
$13.88
|
| Rate for Payer: TriWest Veterans Administration |
$12.22
|
| Rate for Payer: United Healthcare Commercial |
$16.10
|
| Rate for Payer: United Healthcare Medicare |
$12.22
|
| Rate for Payer: WINHealth Partners Commercial |
$17.58
|
| Rate for Payer: Wise Provider Network Commercial |
$17.58
|
|
|
HAMILTON G5 ADULT CIRCUIT ER
|
Facility
|
OP
|
$18.51
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.14
|
| Rate for Payer: Aetna of WY Medicare |
$12.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.77
|
| Rate for Payer: Altius Commercial |
$17.77
|
| Rate for Payer: Beech Street Commercial |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.95
|
| Rate for Payer: Cigna of WY Commercial |
$18.14
|
| Rate for Payer: Entrust Commercial |
$17.58
|
| Rate for Payer: First Choice Health Commercial |
$17.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.74
|
| Rate for Payer: HealthUtah PPO |
$18.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.95
|
| Rate for Payer: Multiplan Medicare/VA |
$10.20
|
| Rate for Payer: One Health Plan of WY PPO |
$18.14
|
| Rate for Payer: PacificSource Commercial |
$16.66
|
| Rate for Payer: PHCS PPO |
$18.14
|
| Rate for Payer: Three Rivers PPO |
$13.88
|
| Rate for Payer: TriWest Veterans Administration |
$10.74
|
| Rate for Payer: United Healthcare Commercial |
$16.10
|
| Rate for Payer: United Healthcare Medicare |
$10.74
|
| Rate for Payer: WINHealth Partners Commercial |
$18.14
|
| Rate for Payer: Wise Provider Network Commercial |
$17.58
|
|
|
HAMILTON T1 CIRCUIT ADULT & EXP VALVE
|
Facility
|
IP
|
$201.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.53 |
| Max. Negotiated Rate |
$201.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$193.74
|
| Rate for Payer: Altius Commercial |
$193.74
|
| Rate for Payer: Beech Street Commercial |
$197.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.69
|
| Rate for Payer: Cash Price |
$141.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.76
|
| Rate for Payer: Cigna of WY Commercial |
$197.77
|
| Rate for Payer: Entrust Commercial |
$191.72
|
| Rate for Payer: First Choice Health Commercial |
$191.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.19
|
| Rate for Payer: HealthUtah PPO |
$201.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.76
|
| Rate for Payer: Multiplan Medicare/VA |
$126.53
|
| Rate for Payer: One Health Plan of WY PPO |
$197.77
|
| Rate for Payer: PacificSource Commercial |
$181.63
|
| Rate for Payer: PHCS PPO |
$197.77
|
| Rate for Payer: Three Rivers PPO |
$151.36
|
| Rate for Payer: TriWest Veterans Administration |
$133.19
|
| Rate for Payer: United Healthcare Commercial |
$175.57
|
| Rate for Payer: United Healthcare Medicare |
$133.19
|
| Rate for Payer: WINHealth Partners Commercial |
$191.72
|
| Rate for Payer: Wise Provider Network Commercial |
$191.72
|
|
|
HAMILTON T1 CIRCUIT ADULT & EXP VALVE
|
Facility
|
OP
|
$201.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$201.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.77
|
| Rate for Payer: Aetna of WY Medicare |
$133.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$193.74
|
| Rate for Payer: Altius Commercial |
$193.74
|
| Rate for Payer: Beech Street Commercial |
$197.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$165.69
|
| Rate for Payer: Cash Price |
$141.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.76
|
| Rate for Payer: Cigna of WY Commercial |
$197.77
|
| Rate for Payer: Entrust Commercial |
$191.72
|
| Rate for Payer: First Choice Health Commercial |
$191.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.05
|
| Rate for Payer: HealthUtah PPO |
$201.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.76
|
| Rate for Payer: Multiplan Medicare/VA |
$111.20
|
| Rate for Payer: One Health Plan of WY PPO |
$197.77
|
| Rate for Payer: PacificSource Commercial |
$181.63
|
| Rate for Payer: PHCS PPO |
$197.77
|
| Rate for Payer: Three Rivers PPO |
$151.36
|
| Rate for Payer: TriWest Veterans Administration |
$117.05
|
| Rate for Payer: United Healthcare Commercial |
$175.57
|
| Rate for Payer: United Healthcare Medicare |
$117.05
|
| Rate for Payer: WINHealth Partners Commercial |
$197.77
|
| Rate for Payer: Wise Provider Network Commercial |
$191.72
|
|
|
HAMILTON T1 NEONATAL CIRCUIT
|
Facility
|
OP
|
$217.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$119.78 |
| Max. Negotiated Rate |
$217.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.03
|
| Rate for Payer: Aetna of WY Medicare |
$143.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.68
|
| Rate for Payer: Altius Commercial |
$208.68
|
| Rate for Payer: Beech Street Commercial |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.47
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.86
|
| Rate for Payer: Cigna of WY Commercial |
$213.03
|
| Rate for Payer: Entrust Commercial |
$206.51
|
| Rate for Payer: First Choice Health Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.08
|
| Rate for Payer: HealthUtah PPO |
$217.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.86
|
| Rate for Payer: Multiplan Medicare/VA |
$119.78
|
| Rate for Payer: One Health Plan of WY PPO |
$213.03
|
| Rate for Payer: PacificSource Commercial |
$195.64
|
| Rate for Payer: PHCS PPO |
$213.03
|
| Rate for Payer: Three Rivers PPO |
$163.04
|
| Rate for Payer: TriWest Veterans Administration |
$126.08
|
| Rate for Payer: United Healthcare Commercial |
$189.12
|
| Rate for Payer: United Healthcare Medicare |
$126.08
|
| Rate for Payer: WINHealth Partners Commercial |
$213.03
|
| Rate for Payer: Wise Provider Network Commercial |
$206.51
|
|
|
HAMILTON T1 NEONATAL CIRCUIT
|
Facility
|
IP
|
$217.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.30 |
| Max. Negotiated Rate |
$217.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$213.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.68
|
| Rate for Payer: Altius Commercial |
$208.68
|
| Rate for Payer: Beech Street Commercial |
$213.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.47
|
| Rate for Payer: Cash Price |
$152.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.86
|
| Rate for Payer: Cigna of WY Commercial |
$213.03
|
| Rate for Payer: Entrust Commercial |
$206.51
|
| Rate for Payer: First Choice Health Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.47
|
| Rate for Payer: HealthUtah PPO |
$217.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.86
|
| Rate for Payer: Multiplan Medicare/VA |
$136.30
|
| Rate for Payer: One Health Plan of WY PPO |
$213.03
|
| Rate for Payer: PacificSource Commercial |
$195.64
|
| Rate for Payer: PHCS PPO |
$213.03
|
| Rate for Payer: Three Rivers PPO |
$163.04
|
| Rate for Payer: TriWest Veterans Administration |
$143.47
|
| Rate for Payer: United Healthcare Commercial |
$189.12
|
| Rate for Payer: United Healthcare Medicare |
$143.47
|
| Rate for Payer: WINHealth Partners Commercial |
$206.51
|
| Rate for Payer: Wise Provider Network Commercial |
$206.51
|
|
|
HANA PERINEAL PAD SUPINE
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.40
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.62
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.90
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$197.50
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$207.90
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$207.90
|
| Rate for Payer: WINHealth Partners Commercial |
$299.25
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
HANA PERINEAL PAD SUPINE
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.70
|
| Rate for Payer: Aetna of WY Medicare |
$207.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$302.40
|
| Rate for Payer: Altius Commercial |
$302.40
|
| Rate for Payer: Beech Street Commercial |
$308.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$258.62
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.55
|
| Rate for Payer: Cigna of WY Commercial |
$308.70
|
| Rate for Payer: Entrust Commercial |
$299.25
|
| Rate for Payer: First Choice Health Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.70
|
| Rate for Payer: HealthUtah PPO |
$315.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.55
|
| Rate for Payer: Multiplan Medicare/VA |
$173.56
|
| Rate for Payer: One Health Plan of WY PPO |
$308.70
|
| Rate for Payer: PacificSource Commercial |
$283.50
|
| Rate for Payer: PHCS PPO |
$308.70
|
| Rate for Payer: Three Rivers PPO |
$236.25
|
| Rate for Payer: TriWest Veterans Administration |
$182.70
|
| Rate for Payer: United Healthcare Commercial |
$274.05
|
| Rate for Payer: United Healthcare Medicare |
$182.70
|
| Rate for Payer: WINHealth Partners Commercial |
$308.70
|
| Rate for Payer: Wise Provider Network Commercial |
$299.25
|
|
|
HAND-HELD PEFR METER
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS A4614
|
| Hospital Charge Code |
A4614
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Beech Street Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: First Choice Health Commercial |
$35.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$37.05
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
|
|
HAND/WRIST INTERNAL BRACE KIT
|
Facility
|
IP
|
$6,111.56
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,831.95 |
| Max. Negotiated Rate |
$6,111.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,989.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,867.10
|
| Rate for Payer: Altius Commercial |
$5,867.10
|
| Rate for Payer: Beech Street Commercial |
$5,989.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,017.59
|
| Rate for Payer: Cash Price |
$4,278.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,928.21
|
| Rate for Payer: Cigna of WY Commercial |
$5,989.33
|
| Rate for Payer: Entrust Commercial |
$5,805.98
|
| Rate for Payer: First Choice Health Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,033.63
|
| Rate for Payer: HealthUtah PPO |
$6,111.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,928.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3,831.95
|
| Rate for Payer: One Health Plan of WY PPO |
$5,989.33
|
| Rate for Payer: PacificSource Commercial |
$5,500.40
|
| Rate for Payer: PHCS PPO |
$5,989.33
|
| Rate for Payer: Three Rivers PPO |
$4,583.67
|
| Rate for Payer: TriWest Veterans Administration |
$4,033.63
|
| Rate for Payer: United Healthcare Commercial |
$5,317.06
|
| Rate for Payer: United Healthcare Medicare |
$4,033.63
|
| Rate for Payer: WINHealth Partners Commercial |
$5,805.98
|
| Rate for Payer: Wise Provider Network Commercial |
$5,805.98
|
|
|
HAND/WRIST INTERNAL BRACE KIT
|
Facility
|
OP
|
$6,111.56
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,367.47 |
| Max. Negotiated Rate |
$6,111.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,989.33
|
| Rate for Payer: Aetna of WY Medicare |
$4,033.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5,867.10
|
| Rate for Payer: Altius Commercial |
$5,867.10
|
| Rate for Payer: Beech Street Commercial |
$5,989.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,017.59
|
| Rate for Payer: Cash Price |
$4,278.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,928.21
|
| Rate for Payer: Cigna of WY Commercial |
$5,989.33
|
| Rate for Payer: Entrust Commercial |
$5,805.98
|
| Rate for Payer: First Choice Health Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,805.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,544.70
|
| Rate for Payer: HealthUtah PPO |
$6,111.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,928.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3,367.47
|
| Rate for Payer: One Health Plan of WY PPO |
$5,989.33
|
| Rate for Payer: PacificSource Commercial |
$5,500.40
|
| Rate for Payer: PHCS PPO |
$5,989.33
|
| Rate for Payer: Three Rivers PPO |
$4,583.67
|
| Rate for Payer: TriWest Veterans Administration |
$3,544.70
|
| Rate for Payer: United Healthcare Commercial |
$5,317.06
|
| Rate for Payer: United Healthcare Medicare |
$3,544.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,989.33
|
| Rate for Payer: Wise Provider Network Commercial |
$5,805.98
|
|
|
HANGING CAST SLING LARGE
|
Facility
|
OP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.56
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.93
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$12.56
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$12.56
|
| Rate for Payer: WINHealth Partners Commercial |
$21.23
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HANGING CAST SLING LARGE
|
Facility
|
IP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.30
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$13.58
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HANGING CAST SLING MEDIUM
|
Facility
|
IP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.30
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$13.58
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.58
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
|
HANGING CAST SLING MEDIUM
|
Facility
|
OP
|
$21.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.23
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.79
|
| Rate for Payer: Altius Commercial |
$20.79
|
| Rate for Payer: Beech Street Commercial |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.78
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.01
|
| Rate for Payer: Cigna of WY Commercial |
$21.23
|
| Rate for Payer: Entrust Commercial |
$20.58
|
| Rate for Payer: First Choice Health Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.56
|
| Rate for Payer: HealthUtah PPO |
$21.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.93
|
| Rate for Payer: One Health Plan of WY PPO |
$21.23
|
| Rate for Payer: PacificSource Commercial |
$19.49
|
| Rate for Payer: PHCS PPO |
$21.23
|
| Rate for Payer: Three Rivers PPO |
$16.24
|
| Rate for Payer: TriWest Veterans Administration |
$12.56
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$12.56
|
| Rate for Payer: WINHealth Partners Commercial |
$21.23
|
| Rate for Payer: Wise Provider Network Commercial |
$20.58
|
|
