|
EYE SPEAR STERILE 400101
|
Facility
|
IP
|
$10.37
|
|
| Hospital Charge Code |
2650904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.16
|
| Rate for Payer: Aetna of WY Medicare |
$6.64
|
| Rate for Payer: Altius Commercial |
$9.96
|
| Rate for Payer: Beech Street Commercial |
$10.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.06
|
| Rate for Payer: Cash Price |
$7.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.06
|
| Rate for Payer: Cigna of WY Commercial |
$10.16
|
| Rate for Payer: Entrust Commercial |
$9.85
|
| Rate for Payer: First Choice Health Commercial |
$9.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.33
|
| Rate for Payer: HealthUtah PPO |
$10.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.06
|
| Rate for Payer: Multiplan Medicare/VA |
$6.01
|
| Rate for Payer: One Health Plan of WY PPO |
$10.16
|
| Rate for Payer: PacificSource Commercial |
$9.33
|
| Rate for Payer: PHCS PPO |
$10.16
|
| Rate for Payer: Three Rivers PPO |
$7.78
|
| Rate for Payer: TriWest Veterans Administration |
$6.33
|
| Rate for Payer: United Healthcare Commercial |
$9.90
|
| Rate for Payer: United Healthcare Medicare |
$6.33
|
| Rate for Payer: WINHealth Partners Commercial |
$9.85
|
| Rate for Payer: Wise Provider Network Commercial |
$9.85
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
IP
|
$16.13
|
|
|
Service Code
|
NDC 5965105230
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
OP
|
$16.13
|
|
|
Service Code
|
NDC 5965105230
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
IP
|
$33.74
|
|
|
Service Code
|
NDC 5965105290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.07
|
| Rate for Payer: Aetna of WY Medicare |
$21.59
|
| Rate for Payer: Altius Commercial |
$32.39
|
| Rate for Payer: Beech Street Commercial |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.73
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.73
|
| Rate for Payer: Cigna of WY Commercial |
$33.07
|
| Rate for Payer: Entrust Commercial |
$32.05
|
| Rate for Payer: First Choice Health Commercial |
$32.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.58
|
| Rate for Payer: HealthUtah PPO |
$33.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.73
|
| Rate for Payer: Multiplan Medicare/VA |
$19.55
|
| Rate for Payer: One Health Plan of WY PPO |
$33.07
|
| Rate for Payer: PacificSource Commercial |
$30.37
|
| Rate for Payer: PHCS PPO |
$33.07
|
| Rate for Payer: Three Rivers PPO |
$25.30
|
| Rate for Payer: TriWest Veterans Administration |
$20.58
|
| Rate for Payer: United Healthcare Commercial |
$32.22
|
| Rate for Payer: United Healthcare Medicare |
$20.58
|
| Rate for Payer: WINHealth Partners Commercial |
$32.05
|
| Rate for Payer: Wise Provider Network Commercial |
$32.05
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
IP
|
$16.09
|
|
|
Service Code
|
NDC 5026829811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.77
|
| Rate for Payer: Aetna of WY Medicare |
$10.30
|
| Rate for Payer: Altius Commercial |
$15.45
|
| Rate for Payer: Beech Street Commercial |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.61
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.61
|
| Rate for Payer: Cigna of WY Commercial |
$15.77
|
| Rate for Payer: Entrust Commercial |
$15.29
|
| Rate for Payer: First Choice Health Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
| Rate for Payer: HealthUtah PPO |
$16.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.61
|
| Rate for Payer: Multiplan Medicare/VA |
$9.32
|
| Rate for Payer: One Health Plan of WY PPO |
$15.77
|
| Rate for Payer: PacificSource Commercial |
$14.48
|
| Rate for Payer: PHCS PPO |
$15.77
|
| Rate for Payer: Three Rivers PPO |
$12.07
|
| Rate for Payer: TriWest Veterans Administration |
$9.81
|
| Rate for Payer: United Healthcare Commercial |
$15.37
|
| Rate for Payer: United Healthcare Medicare |
$9.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.29
|
| Rate for Payer: Wise Provider Network Commercial |
$15.29
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
OP
|
$16.09
|
|
|
Service Code
|
NDC 5026829811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$16.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.77
|
| Rate for Payer: Aetna of WY Medicare |
$10.62
|
| Rate for Payer: Altius Commercial |
$15.45
|
| Rate for Payer: Beech Street Commercial |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.61
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.61
|
| Rate for Payer: Cigna of WY Commercial |
$15.77
|
| Rate for Payer: Entrust Commercial |
$15.29
|
| Rate for Payer: First Choice Health Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.17
|
| Rate for Payer: HealthUtah PPO |
$16.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.61
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.77
|
| Rate for Payer: PacificSource Commercial |
$14.48
|
| Rate for Payer: PHCS PPO |
$15.77
|
| Rate for Payer: Three Rivers PPO |
$12.07
|
| Rate for Payer: TriWest Veterans Administration |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$15.37
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
| Rate for Payer: WINHealth Partners Commercial |
$15.77
|
| Rate for Payer: Wise Provider Network Commercial |
$15.29
|
|
|
EZETIMIBE 10 MG TABLET [26493]
|
Facility
|
OP
|
$33.74
|
|
|
Service Code
|
NDC 5965105290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.07
|
| Rate for Payer: Aetna of WY Medicare |
$22.27
|
| Rate for Payer: Altius Commercial |
$32.39
|
| Rate for Payer: Beech Street Commercial |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.73
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.73
|
| Rate for Payer: Cigna of WY Commercial |
$33.07
|
| Rate for Payer: Entrust Commercial |
$32.05
|
| Rate for Payer: First Choice Health Commercial |
$32.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.23
|
| Rate for Payer: HealthUtah PPO |
$33.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.73
|
| Rate for Payer: Multiplan Medicare/VA |
$18.27
|
| Rate for Payer: One Health Plan of WY PPO |
$33.07
|
| Rate for Payer: PacificSource Commercial |
$30.37
|
| Rate for Payer: PHCS PPO |
$33.07
|
| Rate for Payer: Three Rivers PPO |
$25.30
|
| Rate for Payer: TriWest Veterans Administration |
$19.23
|
| Rate for Payer: United Healthcare Commercial |
$32.22
|
| Rate for Payer: United Healthcare Medicare |
$19.23
|
| Rate for Payer: WINHealth Partners Commercial |
$33.07
|
| Rate for Payer: Wise Provider Network Commercial |
$32.05
|
|
|
F15 LEAD IMPLANT KIT
|
Facility
|
OP
|
$1,207.50
|
|
| Hospital Charge Code |
3004585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.86 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$796.95
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,171.28
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$688.28
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$653.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$688.28
|
| Rate for Payer: United Healthcare Commercial |
$1,153.16
|
| Rate for Payer: United Healthcare Medicare |
$688.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,183.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
F15 LEAD IMPLANT KIT
|
Facility
|
IP
|
$1,207.50
|
|
| Hospital Charge Code |
3004585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.75 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,183.35
|
| Rate for Payer: Aetna of WY Medicare |
$772.80
|
| Rate for Payer: Altius Commercial |
$1,159.20
|
| Rate for Payer: Beech Street Commercial |
$1,183.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,171.28
|
| Rate for Payer: Cash Price |
$845.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,171.28
|
| Rate for Payer: Cigna of WY Commercial |
$1,183.35
|
| Rate for Payer: Entrust Commercial |
$1,147.12
|
| Rate for Payer: First Choice Health Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,147.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$736.58
|
| Rate for Payer: HealthUtah PPO |
$1,207.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,171.28
|
| Rate for Payer: Multiplan Medicare/VA |
$699.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1,183.35
|
| Rate for Payer: PacificSource Commercial |
$1,086.75
|
| Rate for Payer: PHCS PPO |
$1,183.35
|
| Rate for Payer: Three Rivers PPO |
$905.62
|
| Rate for Payer: TriWest Veterans Administration |
$736.58
|
| Rate for Payer: United Healthcare Commercial |
$1,153.16
|
| Rate for Payer: United Healthcare Medicare |
$736.58
|
| Rate for Payer: WINHealth Partners Commercial |
$1,147.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,147.12
|
|
|
F15 NEUROSTIMULATOR
|
Facility
|
IP
|
$40,778.50
|
|
| Hospital Charge Code |
3004582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,631.14 |
| Max. Negotiated Rate |
$40,778.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39,962.93
|
| Rate for Payer: Aetna of WY Medicare |
$26,098.24
|
| Rate for Payer: Altius Commercial |
$39,147.36
|
| Rate for Payer: Beech Street Commercial |
$39,962.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39,555.14
|
| Rate for Payer: Cash Price |
$28,544.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$39,555.14
|
| Rate for Payer: Cigna of WY Commercial |
$39,962.93
|
| Rate for Payer: Entrust Commercial |
$38,739.58
|
| Rate for Payer: First Choice Health Commercial |
$38,739.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38,739.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24,874.88
|
| Rate for Payer: HealthUtah PPO |
$40,778.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39,555.14
|
| Rate for Payer: Multiplan Medicare/VA |
$23,631.14
|
| Rate for Payer: One Health Plan of WY PPO |
$39,962.93
|
| Rate for Payer: PacificSource Commercial |
$36,700.65
|
| Rate for Payer: PHCS PPO |
$39,962.93
|
| Rate for Payer: Three Rivers PPO |
$30,583.88
|
| Rate for Payer: TriWest Veterans Administration |
$24,874.88
|
| Rate for Payer: United Healthcare Commercial |
$38,943.47
|
| Rate for Payer: United Healthcare Medicare |
$24,874.88
|
| Rate for Payer: WINHealth Partners Commercial |
$38,739.58
|
| Rate for Payer: Wise Provider Network Commercial |
$38,739.58
|
|
|
F15 NEUROSTIMULATOR
|
Facility
|
OP
|
$40,778.50
|
|
| Hospital Charge Code |
3004582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,081.56 |
| Max. Negotiated Rate |
$40,778.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39,962.93
|
| Rate for Payer: Aetna of WY Medicare |
$26,913.81
|
| Rate for Payer: Altius Commercial |
$39,147.36
|
| Rate for Payer: Beech Street Commercial |
$39,962.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39,555.14
|
| Rate for Payer: Cash Price |
$28,544.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$39,555.14
|
| Rate for Payer: Cigna of WY Commercial |
$39,962.93
|
| Rate for Payer: Entrust Commercial |
$38,739.58
|
| Rate for Payer: First Choice Health Commercial |
$38,739.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38,739.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23,243.74
|
| Rate for Payer: HealthUtah PPO |
$40,778.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39,555.14
|
| Rate for Payer: Multiplan Medicare/VA |
$22,081.56
|
| Rate for Payer: One Health Plan of WY PPO |
$39,962.93
|
| Rate for Payer: PacificSource Commercial |
$36,700.65
|
| Rate for Payer: PHCS PPO |
$39,962.93
|
| Rate for Payer: Three Rivers PPO |
$30,583.88
|
| Rate for Payer: TriWest Veterans Administration |
$23,243.74
|
| Rate for Payer: United Healthcare Commercial |
$38,943.47
|
| Rate for Payer: United Healthcare Medicare |
$23,243.74
|
| Rate for Payer: WINHealth Partners Commercial |
$39,962.93
|
| Rate for Payer: Wise Provider Network Commercial |
$38,739.58
|
|
|
F15 REMOTE CONTROL
|
Facility
|
IP
|
$2,950.50
|
|
| Hospital Charge Code |
3004584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,709.81 |
| Max. Negotiated Rate |
$2,950.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,891.49
|
| Rate for Payer: Aetna of WY Medicare |
$1,888.32
|
| Rate for Payer: Altius Commercial |
$2,832.48
|
| Rate for Payer: Beech Street Commercial |
$2,891.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,861.98
|
| Rate for Payer: Cash Price |
$2,065.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,861.98
|
| Rate for Payer: Cigna of WY Commercial |
$2,891.49
|
| Rate for Payer: Entrust Commercial |
$2,802.98
|
| Rate for Payer: First Choice Health Commercial |
$2,802.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,802.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,799.80
|
| Rate for Payer: HealthUtah PPO |
$2,950.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,861.98
|
| Rate for Payer: Multiplan Medicare/VA |
$1,709.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,891.49
|
| Rate for Payer: PacificSource Commercial |
$2,655.45
|
| Rate for Payer: PHCS PPO |
$2,891.49
|
| Rate for Payer: Three Rivers PPO |
$2,212.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,799.80
|
| Rate for Payer: United Healthcare Commercial |
$2,817.73
|
| Rate for Payer: United Healthcare Medicare |
$1,799.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,802.98
|
| Rate for Payer: Wise Provider Network Commercial |
$2,802.98
|
|
|
F15 REMOTE CONTROL
|
Facility
|
OP
|
$2,950.50
|
|
| Hospital Charge Code |
3004584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,597.70 |
| Max. Negotiated Rate |
$2,950.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,891.49
|
| Rate for Payer: Aetna of WY Medicare |
$1,947.33
|
| Rate for Payer: Altius Commercial |
$2,832.48
|
| Rate for Payer: Beech Street Commercial |
$2,891.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,861.98
|
| Rate for Payer: Cash Price |
$2,065.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,861.98
|
| Rate for Payer: Cigna of WY Commercial |
$2,891.49
|
| Rate for Payer: Entrust Commercial |
$2,802.98
|
| Rate for Payer: First Choice Health Commercial |
$2,802.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,802.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,681.78
|
| Rate for Payer: HealthUtah PPO |
$2,950.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,861.98
|
| Rate for Payer: Multiplan Medicare/VA |
$1,597.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,891.49
|
| Rate for Payer: PacificSource Commercial |
$2,655.45
|
| Rate for Payer: PHCS PPO |
$2,891.49
|
| Rate for Payer: Three Rivers PPO |
$2,212.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,681.78
|
| Rate for Payer: United Healthcare Commercial |
$2,817.73
|
| Rate for Payer: United Healthcare Medicare |
$1,681.78
|
| Rate for Payer: WINHealth Partners Commercial |
$2,891.49
|
| Rate for Payer: Wise Provider Network Commercial |
$2,802.98
|
|
|
F15 TINED LEAD KIT
|
Facility
|
OP
|
$11,728.50
|
|
| Hospital Charge Code |
3004583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,350.98 |
| Max. Negotiated Rate |
$11,728.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,493.93
|
| Rate for Payer: Aetna of WY Medicare |
$7,740.81
|
| Rate for Payer: Altius Commercial |
$11,259.36
|
| Rate for Payer: Beech Street Commercial |
$11,493.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,376.64
|
| Rate for Payer: Cash Price |
$8,209.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,376.64
|
| Rate for Payer: Cigna of WY Commercial |
$11,493.93
|
| Rate for Payer: Entrust Commercial |
$11,142.08
|
| Rate for Payer: First Choice Health Commercial |
$11,142.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,142.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6,685.24
|
| Rate for Payer: HealthUtah PPO |
$11,728.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,376.64
|
| Rate for Payer: Multiplan Medicare/VA |
$6,350.98
|
| Rate for Payer: One Health Plan of WY PPO |
$11,493.93
|
| Rate for Payer: PacificSource Commercial |
$10,555.65
|
| Rate for Payer: PHCS PPO |
$11,493.93
|
| Rate for Payer: Three Rivers PPO |
$8,796.38
|
| Rate for Payer: TriWest Veterans Administration |
$6,685.24
|
| Rate for Payer: United Healthcare Commercial |
$11,200.72
|
| Rate for Payer: United Healthcare Medicare |
$6,685.24
|
| Rate for Payer: WINHealth Partners Commercial |
$11,493.93
|
| Rate for Payer: Wise Provider Network Commercial |
$11,142.08
|
|
|
F15 TINED LEAD KIT
|
Facility
|
IP
|
$11,728.50
|
|
| Hospital Charge Code |
3004583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,796.67 |
| Max. Negotiated Rate |
$11,728.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11,493.93
|
| Rate for Payer: Aetna of WY Medicare |
$7,506.24
|
| Rate for Payer: Altius Commercial |
$11,259.36
|
| Rate for Payer: Beech Street Commercial |
$11,493.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,376.64
|
| Rate for Payer: Cash Price |
$8,209.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$11,376.64
|
| Rate for Payer: Cigna of WY Commercial |
$11,493.93
|
| Rate for Payer: Entrust Commercial |
$11,142.08
|
| Rate for Payer: First Choice Health Commercial |
$11,142.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11,142.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,154.38
|
| Rate for Payer: HealthUtah PPO |
$11,728.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11,376.64
|
| Rate for Payer: Multiplan Medicare/VA |
$6,796.67
|
| Rate for Payer: One Health Plan of WY PPO |
$11,493.93
|
| Rate for Payer: PacificSource Commercial |
$10,555.65
|
| Rate for Payer: PHCS PPO |
$11,493.93
|
| Rate for Payer: Three Rivers PPO |
$8,796.38
|
| Rate for Payer: TriWest Veterans Administration |
$7,154.38
|
| Rate for Payer: United Healthcare Commercial |
$11,200.72
|
| Rate for Payer: United Healthcare Medicare |
$7,154.38
|
| Rate for Payer: WINHealth Partners Commercial |
$11,142.08
|
| Rate for Payer: Wise Provider Network Commercial |
$11,142.08
|
|
|
FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$319.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$95.01
|
| Rate for Payer: Beech Street Commercial |
$303.05
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.43
|
| Rate for Payer: Cigna of WY Commercial |
$312.62
|
| Rate for Payer: First Choice Health Commercial |
$287.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.01
|
| Rate for Payer: HealthUtah PPO |
$319.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Multiplan Medicare/VA |
$80.76
|
| Rate for Payer: One Health Plan of WY PPO |
$312.62
|
| Rate for Payer: PacificSource Commercial |
$287.10
|
| Rate for Payer: PHCS PPO |
$303.05
|
| Rate for Payer: Three Rivers PPO |
$239.25
|
| Rate for Payer: TriWest Veterans Administration |
$95.01
|
| Rate for Payer: United Healthcare Commercial |
$303.05
|
| Rate for Payer: WINHealth Partners Commercial |
$303.05
|
|
|
FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$403.00
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$394.94
|
| Rate for Payer: Aetna of WY Medicare |
$99.27
|
| Rate for Payer: Beech Street Commercial |
$382.85
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: Cash Price |
$282.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$390.91
|
| Rate for Payer: Cigna of WY Commercial |
$394.94
|
| Rate for Payer: First Choice Health Commercial |
$362.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$382.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.27
|
| Rate for Payer: HealthUtah PPO |
$403.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$390.91
|
| Rate for Payer: Multiplan Medicare/VA |
$84.38
|
| Rate for Payer: One Health Plan of WY PPO |
$394.94
|
| Rate for Payer: PacificSource Commercial |
$362.70
|
| Rate for Payer: PHCS PPO |
$382.85
|
| Rate for Payer: Three Rivers PPO |
$302.25
|
| Rate for Payer: TriWest Veterans Administration |
$99.27
|
| Rate for Payer: United Healthcare Commercial |
$382.85
|
| Rate for Payer: WINHealth Partners Commercial |
$382.85
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 0904719361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.99
|
| Rate for Payer: Aetna of WY Medicare |
$10.10
|
| Rate for Payer: Altius Commercial |
$14.69
|
| Rate for Payer: Beech Street Commercial |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.84
|
| Rate for Payer: Cigna of WY Commercial |
$14.99
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.72
|
| Rate for Payer: HealthUtah PPO |
$15.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.99
|
| Rate for Payer: PacificSource Commercial |
$13.77
|
| Rate for Payer: PHCS PPO |
$14.99
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$14.61
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.99
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$15.34
|
|
|
Service Code
|
NDC 5026829911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$15.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.03
|
| Rate for Payer: Aetna of WY Medicare |
$9.82
|
| Rate for Payer: Altius Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.88
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.88
|
| Rate for Payer: Cigna of WY Commercial |
$15.03
|
| Rate for Payer: Entrust Commercial |
$14.57
|
| Rate for Payer: First Choice Health Commercial |
$14.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.36
|
| Rate for Payer: HealthUtah PPO |
$15.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.88
|
| Rate for Payer: Multiplan Medicare/VA |
$8.89
|
| Rate for Payer: One Health Plan of WY PPO |
$15.03
|
| Rate for Payer: PacificSource Commercial |
$13.81
|
| Rate for Payer: PHCS PPO |
$15.03
|
| Rate for Payer: Three Rivers PPO |
$11.50
|
| Rate for Payer: TriWest Veterans Administration |
$9.36
|
| Rate for Payer: United Healthcare Commercial |
$14.65
|
| Rate for Payer: United Healthcare Medicare |
$9.36
|
| Rate for Payer: WINHealth Partners Commercial |
$14.57
|
| Rate for Payer: Wise Provider Network Commercial |
$14.57
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$15.56
|
|
|
Service Code
|
NDC 6373964510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.25
|
| Rate for Payer: Aetna of WY Medicare |
$9.96
|
| Rate for Payer: Altius Commercial |
$14.94
|
| Rate for Payer: Beech Street Commercial |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.09
|
| Rate for Payer: Cigna of WY Commercial |
$15.25
|
| Rate for Payer: Entrust Commercial |
$14.78
|
| Rate for Payer: First Choice Health Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$15.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.09
|
| Rate for Payer: Multiplan Medicare/VA |
$9.02
|
| Rate for Payer: One Health Plan of WY PPO |
$15.25
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.25
|
| Rate for Payer: Three Rivers PPO |
$11.67
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$14.78
|
| Rate for Payer: Wise Provider Network Commercial |
$14.78
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 0904719361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.99
|
| Rate for Payer: Aetna of WY Medicare |
$9.79
|
| Rate for Payer: Altius Commercial |
$14.69
|
| Rate for Payer: Beech Street Commercial |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.84
|
| Rate for Payer: Cigna of WY Commercial |
$14.99
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.33
|
| Rate for Payer: HealthUtah PPO |
$15.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| Rate for Payer: One Health Plan of WY PPO |
$14.99
|
| Rate for Payer: PacificSource Commercial |
$13.77
|
| Rate for Payer: PHCS PPO |
$14.99
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$9.33
|
| Rate for Payer: United Healthcare Commercial |
$14.61
|
| Rate for Payer: United Healthcare Medicare |
$9.33
|
| Rate for Payer: WINHealth Partners Commercial |
$14.54
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$15.34
|
|
|
Service Code
|
NDC 5026829911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$15.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.03
|
| Rate for Payer: Aetna of WY Medicare |
$10.12
|
| Rate for Payer: Altius Commercial |
$14.73
|
| Rate for Payer: Beech Street Commercial |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.88
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.88
|
| Rate for Payer: Cigna of WY Commercial |
$15.03
|
| Rate for Payer: Entrust Commercial |
$14.57
|
| Rate for Payer: First Choice Health Commercial |
$14.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.57
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.74
|
| Rate for Payer: HealthUtah PPO |
$15.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.88
|
| Rate for Payer: Multiplan Medicare/VA |
$8.31
|
| Rate for Payer: One Health Plan of WY PPO |
$15.03
|
| Rate for Payer: PacificSource Commercial |
$13.81
|
| Rate for Payer: PHCS PPO |
$15.03
|
| Rate for Payer: Three Rivers PPO |
$11.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$14.65
|
| Rate for Payer: United Healthcare Medicare |
$8.74
|
| Rate for Payer: WINHealth Partners Commercial |
$15.03
|
| Rate for Payer: Wise Provider Network Commercial |
$14.57
|
|
|
FAMOTIDINE 20 MG TABLET [10173]
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 6373964510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.25
|
| Rate for Payer: Aetna of WY Medicare |
$10.27
|
| Rate for Payer: Altius Commercial |
$14.94
|
| Rate for Payer: Beech Street Commercial |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.09
|
| Rate for Payer: Cigna of WY Commercial |
$15.25
|
| Rate for Payer: Entrust Commercial |
$14.78
|
| Rate for Payer: First Choice Health Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.87
|
| Rate for Payer: HealthUtah PPO |
$15.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.09
|
| Rate for Payer: Multiplan Medicare/VA |
$8.43
|
| Rate for Payer: One Health Plan of WY PPO |
$15.25
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.25
|
| Rate for Payer: Three Rivers PPO |
$11.67
|
| Rate for Payer: TriWest Veterans Administration |
$8.87
|
| Rate for Payer: United Healthcare Commercial |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$8.87
|
| Rate for Payer: WINHealth Partners Commercial |
$15.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.78
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6332373912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$10.75
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION [45658]
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
NDC 6332373911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.46
|
| Rate for Payer: Aetna of WY Medicare |
$10.75
|
| Rate for Payer: Altius Commercial |
$16.13
|
| Rate for Payer: Beech Street Commercial |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.30
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.30
|
| Rate for Payer: Cigna of WY Commercial |
$16.46
|
| Rate for Payer: Entrust Commercial |
$15.96
|
| Rate for Payer: First Choice Health Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$16.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$16.46
|
| Rate for Payer: PacificSource Commercial |
$15.12
|
| Rate for Payer: PHCS PPO |
$16.46
|
| Rate for Payer: Three Rivers PPO |
$12.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$16.04
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$15.96
|
| Rate for Payer: Wise Provider Network Commercial |
$15.96
|
|
