|
FINGER TRAP, MED, YELLOW
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
3000211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.88
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$45.49
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.88
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
FINGER TRAP, MED, YELLOW
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
3000211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$53.76
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$48.68
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$51.24
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
FINGER TRAP XTRA LG GREEN
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
3000209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.68 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$53.76
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$48.68
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$51.24
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$51.24
|
| Rate for Payer: WINHealth Partners Commercial |
$79.80
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
FINGER TRAP XTRA LG GREEN
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
3000209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$55.44
|
| Rate for Payer: Altius Commercial |
$80.64
|
| Rate for Payer: Beech Street Commercial |
$82.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$81.48
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: Entrust Commercial |
$79.80
|
| Rate for Payer: First Choice Health Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.88
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$45.49
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$82.32
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$47.88
|
| Rate for Payer: United Healthcare Commercial |
$80.22
|
| Rate for Payer: United Healthcare Medicare |
$47.88
|
| Rate for Payer: WINHealth Partners Commercial |
$82.32
|
| Rate for Payer: Wise Provider Network Commercial |
$79.80
|
|
|
FISKARS PT SCISSORS
|
Facility
|
OP
|
$36.23
|
|
| Hospital Charge Code |
2250169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.51
|
| Rate for Payer: Aetna of WY Medicare |
$23.91
|
| Rate for Payer: Altius Commercial |
$34.78
|
| Rate for Payer: Beech Street Commercial |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.14
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.14
|
| Rate for Payer: Cigna of WY Commercial |
$35.51
|
| Rate for Payer: Entrust Commercial |
$34.42
|
| Rate for Payer: First Choice Health Commercial |
$34.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.65
|
| Rate for Payer: HealthUtah PPO |
$36.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.14
|
| Rate for Payer: Multiplan Medicare/VA |
$19.62
|
| Rate for Payer: One Health Plan of WY PPO |
$35.51
|
| Rate for Payer: PacificSource Commercial |
$32.61
|
| Rate for Payer: PHCS PPO |
$35.51
|
| Rate for Payer: Three Rivers PPO |
$27.17
|
| Rate for Payer: TriWest Veterans Administration |
$20.65
|
| Rate for Payer: United Healthcare Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicare |
$20.65
|
| Rate for Payer: WINHealth Partners Commercial |
$35.51
|
| Rate for Payer: Wise Provider Network Commercial |
$34.42
|
|
|
FISKARS PT SCISSORS
|
Facility
|
IP
|
$36.23
|
|
| Hospital Charge Code |
2250169
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.51
|
| Rate for Payer: Aetna of WY Medicare |
$23.19
|
| Rate for Payer: Altius Commercial |
$34.78
|
| Rate for Payer: Beech Street Commercial |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.14
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.14
|
| Rate for Payer: Cigna of WY Commercial |
$35.51
|
| Rate for Payer: Entrust Commercial |
$34.42
|
| Rate for Payer: First Choice Health Commercial |
$34.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.10
|
| Rate for Payer: HealthUtah PPO |
$36.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.14
|
| Rate for Payer: Multiplan Medicare/VA |
$21.00
|
| Rate for Payer: One Health Plan of WY PPO |
$35.51
|
| Rate for Payer: PacificSource Commercial |
$32.61
|
| Rate for Payer: PHCS PPO |
$35.51
|
| Rate for Payer: Three Rivers PPO |
$27.17
|
| Rate for Payer: TriWest Veterans Administration |
$22.10
|
| Rate for Payer: United Healthcare Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicare |
$22.10
|
| Rate for Payer: WINHealth Partners Commercial |
$34.42
|
| Rate for Payer: Wise Provider Network Commercial |
$34.42
|
|
|
FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$5,575.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$281.13 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,463.50
|
| Rate for Payer: Aetna of WY Medicare |
$330.74
|
| Rate for Payer: Beech Street Commercial |
$5,296.25
|
| Rate for Payer: Cash Price |
$3,902.50
|
| Rate for Payer: Cash Price |
$3,902.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,407.75
|
| Rate for Payer: Cigna of WY Commercial |
$5,463.50
|
| Rate for Payer: First Choice Health Commercial |
$5,017.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,296.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$330.74
|
| Rate for Payer: HealthUtah PPO |
$5,575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,407.75
|
| Rate for Payer: Multiplan Medicare/VA |
$281.13
|
| Rate for Payer: One Health Plan of WY PPO |
$5,463.50
|
| Rate for Payer: PacificSource Commercial |
$5,017.50
|
| Rate for Payer: PHCS PPO |
$5,296.25
|
| Rate for Payer: Three Rivers PPO |
$4,181.25
|
| Rate for Payer: TriWest Veterans Administration |
$330.74
|
| Rate for Payer: United Healthcare Commercial |
$5,296.25
|
| Rate for Payer: WINHealth Partners Commercial |
$4,738.75
|
|
|
FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.00
|
| Rate for Payer: Aetna of WY Medicare |
$43.66
|
| Rate for Payer: Beech Street Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.00
|
| Rate for Payer: Cigna of WY Commercial |
$196.00
|
| Rate for Payer: First Choice Health Commercial |
$180.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.66
|
| Rate for Payer: HealthUtah PPO |
$200.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.00
|
| Rate for Payer: Multiplan Medicare/VA |
$37.11
|
| Rate for Payer: One Health Plan of WY PPO |
$196.00
|
| Rate for Payer: PacificSource Commercial |
$180.00
|
| Rate for Payer: PHCS PPO |
$190.00
|
| Rate for Payer: Three Rivers PPO |
$150.00
|
| Rate for Payer: TriWest Veterans Administration |
$43.66
|
| Rate for Payer: United Healthcare Commercial |
$190.00
|
| Rate for Payer: WINHealth Partners Commercial |
$170.00
|
|
|
FIT TEST KIT BITREX
|
Facility
|
IP
|
$458.32
|
|
| Hospital Charge Code |
2100033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$449.15
|
| Rate for Payer: Aetna of WY Medicare |
$293.32
|
| Rate for Payer: Altius Commercial |
$439.99
|
| Rate for Payer: Beech Street Commercial |
$449.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$444.57
|
| Rate for Payer: Cash Price |
$320.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.57
|
| Rate for Payer: Cigna of WY Commercial |
$449.15
|
| Rate for Payer: Entrust Commercial |
$435.40
|
| Rate for Payer: First Choice Health Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$279.58
|
| Rate for Payer: HealthUtah PPO |
$458.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.57
|
| Rate for Payer: Multiplan Medicare/VA |
$265.60
|
| Rate for Payer: One Health Plan of WY PPO |
$449.15
|
| Rate for Payer: PacificSource Commercial |
$412.49
|
| Rate for Payer: PHCS PPO |
$449.15
|
| Rate for Payer: Three Rivers PPO |
$343.74
|
| Rate for Payer: TriWest Veterans Administration |
$279.58
|
| Rate for Payer: United Healthcare Commercial |
$437.70
|
| Rate for Payer: United Healthcare Medicare |
$279.58
|
| Rate for Payer: WINHealth Partners Commercial |
$435.40
|
| Rate for Payer: Wise Provider Network Commercial |
$435.40
|
|
|
FIT TEST KIT BITREX
|
Facility
|
OP
|
$458.32
|
|
| Hospital Charge Code |
2100033
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$449.15
|
| Rate for Payer: Aetna of WY Medicare |
$302.49
|
| Rate for Payer: Altius Commercial |
$439.99
|
| Rate for Payer: Beech Street Commercial |
$449.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$444.57
|
| Rate for Payer: Cash Price |
$320.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.57
|
| Rate for Payer: Cigna of WY Commercial |
$449.15
|
| Rate for Payer: Entrust Commercial |
$435.40
|
| Rate for Payer: First Choice Health Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.24
|
| Rate for Payer: HealthUtah PPO |
$458.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.57
|
| Rate for Payer: Multiplan Medicare/VA |
$248.18
|
| Rate for Payer: One Health Plan of WY PPO |
$449.15
|
| Rate for Payer: PacificSource Commercial |
$412.49
|
| Rate for Payer: PHCS PPO |
$449.15
|
| Rate for Payer: Three Rivers PPO |
$343.74
|
| Rate for Payer: TriWest Veterans Administration |
$261.24
|
| Rate for Payer: United Healthcare Commercial |
$437.70
|
| Rate for Payer: United Healthcare Medicare |
$261.24
|
| Rate for Payer: WINHealth Partners Commercial |
$449.15
|
| Rate for Payer: Wise Provider Network Commercial |
$435.40
|
|
|
FIT TEST KIT SACCHARIN
|
Facility
|
IP
|
$458.32
|
|
| Hospital Charge Code |
2100032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.60 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$449.15
|
| Rate for Payer: Aetna of WY Medicare |
$293.32
|
| Rate for Payer: Altius Commercial |
$439.99
|
| Rate for Payer: Beech Street Commercial |
$449.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$444.57
|
| Rate for Payer: Cash Price |
$320.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.57
|
| Rate for Payer: Cigna of WY Commercial |
$449.15
|
| Rate for Payer: Entrust Commercial |
$435.40
|
| Rate for Payer: First Choice Health Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$279.58
|
| Rate for Payer: HealthUtah PPO |
$458.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.57
|
| Rate for Payer: Multiplan Medicare/VA |
$265.60
|
| Rate for Payer: One Health Plan of WY PPO |
$449.15
|
| Rate for Payer: PacificSource Commercial |
$412.49
|
| Rate for Payer: PHCS PPO |
$449.15
|
| Rate for Payer: Three Rivers PPO |
$343.74
|
| Rate for Payer: TriWest Veterans Administration |
$279.58
|
| Rate for Payer: United Healthcare Commercial |
$437.70
|
| Rate for Payer: United Healthcare Medicare |
$279.58
|
| Rate for Payer: WINHealth Partners Commercial |
$435.40
|
| Rate for Payer: Wise Provider Network Commercial |
$435.40
|
|
|
FIT TEST KIT SACCHARIN
|
Facility
|
OP
|
$458.32
|
|
| Hospital Charge Code |
2100032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$458.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$449.15
|
| Rate for Payer: Aetna of WY Medicare |
$302.49
|
| Rate for Payer: Altius Commercial |
$439.99
|
| Rate for Payer: Beech Street Commercial |
$449.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$444.57
|
| Rate for Payer: Cash Price |
$320.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$444.57
|
| Rate for Payer: Cigna of WY Commercial |
$449.15
|
| Rate for Payer: Entrust Commercial |
$435.40
|
| Rate for Payer: First Choice Health Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$435.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.24
|
| Rate for Payer: HealthUtah PPO |
$458.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$444.57
|
| Rate for Payer: Multiplan Medicare/VA |
$248.18
|
| Rate for Payer: One Health Plan of WY PPO |
$449.15
|
| Rate for Payer: PacificSource Commercial |
$412.49
|
| Rate for Payer: PHCS PPO |
$449.15
|
| Rate for Payer: Three Rivers PPO |
$343.74
|
| Rate for Payer: TriWest Veterans Administration |
$261.24
|
| Rate for Payer: United Healthcare Commercial |
$437.70
|
| Rate for Payer: United Healthcare Medicare |
$261.24
|
| Rate for Payer: WINHealth Partners Commercial |
$449.15
|
| Rate for Payer: Wise Provider Network Commercial |
$435.40
|
|
|
FIT TEST REPLACEMENT HOODS
|
Facility
|
IP
|
$29.80
|
|
| Hospital Charge Code |
2100034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.20
|
| Rate for Payer: Aetna of WY Medicare |
$19.07
|
| Rate for Payer: Altius Commercial |
$28.61
|
| Rate for Payer: Beech Street Commercial |
$29.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.91
|
| Rate for Payer: Cigna of WY Commercial |
$29.20
|
| Rate for Payer: Entrust Commercial |
$28.31
|
| Rate for Payer: First Choice Health Commercial |
$28.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.18
|
| Rate for Payer: HealthUtah PPO |
$29.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.91
|
| Rate for Payer: Multiplan Medicare/VA |
$17.27
|
| Rate for Payer: One Health Plan of WY PPO |
$29.20
|
| Rate for Payer: PacificSource Commercial |
$26.82
|
| Rate for Payer: PHCS PPO |
$29.20
|
| Rate for Payer: Three Rivers PPO |
$22.35
|
| Rate for Payer: TriWest Veterans Administration |
$18.18
|
| Rate for Payer: United Healthcare Commercial |
$28.46
|
| Rate for Payer: United Healthcare Medicare |
$18.18
|
| Rate for Payer: WINHealth Partners Commercial |
$28.31
|
| Rate for Payer: Wise Provider Network Commercial |
$28.31
|
|
|
FIT TEST REPLACEMENT HOODS
|
Facility
|
OP
|
$29.80
|
|
| Hospital Charge Code |
2100034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$29.80 |
| Rate for Payer: United Healthcare Commercial |
$28.46
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.20
|
| Rate for Payer: Aetna of WY Medicare |
$19.67
|
| Rate for Payer: Altius Commercial |
$28.61
|
| Rate for Payer: Beech Street Commercial |
$29.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.91
|
| Rate for Payer: Cigna of WY Commercial |
$29.20
|
| Rate for Payer: Entrust Commercial |
$28.31
|
| Rate for Payer: First Choice Health Commercial |
$28.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.99
|
| Rate for Payer: HealthUtah PPO |
$29.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.91
|
| Rate for Payer: Multiplan Medicare/VA |
$16.14
|
| Rate for Payer: One Health Plan of WY PPO |
$29.20
|
| Rate for Payer: PacificSource Commercial |
$26.82
|
| Rate for Payer: PHCS PPO |
$29.20
|
| Rate for Payer: Three Rivers PPO |
$22.35
|
| Rate for Payer: TriWest Veterans Administration |
$16.99
|
| Rate for Payer: United Healthcare Medicare |
$16.99
|
| Rate for Payer: WINHealth Partners Commercial |
$29.20
|
| Rate for Payer: Wise Provider Network Commercial |
$28.31
|
|
|
FIT TEST SENSITIVITY BITREX
|
Facility
|
OP
|
$42.15
|
|
| Hospital Charge Code |
2100139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.31
|
| Rate for Payer: Aetna of WY Medicare |
$27.82
|
| Rate for Payer: Altius Commercial |
$40.46
|
| Rate for Payer: Beech Street Commercial |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.89
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.89
|
| Rate for Payer: Cigna of WY Commercial |
$41.31
|
| Rate for Payer: Entrust Commercial |
$40.04
|
| Rate for Payer: First Choice Health Commercial |
$40.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.03
|
| Rate for Payer: HealthUtah PPO |
$42.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.89
|
| Rate for Payer: Multiplan Medicare/VA |
$22.82
|
| Rate for Payer: One Health Plan of WY PPO |
$41.31
|
| Rate for Payer: PacificSource Commercial |
$37.94
|
| Rate for Payer: PHCS PPO |
$41.31
|
| Rate for Payer: Three Rivers PPO |
$31.61
|
| Rate for Payer: TriWest Veterans Administration |
$24.03
|
| Rate for Payer: United Healthcare Commercial |
$40.25
|
| Rate for Payer: United Healthcare Medicare |
$24.03
|
| Rate for Payer: WINHealth Partners Commercial |
$41.31
|
| Rate for Payer: Wise Provider Network Commercial |
$40.04
|
|
|
FIT TEST SENSITIVITY BITREX
|
Facility
|
IP
|
$42.15
|
|
| Hospital Charge Code |
2100139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.31
|
| Rate for Payer: Aetna of WY Medicare |
$26.98
|
| Rate for Payer: Altius Commercial |
$40.46
|
| Rate for Payer: Beech Street Commercial |
$41.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.89
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.89
|
| Rate for Payer: Cigna of WY Commercial |
$41.31
|
| Rate for Payer: Entrust Commercial |
$40.04
|
| Rate for Payer: First Choice Health Commercial |
$40.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.71
|
| Rate for Payer: HealthUtah PPO |
$42.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.89
|
| Rate for Payer: Multiplan Medicare/VA |
$24.43
|
| Rate for Payer: One Health Plan of WY PPO |
$41.31
|
| Rate for Payer: PacificSource Commercial |
$37.94
|
| Rate for Payer: PHCS PPO |
$41.31
|
| Rate for Payer: Three Rivers PPO |
$31.61
|
| Rate for Payer: TriWest Veterans Administration |
$25.71
|
| Rate for Payer: United Healthcare Commercial |
$40.25
|
| Rate for Payer: United Healthcare Medicare |
$25.71
|
| Rate for Payer: WINHealth Partners Commercial |
$40.04
|
| Rate for Payer: Wise Provider Network Commercial |
$40.04
|
|
|
FIT TEST SENSITIVITY SACCHARIN
|
Facility
|
OP
|
$41.21
|
|
| Hospital Charge Code |
2100138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$41.21 |
| Rate for Payer: United Healthcare Commercial |
$39.36
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.39
|
| Rate for Payer: Aetna of WY Medicare |
$27.20
|
| Rate for Payer: Altius Commercial |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$40.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.97
|
| Rate for Payer: Cash Price |
$28.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.97
|
| Rate for Payer: Cigna of WY Commercial |
$40.39
|
| Rate for Payer: Entrust Commercial |
$39.15
|
| Rate for Payer: First Choice Health Commercial |
$39.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.49
|
| Rate for Payer: HealthUtah PPO |
$41.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.97
|
| Rate for Payer: Multiplan Medicare/VA |
$22.32
|
| Rate for Payer: One Health Plan of WY PPO |
$40.39
|
| Rate for Payer: PacificSource Commercial |
$37.09
|
| Rate for Payer: PHCS PPO |
$40.39
|
| Rate for Payer: Three Rivers PPO |
$30.91
|
| Rate for Payer: TriWest Veterans Administration |
$23.49
|
| Rate for Payer: United Healthcare Medicare |
$23.49
|
| Rate for Payer: WINHealth Partners Commercial |
$40.39
|
| Rate for Payer: Wise Provider Network Commercial |
$39.15
|
|
|
FIT TEST SENSITIVITY SACCHARIN
|
Facility
|
IP
|
$41.21
|
|
| Hospital Charge Code |
2100138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$41.21 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.39
|
| Rate for Payer: Aetna of WY Medicare |
$26.37
|
| Rate for Payer: Altius Commercial |
$39.56
|
| Rate for Payer: Beech Street Commercial |
$40.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.97
|
| Rate for Payer: Cash Price |
$28.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.97
|
| Rate for Payer: Cigna of WY Commercial |
$40.39
|
| Rate for Payer: Entrust Commercial |
$39.15
|
| Rate for Payer: First Choice Health Commercial |
$39.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.14
|
| Rate for Payer: HealthUtah PPO |
$41.21
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.97
|
| Rate for Payer: Multiplan Medicare/VA |
$23.88
|
| Rate for Payer: One Health Plan of WY PPO |
$40.39
|
| Rate for Payer: PacificSource Commercial |
$37.09
|
| Rate for Payer: PHCS PPO |
$40.39
|
| Rate for Payer: Three Rivers PPO |
$30.91
|
| Rate for Payer: TriWest Veterans Administration |
$25.14
|
| Rate for Payer: United Healthcare Commercial |
$39.36
|
| Rate for Payer: United Healthcare Medicare |
$25.14
|
| Rate for Payer: WINHealth Partners Commercial |
$39.15
|
| Rate for Payer: Wise Provider Network Commercial |
$39.15
|
|
|
FIT TEST SOLUTION NEBULIZERS
|
Facility
|
IP
|
$202.18
|
|
| Hospital Charge Code |
2100035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.16 |
| Max. Negotiated Rate |
$202.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.14
|
| Rate for Payer: Aetna of WY Medicare |
$129.40
|
| Rate for Payer: Altius Commercial |
$194.09
|
| Rate for Payer: Beech Street Commercial |
$198.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.11
|
| Rate for Payer: Cash Price |
$141.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.11
|
| Rate for Payer: Cigna of WY Commercial |
$198.14
|
| Rate for Payer: Entrust Commercial |
$192.07
|
| Rate for Payer: First Choice Health Commercial |
$192.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.33
|
| Rate for Payer: HealthUtah PPO |
$202.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.11
|
| Rate for Payer: Multiplan Medicare/VA |
$117.16
|
| Rate for Payer: One Health Plan of WY PPO |
$198.14
|
| Rate for Payer: PacificSource Commercial |
$181.96
|
| Rate for Payer: PHCS PPO |
$198.14
|
| Rate for Payer: Three Rivers PPO |
$151.64
|
| Rate for Payer: TriWest Veterans Administration |
$123.33
|
| Rate for Payer: United Healthcare Commercial |
$193.08
|
| Rate for Payer: United Healthcare Medicare |
$123.33
|
| Rate for Payer: WINHealth Partners Commercial |
$192.07
|
| Rate for Payer: Wise Provider Network Commercial |
$192.07
|
|
|
FIT TEST SOLUTION NEBULIZERS
|
Facility
|
OP
|
$202.18
|
|
| Hospital Charge Code |
2100035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$202.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$198.14
|
| Rate for Payer: Aetna of WY Medicare |
$133.44
|
| Rate for Payer: Altius Commercial |
$194.09
|
| Rate for Payer: Beech Street Commercial |
$198.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.11
|
| Rate for Payer: Cash Price |
$141.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$196.11
|
| Rate for Payer: Cigna of WY Commercial |
$198.14
|
| Rate for Payer: Entrust Commercial |
$192.07
|
| Rate for Payer: First Choice Health Commercial |
$192.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$192.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.24
|
| Rate for Payer: HealthUtah PPO |
$202.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$196.11
|
| Rate for Payer: Multiplan Medicare/VA |
$109.48
|
| Rate for Payer: One Health Plan of WY PPO |
$198.14
|
| Rate for Payer: PacificSource Commercial |
$181.96
|
| Rate for Payer: PHCS PPO |
$198.14
|
| Rate for Payer: Three Rivers PPO |
$151.64
|
| Rate for Payer: TriWest Veterans Administration |
$115.24
|
| Rate for Payer: United Healthcare Commercial |
$193.08
|
| Rate for Payer: United Healthcare Medicare |
$115.24
|
| Rate for Payer: WINHealth Partners Commercial |
$198.14
|
| Rate for Payer: Wise Provider Network Commercial |
$192.07
|
|
|
FIT TEST TESTING BITREX
|
Facility
|
OP
|
$43.63
|
|
| Hospital Charge Code |
2100142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$43.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.76
|
| Rate for Payer: Aetna of WY Medicare |
$28.80
|
| Rate for Payer: Altius Commercial |
$41.88
|
| Rate for Payer: Beech Street Commercial |
$42.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.32
|
| Rate for Payer: Cash Price |
$30.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.32
|
| Rate for Payer: Cigna of WY Commercial |
$42.76
|
| Rate for Payer: Entrust Commercial |
$41.45
|
| Rate for Payer: First Choice Health Commercial |
$41.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.87
|
| Rate for Payer: HealthUtah PPO |
$43.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.32
|
| Rate for Payer: Multiplan Medicare/VA |
$23.63
|
| Rate for Payer: One Health Plan of WY PPO |
$42.76
|
| Rate for Payer: PacificSource Commercial |
$39.27
|
| Rate for Payer: PHCS PPO |
$42.76
|
| Rate for Payer: Three Rivers PPO |
$32.72
|
| Rate for Payer: TriWest Veterans Administration |
$24.87
|
| Rate for Payer: United Healthcare Commercial |
$41.67
|
| Rate for Payer: United Healthcare Medicare |
$24.87
|
| Rate for Payer: WINHealth Partners Commercial |
$42.76
|
| Rate for Payer: Wise Provider Network Commercial |
$41.45
|
|
|
FIT TEST TESTING BITREX
|
Facility
|
IP
|
$43.63
|
|
| Hospital Charge Code |
2100142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$43.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.76
|
| Rate for Payer: Aetna of WY Medicare |
$27.92
|
| Rate for Payer: Altius Commercial |
$41.88
|
| Rate for Payer: Beech Street Commercial |
$42.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.32
|
| Rate for Payer: Cash Price |
$30.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.32
|
| Rate for Payer: Cigna of WY Commercial |
$42.76
|
| Rate for Payer: Entrust Commercial |
$41.45
|
| Rate for Payer: First Choice Health Commercial |
$41.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.61
|
| Rate for Payer: HealthUtah PPO |
$43.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.32
|
| Rate for Payer: Multiplan Medicare/VA |
$25.28
|
| Rate for Payer: One Health Plan of WY PPO |
$42.76
|
| Rate for Payer: PacificSource Commercial |
$39.27
|
| Rate for Payer: PHCS PPO |
$42.76
|
| Rate for Payer: Three Rivers PPO |
$32.72
|
| Rate for Payer: TriWest Veterans Administration |
$26.61
|
| Rate for Payer: United Healthcare Commercial |
$41.67
|
| Rate for Payer: United Healthcare Medicare |
$26.61
|
| Rate for Payer: WINHealth Partners Commercial |
$41.45
|
| Rate for Payer: Wise Provider Network Commercial |
$41.45
|
|
|
FIT TEST TESTING SACCHARIN
|
Facility
|
OP
|
$68.54
|
|
| Hospital Charge Code |
2100141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$68.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.17
|
| Rate for Payer: Aetna of WY Medicare |
$45.24
|
| Rate for Payer: Altius Commercial |
$65.80
|
| Rate for Payer: Beech Street Commercial |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.48
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.48
|
| Rate for Payer: Cigna of WY Commercial |
$67.17
|
| Rate for Payer: Entrust Commercial |
$65.11
|
| Rate for Payer: First Choice Health Commercial |
$65.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.07
|
| Rate for Payer: HealthUtah PPO |
$68.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.48
|
| Rate for Payer: Multiplan Medicare/VA |
$37.11
|
| Rate for Payer: One Health Plan of WY PPO |
$67.17
|
| Rate for Payer: PacificSource Commercial |
$61.69
|
| Rate for Payer: PHCS PPO |
$67.17
|
| Rate for Payer: Three Rivers PPO |
$51.40
|
| Rate for Payer: TriWest Veterans Administration |
$39.07
|
| Rate for Payer: United Healthcare Commercial |
$65.46
|
| Rate for Payer: United Healthcare Medicare |
$39.07
|
| Rate for Payer: WINHealth Partners Commercial |
$67.17
|
| Rate for Payer: Wise Provider Network Commercial |
$65.11
|
|
|
FIT TEST TESTING SACCHARIN
|
Facility
|
IP
|
$68.54
|
|
| Hospital Charge Code |
2100141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$68.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.17
|
| Rate for Payer: Aetna of WY Medicare |
$43.87
|
| Rate for Payer: Altius Commercial |
$65.80
|
| Rate for Payer: Beech Street Commercial |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.48
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.48
|
| Rate for Payer: Cigna of WY Commercial |
$67.17
|
| Rate for Payer: Entrust Commercial |
$65.11
|
| Rate for Payer: First Choice Health Commercial |
$65.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.81
|
| Rate for Payer: HealthUtah PPO |
$68.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.48
|
| Rate for Payer: Multiplan Medicare/VA |
$39.72
|
| Rate for Payer: One Health Plan of WY PPO |
$67.17
|
| Rate for Payer: PacificSource Commercial |
$61.69
|
| Rate for Payer: PHCS PPO |
$67.17
|
| Rate for Payer: Three Rivers PPO |
$51.40
|
| Rate for Payer: TriWest Veterans Administration |
$41.81
|
| Rate for Payer: United Healthcare Commercial |
$65.46
|
| Rate for Payer: United Healthcare Medicare |
$41.81
|
| Rate for Payer: WINHealth Partners Commercial |
$65.11
|
| Rate for Payer: Wise Provider Network Commercial |
$65.11
|
|
|
FIXATE SUTURING DEVICE
|
Facility
|
OP
|
$2,100.00
|
|
| Hospital Charge Code |
2800250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,137.15 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,058.00
|
| Rate for Payer: Aetna of WY Medicare |
$1,386.00
|
| Rate for Payer: Altius Commercial |
$2,016.00
|
| Rate for Payer: Beech Street Commercial |
$2,058.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,037.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,037.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,058.00
|
| Rate for Payer: Entrust Commercial |
$1,995.00
|
| Rate for Payer: First Choice Health Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,995.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,197.00
|
| Rate for Payer: HealthUtah PPO |
$2,100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,037.00
|
| Rate for Payer: Multiplan Medicare/VA |
$1,137.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,058.00
|
| Rate for Payer: PacificSource Commercial |
$1,890.00
|
| Rate for Payer: PHCS PPO |
$2,058.00
|
| Rate for Payer: Three Rivers PPO |
$1,575.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,197.00
|
| Rate for Payer: United Healthcare Commercial |
$2,005.50
|
| Rate for Payer: United Healthcare Medicare |
$1,197.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,058.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1,995.00
|
|
