|
FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [181815]
|
Facility
|
OP
|
$91.02
|
|
|
Service Code
|
NDC 4928142350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.29 |
| Max. Negotiated Rate |
$91.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.20
|
| Rate for Payer: Aetna of WY Medicare |
$60.07
|
| Rate for Payer: Altius Commercial |
$87.38
|
| Rate for Payer: Beech Street Commercial |
$89.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$88.29
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.29
|
| Rate for Payer: Cigna of WY Commercial |
$89.20
|
| Rate for Payer: Entrust Commercial |
$86.47
|
| Rate for Payer: First Choice Health Commercial |
$86.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.88
|
| Rate for Payer: HealthUtah PPO |
$91.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.29
|
| Rate for Payer: Multiplan Medicare/VA |
$49.29
|
| Rate for Payer: One Health Plan of WY PPO |
$89.20
|
| Rate for Payer: PacificSource Commercial |
$81.92
|
| Rate for Payer: PHCS PPO |
$89.20
|
| Rate for Payer: Three Rivers PPO |
$68.26
|
| Rate for Payer: TriWest Veterans Administration |
$51.88
|
| Rate for Payer: United Healthcare Commercial |
$86.92
|
| Rate for Payer: United Healthcare Medicare |
$51.88
|
| Rate for Payer: WINHealth Partners Commercial |
$89.20
|
| Rate for Payer: Wise Provider Network Commercial |
$86.47
|
|
|
FLU VACCINE QS 2023-24(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [181815]
|
Facility
|
IP
|
$91.02
|
|
|
Service Code
|
NDC 4928142350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$91.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.20
|
| Rate for Payer: Aetna of WY Medicare |
$58.25
|
| Rate for Payer: Altius Commercial |
$87.38
|
| Rate for Payer: Beech Street Commercial |
$89.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$88.29
|
| Rate for Payer: Cash Price |
$63.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.29
|
| Rate for Payer: Cigna of WY Commercial |
$89.20
|
| Rate for Payer: Entrust Commercial |
$86.47
|
| Rate for Payer: First Choice Health Commercial |
$86.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.52
|
| Rate for Payer: HealthUtah PPO |
$91.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.29
|
| Rate for Payer: Multiplan Medicare/VA |
$52.75
|
| Rate for Payer: One Health Plan of WY PPO |
$89.20
|
| Rate for Payer: PacificSource Commercial |
$81.92
|
| Rate for Payer: PHCS PPO |
$89.20
|
| Rate for Payer: Three Rivers PPO |
$68.26
|
| Rate for Payer: TriWest Veterans Administration |
$55.52
|
| Rate for Payer: United Healthcare Commercial |
$86.92
|
| Rate for Payer: United Healthcare Medicare |
$55.52
|
| Rate for Payer: WINHealth Partners Commercial |
$86.47
|
| Rate for Payer: Wise Provider Network Commercial |
$86.47
|
|
|
FLU VACC QS2023-24 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE [181523]
|
Facility
|
IP
|
$95.18
|
|
|
Service Code
|
NDC 3333232304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.28
|
| Rate for Payer: Aetna of WY Medicare |
$60.92
|
| Rate for Payer: Altius Commercial |
$91.37
|
| Rate for Payer: Beech Street Commercial |
$93.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.32
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.32
|
| Rate for Payer: Cigna of WY Commercial |
$93.28
|
| Rate for Payer: Entrust Commercial |
$90.42
|
| Rate for Payer: First Choice Health Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.06
|
| Rate for Payer: HealthUtah PPO |
$95.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.32
|
| Rate for Payer: Multiplan Medicare/VA |
$55.16
|
| Rate for Payer: One Health Plan of WY PPO |
$93.28
|
| Rate for Payer: PacificSource Commercial |
$85.66
|
| Rate for Payer: PHCS PPO |
$93.28
|
| Rate for Payer: Three Rivers PPO |
$71.38
|
| Rate for Payer: TriWest Veterans Administration |
$58.06
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
| Rate for Payer: United Healthcare Medicare |
$58.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.42
|
| Rate for Payer: Wise Provider Network Commercial |
$90.42
|
|
|
FLU VACC QS2023-24 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE [181523]
|
Facility
|
OP
|
$95.18
|
|
|
Service Code
|
NDC 3333232303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.28
|
| Rate for Payer: Aetna of WY Medicare |
$62.82
|
| Rate for Payer: Altius Commercial |
$91.37
|
| Rate for Payer: Beech Street Commercial |
$93.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.32
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.32
|
| Rate for Payer: Cigna of WY Commercial |
$93.28
|
| Rate for Payer: Entrust Commercial |
$90.42
|
| Rate for Payer: First Choice Health Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.25
|
| Rate for Payer: HealthUtah PPO |
$95.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.32
|
| Rate for Payer: Multiplan Medicare/VA |
$51.54
|
| Rate for Payer: One Health Plan of WY PPO |
$93.28
|
| Rate for Payer: PacificSource Commercial |
$85.66
|
| Rate for Payer: PHCS PPO |
$93.28
|
| Rate for Payer: Three Rivers PPO |
$71.38
|
| Rate for Payer: TriWest Veterans Administration |
$54.25
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
| Rate for Payer: United Healthcare Medicare |
$54.25
|
| Rate for Payer: WINHealth Partners Commercial |
$93.28
|
| Rate for Payer: Wise Provider Network Commercial |
$90.42
|
|
|
FLU VACC QS2023-24 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE [181523]
|
Facility
|
IP
|
$95.18
|
|
|
Service Code
|
NDC 3333232303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.28
|
| Rate for Payer: Aetna of WY Medicare |
$60.92
|
| Rate for Payer: Altius Commercial |
$91.37
|
| Rate for Payer: Beech Street Commercial |
$93.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.32
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.32
|
| Rate for Payer: Cigna of WY Commercial |
$93.28
|
| Rate for Payer: Entrust Commercial |
$90.42
|
| Rate for Payer: First Choice Health Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.06
|
| Rate for Payer: HealthUtah PPO |
$95.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.32
|
| Rate for Payer: Multiplan Medicare/VA |
$55.16
|
| Rate for Payer: One Health Plan of WY PPO |
$93.28
|
| Rate for Payer: PacificSource Commercial |
$85.66
|
| Rate for Payer: PHCS PPO |
$93.28
|
| Rate for Payer: Three Rivers PPO |
$71.38
|
| Rate for Payer: TriWest Veterans Administration |
$58.06
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
| Rate for Payer: United Healthcare Medicare |
$58.06
|
| Rate for Payer: WINHealth Partners Commercial |
$90.42
|
| Rate for Payer: Wise Provider Network Commercial |
$90.42
|
|
|
FLU VACC QS2023-24 (36 MOS UP)(PF)60 MCG (15 MCG X4)/0.5 ML IM SYRINGE [181523]
|
Facility
|
OP
|
$95.18
|
|
|
Service Code
|
NDC 3333232304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.28
|
| Rate for Payer: Aetna of WY Medicare |
$62.82
|
| Rate for Payer: Altius Commercial |
$91.37
|
| Rate for Payer: Beech Street Commercial |
$93.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.32
|
| Rate for Payer: Cash Price |
$66.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.32
|
| Rate for Payer: Cigna of WY Commercial |
$93.28
|
| Rate for Payer: Entrust Commercial |
$90.42
|
| Rate for Payer: First Choice Health Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.25
|
| Rate for Payer: HealthUtah PPO |
$95.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.32
|
| Rate for Payer: Multiplan Medicare/VA |
$51.54
|
| Rate for Payer: One Health Plan of WY PPO |
$93.28
|
| Rate for Payer: PacificSource Commercial |
$85.66
|
| Rate for Payer: PHCS PPO |
$93.28
|
| Rate for Payer: Three Rivers PPO |
$71.38
|
| Rate for Payer: TriWest Veterans Administration |
$54.25
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
| Rate for Payer: United Healthcare Medicare |
$54.25
|
| Rate for Payer: WINHealth Partners Commercial |
$93.28
|
| Rate for Payer: Wise Provider Network Commercial |
$90.42
|
|
|
FLU VAC QS 2023(6 MOS UP)C.DER.(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [181428]
|
Facility
|
IP
|
$117.72
|
|
|
Service Code
|
NDC 7046132303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.22 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.37
|
| Rate for Payer: Aetna of WY Medicare |
$75.34
|
| Rate for Payer: Altius Commercial |
$113.01
|
| Rate for Payer: Beech Street Commercial |
$115.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.19
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.19
|
| Rate for Payer: Cigna of WY Commercial |
$115.37
|
| Rate for Payer: Entrust Commercial |
$111.83
|
| Rate for Payer: First Choice Health Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.81
|
| Rate for Payer: HealthUtah PPO |
$117.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.19
|
| Rate for Payer: Multiplan Medicare/VA |
$68.22
|
| Rate for Payer: One Health Plan of WY PPO |
$115.37
|
| Rate for Payer: PacificSource Commercial |
$105.95
|
| Rate for Payer: PHCS PPO |
$115.37
|
| Rate for Payer: Three Rivers PPO |
$88.29
|
| Rate for Payer: TriWest Veterans Administration |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$112.42
|
| Rate for Payer: United Healthcare Medicare |
$71.81
|
| Rate for Payer: WINHealth Partners Commercial |
$111.83
|
| Rate for Payer: Wise Provider Network Commercial |
$111.83
|
|
|
FLU VAC QS 2023(6 MOS UP)C.DER.(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [181428]
|
Facility
|
OP
|
$117.72
|
|
|
Service Code
|
NDC 7046132304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.37
|
| Rate for Payer: Aetna of WY Medicare |
$77.70
|
| Rate for Payer: Altius Commercial |
$113.01
|
| Rate for Payer: Beech Street Commercial |
$115.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.19
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.19
|
| Rate for Payer: Cigna of WY Commercial |
$115.37
|
| Rate for Payer: Entrust Commercial |
$111.83
|
| Rate for Payer: First Choice Health Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$117.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.19
|
| Rate for Payer: Multiplan Medicare/VA |
$63.75
|
| Rate for Payer: One Health Plan of WY PPO |
$115.37
|
| Rate for Payer: PacificSource Commercial |
$105.95
|
| Rate for Payer: PHCS PPO |
$115.37
|
| Rate for Payer: Three Rivers PPO |
$88.29
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$112.42
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$115.37
|
| Rate for Payer: Wise Provider Network Commercial |
$111.83
|
|
|
FLU VAC QS 2023(6 MOS UP)C.DER.(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [181428]
|
Facility
|
IP
|
$117.72
|
|
|
Service Code
|
NDC 7046132304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.22 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.37
|
| Rate for Payer: Aetna of WY Medicare |
$75.34
|
| Rate for Payer: Altius Commercial |
$113.01
|
| Rate for Payer: Beech Street Commercial |
$115.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.19
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.19
|
| Rate for Payer: Cigna of WY Commercial |
$115.37
|
| Rate for Payer: Entrust Commercial |
$111.83
|
| Rate for Payer: First Choice Health Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.81
|
| Rate for Payer: HealthUtah PPO |
$117.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.19
|
| Rate for Payer: Multiplan Medicare/VA |
$68.22
|
| Rate for Payer: One Health Plan of WY PPO |
$115.37
|
| Rate for Payer: PacificSource Commercial |
$105.95
|
| Rate for Payer: PHCS PPO |
$115.37
|
| Rate for Payer: Three Rivers PPO |
$88.29
|
| Rate for Payer: TriWest Veterans Administration |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$112.42
|
| Rate for Payer: United Healthcare Medicare |
$71.81
|
| Rate for Payer: WINHealth Partners Commercial |
$111.83
|
| Rate for Payer: Wise Provider Network Commercial |
$111.83
|
|
|
FLU VAC QS 2023(6 MOS UP)C.DER.(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE [181428]
|
Facility
|
OP
|
$117.72
|
|
|
Service Code
|
NDC 7046132303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.37
|
| Rate for Payer: Aetna of WY Medicare |
$77.70
|
| Rate for Payer: Altius Commercial |
$113.01
|
| Rate for Payer: Beech Street Commercial |
$115.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$114.19
|
| Rate for Payer: Cash Price |
$82.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.19
|
| Rate for Payer: Cigna of WY Commercial |
$115.37
|
| Rate for Payer: Entrust Commercial |
$111.83
|
| Rate for Payer: First Choice Health Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.10
|
| Rate for Payer: HealthUtah PPO |
$117.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.19
|
| Rate for Payer: Multiplan Medicare/VA |
$63.75
|
| Rate for Payer: One Health Plan of WY PPO |
$115.37
|
| Rate for Payer: PacificSource Commercial |
$105.95
|
| Rate for Payer: PHCS PPO |
$115.37
|
| Rate for Payer: Three Rivers PPO |
$88.29
|
| Rate for Payer: TriWest Veterans Administration |
$67.10
|
| Rate for Payer: United Healthcare Commercial |
$112.42
|
| Rate for Payer: United Healthcare Medicare |
$67.10
|
| Rate for Payer: WINHealth Partners Commercial |
$115.37
|
| Rate for Payer: Wise Provider Network Commercial |
$111.83
|
|
|
FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Beech Street Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: First Choice Health Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$30.40
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$30.40
|
| Rate for Payer: WINHealth Partners Commercial |
$30.40
|
|
|
FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.36
|
| Rate for Payer: Beech Street Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.04
|
| Rate for Payer: Cigna of WY Commercial |
$31.36
|
| Rate for Payer: First Choice Health Commercial |
$28.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.40
|
| Rate for Payer: HealthUtah PPO |
$32.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.04
|
| Rate for Payer: One Health Plan of WY PPO |
$31.36
|
| Rate for Payer: PacificSource Commercial |
$28.80
|
| Rate for Payer: PHCS PPO |
$30.40
|
| Rate for Payer: Three Rivers PPO |
$24.00
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$30.40
|
| Rate for Payer: WINHealth Partners Commercial |
$30.40
|
|
|
FOAM-O-FELT 8.875X17.5
|
Facility
|
OP
|
$92.68
|
|
| Hospital Charge Code |
2250157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.19 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.83
|
| Rate for Payer: Aetna of WY Medicare |
$61.17
|
| Rate for Payer: Altius Commercial |
$88.97
|
| Rate for Payer: Beech Street Commercial |
$90.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.90
|
| Rate for Payer: Cash Price |
$64.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.90
|
| Rate for Payer: Cigna of WY Commercial |
$90.83
|
| Rate for Payer: Entrust Commercial |
$88.05
|
| Rate for Payer: First Choice Health Commercial |
$88.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.83
|
| Rate for Payer: HealthUtah PPO |
$92.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.90
|
| Rate for Payer: Multiplan Medicare/VA |
$50.19
|
| Rate for Payer: One Health Plan of WY PPO |
$90.83
|
| Rate for Payer: PacificSource Commercial |
$83.41
|
| Rate for Payer: PHCS PPO |
$90.83
|
| Rate for Payer: Three Rivers PPO |
$69.51
|
| Rate for Payer: TriWest Veterans Administration |
$52.83
|
| Rate for Payer: United Healthcare Commercial |
$88.51
|
| Rate for Payer: United Healthcare Medicare |
$52.83
|
| Rate for Payer: WINHealth Partners Commercial |
$90.83
|
| Rate for Payer: Wise Provider Network Commercial |
$88.05
|
|
|
FOAM-O-FELT 8.875X17.5
|
Facility
|
IP
|
$92.68
|
|
| Hospital Charge Code |
2250157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.71 |
| Max. Negotiated Rate |
$92.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.83
|
| Rate for Payer: Aetna of WY Medicare |
$59.32
|
| Rate for Payer: Altius Commercial |
$88.97
|
| Rate for Payer: Beech Street Commercial |
$90.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.90
|
| Rate for Payer: Cash Price |
$64.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.90
|
| Rate for Payer: Cigna of WY Commercial |
$90.83
|
| Rate for Payer: Entrust Commercial |
$88.05
|
| Rate for Payer: First Choice Health Commercial |
$88.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.53
|
| Rate for Payer: HealthUtah PPO |
$92.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.90
|
| Rate for Payer: Multiplan Medicare/VA |
$53.71
|
| Rate for Payer: One Health Plan of WY PPO |
$90.83
|
| Rate for Payer: PacificSource Commercial |
$83.41
|
| Rate for Payer: PHCS PPO |
$90.83
|
| Rate for Payer: Three Rivers PPO |
$69.51
|
| Rate for Payer: TriWest Veterans Administration |
$56.53
|
| Rate for Payer: United Healthcare Commercial |
$88.51
|
| Rate for Payer: United Healthcare Medicare |
$56.53
|
| Rate for Payer: WINHealth Partners Commercial |
$88.05
|
| Rate for Payer: Wise Provider Network Commercial |
$88.05
|
|
|
FOAM THERAPY ROLL 6X36
|
Facility
|
OP
|
$47.00
|
|
| Hospital Charge Code |
2900009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Aetna of WY Medicare |
$31.02
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.79
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$25.45
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.79
|
| Rate for Payer: United Healthcare Commercial |
$44.88
|
| Rate for Payer: United Healthcare Medicare |
$26.79
|
| Rate for Payer: WINHealth Partners Commercial |
$46.06
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
FOAM THERAPY ROLL 6X36
|
Facility
|
IP
|
$47.00
|
|
| Hospital Charge Code |
2900009
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.24 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Aetna of WY Medicare |
$30.08
|
| Rate for Payer: Altius Commercial |
$45.12
|
| Rate for Payer: Beech Street Commercial |
$46.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.59
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: Entrust Commercial |
$44.65
|
| Rate for Payer: First Choice Health Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.67
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: Multiplan Medicare/VA |
$27.24
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$46.06
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: TriWest Veterans Administration |
$28.67
|
| Rate for Payer: United Healthcare Commercial |
$44.88
|
| Rate for Payer: United Healthcare Medicare |
$28.67
|
| Rate for Payer: WINHealth Partners Commercial |
$44.65
|
| Rate for Payer: Wise Provider Network Commercial |
$44.65
|
|
|
FOCUS CURVED SHEARS
|
Facility
|
IP
|
$1,746.50
|
|
| Hospital Charge Code |
2650490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,012.10 |
| Max. Negotiated Rate |
$1,746.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,711.57
|
| Rate for Payer: Aetna of WY Medicare |
$1,117.76
|
| Rate for Payer: Altius Commercial |
$1,676.64
|
| Rate for Payer: Beech Street Commercial |
$1,711.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,694.10
|
| Rate for Payer: Cash Price |
$1,222.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,694.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,711.57
|
| Rate for Payer: Entrust Commercial |
$1,659.18
|
| Rate for Payer: First Choice Health Commercial |
$1,659.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,659.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,065.36
|
| Rate for Payer: HealthUtah PPO |
$1,746.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,694.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,012.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,711.57
|
| Rate for Payer: PacificSource Commercial |
$1,571.85
|
| Rate for Payer: PHCS PPO |
$1,711.57
|
| Rate for Payer: Three Rivers PPO |
$1,309.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,065.36
|
| Rate for Payer: United Healthcare Commercial |
$1,667.91
|
| Rate for Payer: United Healthcare Medicare |
$1,065.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,659.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1,659.18
|
|
|
FOCUS CURVED SHEARS
|
Facility
|
OP
|
$1,746.50
|
|
| Hospital Charge Code |
2650490
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.73 |
| Max. Negotiated Rate |
$1,746.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,711.57
|
| Rate for Payer: Aetna of WY Medicare |
$1,152.69
|
| Rate for Payer: Altius Commercial |
$1,676.64
|
| Rate for Payer: Beech Street Commercial |
$1,711.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,694.10
|
| Rate for Payer: Cash Price |
$1,222.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,694.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,711.57
|
| Rate for Payer: Entrust Commercial |
$1,659.18
|
| Rate for Payer: First Choice Health Commercial |
$1,659.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,659.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$995.50
|
| Rate for Payer: HealthUtah PPO |
$1,746.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,694.10
|
| Rate for Payer: Multiplan Medicare/VA |
$945.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1,711.57
|
| Rate for Payer: PacificSource Commercial |
$1,571.85
|
| Rate for Payer: PHCS PPO |
$1,711.57
|
| Rate for Payer: Three Rivers PPO |
$1,309.88
|
| Rate for Payer: TriWest Veterans Administration |
$995.50
|
| Rate for Payer: United Healthcare Commercial |
$1,667.91
|
| Rate for Payer: United Healthcare Medicare |
$995.50
|
| Rate for Payer: WINHealth Partners Commercial |
$1,711.57
|
| Rate for Payer: Wise Provider Network Commercial |
$1,659.18
|
|
|
FOLDING DRILL CASE
|
Facility
|
IP
|
$1,347.50
|
|
| Hospital Charge Code |
2650885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.88 |
| Max. Negotiated Rate |
$1,347.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,320.55
|
| Rate for Payer: Aetna of WY Medicare |
$862.40
|
| Rate for Payer: Altius Commercial |
$1,293.60
|
| Rate for Payer: Beech Street Commercial |
$1,320.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,307.08
|
| Rate for Payer: Cash Price |
$943.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,307.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,320.55
|
| Rate for Payer: Entrust Commercial |
$1,280.12
|
| Rate for Payer: First Choice Health Commercial |
$1,280.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,280.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$821.98
|
| Rate for Payer: HealthUtah PPO |
$1,347.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,307.08
|
| Rate for Payer: Multiplan Medicare/VA |
$780.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,320.55
|
| Rate for Payer: PacificSource Commercial |
$1,212.75
|
| Rate for Payer: PHCS PPO |
$1,320.55
|
| Rate for Payer: Three Rivers PPO |
$1,010.62
|
| Rate for Payer: TriWest Veterans Administration |
$821.98
|
| Rate for Payer: United Healthcare Commercial |
$1,286.86
|
| Rate for Payer: United Healthcare Medicare |
$821.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,280.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,280.12
|
|
|
FOLDING DRILL CASE
|
Facility
|
OP
|
$1,347.50
|
|
| Hospital Charge Code |
2650885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.67 |
| Max. Negotiated Rate |
$1,347.50 |
| Rate for Payer: United Healthcare Commercial |
$1,286.86
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,320.55
|
| Rate for Payer: Aetna of WY Medicare |
$889.35
|
| Rate for Payer: Altius Commercial |
$1,293.60
|
| Rate for Payer: Beech Street Commercial |
$1,320.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,307.08
|
| Rate for Payer: Cash Price |
$943.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,307.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,320.55
|
| Rate for Payer: Entrust Commercial |
$1,280.12
|
| Rate for Payer: First Choice Health Commercial |
$1,280.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,280.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$768.08
|
| Rate for Payer: HealthUtah PPO |
$1,347.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,307.08
|
| Rate for Payer: Multiplan Medicare/VA |
$729.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1,320.55
|
| Rate for Payer: PacificSource Commercial |
$1,212.75
|
| Rate for Payer: PHCS PPO |
$1,320.55
|
| Rate for Payer: Three Rivers PPO |
$1,010.62
|
| Rate for Payer: TriWest Veterans Administration |
$768.08
|
| Rate for Payer: United Healthcare Medicare |
$768.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,320.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,280.12
|
|
|
FOLEY TRAY LATEX BAG A300316A
|
Facility
|
OP
|
$46.86
|
|
| Hospital Charge Code |
2750134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.92
|
| Rate for Payer: Aetna of WY Medicare |
$30.93
|
| Rate for Payer: Altius Commercial |
$44.99
|
| Rate for Payer: Beech Street Commercial |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.45
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.45
|
| Rate for Payer: Cigna of WY Commercial |
$45.92
|
| Rate for Payer: Entrust Commercial |
$44.52
|
| Rate for Payer: First Choice Health Commercial |
$44.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.71
|
| Rate for Payer: HealthUtah PPO |
$46.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.45
|
| Rate for Payer: Multiplan Medicare/VA |
$25.37
|
| Rate for Payer: One Health Plan of WY PPO |
$45.92
|
| Rate for Payer: PacificSource Commercial |
$42.17
|
| Rate for Payer: PHCS PPO |
$45.92
|
| Rate for Payer: Three Rivers PPO |
$35.14
|
| Rate for Payer: TriWest Veterans Administration |
$26.71
|
| Rate for Payer: United Healthcare Commercial |
$44.75
|
| Rate for Payer: United Healthcare Medicare |
$26.71
|
| Rate for Payer: WINHealth Partners Commercial |
$45.92
|
| Rate for Payer: Wise Provider Network Commercial |
$44.52
|
|
|
FOLEY TRAY LATEX BAG A300316A
|
Facility
|
IP
|
$46.86
|
|
| Hospital Charge Code |
2750134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.92
|
| Rate for Payer: Aetna of WY Medicare |
$29.99
|
| Rate for Payer: Altius Commercial |
$44.99
|
| Rate for Payer: Beech Street Commercial |
$45.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.45
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.45
|
| Rate for Payer: Cigna of WY Commercial |
$45.92
|
| Rate for Payer: Entrust Commercial |
$44.52
|
| Rate for Payer: First Choice Health Commercial |
$44.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.58
|
| Rate for Payer: HealthUtah PPO |
$46.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.45
|
| Rate for Payer: Multiplan Medicare/VA |
$27.16
|
| Rate for Payer: One Health Plan of WY PPO |
$45.92
|
| Rate for Payer: PacificSource Commercial |
$42.17
|
| Rate for Payer: PHCS PPO |
$45.92
|
| Rate for Payer: Three Rivers PPO |
$35.14
|
| Rate for Payer: TriWest Veterans Administration |
$28.58
|
| Rate for Payer: United Healthcare Commercial |
$44.75
|
| Rate for Payer: United Healthcare Medicare |
$28.58
|
| Rate for Payer: WINHealth Partners Commercial |
$44.52
|
| Rate for Payer: Wise Provider Network Commercial |
$44.52
|
|
|
FOLEY TRAY LATEX M&T A319416AM
|
Facility
|
IP
|
$90.11
|
|
| Hospital Charge Code |
2750119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.22 |
| Max. Negotiated Rate |
$90.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.31
|
| Rate for Payer: Aetna of WY Medicare |
$57.67
|
| Rate for Payer: Altius Commercial |
$86.51
|
| Rate for Payer: Beech Street Commercial |
$88.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.41
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.41
|
| Rate for Payer: Cigna of WY Commercial |
$88.31
|
| Rate for Payer: Entrust Commercial |
$85.60
|
| Rate for Payer: First Choice Health Commercial |
$85.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.97
|
| Rate for Payer: HealthUtah PPO |
$90.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.41
|
| Rate for Payer: Multiplan Medicare/VA |
$52.22
|
| Rate for Payer: One Health Plan of WY PPO |
$88.31
|
| Rate for Payer: PacificSource Commercial |
$81.10
|
| Rate for Payer: PHCS PPO |
$88.31
|
| Rate for Payer: Three Rivers PPO |
$67.58
|
| Rate for Payer: TriWest Veterans Administration |
$54.97
|
| Rate for Payer: United Healthcare Commercial |
$86.06
|
| Rate for Payer: United Healthcare Medicare |
$54.97
|
| Rate for Payer: WINHealth Partners Commercial |
$85.60
|
| Rate for Payer: Wise Provider Network Commercial |
$85.60
|
|
|
FOLEY TRAY LATEX M&T A319416AM
|
Facility
|
OP
|
$90.11
|
|
| Hospital Charge Code |
2750119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$90.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.31
|
| Rate for Payer: Aetna of WY Medicare |
$59.47
|
| Rate for Payer: Altius Commercial |
$86.51
|
| Rate for Payer: Beech Street Commercial |
$88.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.41
|
| Rate for Payer: Cash Price |
$63.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.41
|
| Rate for Payer: Cigna of WY Commercial |
$88.31
|
| Rate for Payer: Entrust Commercial |
$85.60
|
| Rate for Payer: First Choice Health Commercial |
$85.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.36
|
| Rate for Payer: HealthUtah PPO |
$90.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.41
|
| Rate for Payer: Multiplan Medicare/VA |
$48.79
|
| Rate for Payer: One Health Plan of WY PPO |
$88.31
|
| Rate for Payer: PacificSource Commercial |
$81.10
|
| Rate for Payer: PHCS PPO |
$88.31
|
| Rate for Payer: Three Rivers PPO |
$67.58
|
| Rate for Payer: TriWest Veterans Administration |
$51.36
|
| Rate for Payer: United Healthcare Commercial |
$86.06
|
| Rate for Payer: United Healthcare Medicare |
$51.36
|
| Rate for Payer: WINHealth Partners Commercial |
$88.31
|
| Rate for Payer: Wise Provider Network Commercial |
$85.60
|
|
|
FOLEY TRAY LATEX UM A303316A
|
Facility
|
OP
|
$60.78
|
|
| Hospital Charge Code |
2750120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$60.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.56
|
| Rate for Payer: Aetna of WY Medicare |
$40.11
|
| Rate for Payer: Altius Commercial |
$58.35
|
| Rate for Payer: Beech Street Commercial |
$59.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.96
|
| Rate for Payer: Cash Price |
$42.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.96
|
| Rate for Payer: Cigna of WY Commercial |
$59.56
|
| Rate for Payer: Entrust Commercial |
$57.74
|
| Rate for Payer: First Choice Health Commercial |
$57.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.64
|
| Rate for Payer: HealthUtah PPO |
$60.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.96
|
| Rate for Payer: Multiplan Medicare/VA |
$32.91
|
| Rate for Payer: One Health Plan of WY PPO |
$59.56
|
| Rate for Payer: PacificSource Commercial |
$54.70
|
| Rate for Payer: PHCS PPO |
$59.56
|
| Rate for Payer: Three Rivers PPO |
$45.58
|
| Rate for Payer: TriWest Veterans Administration |
$34.64
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Medicare |
$34.64
|
| Rate for Payer: WINHealth Partners Commercial |
$59.56
|
| Rate for Payer: Wise Provider Network Commercial |
$57.74
|
|
