|
GENTAMICIN 40 MG/ML INJECTION SOLUTION [17722]
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: Entrust Commercial |
$21.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.68
|
| Rate for Payer: Aetna of WY Medicare |
$15.27
|
| Rate for Payer: Altius Commercial |
$22.21
|
| Rate for Payer: Beech Street Commercial |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.45
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.45
|
| Rate for Payer: Cigna of WY Commercial |
$22.68
|
| Rate for Payer: First Choice Health Commercial |
$21.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.19
|
| Rate for Payer: HealthUtah PPO |
$23.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.45
|
| Rate for Payer: Multiplan Medicare/VA |
$12.53
|
| Rate for Payer: One Health Plan of WY PPO |
$22.68
|
| Rate for Payer: PacificSource Commercial |
$20.83
|
| Rate for Payer: PHCS PPO |
$22.68
|
| Rate for Payer: Three Rivers PPO |
$17.36
|
| Rate for Payer: TriWest Veterans Administration |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$22.10
|
| Rate for Payer: United Healthcare Medicare |
$13.19
|
| Rate for Payer: WINHealth Partners Commercial |
$22.68
|
| Rate for Payer: Wise Provider Network Commercial |
$21.98
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION [17722]
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.68
|
| Rate for Payer: Aetna of WY Medicare |
$14.81
|
| Rate for Payer: Altius Commercial |
$22.21
|
| Rate for Payer: Beech Street Commercial |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.45
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.45
|
| Rate for Payer: Cigna of WY Commercial |
$22.68
|
| Rate for Payer: Entrust Commercial |
$21.98
|
| Rate for Payer: First Choice Health Commercial |
$21.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.12
|
| Rate for Payer: HealthUtah PPO |
$23.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.45
|
| Rate for Payer: Multiplan Medicare/VA |
$13.41
|
| Rate for Payer: One Health Plan of WY PPO |
$22.68
|
| Rate for Payer: PacificSource Commercial |
$20.83
|
| Rate for Payer: PHCS PPO |
$22.68
|
| Rate for Payer: Three Rivers PPO |
$17.36
|
| Rate for Payer: TriWest Veterans Administration |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$22.10
|
| Rate for Payer: United Healthcare Medicare |
$14.12
|
| Rate for Payer: WINHealth Partners Commercial |
$21.98
|
| Rate for Payer: Wise Provider Network Commercial |
$21.98
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [45058]
|
Facility
|
IP
|
$25.14
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.64
|
| Rate for Payer: Aetna of WY Medicare |
$16.09
|
| Rate for Payer: Altius Commercial |
$24.13
|
| Rate for Payer: Beech Street Commercial |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.39
|
| Rate for Payer: Cigna of WY Commercial |
$24.64
|
| Rate for Payer: Entrust Commercial |
$23.88
|
| Rate for Payer: First Choice Health Commercial |
$23.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.34
|
| Rate for Payer: HealthUtah PPO |
$25.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.39
|
| Rate for Payer: Multiplan Medicare/VA |
$14.57
|
| Rate for Payer: One Health Plan of WY PPO |
$24.64
|
| Rate for Payer: PacificSource Commercial |
$22.63
|
| Rate for Payer: PHCS PPO |
$24.64
|
| Rate for Payer: Three Rivers PPO |
$18.86
|
| Rate for Payer: TriWest Veterans Administration |
$15.34
|
| Rate for Payer: United Healthcare Commercial |
$24.01
|
| Rate for Payer: United Healthcare Medicare |
$15.34
|
| Rate for Payer: WINHealth Partners Commercial |
$23.88
|
| Rate for Payer: Wise Provider Network Commercial |
$23.88
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [45058]
|
Facility
|
OP
|
$25.14
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.64
|
| Rate for Payer: Aetna of WY Medicare |
$16.59
|
| Rate for Payer: Altius Commercial |
$24.13
|
| Rate for Payer: Beech Street Commercial |
$24.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.39
|
| Rate for Payer: Cigna of WY Commercial |
$24.64
|
| Rate for Payer: Entrust Commercial |
$23.88
|
| Rate for Payer: First Choice Health Commercial |
$23.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.33
|
| Rate for Payer: HealthUtah PPO |
$25.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.39
|
| Rate for Payer: Multiplan Medicare/VA |
$13.61
|
| Rate for Payer: One Health Plan of WY PPO |
$24.64
|
| Rate for Payer: PacificSource Commercial |
$22.63
|
| Rate for Payer: PHCS PPO |
$24.64
|
| Rate for Payer: Three Rivers PPO |
$18.86
|
| Rate for Payer: TriWest Veterans Administration |
$14.33
|
| Rate for Payer: United Healthcare Commercial |
$24.01
|
| Rate for Payer: United Healthcare Medicare |
$14.33
|
| Rate for Payer: WINHealth Partners Commercial |
$24.64
|
| Rate for Payer: Wise Provider Network Commercial |
$23.88
|
|
|
GENTIAN VIOLET 1 % TOPICAL SOLUTION [5027]
|
Facility
|
OP
|
$15.23
|
|
|
Service Code
|
NDC 2438500346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.93
|
| Rate for Payer: Aetna of WY Medicare |
$10.05
|
| Rate for Payer: Altius Commercial |
$14.62
|
| Rate for Payer: Beech Street Commercial |
$14.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.77
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.77
|
| Rate for Payer: Cigna of WY Commercial |
$14.93
|
| Rate for Payer: Entrust Commercial |
$14.47
|
| Rate for Payer: First Choice Health Commercial |
$14.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.68
|
| Rate for Payer: HealthUtah PPO |
$15.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.77
|
| Rate for Payer: Multiplan Medicare/VA |
$8.25
|
| Rate for Payer: One Health Plan of WY PPO |
$14.93
|
| Rate for Payer: PacificSource Commercial |
$13.71
|
| Rate for Payer: PHCS PPO |
$14.93
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$8.68
|
| Rate for Payer: WINHealth Partners Commercial |
$14.93
|
| Rate for Payer: Wise Provider Network Commercial |
$14.47
|
|
|
GENTIAN VIOLET 1 % TOPICAL SOLUTION [5027]
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
NDC 2438500346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.93
|
| Rate for Payer: Aetna of WY Medicare |
$9.75
|
| Rate for Payer: Altius Commercial |
$14.62
|
| Rate for Payer: Beech Street Commercial |
$14.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.77
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.77
|
| Rate for Payer: Cigna of WY Commercial |
$14.93
|
| Rate for Payer: Entrust Commercial |
$14.47
|
| Rate for Payer: First Choice Health Commercial |
$14.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.29
|
| Rate for Payer: HealthUtah PPO |
$15.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.77
|
| Rate for Payer: Multiplan Medicare/VA |
$8.83
|
| Rate for Payer: One Health Plan of WY PPO |
$14.93
|
| Rate for Payer: PacificSource Commercial |
$13.71
|
| Rate for Payer: PHCS PPO |
$14.93
|
| Rate for Payer: Three Rivers PPO |
$11.42
|
| Rate for Payer: TriWest Veterans Administration |
$9.29
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$9.29
|
| Rate for Payer: WINHealth Partners Commercial |
$14.47
|
| Rate for Payer: Wise Provider Network Commercial |
$14.47
|
|
|
GENVISC 850, INJ, 1MG
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS J7320
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$5.16
|
| Rate for Payer: Beech Street Commercial |
$40.85
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: First Choice Health Commercial |
$38.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.16
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$4.39
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$40.85
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$5.16
|
| Rate for Payer: United Healthcare Commercial |
$40.85
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
|
|
GERI-SLEEVE ARM MEDIUM 15"
|
Facility
|
IP
|
$275.62
|
|
| Hospital Charge Code |
3002310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$159.72 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.11
|
| Rate for Payer: Aetna of WY Medicare |
$176.40
|
| Rate for Payer: Altius Commercial |
$264.60
|
| Rate for Payer: Beech Street Commercial |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$267.35
|
| Rate for Payer: Cash Price |
$192.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.35
|
| Rate for Payer: Cigna of WY Commercial |
$270.11
|
| Rate for Payer: Entrust Commercial |
$261.84
|
| Rate for Payer: First Choice Health Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.13
|
| Rate for Payer: HealthUtah PPO |
$275.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.72
|
| Rate for Payer: One Health Plan of WY PPO |
$270.11
|
| Rate for Payer: PacificSource Commercial |
$248.06
|
| Rate for Payer: PHCS PPO |
$270.11
|
| Rate for Payer: Three Rivers PPO |
$206.72
|
| Rate for Payer: TriWest Veterans Administration |
$168.13
|
| Rate for Payer: United Healthcare Commercial |
$263.22
|
| Rate for Payer: United Healthcare Medicare |
$168.13
|
| Rate for Payer: WINHealth Partners Commercial |
$261.84
|
| Rate for Payer: Wise Provider Network Commercial |
$261.84
|
|
|
GERI-SLEEVE ARM MEDIUM 15"
|
Facility
|
OP
|
$275.62
|
|
| Hospital Charge Code |
3002310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.11
|
| Rate for Payer: Aetna of WY Medicare |
$181.91
|
| Rate for Payer: Altius Commercial |
$264.60
|
| Rate for Payer: Beech Street Commercial |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$267.35
|
| Rate for Payer: Cash Price |
$192.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.35
|
| Rate for Payer: Cigna of WY Commercial |
$270.11
|
| Rate for Payer: Entrust Commercial |
$261.84
|
| Rate for Payer: First Choice Health Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.10
|
| Rate for Payer: HealthUtah PPO |
$275.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.35
|
| Rate for Payer: Multiplan Medicare/VA |
$149.25
|
| Rate for Payer: One Health Plan of WY PPO |
$270.11
|
| Rate for Payer: PacificSource Commercial |
$248.06
|
| Rate for Payer: PHCS PPO |
$270.11
|
| Rate for Payer: Three Rivers PPO |
$206.72
|
| Rate for Payer: TriWest Veterans Administration |
$157.10
|
| Rate for Payer: United Healthcare Commercial |
$263.22
|
| Rate for Payer: United Healthcare Medicare |
$157.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.11
|
| Rate for Payer: Wise Provider Network Commercial |
$261.84
|
|
|
GERI-SLEEVE ARM SMALL 14"
|
Facility
|
IP
|
$275.62
|
|
| Hospital Charge Code |
3002313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$159.72 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.11
|
| Rate for Payer: Aetna of WY Medicare |
$176.40
|
| Rate for Payer: Altius Commercial |
$264.60
|
| Rate for Payer: Beech Street Commercial |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$267.35
|
| Rate for Payer: Cash Price |
$192.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.35
|
| Rate for Payer: Cigna of WY Commercial |
$270.11
|
| Rate for Payer: Entrust Commercial |
$261.84
|
| Rate for Payer: First Choice Health Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.13
|
| Rate for Payer: HealthUtah PPO |
$275.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.35
|
| Rate for Payer: Multiplan Medicare/VA |
$159.72
|
| Rate for Payer: One Health Plan of WY PPO |
$270.11
|
| Rate for Payer: PacificSource Commercial |
$248.06
|
| Rate for Payer: PHCS PPO |
$270.11
|
| Rate for Payer: Three Rivers PPO |
$206.72
|
| Rate for Payer: TriWest Veterans Administration |
$168.13
|
| Rate for Payer: United Healthcare Commercial |
$263.22
|
| Rate for Payer: United Healthcare Medicare |
$168.13
|
| Rate for Payer: WINHealth Partners Commercial |
$261.84
|
| Rate for Payer: Wise Provider Network Commercial |
$261.84
|
|
|
GERI-SLEEVE ARM SMALL 14"
|
Facility
|
OP
|
$275.62
|
|
| Hospital Charge Code |
3002313
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.11
|
| Rate for Payer: Aetna of WY Medicare |
$181.91
|
| Rate for Payer: Altius Commercial |
$264.60
|
| Rate for Payer: Beech Street Commercial |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$267.35
|
| Rate for Payer: Cash Price |
$192.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.35
|
| Rate for Payer: Cigna of WY Commercial |
$270.11
|
| Rate for Payer: Entrust Commercial |
$261.84
|
| Rate for Payer: First Choice Health Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.10
|
| Rate for Payer: HealthUtah PPO |
$275.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.35
|
| Rate for Payer: Multiplan Medicare/VA |
$149.25
|
| Rate for Payer: One Health Plan of WY PPO |
$270.11
|
| Rate for Payer: PacificSource Commercial |
$248.06
|
| Rate for Payer: PHCS PPO |
$270.11
|
| Rate for Payer: Three Rivers PPO |
$206.72
|
| Rate for Payer: TriWest Veterans Administration |
$157.10
|
| Rate for Payer: United Healthcare Commercial |
$263.22
|
| Rate for Payer: United Healthcare Medicare |
$157.10
|
| Rate for Payer: WINHealth Partners Commercial |
$270.11
|
| Rate for Payer: Wise Provider Network Commercial |
$261.84
|
|
|
GERI-SLEEVE LEG
|
Facility
|
IP
|
$406.88
|
|
| Hospital Charge Code |
3002315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$235.79 |
| Max. Negotiated Rate |
$406.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$398.74
|
| Rate for Payer: Aetna of WY Medicare |
$260.40
|
| Rate for Payer: Altius Commercial |
$390.60
|
| Rate for Payer: Beech Street Commercial |
$398.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.67
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$394.67
|
| Rate for Payer: Cigna of WY Commercial |
$398.74
|
| Rate for Payer: Entrust Commercial |
$386.54
|
| Rate for Payer: First Choice Health Commercial |
$386.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$386.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$248.20
|
| Rate for Payer: HealthUtah PPO |
$406.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$394.67
|
| Rate for Payer: Multiplan Medicare/VA |
$235.79
|
| Rate for Payer: One Health Plan of WY PPO |
$398.74
|
| Rate for Payer: PacificSource Commercial |
$366.19
|
| Rate for Payer: PHCS PPO |
$398.74
|
| Rate for Payer: Three Rivers PPO |
$305.16
|
| Rate for Payer: TriWest Veterans Administration |
$248.20
|
| Rate for Payer: United Healthcare Commercial |
$388.57
|
| Rate for Payer: United Healthcare Medicare |
$248.20
|
| Rate for Payer: WINHealth Partners Commercial |
$386.54
|
| Rate for Payer: Wise Provider Network Commercial |
$386.54
|
|
|
GERI-SLEEVE LEG
|
Facility
|
OP
|
$406.88
|
|
| Hospital Charge Code |
3002315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$220.33 |
| Max. Negotiated Rate |
$406.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$398.74
|
| Rate for Payer: Aetna of WY Medicare |
$268.54
|
| Rate for Payer: Altius Commercial |
$390.60
|
| Rate for Payer: Beech Street Commercial |
$398.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$394.67
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$394.67
|
| Rate for Payer: Cigna of WY Commercial |
$398.74
|
| Rate for Payer: Entrust Commercial |
$386.54
|
| Rate for Payer: First Choice Health Commercial |
$386.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$386.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.92
|
| Rate for Payer: HealthUtah PPO |
$406.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$394.67
|
| Rate for Payer: Multiplan Medicare/VA |
$220.33
|
| Rate for Payer: One Health Plan of WY PPO |
$398.74
|
| Rate for Payer: PacificSource Commercial |
$366.19
|
| Rate for Payer: PHCS PPO |
$398.74
|
| Rate for Payer: Three Rivers PPO |
$305.16
|
| Rate for Payer: TriWest Veterans Administration |
$231.92
|
| Rate for Payer: United Healthcare Commercial |
$388.57
|
| Rate for Payer: United Healthcare Medicare |
$231.92
|
| Rate for Payer: WINHealth Partners Commercial |
$398.74
|
| Rate for Payer: Wise Provider Network Commercial |
$386.54
|
|
|
GERI-SLEEVE PADDED MED
|
Facility
|
OP
|
$45.99
|
|
| Hospital Charge Code |
3002314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.07
|
| Rate for Payer: Aetna of WY Medicare |
$30.35
|
| Rate for Payer: Altius Commercial |
$44.15
|
| Rate for Payer: Beech Street Commercial |
$45.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.61
|
| Rate for Payer: Cash Price |
$32.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.61
|
| Rate for Payer: Cigna of WY Commercial |
$45.07
|
| Rate for Payer: Entrust Commercial |
$43.69
|
| Rate for Payer: First Choice Health Commercial |
$43.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.21
|
| Rate for Payer: HealthUtah PPO |
$45.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.61
|
| Rate for Payer: Multiplan Medicare/VA |
$24.90
|
| Rate for Payer: One Health Plan of WY PPO |
$45.07
|
| Rate for Payer: PacificSource Commercial |
$41.39
|
| Rate for Payer: PHCS PPO |
$45.07
|
| Rate for Payer: Three Rivers PPO |
$34.49
|
| Rate for Payer: TriWest Veterans Administration |
$26.21
|
| Rate for Payer: United Healthcare Commercial |
$43.92
|
| Rate for Payer: United Healthcare Medicare |
$26.21
|
| Rate for Payer: WINHealth Partners Commercial |
$45.07
|
| Rate for Payer: Wise Provider Network Commercial |
$43.69
|
|
|
GERI-SLEEVE PADDED MED
|
Facility
|
IP
|
$45.99
|
|
| Hospital Charge Code |
3002314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.07
|
| Rate for Payer: Aetna of WY Medicare |
$29.43
|
| Rate for Payer: Altius Commercial |
$44.15
|
| Rate for Payer: Beech Street Commercial |
$45.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.61
|
| Rate for Payer: Cash Price |
$32.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.61
|
| Rate for Payer: Cigna of WY Commercial |
$45.07
|
| Rate for Payer: Entrust Commercial |
$43.69
|
| Rate for Payer: First Choice Health Commercial |
$43.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.05
|
| Rate for Payer: HealthUtah PPO |
$45.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.61
|
| Rate for Payer: Multiplan Medicare/VA |
$26.65
|
| Rate for Payer: One Health Plan of WY PPO |
$45.07
|
| Rate for Payer: PacificSource Commercial |
$41.39
|
| Rate for Payer: PHCS PPO |
$45.07
|
| Rate for Payer: Three Rivers PPO |
$34.49
|
| Rate for Payer: TriWest Veterans Administration |
$28.05
|
| Rate for Payer: United Healthcare Commercial |
$43.92
|
| Rate for Payer: United Healthcare Medicare |
$28.05
|
| Rate for Payer: WINHealth Partners Commercial |
$43.69
|
| Rate for Payer: Wise Provider Network Commercial |
$43.69
|
|
|
GERI-SLEEVE PADDED SMALL
|
Facility
|
IP
|
$38.15
|
|
| Hospital Charge Code |
3002311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.39
|
| Rate for Payer: Aetna of WY Medicare |
$24.42
|
| Rate for Payer: Altius Commercial |
$36.62
|
| Rate for Payer: Beech Street Commercial |
$37.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.01
|
| Rate for Payer: Cigna of WY Commercial |
$37.39
|
| Rate for Payer: Entrust Commercial |
$36.24
|
| Rate for Payer: First Choice Health Commercial |
$36.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.27
|
| Rate for Payer: HealthUtah PPO |
$38.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.01
|
| Rate for Payer: Multiplan Medicare/VA |
$22.11
|
| Rate for Payer: One Health Plan of WY PPO |
$37.39
|
| Rate for Payer: PacificSource Commercial |
$34.34
|
| Rate for Payer: PHCS PPO |
$37.39
|
| Rate for Payer: Three Rivers PPO |
$28.61
|
| Rate for Payer: TriWest Veterans Administration |
$23.27
|
| Rate for Payer: United Healthcare Commercial |
$36.43
|
| Rate for Payer: United Healthcare Medicare |
$23.27
|
| Rate for Payer: WINHealth Partners Commercial |
$36.24
|
| Rate for Payer: Wise Provider Network Commercial |
$36.24
|
|
|
GERI-SLEEVE PADDED SMALL
|
Facility
|
OP
|
$38.15
|
|
| Hospital Charge Code |
3002311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$38.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.39
|
| Rate for Payer: Aetna of WY Medicare |
$25.18
|
| Rate for Payer: Altius Commercial |
$36.62
|
| Rate for Payer: Beech Street Commercial |
$37.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.01
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.01
|
| Rate for Payer: Cigna of WY Commercial |
$37.39
|
| Rate for Payer: Entrust Commercial |
$36.24
|
| Rate for Payer: First Choice Health Commercial |
$36.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.75
|
| Rate for Payer: HealthUtah PPO |
$38.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.01
|
| Rate for Payer: Multiplan Medicare/VA |
$20.66
|
| Rate for Payer: One Health Plan of WY PPO |
$37.39
|
| Rate for Payer: PacificSource Commercial |
$34.34
|
| Rate for Payer: PHCS PPO |
$37.39
|
| Rate for Payer: Three Rivers PPO |
$28.61
|
| Rate for Payer: TriWest Veterans Administration |
$21.75
|
| Rate for Payer: United Healthcare Commercial |
$36.43
|
| Rate for Payer: United Healthcare Medicare |
$21.75
|
| Rate for Payer: WINHealth Partners Commercial |
$37.39
|
| Rate for Payer: Wise Provider Network Commercial |
$36.24
|
|
|
GII QUICKANC + ETHIBOND 212034
|
Facility
|
IP
|
$798.00
|
|
| Hospital Charge Code |
2150055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.44 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$782.04
|
| Rate for Payer: Aetna of WY Medicare |
$510.72
|
| Rate for Payer: Altius Commercial |
$766.08
|
| Rate for Payer: Beech Street Commercial |
$782.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$774.06
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$774.06
|
| Rate for Payer: Cigna of WY Commercial |
$782.04
|
| Rate for Payer: Entrust Commercial |
$758.10
|
| Rate for Payer: First Choice Health Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$486.78
|
| Rate for Payer: HealthUtah PPO |
$798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$774.06
|
| Rate for Payer: Multiplan Medicare/VA |
$462.44
|
| Rate for Payer: One Health Plan of WY PPO |
$782.04
|
| Rate for Payer: PacificSource Commercial |
$718.20
|
| Rate for Payer: PHCS PPO |
$782.04
|
| Rate for Payer: Three Rivers PPO |
$598.50
|
| Rate for Payer: TriWest Veterans Administration |
$486.78
|
| Rate for Payer: United Healthcare Commercial |
$762.09
|
| Rate for Payer: United Healthcare Medicare |
$486.78
|
| Rate for Payer: WINHealth Partners Commercial |
$758.10
|
| Rate for Payer: Wise Provider Network Commercial |
$758.10
|
|
|
GII QUICKANC + ETHIBOND 212034
|
Facility
|
OP
|
$798.00
|
|
| Hospital Charge Code |
2150055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.12 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$782.04
|
| Rate for Payer: Aetna of WY Medicare |
$526.68
|
| Rate for Payer: Altius Commercial |
$766.08
|
| Rate for Payer: Beech Street Commercial |
$782.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$774.06
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$774.06
|
| Rate for Payer: Cigna of WY Commercial |
$782.04
|
| Rate for Payer: Entrust Commercial |
$758.10
|
| Rate for Payer: First Choice Health Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$454.86
|
| Rate for Payer: HealthUtah PPO |
$798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$774.06
|
| Rate for Payer: Multiplan Medicare/VA |
$432.12
|
| Rate for Payer: One Health Plan of WY PPO |
$782.04
|
| Rate for Payer: PacificSource Commercial |
$718.20
|
| Rate for Payer: PHCS PPO |
$782.04
|
| Rate for Payer: Three Rivers PPO |
$598.50
|
| Rate for Payer: TriWest Veterans Administration |
$454.86
|
| Rate for Payer: United Healthcare Commercial |
$762.09
|
| Rate for Payer: United Healthcare Medicare |
$454.86
|
| Rate for Payer: WINHealth Partners Commercial |
$782.04
|
| Rate for Payer: Wise Provider Network Commercial |
$758.10
|
|
|
GIV SUPER QUICK ANCHOR 222984
|
Facility
|
OP
|
$1,900.50
|
|
| Hospital Charge Code |
2150337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.12 |
| Max. Negotiated Rate |
$1,900.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.49
|
| Rate for Payer: Aetna of WY Medicare |
$1,254.33
|
| Rate for Payer: Altius Commercial |
$1,824.48
|
| Rate for Payer: Beech Street Commercial |
$1,862.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,843.48
|
| Rate for Payer: Cash Price |
$1,330.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.49
|
| Rate for Payer: Entrust Commercial |
$1,805.48
|
| Rate for Payer: First Choice Health Commercial |
$1,805.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,083.28
|
| Rate for Payer: HealthUtah PPO |
$1,900.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.48
|
| Rate for Payer: Multiplan Medicare/VA |
$1,029.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.49
|
| Rate for Payer: PacificSource Commercial |
$1,710.45
|
| Rate for Payer: PHCS PPO |
$1,862.49
|
| Rate for Payer: Three Rivers PPO |
$1,425.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,083.28
|
| Rate for Payer: United Healthcare Commercial |
$1,814.98
|
| Rate for Payer: United Healthcare Medicare |
$1,083.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,862.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.48
|
|
|
GIV SUPER QUICK ANCHOR 222984
|
Facility
|
IP
|
$1,900.50
|
|
| Hospital Charge Code |
2150337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.34 |
| Max. Negotiated Rate |
$1,900.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,862.49
|
| Rate for Payer: Aetna of WY Medicare |
$1,216.32
|
| Rate for Payer: Altius Commercial |
$1,824.48
|
| Rate for Payer: Beech Street Commercial |
$1,862.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,843.48
|
| Rate for Payer: Cash Price |
$1,330.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,843.48
|
| Rate for Payer: Cigna of WY Commercial |
$1,862.49
|
| Rate for Payer: Entrust Commercial |
$1,805.48
|
| Rate for Payer: First Choice Health Commercial |
$1,805.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,805.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,159.30
|
| Rate for Payer: HealthUtah PPO |
$1,900.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,843.48
|
| Rate for Payer: Multiplan Medicare/VA |
$1,101.34
|
| Rate for Payer: One Health Plan of WY PPO |
$1,862.49
|
| Rate for Payer: PacificSource Commercial |
$1,710.45
|
| Rate for Payer: PHCS PPO |
$1,862.49
|
| Rate for Payer: Three Rivers PPO |
$1,425.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,159.30
|
| Rate for Payer: United Healthcare Commercial |
$1,814.98
|
| Rate for Payer: United Healthcare Medicare |
$1,159.30
|
| Rate for Payer: WINHealth Partners Commercial |
$1,805.48
|
| Rate for Payer: Wise Provider Network Commercial |
$1,805.48
|
|
|
GLIDESCOPE 2.8 BFLEX 0570-0416
|
Facility
|
IP
|
$1,085.00
|
|
| Hospital Charge Code |
2600063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.76 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.30
|
| Rate for Payer: Aetna of WY Medicare |
$694.40
|
| Rate for Payer: Altius Commercial |
$1,041.60
|
| Rate for Payer: Beech Street Commercial |
$1,063.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,052.45
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.30
|
| Rate for Payer: Entrust Commercial |
$1,030.75
|
| Rate for Payer: First Choice Health Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$661.85
|
| Rate for Payer: HealthUtah PPO |
$1,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.45
|
| Rate for Payer: Multiplan Medicare/VA |
$628.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.30
|
| Rate for Payer: PacificSource Commercial |
$976.50
|
| Rate for Payer: PHCS PPO |
$1,063.30
|
| Rate for Payer: Three Rivers PPO |
$813.75
|
| Rate for Payer: TriWest Veterans Administration |
$661.85
|
| Rate for Payer: United Healthcare Commercial |
$1,036.18
|
| Rate for Payer: United Healthcare Medicare |
$661.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,030.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,030.75
|
|
|
GLIDESCOPE 2.8 BFLEX 0570-0416
|
Facility
|
OP
|
$1,085.00
|
|
| Hospital Charge Code |
2600063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$587.53 |
| Max. Negotiated Rate |
$1,085.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,063.30
|
| Rate for Payer: Aetna of WY Medicare |
$716.10
|
| Rate for Payer: Altius Commercial |
$1,041.60
|
| Rate for Payer: Beech Street Commercial |
$1,063.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,052.45
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,052.45
|
| Rate for Payer: Cigna of WY Commercial |
$1,063.30
|
| Rate for Payer: Entrust Commercial |
$1,030.75
|
| Rate for Payer: First Choice Health Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,030.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$618.45
|
| Rate for Payer: HealthUtah PPO |
$1,085.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,052.45
|
| Rate for Payer: Multiplan Medicare/VA |
$587.53
|
| Rate for Payer: One Health Plan of WY PPO |
$1,063.30
|
| Rate for Payer: PacificSource Commercial |
$976.50
|
| Rate for Payer: PHCS PPO |
$1,063.30
|
| Rate for Payer: Three Rivers PPO |
$813.75
|
| Rate for Payer: TriWest Veterans Administration |
$618.45
|
| Rate for Payer: United Healthcare Commercial |
$1,036.18
|
| Rate for Payer: United Healthcare Medicare |
$618.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,063.30
|
| Rate for Payer: Wise Provider Network Commercial |
$1,030.75
|
|
|
GLIDESCOPE 3.8 BFLEX 0570-0448
|
Facility
|
OP
|
$908.25
|
|
| Hospital Charge Code |
2600054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.82 |
| Max. Negotiated Rate |
$908.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$890.08
|
| Rate for Payer: Aetna of WY Medicare |
$599.44
|
| Rate for Payer: Altius Commercial |
$871.92
|
| Rate for Payer: Beech Street Commercial |
$890.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$881.00
|
| Rate for Payer: Cash Price |
$635.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$881.00
|
| Rate for Payer: Cigna of WY Commercial |
$890.08
|
| Rate for Payer: Entrust Commercial |
$862.84
|
| Rate for Payer: First Choice Health Commercial |
$862.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$517.70
|
| Rate for Payer: HealthUtah PPO |
$908.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$881.00
|
| Rate for Payer: Multiplan Medicare/VA |
$491.82
|
| Rate for Payer: One Health Plan of WY PPO |
$890.08
|
| Rate for Payer: PacificSource Commercial |
$817.42
|
| Rate for Payer: PHCS PPO |
$890.08
|
| Rate for Payer: Three Rivers PPO |
$681.19
|
| Rate for Payer: TriWest Veterans Administration |
$517.70
|
| Rate for Payer: United Healthcare Commercial |
$867.38
|
| Rate for Payer: United Healthcare Medicare |
$517.70
|
| Rate for Payer: WINHealth Partners Commercial |
$890.08
|
| Rate for Payer: Wise Provider Network Commercial |
$862.84
|
|
|
GLIDESCOPE 3.8 BFLEX 0570-0448
|
Facility
|
IP
|
$908.25
|
|
| Hospital Charge Code |
2600054
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.33 |
| Max. Negotiated Rate |
$908.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$890.08
|
| Rate for Payer: Aetna of WY Medicare |
$581.28
|
| Rate for Payer: Altius Commercial |
$871.92
|
| Rate for Payer: Beech Street Commercial |
$890.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$881.00
|
| Rate for Payer: Cash Price |
$635.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$881.00
|
| Rate for Payer: Cigna of WY Commercial |
$890.08
|
| Rate for Payer: Entrust Commercial |
$862.84
|
| Rate for Payer: First Choice Health Commercial |
$862.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$862.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$554.03
|
| Rate for Payer: HealthUtah PPO |
$908.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$881.00
|
| Rate for Payer: Multiplan Medicare/VA |
$526.33
|
| Rate for Payer: One Health Plan of WY PPO |
$890.08
|
| Rate for Payer: PacificSource Commercial |
$817.42
|
| Rate for Payer: PHCS PPO |
$890.08
|
| Rate for Payer: Three Rivers PPO |
$681.19
|
| Rate for Payer: TriWest Veterans Administration |
$554.03
|
| Rate for Payer: United Healthcare Commercial |
$867.38
|
| Rate for Payer: United Healthcare Medicare |
$554.03
|
| Rate for Payer: WINHealth Partners Commercial |
$862.84
|
| Rate for Payer: Wise Provider Network Commercial |
$862.84
|
|
