|
GLIDESCOPE 5.0 BFLEX 0570-0449
|
Facility
|
IP
|
$908.25
|
|
| Hospital Charge Code |
2600055
|
|
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
|
|
|
GLIDESCOPE 5.0 BFLEX 0570-0449
|
Facility
|
OP
|
$908.25
|
|
| Hospital Charge Code |
2600055
|
|
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 5.8 BFLEX 0570-0397
|
Facility
|
IP
|
$1,015.00
|
|
| Hospital Charge Code |
2600056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$588.19 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$994.70
|
| Rate for Payer: Aetna of WY Medicare |
$649.60
|
| Rate for Payer: Altius Commercial |
$974.40
|
| Rate for Payer: Beech Street Commercial |
$994.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$984.55
|
| Rate for Payer: Cash Price |
$710.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$984.55
|
| Rate for Payer: Cigna of WY Commercial |
$994.70
|
| Rate for Payer: Entrust Commercial |
$964.25
|
| Rate for Payer: First Choice Health Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$619.15
|
| Rate for Payer: HealthUtah PPO |
$1,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$984.55
|
| Rate for Payer: Multiplan Medicare/VA |
$588.19
|
| Rate for Payer: One Health Plan of WY PPO |
$994.70
|
| Rate for Payer: PacificSource Commercial |
$913.50
|
| Rate for Payer: PHCS PPO |
$994.70
|
| Rate for Payer: Three Rivers PPO |
$761.25
|
| Rate for Payer: TriWest Veterans Administration |
$619.15
|
| Rate for Payer: United Healthcare Commercial |
$969.32
|
| Rate for Payer: United Healthcare Medicare |
$619.15
|
| Rate for Payer: WINHealth Partners Commercial |
$964.25
|
| Rate for Payer: Wise Provider Network Commercial |
$964.25
|
|
|
GLIDESCOPE 5.8 BFLEX 0570-0397
|
Facility
|
OP
|
$1,015.00
|
|
| Hospital Charge Code |
2600056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.62 |
| Max. Negotiated Rate |
$1,015.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$994.70
|
| Rate for Payer: Aetna of WY Medicare |
$669.90
|
| Rate for Payer: Altius Commercial |
$974.40
|
| Rate for Payer: Beech Street Commercial |
$994.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$984.55
|
| Rate for Payer: Cash Price |
$710.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$984.55
|
| Rate for Payer: Cigna of WY Commercial |
$994.70
|
| Rate for Payer: Entrust Commercial |
$964.25
|
| Rate for Payer: First Choice Health Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$964.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$578.55
|
| Rate for Payer: HealthUtah PPO |
$1,015.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$984.55
|
| Rate for Payer: Multiplan Medicare/VA |
$549.62
|
| Rate for Payer: One Health Plan of WY PPO |
$994.70
|
| Rate for Payer: PacificSource Commercial |
$913.50
|
| Rate for Payer: PHCS PPO |
$994.70
|
| Rate for Payer: Three Rivers PPO |
$761.25
|
| Rate for Payer: TriWest Veterans Administration |
$578.55
|
| Rate for Payer: United Healthcare Commercial |
$969.32
|
| Rate for Payer: United Healthcare Medicare |
$578.55
|
| Rate for Payer: WINHealth Partners Commercial |
$994.70
|
| Rate for Payer: Wise Provider Network Commercial |
$964.25
|
|
|
GLIDESCOPE GVL 1 STAT
|
Facility
|
OP
|
$107.52
|
|
| Hospital Charge Code |
2500183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$70.96
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.29
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$58.22
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$61.29
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$61.29
|
| Rate for Payer: WINHealth Partners Commercial |
$105.37
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 1 STAT
|
Facility
|
IP
|
$107.52
|
|
| Hospital Charge Code |
2500183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$68.81
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.59
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$62.31
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$65.59
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$65.59
|
| Rate for Payer: WINHealth Partners Commercial |
$102.14
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 2 STAT
|
Facility
|
IP
|
$107.52
|
|
| Hospital Charge Code |
2500184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$68.81
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.59
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$62.31
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$65.59
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$65.59
|
| Rate for Payer: WINHealth Partners Commercial |
$102.14
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 2 STAT
|
Facility
|
OP
|
$107.52
|
|
| Hospital Charge Code |
2500184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$70.96
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.29
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$58.22
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$61.29
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$61.29
|
| Rate for Payer: WINHealth Partners Commercial |
$105.37
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 3 STAT
|
Facility
|
IP
|
$107.52
|
|
| Hospital Charge Code |
2500137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$68.81
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.59
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$62.31
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$65.59
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$65.59
|
| Rate for Payer: WINHealth Partners Commercial |
$102.14
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 3 STAT
|
Facility
|
OP
|
$107.52
|
|
| Hospital Charge Code |
2500137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$70.96
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.29
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$58.22
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$61.29
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$61.29
|
| Rate for Payer: WINHealth Partners Commercial |
$105.37
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 4 STAT
|
Facility
|
IP
|
$107.52
|
|
| Hospital Charge Code |
2500138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$68.81
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.59
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$62.31
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$65.59
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$65.59
|
| Rate for Payer: WINHealth Partners Commercial |
$102.14
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE GVL 4 STAT
|
Facility
|
OP
|
$107.52
|
|
| Hospital Charge Code |
2500138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$107.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.37
|
| Rate for Payer: Aetna of WY Medicare |
$70.96
|
| Rate for Payer: Altius Commercial |
$103.22
|
| Rate for Payer: Beech Street Commercial |
$105.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$104.29
|
| Rate for Payer: Cash Price |
$75.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.29
|
| Rate for Payer: Cigna of WY Commercial |
$105.37
|
| Rate for Payer: Entrust Commercial |
$102.14
|
| Rate for Payer: First Choice Health Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.29
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$58.22
|
| Rate for Payer: One Health Plan of WY PPO |
$105.37
|
| Rate for Payer: PacificSource Commercial |
$96.77
|
| Rate for Payer: PHCS PPO |
$105.37
|
| Rate for Payer: Three Rivers PPO |
$80.64
|
| Rate for Payer: TriWest Veterans Administration |
$61.29
|
| Rate for Payer: United Healthcare Commercial |
$102.68
|
| Rate for Payer: United Healthcare Medicare |
$61.29
|
| Rate for Payer: WINHealth Partners Commercial |
$105.37
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
|
GLIDESCOPE RIGID STYLET
|
Facility
|
IP
|
$120.05
|
|
| Hospital Charge Code |
2500139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.57 |
| Max. Negotiated Rate |
$120.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.65
|
| Rate for Payer: Aetna of WY Medicare |
$76.83
|
| Rate for Payer: Altius Commercial |
$115.25
|
| Rate for Payer: Beech Street Commercial |
$117.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.45
|
| Rate for Payer: Cash Price |
$84.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.45
|
| Rate for Payer: Cigna of WY Commercial |
$117.65
|
| Rate for Payer: Entrust Commercial |
$114.05
|
| Rate for Payer: First Choice Health Commercial |
$114.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.23
|
| Rate for Payer: HealthUtah PPO |
$120.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.45
|
| Rate for Payer: Multiplan Medicare/VA |
$69.57
|
| Rate for Payer: One Health Plan of WY PPO |
$117.65
|
| Rate for Payer: PacificSource Commercial |
$108.04
|
| Rate for Payer: PHCS PPO |
$117.65
|
| Rate for Payer: Three Rivers PPO |
$90.04
|
| Rate for Payer: TriWest Veterans Administration |
$73.23
|
| Rate for Payer: United Healthcare Commercial |
$114.65
|
| Rate for Payer: United Healthcare Medicare |
$73.23
|
| Rate for Payer: WINHealth Partners Commercial |
$114.05
|
| Rate for Payer: Wise Provider Network Commercial |
$114.05
|
|
|
GLIDESCOPE RIGID STYLET
|
Facility
|
OP
|
$120.05
|
|
| Hospital Charge Code |
2500139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$120.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$117.65
|
| Rate for Payer: Aetna of WY Medicare |
$79.23
|
| Rate for Payer: Altius Commercial |
$115.25
|
| Rate for Payer: Beech Street Commercial |
$117.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$116.45
|
| Rate for Payer: Cash Price |
$84.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$116.45
|
| Rate for Payer: Cigna of WY Commercial |
$117.65
|
| Rate for Payer: Entrust Commercial |
$114.05
|
| Rate for Payer: First Choice Health Commercial |
$114.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$114.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.43
|
| Rate for Payer: HealthUtah PPO |
$120.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$116.45
|
| Rate for Payer: Multiplan Medicare/VA |
$65.01
|
| Rate for Payer: One Health Plan of WY PPO |
$117.65
|
| Rate for Payer: PacificSource Commercial |
$108.04
|
| Rate for Payer: PHCS PPO |
$117.65
|
| Rate for Payer: Three Rivers PPO |
$90.04
|
| Rate for Payer: TriWest Veterans Administration |
$68.43
|
| Rate for Payer: United Healthcare Commercial |
$114.65
|
| Rate for Payer: United Healthcare Medicare |
$68.43
|
| Rate for Payer: WINHealth Partners Commercial |
$117.65
|
| Rate for Payer: Wise Provider Network Commercial |
$114.05
|
|
|
GLIDESCOPE SZ 1 LOPRO SPECTRUM
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
2600061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Aetna of WY Medicare |
$114.11
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.71
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.55
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$93.63
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$98.55
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare |
$98.55
|
| Rate for Payer: WINHealth Partners Commercial |
$169.44
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 1 LOPRO SPECTRUM
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
2600061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Aetna of WY Medicare |
$110.66
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.71
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.47
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$100.20
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$105.47
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare |
$105.47
|
| Rate for Payer: WINHealth Partners Commercial |
$164.26
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 2 LOPRO SPECTRUM
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
2600062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Aetna of WY Medicare |
$114.11
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.71
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.55
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$93.63
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$98.55
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare |
$98.55
|
| Rate for Payer: WINHealth Partners Commercial |
$169.44
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 2 LOPRO SPECTRUM
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
2600062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Aetna of WY Medicare |
$110.66
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$167.71
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.47
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$100.20
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$105.47
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare |
$105.47
|
| Rate for Payer: WINHealth Partners Commercial |
$164.26
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 3 DVM SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2600057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.81
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$72.02
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.81
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$75.81
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 3 DVM SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2600057
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$85.12
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.13
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$77.07
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.13
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$81.13
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 3 LOPRO SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2600059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.81
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$72.02
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.81
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$75.81
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 3 LOPRO SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2600059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$85.12
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.13
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$77.07
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.13
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$81.13
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 4 DVM SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2600058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$85.12
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.13
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$77.07
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.13
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$81.13
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 4 DVM SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2600058
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.81
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$72.02
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.81
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$75.81
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 4 LOPRO SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
2600060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.81
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$72.02
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.81
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$75.81
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
