|
GUIDE WIRE .86MM TROCAR TIP
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
3002293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Aetna of WY Medicare |
$50.82
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.69
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.89
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$41.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$43.89
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$43.89
|
| Rate for Payer: WINHealth Partners Commercial |
$75.46
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
GUIDEWIRE .9MM EXTREMITY
|
Facility
|
OP
|
$73.50
|
|
| Hospital Charge Code |
3004088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.03
|
| Rate for Payer: Aetna of WY Medicare |
$48.51
|
| Rate for Payer: Altius Commercial |
$70.56
|
| Rate for Payer: Beech Street Commercial |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.30
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.30
|
| Rate for Payer: Cigna of WY Commercial |
$72.03
|
| Rate for Payer: Entrust Commercial |
$69.82
|
| Rate for Payer: First Choice Health Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.90
|
| Rate for Payer: HealthUtah PPO |
$73.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.30
|
| Rate for Payer: Multiplan Medicare/VA |
$39.80
|
| Rate for Payer: One Health Plan of WY PPO |
$72.03
|
| Rate for Payer: PacificSource Commercial |
$66.15
|
| Rate for Payer: PHCS PPO |
$72.03
|
| Rate for Payer: Three Rivers PPO |
$55.12
|
| Rate for Payer: TriWest Veterans Administration |
$41.90
|
| Rate for Payer: United Healthcare Commercial |
$70.19
|
| Rate for Payer: United Healthcare Medicare |
$41.90
|
| Rate for Payer: WINHealth Partners Commercial |
$72.03
|
| Rate for Payer: Wise Provider Network Commercial |
$69.82
|
|
|
GUIDEWIRE .9MM EXTREMITY
|
Facility
|
IP
|
$73.50
|
|
| Hospital Charge Code |
3004088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.59 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.03
|
| Rate for Payer: Aetna of WY Medicare |
$47.04
|
| Rate for Payer: Altius Commercial |
$70.56
|
| Rate for Payer: Beech Street Commercial |
$72.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.30
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$71.30
|
| Rate for Payer: Cigna of WY Commercial |
$72.03
|
| Rate for Payer: Entrust Commercial |
$69.82
|
| Rate for Payer: First Choice Health Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.84
|
| Rate for Payer: HealthUtah PPO |
$73.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$71.30
|
| Rate for Payer: Multiplan Medicare/VA |
$42.59
|
| Rate for Payer: One Health Plan of WY PPO |
$72.03
|
| Rate for Payer: PacificSource Commercial |
$66.15
|
| Rate for Payer: PHCS PPO |
$72.03
|
| Rate for Payer: Three Rivers PPO |
$55.12
|
| Rate for Payer: TriWest Veterans Administration |
$44.84
|
| Rate for Payer: United Healthcare Commercial |
$70.19
|
| Rate for Payer: United Healthcare Medicare |
$44.84
|
| Rate for Payer: WINHealth Partners Commercial |
$69.82
|
| Rate for Payer: Wise Provider Network Commercial |
$69.82
|
|
|
GUIDEWIRE AMPLATZ .038"X145CM
|
Facility
|
IP
|
$124.06
|
|
| Hospital Charge Code |
2650628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.89 |
| Max. Negotiated Rate |
$124.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.58
|
| Rate for Payer: Aetna of WY Medicare |
$79.40
|
| Rate for Payer: Altius Commercial |
$119.10
|
| Rate for Payer: Beech Street Commercial |
$121.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.34
|
| Rate for Payer: Cash Price |
$86.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.34
|
| Rate for Payer: Cigna of WY Commercial |
$121.58
|
| Rate for Payer: Entrust Commercial |
$117.86
|
| Rate for Payer: First Choice Health Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.68
|
| Rate for Payer: HealthUtah PPO |
$124.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.34
|
| Rate for Payer: Multiplan Medicare/VA |
$71.89
|
| Rate for Payer: One Health Plan of WY PPO |
$121.58
|
| Rate for Payer: PacificSource Commercial |
$111.65
|
| Rate for Payer: PHCS PPO |
$121.58
|
| Rate for Payer: Three Rivers PPO |
$93.04
|
| Rate for Payer: TriWest Veterans Administration |
$75.68
|
| Rate for Payer: United Healthcare Commercial |
$118.48
|
| Rate for Payer: United Healthcare Medicare |
$75.68
|
| Rate for Payer: WINHealth Partners Commercial |
$117.86
|
| Rate for Payer: Wise Provider Network Commercial |
$117.86
|
|
|
GUIDEWIRE AMPLATZ .038"X145CM
|
Facility
|
OP
|
$124.06
|
|
| Hospital Charge Code |
2650628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$124.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.58
|
| Rate for Payer: Aetna of WY Medicare |
$81.88
|
| Rate for Payer: Altius Commercial |
$119.10
|
| Rate for Payer: Beech Street Commercial |
$121.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$120.34
|
| Rate for Payer: Cash Price |
$86.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.34
|
| Rate for Payer: Cigna of WY Commercial |
$121.58
|
| Rate for Payer: Entrust Commercial |
$117.86
|
| Rate for Payer: First Choice Health Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.71
|
| Rate for Payer: HealthUtah PPO |
$124.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.34
|
| Rate for Payer: Multiplan Medicare/VA |
$67.18
|
| Rate for Payer: One Health Plan of WY PPO |
$121.58
|
| Rate for Payer: PacificSource Commercial |
$111.65
|
| Rate for Payer: PHCS PPO |
$121.58
|
| Rate for Payer: Three Rivers PPO |
$93.04
|
| Rate for Payer: TriWest Veterans Administration |
$70.71
|
| Rate for Payer: United Healthcare Commercial |
$118.48
|
| Rate for Payer: United Healthcare Medicare |
$70.71
|
| Rate for Payer: WINHealth Partners Commercial |
$121.58
|
| Rate for Payer: Wise Provider Network Commercial |
$117.86
|
|
|
GUIDE WIRE ASSY PARALLEL .035"
|
Facility
|
OP
|
$1,603.00
|
|
| Hospital Charge Code |
3004253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$868.02 |
| Max. Negotiated Rate |
$1,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,570.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,057.98
|
| Rate for Payer: Altius Commercial |
$1,538.88
|
| Rate for Payer: Beech Street Commercial |
$1,570.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,554.91
|
| Rate for Payer: Cash Price |
$1,122.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,554.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,570.94
|
| Rate for Payer: Entrust Commercial |
$1,522.85
|
| Rate for Payer: First Choice Health Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$913.71
|
| Rate for Payer: HealthUtah PPO |
$1,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,554.91
|
| Rate for Payer: Multiplan Medicare/VA |
$868.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1,570.94
|
| Rate for Payer: PacificSource Commercial |
$1,442.70
|
| Rate for Payer: PHCS PPO |
$1,570.94
|
| Rate for Payer: Three Rivers PPO |
$1,202.25
|
| Rate for Payer: TriWest Veterans Administration |
$913.71
|
| Rate for Payer: United Healthcare Commercial |
$1,530.86
|
| Rate for Payer: United Healthcare Medicare |
$913.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,570.94
|
| Rate for Payer: Wise Provider Network Commercial |
$1,522.85
|
|
|
GUIDE WIRE ASSY PARALLEL .035"
|
Facility
|
IP
|
$1,603.00
|
|
| Hospital Charge Code |
3004253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.94 |
| Max. Negotiated Rate |
$1,603.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,570.94
|
| Rate for Payer: Aetna of WY Medicare |
$1,025.92
|
| Rate for Payer: Altius Commercial |
$1,538.88
|
| Rate for Payer: Beech Street Commercial |
$1,570.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,554.91
|
| Rate for Payer: Cash Price |
$1,122.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,554.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,570.94
|
| Rate for Payer: Entrust Commercial |
$1,522.85
|
| Rate for Payer: First Choice Health Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,522.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.83
|
| Rate for Payer: HealthUtah PPO |
$1,603.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,554.91
|
| Rate for Payer: Multiplan Medicare/VA |
$928.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,570.94
|
| Rate for Payer: PacificSource Commercial |
$1,442.70
|
| Rate for Payer: PHCS PPO |
$1,570.94
|
| Rate for Payer: Three Rivers PPO |
$1,202.25
|
| Rate for Payer: TriWest Veterans Administration |
$977.83
|
| Rate for Payer: United Healthcare Commercial |
$1,530.86
|
| Rate for Payer: United Healthcare Medicare |
$977.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,522.85
|
| Rate for Payer: Wise Provider Network Commercial |
$1,522.85
|
|
|
GUIDEWIRE DOUBLE TROCAR .86MM
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3002331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.85
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$56.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.85
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$59.85
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
GUIDEWIRE DOUBLE TROCAR .86MM
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3002331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.85 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$67.20
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.05
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$60.85
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.05
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$64.05
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
GUIDEWIRE FLUTES 2.8 X 300MM
|
Facility
|
OP
|
$433.12
|
|
| Hospital Charge Code |
3004541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.53 |
| Max. Negotiated Rate |
$433.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$424.46
|
| Rate for Payer: Aetna of WY Medicare |
$285.86
|
| Rate for Payer: Altius Commercial |
$415.80
|
| Rate for Payer: Beech Street Commercial |
$424.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$420.13
|
| Rate for Payer: Cash Price |
$303.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.13
|
| Rate for Payer: Cigna of WY Commercial |
$424.46
|
| Rate for Payer: Entrust Commercial |
$411.46
|
| Rate for Payer: First Choice Health Commercial |
$411.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$411.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$246.88
|
| Rate for Payer: HealthUtah PPO |
$433.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.13
|
| Rate for Payer: Multiplan Medicare/VA |
$234.53
|
| Rate for Payer: One Health Plan of WY PPO |
$424.46
|
| Rate for Payer: PacificSource Commercial |
$389.81
|
| Rate for Payer: PHCS PPO |
$424.46
|
| Rate for Payer: Three Rivers PPO |
$324.84
|
| Rate for Payer: TriWest Veterans Administration |
$246.88
|
| Rate for Payer: United Healthcare Commercial |
$413.63
|
| Rate for Payer: United Healthcare Medicare |
$246.88
|
| Rate for Payer: WINHealth Partners Commercial |
$424.46
|
| Rate for Payer: Wise Provider Network Commercial |
$411.46
|
|
|
GUIDEWIRE FLUTES 2.8 X 300MM
|
Facility
|
IP
|
$433.12
|
|
| Hospital Charge Code |
3004541
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.99 |
| Max. Negotiated Rate |
$433.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$424.46
|
| Rate for Payer: Aetna of WY Medicare |
$277.20
|
| Rate for Payer: Altius Commercial |
$415.80
|
| Rate for Payer: Beech Street Commercial |
$424.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$420.13
|
| Rate for Payer: Cash Price |
$303.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.13
|
| Rate for Payer: Cigna of WY Commercial |
$424.46
|
| Rate for Payer: Entrust Commercial |
$411.46
|
| Rate for Payer: First Choice Health Commercial |
$411.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$411.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$264.20
|
| Rate for Payer: HealthUtah PPO |
$433.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.13
|
| Rate for Payer: Multiplan Medicare/VA |
$250.99
|
| Rate for Payer: One Health Plan of WY PPO |
$424.46
|
| Rate for Payer: PacificSource Commercial |
$389.81
|
| Rate for Payer: PHCS PPO |
$424.46
|
| Rate for Payer: Three Rivers PPO |
$324.84
|
| Rate for Payer: TriWest Veterans Administration |
$264.20
|
| Rate for Payer: United Healthcare Commercial |
$413.63
|
| Rate for Payer: United Healthcare Medicare |
$264.20
|
| Rate for Payer: WINHealth Partners Commercial |
$411.46
|
| Rate for Payer: Wise Provider Network Commercial |
$411.46
|
|
|
GUIDE WIRE MPF NITINOL SMALL
|
Facility
|
OP
|
$584.15
|
|
| Hospital Charge Code |
3004211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.32 |
| Max. Negotiated Rate |
$584.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$572.47
|
| Rate for Payer: Aetna of WY Medicare |
$385.54
|
| Rate for Payer: Altius Commercial |
$560.78
|
| Rate for Payer: Beech Street Commercial |
$572.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.63
|
| Rate for Payer: Cash Price |
$408.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$566.63
|
| Rate for Payer: Cigna of WY Commercial |
$572.47
|
| Rate for Payer: Entrust Commercial |
$554.94
|
| Rate for Payer: First Choice Health Commercial |
$554.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$554.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$332.97
|
| Rate for Payer: HealthUtah PPO |
$584.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$566.63
|
| Rate for Payer: Multiplan Medicare/VA |
$316.32
|
| Rate for Payer: One Health Plan of WY PPO |
$572.47
|
| Rate for Payer: PacificSource Commercial |
$525.74
|
| Rate for Payer: PHCS PPO |
$572.47
|
| Rate for Payer: Three Rivers PPO |
$438.11
|
| Rate for Payer: TriWest Veterans Administration |
$332.97
|
| Rate for Payer: United Healthcare Commercial |
$557.86
|
| Rate for Payer: United Healthcare Medicare |
$332.97
|
| Rate for Payer: WINHealth Partners Commercial |
$572.47
|
| Rate for Payer: Wise Provider Network Commercial |
$554.94
|
|
|
GUIDE WIRE MPF NITINOL SMALL
|
Facility
|
IP
|
$584.15
|
|
| Hospital Charge Code |
3004211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.51 |
| Max. Negotiated Rate |
$584.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$572.47
|
| Rate for Payer: Aetna of WY Medicare |
$373.86
|
| Rate for Payer: Altius Commercial |
$560.78
|
| Rate for Payer: Beech Street Commercial |
$572.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$566.63
|
| Rate for Payer: Cash Price |
$408.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$566.63
|
| Rate for Payer: Cigna of WY Commercial |
$572.47
|
| Rate for Payer: Entrust Commercial |
$554.94
|
| Rate for Payer: First Choice Health Commercial |
$554.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$554.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$356.33
|
| Rate for Payer: HealthUtah PPO |
$584.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$566.63
|
| Rate for Payer: Multiplan Medicare/VA |
$338.51
|
| Rate for Payer: One Health Plan of WY PPO |
$572.47
|
| Rate for Payer: PacificSource Commercial |
$525.74
|
| Rate for Payer: PHCS PPO |
$572.47
|
| Rate for Payer: Three Rivers PPO |
$438.11
|
| Rate for Payer: TriWest Veterans Administration |
$356.33
|
| Rate for Payer: United Healthcare Commercial |
$557.86
|
| Rate for Payer: United Healthcare Medicare |
$356.33
|
| Rate for Payer: WINHealth Partners Commercial |
$554.94
|
| Rate for Payer: Wise Provider Network Commercial |
$554.94
|
|
|
GUIDE WIRE NITINOL 8X400MM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
3004728A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$224.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$213.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$202.82
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$213.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$213.50
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
GUIDE WIRE NITINOL 8X400MM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
3004728A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$339.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.50
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$334.25
|
| Rate for Payer: United Healthcare Medicare |
$199.50
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
GUIDEWIRE PTFE COATED .038X150
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
2650236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$15.68
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.76
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.94
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$14.20
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.94
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Medicare |
$14.94
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
GUIDEWIRE PTFE COATED .038X150
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
2650236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.76
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.96
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.27
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$13.96
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Medicare |
$13.96
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
GUIDEWIRE SENSOR NITINOL ST .038"X150CM
|
Facility
|
OP
|
$195.40
|
|
| Hospital Charge Code |
2750148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.81 |
| Max. Negotiated Rate |
$195.40 |
| Rate for Payer: United Healthcare Commercial |
$186.61
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.49
|
| Rate for Payer: Aetna of WY Medicare |
$128.96
|
| Rate for Payer: Altius Commercial |
$187.58
|
| Rate for Payer: Beech Street Commercial |
$191.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$189.54
|
| Rate for Payer: Cash Price |
$136.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.54
|
| Rate for Payer: Cigna of WY Commercial |
$191.49
|
| Rate for Payer: Entrust Commercial |
$185.63
|
| Rate for Payer: First Choice Health Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.38
|
| Rate for Payer: HealthUtah PPO |
$195.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.54
|
| Rate for Payer: Multiplan Medicare/VA |
$105.81
|
| Rate for Payer: One Health Plan of WY PPO |
$191.49
|
| Rate for Payer: PacificSource Commercial |
$175.86
|
| Rate for Payer: PHCS PPO |
$191.49
|
| Rate for Payer: Three Rivers PPO |
$146.55
|
| Rate for Payer: TriWest Veterans Administration |
$111.38
|
| Rate for Payer: United Healthcare Medicare |
$111.38
|
| Rate for Payer: WINHealth Partners Commercial |
$191.49
|
| Rate for Payer: Wise Provider Network Commercial |
$185.63
|
|
|
GUIDEWIRE SENSOR NITINOL ST .038"X150CM
|
Facility
|
IP
|
$195.40
|
|
| Hospital Charge Code |
2750148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$195.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.49
|
| Rate for Payer: Aetna of WY Medicare |
$125.06
|
| Rate for Payer: Altius Commercial |
$187.58
|
| Rate for Payer: Beech Street Commercial |
$191.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$189.54
|
| Rate for Payer: Cash Price |
$136.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.54
|
| Rate for Payer: Cigna of WY Commercial |
$191.49
|
| Rate for Payer: Entrust Commercial |
$185.63
|
| Rate for Payer: First Choice Health Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.19
|
| Rate for Payer: HealthUtah PPO |
$195.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.54
|
| Rate for Payer: Multiplan Medicare/VA |
$113.23
|
| Rate for Payer: One Health Plan of WY PPO |
$191.49
|
| Rate for Payer: PacificSource Commercial |
$175.86
|
| Rate for Payer: PHCS PPO |
$191.49
|
| Rate for Payer: Three Rivers PPO |
$146.55
|
| Rate for Payer: TriWest Veterans Administration |
$119.19
|
| Rate for Payer: United Healthcare Commercial |
$186.61
|
| Rate for Payer: United Healthcare Medicare |
$119.19
|
| Rate for Payer: WINHealth Partners Commercial |
$185.63
|
| Rate for Payer: Wise Provider Network Commercial |
$185.63
|
|
|
GUIDE WIRE THRD 1.4MM
|
Facility
|
IP
|
$194.18
|
|
| Hospital Charge Code |
3100001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.53 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.30
|
| Rate for Payer: Aetna of WY Medicare |
$124.28
|
| Rate for Payer: Altius Commercial |
$186.41
|
| Rate for Payer: Beech Street Commercial |
$190.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.35
|
| Rate for Payer: Cash Price |
$135.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.35
|
| Rate for Payer: Cigna of WY Commercial |
$190.30
|
| Rate for Payer: Entrust Commercial |
$184.47
|
| Rate for Payer: First Choice Health Commercial |
$184.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.45
|
| Rate for Payer: HealthUtah PPO |
$194.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.35
|
| Rate for Payer: Multiplan Medicare/VA |
$112.53
|
| Rate for Payer: One Health Plan of WY PPO |
$190.30
|
| Rate for Payer: PacificSource Commercial |
$174.76
|
| Rate for Payer: PHCS PPO |
$190.30
|
| Rate for Payer: Three Rivers PPO |
$145.64
|
| Rate for Payer: TriWest Veterans Administration |
$118.45
|
| Rate for Payer: United Healthcare Commercial |
$185.44
|
| Rate for Payer: United Healthcare Medicare |
$118.45
|
| Rate for Payer: WINHealth Partners Commercial |
$184.47
|
| Rate for Payer: Wise Provider Network Commercial |
$184.47
|
|
|
GUIDE WIRE THRD 1.4MM
|
Facility
|
OP
|
$194.18
|
|
| Hospital Charge Code |
3100001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.15 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$190.30
|
| Rate for Payer: Aetna of WY Medicare |
$128.16
|
| Rate for Payer: Altius Commercial |
$186.41
|
| Rate for Payer: Beech Street Commercial |
$190.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$188.35
|
| Rate for Payer: Cash Price |
$135.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$188.35
|
| Rate for Payer: Cigna of WY Commercial |
$190.30
|
| Rate for Payer: Entrust Commercial |
$184.47
|
| Rate for Payer: First Choice Health Commercial |
$184.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$184.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.68
|
| Rate for Payer: HealthUtah PPO |
$194.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$188.35
|
| Rate for Payer: Multiplan Medicare/VA |
$105.15
|
| Rate for Payer: One Health Plan of WY PPO |
$190.30
|
| Rate for Payer: PacificSource Commercial |
$174.76
|
| Rate for Payer: PHCS PPO |
$190.30
|
| Rate for Payer: Three Rivers PPO |
$145.64
|
| Rate for Payer: TriWest Veterans Administration |
$110.68
|
| Rate for Payer: United Healthcare Commercial |
$185.44
|
| Rate for Payer: United Healthcare Medicare |
$110.68
|
| Rate for Payer: WINHealth Partners Commercial |
$190.30
|
| Rate for Payer: Wise Provider Network Commercial |
$184.47
|
|
|
GUIDE-WIRE THRD AR-8941KT
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
3001872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Aetna of WY Medicare |
$49.28
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.69
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.97
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$44.62
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$46.97
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$46.97
|
| Rate for Payer: WINHealth Partners Commercial |
$73.15
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
GUIDE-WIRE THRD AR-8941KT
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
3001872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.46
|
| Rate for Payer: Aetna of WY Medicare |
$50.82
|
| Rate for Payer: Altius Commercial |
$73.92
|
| Rate for Payer: Beech Street Commercial |
$75.46
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.69
|
| Rate for Payer: Cash Price |
$53.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.69
|
| Rate for Payer: Cigna of WY Commercial |
$75.46
|
| Rate for Payer: Entrust Commercial |
$73.15
|
| Rate for Payer: First Choice Health Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$73.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.89
|
| Rate for Payer: HealthUtah PPO |
$77.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.69
|
| Rate for Payer: Multiplan Medicare/VA |
$41.70
|
| Rate for Payer: One Health Plan of WY PPO |
$75.46
|
| Rate for Payer: PacificSource Commercial |
$69.30
|
| Rate for Payer: PHCS PPO |
$75.46
|
| Rate for Payer: Three Rivers PPO |
$57.75
|
| Rate for Payer: TriWest Veterans Administration |
$43.89
|
| Rate for Payer: United Healthcare Commercial |
$73.54
|
| Rate for Payer: United Healthcare Medicare |
$43.89
|
| Rate for Payer: WINHealth Partners Commercial |
$75.46
|
| Rate for Payer: Wise Provider Network Commercial |
$73.15
|
|
|
GUIDE WIRE THRD AR-8967KT-12
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
3001877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.85 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$67.20
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.05
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$60.85
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$64.05
|
| Rate for Payer: United Healthcare Medicare |
$64.05
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
|
GUIDE WIRE THRD AR-8967KT-12
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
3001877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$69.30
|
| Rate for Payer: Altius Commercial |
$100.80
|
| Rate for Payer: Beech Street Commercial |
$102.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: Entrust Commercial |
$99.75
|
| Rate for Payer: First Choice Health Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.85
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$56.86
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$102.90
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$59.85
|
| Rate for Payer: United Healthcare Commercial |
$100.28
|
| Rate for Payer: United Healthcare Medicare |
$59.85
|
| Rate for Payer: WINHealth Partners Commercial |
$102.90
|
| Rate for Payer: Wise Provider Network Commercial |
$99.75
|
|
