|
BICEPS BUTTON AR-2261
|
Facility
|
OP
|
$1,205.96
|
|
| Hospital Charge Code |
2650678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.03 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$795.93
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,169.78
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$687.40
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$653.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$687.40
|
| Rate for Payer: United Healthcare Commercial |
$1,151.69
|
| Rate for Payer: United Healthcare Medicare |
$687.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
BICEPS BUTTON AR-2261
|
Facility
|
IP
|
$1,205.96
|
|
| Hospital Charge Code |
2650678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.85 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$771.81
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,169.78
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$735.64
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$698.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$735.64
|
| Rate for Payer: United Healthcare Commercial |
$1,151.69
|
| Rate for Payer: United Healthcare Medicare |
$735.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
BICEPS BUTTON INSERTER AR-2262
|
Facility
|
IP
|
$572.32
|
|
| Hospital Charge Code |
2650679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.66 |
| Max. Negotiated Rate |
$572.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.87
|
| Rate for Payer: Aetna of WY Medicare |
$366.28
|
| Rate for Payer: Altius Commercial |
$549.43
|
| Rate for Payer: Beech Street Commercial |
$560.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$555.15
|
| Rate for Payer: Cash Price |
$400.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.15
|
| Rate for Payer: Cigna of WY Commercial |
$560.87
|
| Rate for Payer: Entrust Commercial |
$543.70
|
| Rate for Payer: First Choice Health Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$349.12
|
| Rate for Payer: HealthUtah PPO |
$572.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.15
|
| Rate for Payer: Multiplan Medicare/VA |
$331.66
|
| Rate for Payer: One Health Plan of WY PPO |
$560.87
|
| Rate for Payer: PacificSource Commercial |
$515.09
|
| Rate for Payer: PHCS PPO |
$560.87
|
| Rate for Payer: Three Rivers PPO |
$429.24
|
| Rate for Payer: TriWest Veterans Administration |
$349.12
|
| Rate for Payer: United Healthcare Commercial |
$546.57
|
| Rate for Payer: United Healthcare Medicare |
$349.12
|
| Rate for Payer: WINHealth Partners Commercial |
$543.70
|
| Rate for Payer: Wise Provider Network Commercial |
$543.70
|
|
|
BICEPS BUTTON INSERTER AR-2262
|
Facility
|
OP
|
$572.32
|
|
| Hospital Charge Code |
2650679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.91 |
| Max. Negotiated Rate |
$572.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.87
|
| Rate for Payer: Aetna of WY Medicare |
$377.73
|
| Rate for Payer: Altius Commercial |
$549.43
|
| Rate for Payer: Beech Street Commercial |
$560.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$555.15
|
| Rate for Payer: Cash Price |
$400.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.15
|
| Rate for Payer: Cigna of WY Commercial |
$560.87
|
| Rate for Payer: Entrust Commercial |
$543.70
|
| Rate for Payer: First Choice Health Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.22
|
| Rate for Payer: HealthUtah PPO |
$572.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.15
|
| Rate for Payer: Multiplan Medicare/VA |
$309.91
|
| Rate for Payer: One Health Plan of WY PPO |
$560.87
|
| Rate for Payer: PacificSource Commercial |
$515.09
|
| Rate for Payer: PHCS PPO |
$560.87
|
| Rate for Payer: Three Rivers PPO |
$429.24
|
| Rate for Payer: TriWest Veterans Administration |
$326.22
|
| Rate for Payer: United Healthcare Commercial |
$546.57
|
| Rate for Payer: United Healthcare Medicare |
$326.22
|
| Rate for Payer: WINHealth Partners Commercial |
$560.87
|
| Rate for Payer: Wise Provider Network Commercial |
$543.70
|
|
|
BILI BABYFACE SHEILD BFS4001
|
Facility
|
IP
|
$11.90
|
|
| Hospital Charge Code |
2450056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.66
|
| Rate for Payer: Aetna of WY Medicare |
$7.62
|
| Rate for Payer: Altius Commercial |
$11.42
|
| Rate for Payer: Beech Street Commercial |
$11.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.54
|
| Rate for Payer: Cash Price |
$8.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.54
|
| Rate for Payer: Cigna of WY Commercial |
$11.66
|
| Rate for Payer: Entrust Commercial |
$11.30
|
| Rate for Payer: First Choice Health Commercial |
$11.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.26
|
| Rate for Payer: HealthUtah PPO |
$11.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.54
|
| Rate for Payer: Multiplan Medicare/VA |
$6.90
|
| Rate for Payer: One Health Plan of WY PPO |
$11.66
|
| Rate for Payer: PacificSource Commercial |
$10.71
|
| Rate for Payer: PHCS PPO |
$11.66
|
| Rate for Payer: Three Rivers PPO |
$8.92
|
| Rate for Payer: TriWest Veterans Administration |
$7.26
|
| Rate for Payer: United Healthcare Commercial |
$11.36
|
| Rate for Payer: United Healthcare Medicare |
$7.26
|
| Rate for Payer: WINHealth Partners Commercial |
$11.30
|
| Rate for Payer: Wise Provider Network Commercial |
$11.30
|
|
|
BILI BABYFACE SHEILD BFS4001
|
Facility
|
OP
|
$11.90
|
|
| Hospital Charge Code |
2450056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.66
|
| Rate for Payer: Aetna of WY Medicare |
$7.85
|
| Rate for Payer: Altius Commercial |
$11.42
|
| Rate for Payer: Beech Street Commercial |
$11.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.54
|
| Rate for Payer: Cash Price |
$8.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.54
|
| Rate for Payer: Cigna of WY Commercial |
$11.66
|
| Rate for Payer: Entrust Commercial |
$11.30
|
| Rate for Payer: First Choice Health Commercial |
$11.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.78
|
| Rate for Payer: HealthUtah PPO |
$11.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.54
|
| Rate for Payer: Multiplan Medicare/VA |
$6.44
|
| Rate for Payer: One Health Plan of WY PPO |
$11.66
|
| Rate for Payer: PacificSource Commercial |
$10.71
|
| Rate for Payer: PHCS PPO |
$11.66
|
| Rate for Payer: Three Rivers PPO |
$8.92
|
| Rate for Payer: TriWest Veterans Administration |
$6.78
|
| Rate for Payer: United Healthcare Commercial |
$11.36
|
| Rate for Payer: United Healthcare Medicare |
$6.78
|
| Rate for Payer: WINHealth Partners Commercial |
$11.66
|
| Rate for Payer: Wise Provider Network Commercial |
$11.30
|
|
|
BILI BED CHUX
|
Facility
|
IP
|
$1.82
|
|
| Hospital Charge Code |
2450043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Aetna of WY Medicare |
$1.16
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.11
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
BILI BED CHUX
|
Facility
|
OP
|
$1.82
|
|
| Hospital Charge Code |
2450043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Aetna of WY Medicare |
$1.20
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
BILI BED MATTRESS
|
Facility
|
IP
|
$24.85
|
|
| Hospital Charge Code |
2450042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.35
|
| Rate for Payer: Aetna of WY Medicare |
$15.90
|
| Rate for Payer: Altius Commercial |
$23.86
|
| Rate for Payer: Beech Street Commercial |
$24.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.10
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.10
|
| Rate for Payer: Cigna of WY Commercial |
$24.35
|
| Rate for Payer: Entrust Commercial |
$23.61
|
| Rate for Payer: First Choice Health Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.16
|
| Rate for Payer: HealthUtah PPO |
$24.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.10
|
| Rate for Payer: Multiplan Medicare/VA |
$14.40
|
| Rate for Payer: One Health Plan of WY PPO |
$24.35
|
| Rate for Payer: PacificSource Commercial |
$22.36
|
| Rate for Payer: PHCS PPO |
$24.35
|
| Rate for Payer: Three Rivers PPO |
$18.64
|
| Rate for Payer: TriWest Veterans Administration |
$15.16
|
| Rate for Payer: United Healthcare Commercial |
$23.73
|
| Rate for Payer: United Healthcare Medicare |
$15.16
|
| Rate for Payer: WINHealth Partners Commercial |
$23.61
|
| Rate for Payer: Wise Provider Network Commercial |
$23.61
|
|
|
BILI BED MATTRESS
|
Facility
|
OP
|
$24.85
|
|
| Hospital Charge Code |
2450042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.35
|
| Rate for Payer: Aetna of WY Medicare |
$16.40
|
| Rate for Payer: Altius Commercial |
$23.86
|
| Rate for Payer: Beech Street Commercial |
$24.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.10
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.10
|
| Rate for Payer: Cigna of WY Commercial |
$24.35
|
| Rate for Payer: Entrust Commercial |
$23.61
|
| Rate for Payer: First Choice Health Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.16
|
| Rate for Payer: HealthUtah PPO |
$24.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.10
|
| Rate for Payer: Multiplan Medicare/VA |
$13.46
|
| Rate for Payer: One Health Plan of WY PPO |
$24.35
|
| Rate for Payer: PacificSource Commercial |
$22.36
|
| Rate for Payer: PHCS PPO |
$24.35
|
| Rate for Payer: Three Rivers PPO |
$18.64
|
| Rate for Payer: TriWest Veterans Administration |
$14.16
|
| Rate for Payer: United Healthcare Commercial |
$23.73
|
| Rate for Payer: United Healthcare Medicare |
$14.16
|
| Rate for Payer: WINHealth Partners Commercial |
$24.35
|
| Rate for Payer: Wise Provider Network Commercial |
$23.61
|
|
|
BILI BLANKET VEST DISP
|
Facility
|
OP
|
$5.81
|
|
| Hospital Charge Code |
2400179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.69
|
| Rate for Payer: Aetna of WY Medicare |
$3.83
|
| Rate for Payer: Altius Commercial |
$5.58
|
| Rate for Payer: Beech Street Commercial |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.64
|
| Rate for Payer: Cigna of WY Commercial |
$5.69
|
| Rate for Payer: Entrust Commercial |
$5.52
|
| Rate for Payer: First Choice Health Commercial |
$5.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.31
|
| Rate for Payer: HealthUtah PPO |
$5.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.64
|
| Rate for Payer: Multiplan Medicare/VA |
$3.15
|
| Rate for Payer: One Health Plan of WY PPO |
$5.69
|
| Rate for Payer: PacificSource Commercial |
$5.23
|
| Rate for Payer: PHCS PPO |
$5.69
|
| Rate for Payer: Three Rivers PPO |
$4.36
|
| Rate for Payer: TriWest Veterans Administration |
$3.31
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
| Rate for Payer: United Healthcare Medicare |
$3.31
|
| Rate for Payer: WINHealth Partners Commercial |
$5.69
|
| Rate for Payer: Wise Provider Network Commercial |
$5.52
|
|
|
BILI BLANKET VEST DISP
|
Facility
|
IP
|
$5.81
|
|
| Hospital Charge Code |
2400179
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.69
|
| Rate for Payer: Aetna of WY Medicare |
$3.72
|
| Rate for Payer: Altius Commercial |
$5.58
|
| Rate for Payer: Beech Street Commercial |
$5.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.64
|
| Rate for Payer: Cigna of WY Commercial |
$5.69
|
| Rate for Payer: Entrust Commercial |
$5.52
|
| Rate for Payer: First Choice Health Commercial |
$5.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.54
|
| Rate for Payer: HealthUtah PPO |
$5.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.64
|
| Rate for Payer: Multiplan Medicare/VA |
$3.37
|
| Rate for Payer: One Health Plan of WY PPO |
$5.69
|
| Rate for Payer: PacificSource Commercial |
$5.23
|
| Rate for Payer: PHCS PPO |
$5.69
|
| Rate for Payer: Three Rivers PPO |
$4.36
|
| Rate for Payer: TriWest Veterans Administration |
$3.54
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
| Rate for Payer: United Healthcare Medicare |
$3.54
|
| Rate for Payer: WINHealth Partners Commercial |
$5.52
|
| Rate for Payer: Wise Provider Network Commercial |
$5.52
|
|
|
BILICHEK DISPOSABLE TIPS
|
Facility
|
OP
|
$21.10
|
|
| Hospital Charge Code |
2450067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.68
|
| Rate for Payer: Aetna of WY Medicare |
$13.93
|
| Rate for Payer: Altius Commercial |
$20.26
|
| Rate for Payer: Beech Street Commercial |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.47
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.47
|
| Rate for Payer: Cigna of WY Commercial |
$20.68
|
| Rate for Payer: Entrust Commercial |
$20.04
|
| Rate for Payer: First Choice Health Commercial |
$20.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.03
|
| Rate for Payer: HealthUtah PPO |
$21.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.47
|
| Rate for Payer: Multiplan Medicare/VA |
$11.43
|
| Rate for Payer: One Health Plan of WY PPO |
$20.68
|
| Rate for Payer: PacificSource Commercial |
$18.99
|
| Rate for Payer: PHCS PPO |
$20.68
|
| Rate for Payer: Three Rivers PPO |
$15.82
|
| Rate for Payer: TriWest Veterans Administration |
$12.03
|
| Rate for Payer: United Healthcare Commercial |
$20.15
|
| Rate for Payer: United Healthcare Medicare |
$12.03
|
| Rate for Payer: WINHealth Partners Commercial |
$20.68
|
| Rate for Payer: Wise Provider Network Commercial |
$20.04
|
|
|
BILICHEK DISPOSABLE TIPS
|
Facility
|
IP
|
$21.10
|
|
| Hospital Charge Code |
2450067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.68
|
| Rate for Payer: Aetna of WY Medicare |
$13.50
|
| Rate for Payer: Altius Commercial |
$20.26
|
| Rate for Payer: Beech Street Commercial |
$20.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.47
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.47
|
| Rate for Payer: Cigna of WY Commercial |
$20.68
|
| Rate for Payer: Entrust Commercial |
$20.04
|
| Rate for Payer: First Choice Health Commercial |
$20.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.87
|
| Rate for Payer: HealthUtah PPO |
$21.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.47
|
| Rate for Payer: Multiplan Medicare/VA |
$12.23
|
| Rate for Payer: One Health Plan of WY PPO |
$20.68
|
| Rate for Payer: PacificSource Commercial |
$18.99
|
| Rate for Payer: PHCS PPO |
$20.68
|
| Rate for Payer: Three Rivers PPO |
$15.82
|
| Rate for Payer: TriWest Veterans Administration |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$20.15
|
| Rate for Payer: United Healthcare Medicare |
$12.87
|
| Rate for Payer: WINHealth Partners Commercial |
$20.04
|
| Rate for Payer: Wise Provider Network Commercial |
$20.04
|
|
|
BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 92504
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$86.24
|
| Rate for Payer: Aetna of WY Medicare |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$83.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$85.36
|
| Rate for Payer: Cigna of WY Commercial |
$86.24
|
| Rate for Payer: First Choice Health Commercial |
$79.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: HealthUtah PPO |
$88.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$85.36
|
| Rate for Payer: Multiplan Medicare/VA |
$7.45
|
| Rate for Payer: One Health Plan of WY PPO |
$86.24
|
| Rate for Payer: PacificSource Commercial |
$79.20
|
| Rate for Payer: PHCS PPO |
$83.60
|
| Rate for Payer: Three Rivers PPO |
$66.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$83.60
|
| Rate for Payer: WINHealth Partners Commercial |
$83.60
|
|
|
BIOCARTILAGE 0.75CC
|
Facility
|
IP
|
$3,066.00
|
|
| Hospital Charge Code |
3004604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,776.75 |
| Max. Negotiated Rate |
$3,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,004.68
|
| Rate for Payer: Aetna of WY Medicare |
$1,962.24
|
| Rate for Payer: Altius Commercial |
$2,943.36
|
| Rate for Payer: Beech Street Commercial |
$3,004.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,974.02
|
| Rate for Payer: Cash Price |
$2,146.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,974.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,004.68
|
| Rate for Payer: Entrust Commercial |
$2,912.70
|
| Rate for Payer: First Choice Health Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,870.26
|
| Rate for Payer: HealthUtah PPO |
$3,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,974.02
|
| Rate for Payer: Multiplan Medicare/VA |
$1,776.75
|
| Rate for Payer: One Health Plan of WY PPO |
$3,004.68
|
| Rate for Payer: PacificSource Commercial |
$2,759.40
|
| Rate for Payer: PHCS PPO |
$3,004.68
|
| Rate for Payer: Three Rivers PPO |
$2,299.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,870.26
|
| Rate for Payer: United Healthcare Commercial |
$2,928.03
|
| Rate for Payer: United Healthcare Medicare |
$1,870.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,912.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,912.70
|
|
|
BIOCARTILAGE 0.75CC
|
Facility
|
OP
|
$3,066.00
|
|
| Hospital Charge Code |
3004604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.24 |
| Max. Negotiated Rate |
$3,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,004.68
|
| Rate for Payer: Aetna of WY Medicare |
$2,023.56
|
| Rate for Payer: Altius Commercial |
$2,943.36
|
| Rate for Payer: Beech Street Commercial |
$3,004.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,974.02
|
| Rate for Payer: Cash Price |
$2,146.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,974.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,004.68
|
| Rate for Payer: Entrust Commercial |
$2,912.70
|
| Rate for Payer: First Choice Health Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,747.62
|
| Rate for Payer: HealthUtah PPO |
$3,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,974.02
|
| Rate for Payer: Multiplan Medicare/VA |
$1,660.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,004.68
|
| Rate for Payer: PacificSource Commercial |
$2,759.40
|
| Rate for Payer: PHCS PPO |
$3,004.68
|
| Rate for Payer: Three Rivers PPO |
$2,299.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,747.62
|
| Rate for Payer: United Healthcare Commercial |
$2,928.03
|
| Rate for Payer: United Healthcare Medicare |
$1,747.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,004.68
|
| Rate for Payer: Wise Provider Network Commercial |
$2,912.70
|
|
|
BIOCARTILAGE 1CC
|
Facility
|
IP
|
$3,430.00
|
|
| Hospital Charge Code |
3004014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,987.68 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,195.20
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,327.10
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,092.30
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,987.68
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,092.30
|
| Rate for Payer: United Healthcare Commercial |
$3,275.65
|
| Rate for Payer: United Healthcare Medicare |
$2,092.30
|
| Rate for Payer: WINHealth Partners Commercial |
$3,258.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
BIOCARTILAGE 1CC
|
Facility
|
OP
|
$3,430.00
|
|
| Hospital Charge Code |
3004014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,857.34 |
| Max. Negotiated Rate |
$3,430.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,361.40
|
| Rate for Payer: Aetna of WY Medicare |
$2,263.80
|
| Rate for Payer: Altius Commercial |
$3,292.80
|
| Rate for Payer: Beech Street Commercial |
$3,361.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,327.10
|
| Rate for Payer: Cash Price |
$2,401.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,327.10
|
| Rate for Payer: Cigna of WY Commercial |
$3,361.40
|
| Rate for Payer: Entrust Commercial |
$3,258.50
|
| Rate for Payer: First Choice Health Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,258.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,955.10
|
| Rate for Payer: HealthUtah PPO |
$3,430.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,327.10
|
| Rate for Payer: Multiplan Medicare/VA |
$1,857.34
|
| Rate for Payer: One Health Plan of WY PPO |
$3,361.40
|
| Rate for Payer: PacificSource Commercial |
$3,087.00
|
| Rate for Payer: PHCS PPO |
$3,361.40
|
| Rate for Payer: Three Rivers PPO |
$2,572.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,955.10
|
| Rate for Payer: United Healthcare Commercial |
$3,275.65
|
| Rate for Payer: United Healthcare Medicare |
$1,955.10
|
| Rate for Payer: WINHealth Partners Commercial |
$3,361.40
|
| Rate for Payer: Wise Provider Network Commercial |
$3,258.50
|
|
|
BIO-COMP INTER-FERENCE SCRW
|
Facility
|
OP
|
$822.50
|
|
| Hospital Charge Code |
3002060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$542.85
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$468.82
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$445.38
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$468.82
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$468.82
|
| Rate for Payer: WINHealth Partners Commercial |
$806.05
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
BIO-COMP INTER-FERENCE SCRW
|
Facility
|
IP
|
$822.50
|
|
| Hospital Charge Code |
3002060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.64 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$526.40
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.72
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$476.64
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$501.72
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$501.72
|
| Rate for Payer: WINHealth Partners Commercial |
$781.38
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
BIO-COMP INTERFSCRW W/DISP SHT
|
Facility
|
OP
|
$822.50
|
|
| Hospital Charge Code |
3002098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$542.85
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$468.82
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$445.38
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$468.82
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$468.82
|
| Rate for Payer: WINHealth Partners Commercial |
$806.05
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
BIO-COMP INTERFSCRW W/DISP SHT
|
Facility
|
IP
|
$822.50
|
|
| Hospital Charge Code |
3002098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.64 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$526.40
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.72
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$476.64
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$501.72
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$501.72
|
| Rate for Payer: WINHealth Partners Commercial |
$781.38
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
BIO-COMP INTERSCRW CAN-DELTATP
|
Facility
|
IP
|
$822.50
|
|
| Hospital Charge Code |
3002105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.64 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$526.40
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$501.72
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$476.64
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$501.72
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$501.72
|
| Rate for Payer: WINHealth Partners Commercial |
$781.38
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
|
BIO-COMP INTERSCRW CAN-DELTATP
|
Facility
|
OP
|
$822.50
|
|
| Hospital Charge Code |
3002105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$822.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$806.05
|
| Rate for Payer: Aetna of WY Medicare |
$542.85
|
| Rate for Payer: Altius Commercial |
$789.60
|
| Rate for Payer: Beech Street Commercial |
$806.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$797.82
|
| Rate for Payer: Cash Price |
$575.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$797.82
|
| Rate for Payer: Cigna of WY Commercial |
$806.05
|
| Rate for Payer: Entrust Commercial |
$781.38
|
| Rate for Payer: First Choice Health Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$781.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$468.82
|
| Rate for Payer: HealthUtah PPO |
$822.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$797.82
|
| Rate for Payer: Multiplan Medicare/VA |
$445.38
|
| Rate for Payer: One Health Plan of WY PPO |
$806.05
|
| Rate for Payer: PacificSource Commercial |
$740.25
|
| Rate for Payer: PHCS PPO |
$806.05
|
| Rate for Payer: Three Rivers PPO |
$616.88
|
| Rate for Payer: TriWest Veterans Administration |
$468.82
|
| Rate for Payer: United Healthcare Commercial |
$785.49
|
| Rate for Payer: United Healthcare Medicare |
$468.82
|
| Rate for Payer: WINHealth Partners Commercial |
$806.05
|
| Rate for Payer: Wise Provider Network Commercial |
$781.38
|
|
