|
IV SOL DX 5% LR 1L L7510
|
Facility
|
IP
|
$7.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.55
|
| Rate for Payer: Altius Commercial |
$7.55
|
| Rate for Payer: Beech Street Commercial |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.62
|
| Rate for Payer: Cigna of WY Commercial |
$7.70
|
| Rate for Payer: Entrust Commercial |
$7.47
|
| Rate for Payer: First Choice Health Commercial |
$7.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.19
|
| Rate for Payer: HealthUtah PPO |
$7.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.62
|
| Rate for Payer: Multiplan Medicare/VA |
$4.93
|
| Rate for Payer: One Health Plan of WY PPO |
$7.70
|
| Rate for Payer: PacificSource Commercial |
$7.07
|
| Rate for Payer: PHCS PPO |
$7.70
|
| Rate for Payer: Three Rivers PPO |
$5.90
|
| Rate for Payer: TriWest Veterans Administration |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$6.84
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
| Rate for Payer: WINHealth Partners Commercial |
$7.47
|
| Rate for Payer: Wise Provider Network Commercial |
$7.47
|
|
|
IV SOL DX 5% NACL.45% 1L L6120
|
Facility
|
IP
|
$6.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.30
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.33
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$4.11
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$4.33
|
| Rate for Payer: United Healthcare Commercial |
$5.71
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
| Rate for Payer: WINHealth Partners Commercial |
$6.23
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
IV SOL DX 5% NACL.45% 1L L6120
|
Facility
|
OP
|
$6.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Aetna of WY Medicare |
$4.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.30
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.80
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$3.61
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$5.71
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.43
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
IV SOL DX 5% NACL .9% 1L L6100
|
Facility
|
IP
|
$6.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.30
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.33
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$4.11
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$4.33
|
| Rate for Payer: United Healthcare Commercial |
$5.71
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
| Rate for Payer: WINHealth Partners Commercial |
$6.23
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
IV SOL DX 5% NACL .9% 1L L6100
|
Facility
|
OP
|
$6.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Aetna of WY Medicare |
$4.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.30
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.80
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$3.61
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$5.71
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.43
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
IV SOL LAC RINGER 1000ML L7500
|
Facility
|
OP
|
$7.43
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.28
|
| Rate for Payer: Aetna of WY Medicare |
$4.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.13
|
| Rate for Payer: Altius Commercial |
$7.13
|
| Rate for Payer: Beech Street Commercial |
$7.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.21
|
| Rate for Payer: Cigna of WY Commercial |
$7.28
|
| Rate for Payer: Entrust Commercial |
$7.06
|
| Rate for Payer: First Choice Health Commercial |
$7.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.31
|
| Rate for Payer: HealthUtah PPO |
$7.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.09
|
| Rate for Payer: One Health Plan of WY PPO |
$7.28
|
| Rate for Payer: PacificSource Commercial |
$6.69
|
| Rate for Payer: PHCS PPO |
$7.28
|
| Rate for Payer: Three Rivers PPO |
$5.57
|
| Rate for Payer: TriWest Veterans Administration |
$4.31
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
| Rate for Payer: United Healthcare Medicare |
$4.31
|
| Rate for Payer: WINHealth Partners Commercial |
$7.28
|
| Rate for Payer: Wise Provider Network Commercial |
$7.06
|
|
|
IV SOL LAC RINGER 1000ML L7500
|
Facility
|
IP
|
$7.43
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.13
|
| Rate for Payer: Altius Commercial |
$7.13
|
| Rate for Payer: Beech Street Commercial |
$7.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.21
|
| Rate for Payer: Cigna of WY Commercial |
$7.28
|
| Rate for Payer: Entrust Commercial |
$7.06
|
| Rate for Payer: First Choice Health Commercial |
$7.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.90
|
| Rate for Payer: HealthUtah PPO |
$7.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.66
|
| Rate for Payer: One Health Plan of WY PPO |
$7.28
|
| Rate for Payer: PacificSource Commercial |
$6.69
|
| Rate for Payer: PHCS PPO |
$7.28
|
| Rate for Payer: Three Rivers PPO |
$5.57
|
| Rate for Payer: TriWest Veterans Administration |
$4.90
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
| Rate for Payer: United Healthcare Medicare |
$4.90
|
| Rate for Payer: WINHealth Partners Commercial |
$7.06
|
| Rate for Payer: Wise Provider Network Commercial |
$7.06
|
|
|
IV SOL LACT RINGER 500ML L7501
|
Facility
|
OP
|
$7.07
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.93
|
| Rate for Payer: Aetna of WY Medicare |
$4.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.79
|
| Rate for Payer: Altius Commercial |
$6.79
|
| Rate for Payer: Beech Street Commercial |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.86
|
| Rate for Payer: Cigna of WY Commercial |
$6.93
|
| Rate for Payer: Entrust Commercial |
$6.72
|
| Rate for Payer: First Choice Health Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.10
|
| Rate for Payer: HealthUtah PPO |
$7.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.86
|
| Rate for Payer: Multiplan Medicare/VA |
$3.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6.93
|
| Rate for Payer: PacificSource Commercial |
$6.36
|
| Rate for Payer: PHCS PPO |
$6.93
|
| Rate for Payer: Three Rivers PPO |
$5.30
|
| Rate for Payer: TriWest Veterans Administration |
$4.10
|
| Rate for Payer: United Healthcare Commercial |
$6.15
|
| Rate for Payer: United Healthcare Medicare |
$4.10
|
| Rate for Payer: WINHealth Partners Commercial |
$6.93
|
| Rate for Payer: Wise Provider Network Commercial |
$6.72
|
|
|
IV SOL LACT RINGER 500ML L7501
|
Facility
|
IP
|
$7.07
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.79
|
| Rate for Payer: Altius Commercial |
$6.79
|
| Rate for Payer: Beech Street Commercial |
$6.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.86
|
| Rate for Payer: Cigna of WY Commercial |
$6.93
|
| Rate for Payer: Entrust Commercial |
$6.72
|
| Rate for Payer: First Choice Health Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.67
|
| Rate for Payer: HealthUtah PPO |
$7.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.86
|
| Rate for Payer: Multiplan Medicare/VA |
$4.43
|
| Rate for Payer: One Health Plan of WY PPO |
$6.93
|
| Rate for Payer: PacificSource Commercial |
$6.36
|
| Rate for Payer: PHCS PPO |
$6.93
|
| Rate for Payer: Three Rivers PPO |
$5.30
|
| Rate for Payer: TriWest Veterans Administration |
$4.67
|
| Rate for Payer: United Healthcare Commercial |
$6.15
|
| Rate for Payer: United Healthcare Medicare |
$4.67
|
| Rate for Payer: WINHealth Partners Commercial |
$6.72
|
| Rate for Payer: Wise Provider Network Commercial |
$6.72
|
|
|
IV SOL NACL .45% 1L L8020
|
Facility
|
OP
|
$6.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Aetna of WY Medicare |
$4.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.30
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.80
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$3.61
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$5.71
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WINHealth Partners Commercial |
$6.43
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
IV SOL NACL .45% 1L L8020
|
Facility
|
IP
|
$6.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.30
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.39
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.33
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$4.11
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$4.33
|
| Rate for Payer: United Healthcare Commercial |
$5.71
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
| Rate for Payer: WINHealth Partners Commercial |
$6.23
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
IV SOL NACL .9% 100 ML
|
Facility
|
OP
|
$4.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.88
|
| Rate for Payer: Aetna of WY Medicare |
$3.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.78
|
| Rate for Payer: Altius Commercial |
$4.78
|
| Rate for Payer: Beech Street Commercial |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.83
|
| Rate for Payer: Cigna of WY Commercial |
$4.88
|
| Rate for Payer: Entrust Commercial |
$4.73
|
| Rate for Payer: First Choice Health Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.89
|
| Rate for Payer: HealthUtah PPO |
$4.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.83
|
| Rate for Payer: Multiplan Medicare/VA |
$2.74
|
| Rate for Payer: One Health Plan of WY PPO |
$4.88
|
| Rate for Payer: PacificSource Commercial |
$4.48
|
| Rate for Payer: PHCS PPO |
$4.88
|
| Rate for Payer: Three Rivers PPO |
$3.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.89
|
| Rate for Payer: United Healthcare Commercial |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$2.89
|
| Rate for Payer: WINHealth Partners Commercial |
$4.88
|
| Rate for Payer: Wise Provider Network Commercial |
$4.73
|
|
|
IV SOL NACL .9% 100 ML
|
Facility
|
IP
|
$4.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.78
|
| Rate for Payer: Altius Commercial |
$4.78
|
| Rate for Payer: Beech Street Commercial |
$4.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.09
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.83
|
| Rate for Payer: Cigna of WY Commercial |
$4.88
|
| Rate for Payer: Entrust Commercial |
$4.73
|
| Rate for Payer: First Choice Health Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.29
|
| Rate for Payer: HealthUtah PPO |
$4.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.83
|
| Rate for Payer: Multiplan Medicare/VA |
$3.12
|
| Rate for Payer: One Health Plan of WY PPO |
$4.88
|
| Rate for Payer: PacificSource Commercial |
$4.48
|
| Rate for Payer: PHCS PPO |
$4.88
|
| Rate for Payer: Three Rivers PPO |
$3.74
|
| Rate for Payer: TriWest Veterans Administration |
$3.29
|
| Rate for Payer: United Healthcare Commercial |
$4.33
|
| Rate for Payer: United Healthcare Medicare |
$3.29
|
| Rate for Payer: WINHealth Partners Commercial |
$4.73
|
| Rate for Payer: Wise Provider Network Commercial |
$4.73
|
|
|
IV SOL NACL .9% 1L E8000
|
Facility
|
OP
|
$6.93
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.79
|
| Rate for Payer: Aetna of WY Medicare |
$4.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.65
|
| Rate for Payer: Altius Commercial |
$6.65
|
| Rate for Payer: Beech Street Commercial |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.69
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.72
|
| Rate for Payer: Cigna of WY Commercial |
$6.79
|
| Rate for Payer: Entrust Commercial |
$6.58
|
| Rate for Payer: First Choice Health Commercial |
$6.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.02
|
| Rate for Payer: HealthUtah PPO |
$6.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.72
|
| Rate for Payer: Multiplan Medicare/VA |
$3.82
|
| Rate for Payer: One Health Plan of WY PPO |
$6.79
|
| Rate for Payer: PacificSource Commercial |
$6.24
|
| Rate for Payer: PHCS PPO |
$6.79
|
| Rate for Payer: Three Rivers PPO |
$5.20
|
| Rate for Payer: TriWest Veterans Administration |
$4.02
|
| Rate for Payer: United Healthcare Commercial |
$6.03
|
| Rate for Payer: United Healthcare Medicare |
$4.02
|
| Rate for Payer: WINHealth Partners Commercial |
$6.79
|
| Rate for Payer: Wise Provider Network Commercial |
$6.58
|
|
|
IV SOL NACL .9% 1L E8000
|
Facility
|
IP
|
$6.93
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$6.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.65
|
| Rate for Payer: Altius Commercial |
$6.65
|
| Rate for Payer: Beech Street Commercial |
$6.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.69
|
| Rate for Payer: Cash Price |
$4.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.72
|
| Rate for Payer: Cigna of WY Commercial |
$6.79
|
| Rate for Payer: Entrust Commercial |
$6.58
|
| Rate for Payer: First Choice Health Commercial |
$6.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.57
|
| Rate for Payer: HealthUtah PPO |
$6.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.72
|
| Rate for Payer: Multiplan Medicare/VA |
$4.35
|
| Rate for Payer: One Health Plan of WY PPO |
$6.79
|
| Rate for Payer: PacificSource Commercial |
$6.24
|
| Rate for Payer: PHCS PPO |
$6.79
|
| Rate for Payer: Three Rivers PPO |
$5.20
|
| Rate for Payer: TriWest Veterans Administration |
$4.57
|
| Rate for Payer: United Healthcare Commercial |
$6.03
|
| Rate for Payer: United Healthcare Medicare |
$4.57
|
| Rate for Payer: WINHealth Partners Commercial |
$6.58
|
| Rate for Payer: Wise Provider Network Commercial |
$6.58
|
|
|
IV SOL NACL .9% 500 ML L8001
|
Facility
|
IP
|
$6.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.27
|
| Rate for Payer: Altius Commercial |
$6.27
|
| Rate for Payer: Beech Street Commercial |
$6.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.33
|
| Rate for Payer: Cigna of WY Commercial |
$6.40
|
| Rate for Payer: Entrust Commercial |
$6.20
|
| Rate for Payer: First Choice Health Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.31
|
| Rate for Payer: HealthUtah PPO |
$6.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.33
|
| Rate for Payer: Multiplan Medicare/VA |
$4.09
|
| Rate for Payer: One Health Plan of WY PPO |
$6.40
|
| Rate for Payer: PacificSource Commercial |
$5.88
|
| Rate for Payer: PHCS PPO |
$6.40
|
| Rate for Payer: Three Rivers PPO |
$4.90
|
| Rate for Payer: TriWest Veterans Administration |
$4.31
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
| Rate for Payer: United Healthcare Medicare |
$4.31
|
| Rate for Payer: WINHealth Partners Commercial |
$6.20
|
| Rate for Payer: Wise Provider Network Commercial |
$6.20
|
|
|
IV SOL NACL .9% 500 ML L8001
|
Facility
|
OP
|
$6.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.40
|
| Rate for Payer: Aetna of WY Medicare |
$4.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.27
|
| Rate for Payer: Altius Commercial |
$6.27
|
| Rate for Payer: Beech Street Commercial |
$6.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.33
|
| Rate for Payer: Cigna of WY Commercial |
$6.40
|
| Rate for Payer: Entrust Commercial |
$6.20
|
| Rate for Payer: First Choice Health Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.79
|
| Rate for Payer: HealthUtah PPO |
$6.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.33
|
| Rate for Payer: Multiplan Medicare/VA |
$3.60
|
| Rate for Payer: One Health Plan of WY PPO |
$6.40
|
| Rate for Payer: PacificSource Commercial |
$5.88
|
| Rate for Payer: PHCS PPO |
$6.40
|
| Rate for Payer: Three Rivers PPO |
$4.90
|
| Rate for Payer: TriWest Veterans Administration |
$3.79
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
| Rate for Payer: United Healthcare Medicare |
$3.79
|
| Rate for Payer: WINHealth Partners Commercial |
$6.40
|
| Rate for Payer: Wise Provider Network Commercial |
$6.20
|
|
|
JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 90738
|
| Hospital Charge Code |
90738
|
| Min. Negotiated Rate |
$378.75 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Beech Street Commercial |
$479.75
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: First Choice Health Commercial |
$454.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$479.75
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: WINHealth Partners Commercial |
$505.00
|
|
|
JUMPSTART 2.5" DRESSING
|
Facility
|
IP
|
$40.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$40.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.24
|
| Rate for Payer: Altius Commercial |
$39.24
|
| Rate for Payer: Beech Street Commercial |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.65
|
| Rate for Payer: Cigna of WY Commercial |
$40.06
|
| Rate for Payer: Entrust Commercial |
$38.84
|
| Rate for Payer: First Choice Health Commercial |
$38.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.98
|
| Rate for Payer: HealthUtah PPO |
$40.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.65
|
| Rate for Payer: Multiplan Medicare/VA |
$25.63
|
| Rate for Payer: One Health Plan of WY PPO |
$40.06
|
| Rate for Payer: PacificSource Commercial |
$36.79
|
| Rate for Payer: PHCS PPO |
$40.06
|
| Rate for Payer: Three Rivers PPO |
$30.66
|
| Rate for Payer: TriWest Veterans Administration |
$26.98
|
| Rate for Payer: United Healthcare Commercial |
$35.57
|
| Rate for Payer: United Healthcare Medicare |
$26.98
|
| Rate for Payer: WINHealth Partners Commercial |
$38.84
|
| Rate for Payer: Wise Provider Network Commercial |
$38.84
|
|
|
JUMPSTART 2.5" DRESSING
|
Facility
|
OP
|
$40.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$40.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.06
|
| Rate for Payer: Aetna of WY Medicare |
$26.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.24
|
| Rate for Payer: Altius Commercial |
$39.24
|
| Rate for Payer: Beech Street Commercial |
$40.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.56
|
| Rate for Payer: Cash Price |
$28.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.65
|
| Rate for Payer: Cigna of WY Commercial |
$40.06
|
| Rate for Payer: Entrust Commercial |
$38.84
|
| Rate for Payer: First Choice Health Commercial |
$38.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.71
|
| Rate for Payer: HealthUtah PPO |
$40.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.65
|
| Rate for Payer: Multiplan Medicare/VA |
$22.52
|
| Rate for Payer: One Health Plan of WY PPO |
$40.06
|
| Rate for Payer: PacificSource Commercial |
$36.79
|
| Rate for Payer: PHCS PPO |
$40.06
|
| Rate for Payer: Three Rivers PPO |
$30.66
|
| Rate for Payer: TriWest Veterans Administration |
$23.71
|
| Rate for Payer: United Healthcare Commercial |
$35.57
|
| Rate for Payer: United Healthcare Medicare |
$23.71
|
| Rate for Payer: WINHealth Partners Commercial |
$40.06
|
| Rate for Payer: Wise Provider Network Commercial |
$38.84
|
|
|
JUMPSTART 4.5"X10" DRESSING
|
Facility
|
IP
|
$171.71
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.66 |
| Max. Negotiated Rate |
$171.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$164.84
|
| Rate for Payer: Altius Commercial |
$164.84
|
| Rate for Payer: Beech Street Commercial |
$168.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.97
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.56
|
| Rate for Payer: Cigna of WY Commercial |
$168.28
|
| Rate for Payer: Entrust Commercial |
$163.12
|
| Rate for Payer: First Choice Health Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.33
|
| Rate for Payer: HealthUtah PPO |
$171.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.56
|
| Rate for Payer: Multiplan Medicare/VA |
$107.66
|
| Rate for Payer: One Health Plan of WY PPO |
$168.28
|
| Rate for Payer: PacificSource Commercial |
$154.54
|
| Rate for Payer: PHCS PPO |
$168.28
|
| Rate for Payer: Three Rivers PPO |
$128.78
|
| Rate for Payer: TriWest Veterans Administration |
$113.33
|
| Rate for Payer: United Healthcare Commercial |
$149.39
|
| Rate for Payer: United Healthcare Medicare |
$113.33
|
| Rate for Payer: WINHealth Partners Commercial |
$163.12
|
| Rate for Payer: Wise Provider Network Commercial |
$163.12
|
|
|
JUMPSTART 4.5"X10" DRESSING
|
Facility
|
OP
|
$171.71
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.61 |
| Max. Negotiated Rate |
$171.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.28
|
| Rate for Payer: Aetna of WY Medicare |
$113.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$164.84
|
| Rate for Payer: Altius Commercial |
$164.84
|
| Rate for Payer: Beech Street Commercial |
$168.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.97
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.56
|
| Rate for Payer: Cigna of WY Commercial |
$168.28
|
| Rate for Payer: Entrust Commercial |
$163.12
|
| Rate for Payer: First Choice Health Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.59
|
| Rate for Payer: HealthUtah PPO |
$171.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.56
|
| Rate for Payer: Multiplan Medicare/VA |
$94.61
|
| Rate for Payer: One Health Plan of WY PPO |
$168.28
|
| Rate for Payer: PacificSource Commercial |
$154.54
|
| Rate for Payer: PHCS PPO |
$168.28
|
| Rate for Payer: Three Rivers PPO |
$128.78
|
| Rate for Payer: TriWest Veterans Administration |
$99.59
|
| Rate for Payer: United Healthcare Commercial |
$149.39
|
| Rate for Payer: United Healthcare Medicare |
$99.59
|
| Rate for Payer: WINHealth Partners Commercial |
$168.28
|
| Rate for Payer: Wise Provider Network Commercial |
$163.12
|
|
|
JUMPSTART 4" DRESSING
|
Facility
|
IP
|
$53.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.00
|
| Rate for Payer: Altius Commercial |
$51.00
|
| Rate for Payer: Beech Street Commercial |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.62
|
| Rate for Payer: Cash Price |
$37.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.54
|
| Rate for Payer: Cigna of WY Commercial |
$52.07
|
| Rate for Payer: Entrust Commercial |
$50.47
|
| Rate for Payer: First Choice Health Commercial |
$50.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.07
|
| Rate for Payer: HealthUtah PPO |
$53.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.54
|
| Rate for Payer: Multiplan Medicare/VA |
$33.31
|
| Rate for Payer: One Health Plan of WY PPO |
$52.07
|
| Rate for Payer: PacificSource Commercial |
$47.82
|
| Rate for Payer: PHCS PPO |
$52.07
|
| Rate for Payer: Three Rivers PPO |
$39.85
|
| Rate for Payer: TriWest Veterans Administration |
$35.07
|
| Rate for Payer: United Healthcare Commercial |
$46.22
|
| Rate for Payer: United Healthcare Medicare |
$35.07
|
| Rate for Payer: WINHealth Partners Commercial |
$50.47
|
| Rate for Payer: Wise Provider Network Commercial |
$50.47
|
|
|
JUMPSTART 4" DRESSING
|
Facility
|
OP
|
$53.13
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.07
|
| Rate for Payer: Aetna of WY Medicare |
$35.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.00
|
| Rate for Payer: Altius Commercial |
$51.00
|
| Rate for Payer: Beech Street Commercial |
$52.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.62
|
| Rate for Payer: Cash Price |
$37.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.54
|
| Rate for Payer: Cigna of WY Commercial |
$52.07
|
| Rate for Payer: Entrust Commercial |
$50.47
|
| Rate for Payer: First Choice Health Commercial |
$50.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.82
|
| Rate for Payer: HealthUtah PPO |
$53.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.54
|
| Rate for Payer: Multiplan Medicare/VA |
$29.27
|
| Rate for Payer: One Health Plan of WY PPO |
$52.07
|
| Rate for Payer: PacificSource Commercial |
$47.82
|
| Rate for Payer: PHCS PPO |
$52.07
|
| Rate for Payer: Three Rivers PPO |
$39.85
|
| Rate for Payer: TriWest Veterans Administration |
$30.82
|
| Rate for Payer: United Healthcare Commercial |
$46.22
|
| Rate for Payer: United Healthcare Medicare |
$30.82
|
| Rate for Payer: WINHealth Partners Commercial |
$52.07
|
| Rate for Payer: Wise Provider Network Commercial |
$50.47
|
|
|
JUMPSTART FLEX EFIT
|
Facility
|
OP
|
$107.52
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.24 |
| 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 Auto/Workers Compensation |
$103.22
|
| 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 |
$88.27
|
| 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 |
$62.36
|
| Rate for Payer: HealthUtah PPO |
$107.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.29
|
| Rate for Payer: Multiplan Medicare/VA |
$59.24
|
| 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 |
$62.36
|
| Rate for Payer: United Healthcare Commercial |
$93.54
|
| Rate for Payer: United Healthcare Medicare |
$62.36
|
| Rate for Payer: WINHealth Partners Commercial |
$105.37
|
| Rate for Payer: Wise Provider Network Commercial |
$102.14
|
|
