|
MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN
|
Professional
|
Both
|
$6,176.00
|
|
|
Service Code
|
HCPCS 19307 80
|
| Hospital Charge Code |
19307
|
| Min. Negotiated Rate |
$956.39 |
| Max. Negotiated Rate |
$6,176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,052.48
|
| Rate for Payer: Aetna of WY Medicare |
$1,125.17
|
| Rate for Payer: Beech Street Commercial |
$5,867.20
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,990.72
|
| Rate for Payer: Cigna of WY Commercial |
$6,052.48
|
| Rate for Payer: First Choice Health Commercial |
$5,558.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,867.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,125.17
|
| Rate for Payer: HealthUtah PPO |
$6,176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,990.72
|
| Rate for Payer: Multiplan Medicare/VA |
$956.39
|
| Rate for Payer: One Health Plan of WY PPO |
$6,052.48
|
| Rate for Payer: PacificSource Commercial |
$5,558.40
|
| Rate for Payer: PHCS PPO |
$5,867.20
|
| Rate for Payer: Three Rivers PPO |
$4,632.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,125.17
|
| Rate for Payer: United Healthcare Commercial |
$5,373.12
|
| Rate for Payer: United Healthcare Medicare |
$1,125.17
|
| Rate for Payer: WINHealth Partners Commercial |
$5,249.60
|
|
|
MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
HCPCS 19020
|
| Hospital Charge Code |
19020
|
| Min. Negotiated Rate |
$258.21 |
| Max. Negotiated Rate |
$1,587.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,555.26
|
| Rate for Payer: Aetna of WY Medicare |
$303.78
|
| Rate for Payer: Beech Street Commercial |
$1,507.65
|
| Rate for Payer: Cash Price |
$1,110.90
|
| Rate for Payer: Cash Price |
$1,110.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,539.39
|
| Rate for Payer: Cigna of WY Commercial |
$1,555.26
|
| Rate for Payer: First Choice Health Commercial |
$1,428.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,507.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$303.78
|
| Rate for Payer: HealthUtah PPO |
$1,587.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,539.39
|
| Rate for Payer: Multiplan Medicare/VA |
$258.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,555.26
|
| Rate for Payer: PacificSource Commercial |
$1,428.30
|
| Rate for Payer: PHCS PPO |
$1,507.65
|
| Rate for Payer: Three Rivers PPO |
$1,190.25
|
| Rate for Payer: TriWest Veterans Administration |
$303.78
|
| Rate for Payer: United Healthcare Commercial |
$1,380.69
|
| Rate for Payer: United Healthcare Medicare |
$303.78
|
| Rate for Payer: WINHealth Partners Commercial |
$1,348.95
|
|
|
MAT SURGIPAD YELLOW
|
Facility
|
IP
|
$22.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.93
|
| Rate for Payer: Altius Commercial |
$21.93
|
| Rate for Payer: Beech Street Commercial |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.15
|
| Rate for Payer: Cigna of WY Commercial |
$22.38
|
| Rate for Payer: Entrust Commercial |
$21.70
|
| Rate for Payer: First Choice Health Commercial |
$21.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.07
|
| Rate for Payer: HealthUtah PPO |
$22.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.15
|
| Rate for Payer: Multiplan Medicare/VA |
$14.32
|
| Rate for Payer: One Health Plan of WY PPO |
$22.38
|
| Rate for Payer: PacificSource Commercial |
$20.56
|
| Rate for Payer: PHCS PPO |
$22.38
|
| Rate for Payer: Three Rivers PPO |
$17.13
|
| Rate for Payer: TriWest Veterans Administration |
$15.07
|
| Rate for Payer: United Healthcare Commercial |
$19.87
|
| Rate for Payer: United Healthcare Medicare |
$15.07
|
| Rate for Payer: WINHealth Partners Commercial |
$21.70
|
| Rate for Payer: Wise Provider Network Commercial |
$21.70
|
|
|
MAT SURGIPAD YELLOW
|
Facility
|
OP
|
$22.84
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$22.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.38
|
| Rate for Payer: Aetna of WY Medicare |
$15.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.93
|
| Rate for Payer: Altius Commercial |
$21.93
|
| Rate for Payer: Beech Street Commercial |
$22.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.15
|
| Rate for Payer: Cigna of WY Commercial |
$22.38
|
| Rate for Payer: Entrust Commercial |
$21.70
|
| Rate for Payer: First Choice Health Commercial |
$21.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.25
|
| Rate for Payer: HealthUtah PPO |
$22.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.15
|
| Rate for Payer: Multiplan Medicare/VA |
$12.58
|
| Rate for Payer: One Health Plan of WY PPO |
$22.38
|
| Rate for Payer: PacificSource Commercial |
$20.56
|
| Rate for Payer: PHCS PPO |
$22.38
|
| Rate for Payer: Three Rivers PPO |
$17.13
|
| Rate for Payer: TriWest Veterans Administration |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$19.87
|
| Rate for Payer: United Healthcare Medicare |
$13.25
|
| Rate for Payer: WINHealth Partners Commercial |
$22.38
|
| Rate for Payer: Wise Provider Network Commercial |
$21.70
|
|
|
MAXORB II ALGINATE DRESS 4"X8"
|
Facility
|
OP
|
$14.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.78
|
| Rate for Payer: Aetna of WY Medicare |
$9.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.50
|
| Rate for Payer: Altius Commercial |
$13.50
|
| Rate for Payer: Beech Street Commercial |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.54
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.64
|
| Rate for Payer: Cigna of WY Commercial |
$13.78
|
| Rate for Payer: Entrust Commercial |
$13.36
|
| Rate for Payer: First Choice Health Commercial |
$13.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.15
|
| Rate for Payer: HealthUtah PPO |
$14.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.64
|
| Rate for Payer: Multiplan Medicare/VA |
$7.75
|
| Rate for Payer: One Health Plan of WY PPO |
$13.78
|
| Rate for Payer: PacificSource Commercial |
$12.65
|
| Rate for Payer: PHCS PPO |
$13.78
|
| Rate for Payer: Three Rivers PPO |
$10.54
|
| Rate for Payer: TriWest Veterans Administration |
$8.15
|
| Rate for Payer: United Healthcare Commercial |
$12.23
|
| Rate for Payer: United Healthcare Medicare |
$8.15
|
| Rate for Payer: WINHealth Partners Commercial |
$13.78
|
| Rate for Payer: Wise Provider Network Commercial |
$13.36
|
|
|
MAXORB II ALGINATE DRESS 4"X8"
|
Facility
|
IP
|
$14.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.50
|
| Rate for Payer: Altius Commercial |
$13.50
|
| Rate for Payer: Beech Street Commercial |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.54
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.64
|
| Rate for Payer: Cigna of WY Commercial |
$13.78
|
| Rate for Payer: Entrust Commercial |
$13.36
|
| Rate for Payer: First Choice Health Commercial |
$13.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.28
|
| Rate for Payer: HealthUtah PPO |
$14.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.64
|
| Rate for Payer: Multiplan Medicare/VA |
$8.82
|
| Rate for Payer: One Health Plan of WY PPO |
$13.78
|
| Rate for Payer: PacificSource Commercial |
$12.65
|
| Rate for Payer: PHCS PPO |
$13.78
|
| Rate for Payer: Three Rivers PPO |
$10.54
|
| Rate for Payer: TriWest Veterans Administration |
$9.28
|
| Rate for Payer: United Healthcare Commercial |
$12.23
|
| Rate for Payer: United Healthcare Medicare |
$9.28
|
| Rate for Payer: WINHealth Partners Commercial |
$13.36
|
| Rate for Payer: Wise Provider Network Commercial |
$13.36
|
|
|
MCGRATH MAC BLADE SZ 2
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
MCGRATH MAC BLADE SZ 2
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
MCGRATH MAC BLADE SZ 3
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
MCGRATH MAC BLADE SZ 3
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
MCGRATH MAC BLADE SZ 3X
|
Facility
|
IP
|
$87.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.00
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.84
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.75
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$54.86
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$76.12
|
| Rate for Payer: United Healthcare Medicare |
$57.75
|
| Rate for Payer: WINHealth Partners Commercial |
$83.12
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
MCGRATH MAC BLADE SZ 3X
|
Facility
|
OP
|
$87.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.21 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Aetna of WY Medicare |
$57.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$84.00
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.84
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.75
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$48.21
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$50.75
|
| Rate for Payer: United Healthcare Commercial |
$76.12
|
| Rate for Payer: United Healthcare Medicare |
$50.75
|
| Rate for Payer: WINHealth Partners Commercial |
$85.75
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
MCGRATH MAC BLADE SZ 4
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.10
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$21.94
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.10
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$23.10
|
| Rate for Payer: WINHealth Partners Commercial |
$33.25
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
MCGRATH MAC BLADE SZ 4
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.30
|
| Rate for Payer: Aetna of WY Medicare |
$23.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.60
|
| Rate for Payer: Altius Commercial |
$33.60
|
| Rate for Payer: Beech Street Commercial |
$34.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.74
|
| Rate for Payer: Cash Price |
$24.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.95
|
| Rate for Payer: Cigna of WY Commercial |
$34.30
|
| Rate for Payer: Entrust Commercial |
$33.25
|
| Rate for Payer: First Choice Health Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.30
|
| Rate for Payer: HealthUtah PPO |
$35.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.95
|
| Rate for Payer: Multiplan Medicare/VA |
$19.28
|
| Rate for Payer: One Health Plan of WY PPO |
$34.30
|
| Rate for Payer: PacificSource Commercial |
$31.50
|
| Rate for Payer: PHCS PPO |
$34.30
|
| Rate for Payer: Three Rivers PPO |
$26.25
|
| Rate for Payer: TriWest Veterans Administration |
$20.30
|
| Rate for Payer: United Healthcare Commercial |
$30.45
|
| Rate for Payer: United Healthcare Medicare |
$20.30
|
| Rate for Payer: WINHealth Partners Commercial |
$34.30
|
| Rate for Payer: Wise Provider Network Commercial |
$33.25
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [53064]
|
Facility
|
OP
|
$162.66
|
|
|
Service Code
|
NDC 0006468101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.41
|
| Rate for Payer: Aetna of WY Medicare |
$107.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.15
|
| Rate for Payer: Altius Commercial |
$156.15
|
| Rate for Payer: Beech Street Commercial |
$159.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.54
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.78
|
| Rate for Payer: Cigna of WY Commercial |
$159.41
|
| Rate for Payer: Entrust Commercial |
$154.53
|
| Rate for Payer: First Choice Health Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.34
|
| Rate for Payer: HealthUtah PPO |
$162.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.78
|
| Rate for Payer: Multiplan Medicare/VA |
$89.63
|
| Rate for Payer: One Health Plan of WY PPO |
$159.41
|
| Rate for Payer: PacificSource Commercial |
$146.39
|
| Rate for Payer: PHCS PPO |
$159.41
|
| Rate for Payer: Three Rivers PPO |
$122.00
|
| Rate for Payer: TriWest Veterans Administration |
$94.34
|
| Rate for Payer: United Healthcare Commercial |
$141.51
|
| Rate for Payer: United Healthcare Medicare |
$94.34
|
| Rate for Payer: WINHealth Partners Commercial |
$159.41
|
| Rate for Payer: Wise Provider Network Commercial |
$154.53
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [53064]
|
Facility
|
IP
|
$162.66
|
|
|
Service Code
|
NDC 0006468101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.99 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.15
|
| Rate for Payer: Altius Commercial |
$156.15
|
| Rate for Payer: Beech Street Commercial |
$159.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.54
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.78
|
| Rate for Payer: Cigna of WY Commercial |
$159.41
|
| Rate for Payer: Entrust Commercial |
$154.53
|
| Rate for Payer: First Choice Health Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.36
|
| Rate for Payer: HealthUtah PPO |
$162.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.78
|
| Rate for Payer: Multiplan Medicare/VA |
$101.99
|
| Rate for Payer: One Health Plan of WY PPO |
$159.41
|
| Rate for Payer: PacificSource Commercial |
$146.39
|
| Rate for Payer: PHCS PPO |
$159.41
|
| Rate for Payer: Three Rivers PPO |
$122.00
|
| Rate for Payer: TriWest Veterans Administration |
$107.36
|
| Rate for Payer: United Healthcare Commercial |
$141.51
|
| Rate for Payer: United Healthcare Medicare |
$107.36
|
| Rate for Payer: WINHealth Partners Commercial |
$154.53
|
| Rate for Payer: Wise Provider Network Commercial |
$154.53
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [53064]
|
Facility
|
OP
|
$162.66
|
|
|
Service Code
|
NDC 0006468100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$89.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.41
|
| Rate for Payer: Aetna of WY Medicare |
$107.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.15
|
| Rate for Payer: Altius Commercial |
$156.15
|
| Rate for Payer: Beech Street Commercial |
$159.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.54
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.78
|
| Rate for Payer: Cigna of WY Commercial |
$159.41
|
| Rate for Payer: Entrust Commercial |
$154.53
|
| Rate for Payer: First Choice Health Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.34
|
| Rate for Payer: HealthUtah PPO |
$162.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.78
|
| Rate for Payer: Multiplan Medicare/VA |
$89.63
|
| Rate for Payer: One Health Plan of WY PPO |
$159.41
|
| Rate for Payer: PacificSource Commercial |
$146.39
|
| Rate for Payer: PHCS PPO |
$159.41
|
| Rate for Payer: Three Rivers PPO |
$122.00
|
| Rate for Payer: TriWest Veterans Administration |
$94.34
|
| Rate for Payer: United Healthcare Commercial |
$141.51
|
| Rate for Payer: United Healthcare Medicare |
$94.34
|
| Rate for Payer: WINHealth Partners Commercial |
$159.41
|
| Rate for Payer: Wise Provider Network Commercial |
$154.53
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT [53064]
|
Facility
|
IP
|
$162.66
|
|
|
Service Code
|
NDC 0006468100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.99 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.15
|
| Rate for Payer: Altius Commercial |
$156.15
|
| Rate for Payer: Beech Street Commercial |
$159.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.54
|
| Rate for Payer: Cash Price |
$113.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$157.78
|
| Rate for Payer: Cigna of WY Commercial |
$159.41
|
| Rate for Payer: Entrust Commercial |
$154.53
|
| Rate for Payer: First Choice Health Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.36
|
| Rate for Payer: HealthUtah PPO |
$162.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$157.78
|
| Rate for Payer: Multiplan Medicare/VA |
$101.99
|
| Rate for Payer: One Health Plan of WY PPO |
$159.41
|
| Rate for Payer: PacificSource Commercial |
$146.39
|
| Rate for Payer: PHCS PPO |
$159.41
|
| Rate for Payer: Three Rivers PPO |
$122.00
|
| Rate for Payer: TriWest Veterans Administration |
$107.36
|
| Rate for Payer: United Healthcare Commercial |
$141.51
|
| Rate for Payer: United Healthcare Medicare |
$107.36
|
| Rate for Payer: WINHealth Partners Commercial |
$154.53
|
| Rate for Payer: Wise Provider Network Commercial |
$154.53
|
|
|
MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
90710
|
| Min. Negotiated Rate |
$525.75 |
| Max. Negotiated Rate |
$701.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.98
|
| Rate for Payer: Beech Street Commercial |
$665.95
|
| Rate for Payer: Cash Price |
$490.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.97
|
| Rate for Payer: Cigna of WY Commercial |
$686.98
|
| Rate for Payer: First Choice Health Commercial |
$630.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.95
|
| Rate for Payer: HealthUtah PPO |
$701.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.97
|
| Rate for Payer: One Health Plan of WY PPO |
$686.98
|
| Rate for Payer: PacificSource Commercial |
$630.90
|
| Rate for Payer: PHCS PPO |
$665.95
|
| Rate for Payer: Three Rivers PPO |
$525.75
|
| Rate for Payer: United Healthcare Commercial |
$609.87
|
| Rate for Payer: WINHealth Partners Commercial |
$701.00
|
|
|
MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
90707
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.00
|
| Rate for Payer: Beech Street Commercial |
$285.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.00
|
| Rate for Payer: Cigna of WY Commercial |
$294.00
|
| Rate for Payer: First Choice Health Commercial |
$270.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.00
|
| Rate for Payer: HealthUtah PPO |
$300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.00
|
| Rate for Payer: One Health Plan of WY PPO |
$294.00
|
| Rate for Payer: PacificSource Commercial |
$270.00
|
| Rate for Payer: PHCS PPO |
$285.00
|
| Rate for Payer: Three Rivers PPO |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: WINHealth Partners Commercial |
$300.00
|
|
|
MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [39310]
|
Facility
|
IP
|
$343.95
|
|
|
Service Code
|
NDC 0006417100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.66 |
| Max. Negotiated Rate |
$343.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$330.19
|
| Rate for Payer: Altius Commercial |
$330.19
|
| Rate for Payer: Beech Street Commercial |
$337.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.38
|
| Rate for Payer: Cash Price |
$240.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.63
|
| Rate for Payer: Cigna of WY Commercial |
$337.07
|
| Rate for Payer: Entrust Commercial |
$326.75
|
| Rate for Payer: First Choice Health Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.01
|
| Rate for Payer: HealthUtah PPO |
$343.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.63
|
| Rate for Payer: Multiplan Medicare/VA |
$215.66
|
| Rate for Payer: One Health Plan of WY PPO |
$337.07
|
| Rate for Payer: PacificSource Commercial |
$309.56
|
| Rate for Payer: PHCS PPO |
$337.07
|
| Rate for Payer: Three Rivers PPO |
$257.96
|
| Rate for Payer: TriWest Veterans Administration |
$227.01
|
| Rate for Payer: United Healthcare Commercial |
$299.24
|
| Rate for Payer: United Healthcare Medicare |
$227.01
|
| Rate for Payer: WINHealth Partners Commercial |
$326.75
|
| Rate for Payer: Wise Provider Network Commercial |
$326.75
|
|
|
MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [39310]
|
Facility
|
OP
|
$343.95
|
|
|
Service Code
|
NDC 0006417100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$343.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.07
|
| Rate for Payer: Aetna of WY Medicare |
$227.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$330.19
|
| Rate for Payer: Altius Commercial |
$330.19
|
| Rate for Payer: Beech Street Commercial |
$337.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.38
|
| Rate for Payer: Cash Price |
$240.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.63
|
| Rate for Payer: Cigna of WY Commercial |
$337.07
|
| Rate for Payer: Entrust Commercial |
$326.75
|
| Rate for Payer: First Choice Health Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.49
|
| Rate for Payer: HealthUtah PPO |
$343.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.63
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$337.07
|
| Rate for Payer: PacificSource Commercial |
$309.56
|
| Rate for Payer: PHCS PPO |
$337.07
|
| Rate for Payer: Three Rivers PPO |
$257.96
|
| Rate for Payer: TriWest Veterans Administration |
$199.49
|
| Rate for Payer: United Healthcare Commercial |
$299.24
|
| Rate for Payer: United Healthcare Medicare |
$199.49
|
| Rate for Payer: WINHealth Partners Commercial |
$337.07
|
| Rate for Payer: Wise Provider Network Commercial |
$326.75
|
|
|
MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [39310]
|
Facility
|
OP
|
$343.95
|
|
|
Service Code
|
NDC 0006417101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$343.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.07
|
| Rate for Payer: Aetna of WY Medicare |
$227.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$330.19
|
| Rate for Payer: Altius Commercial |
$330.19
|
| Rate for Payer: Beech Street Commercial |
$337.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.38
|
| Rate for Payer: Cash Price |
$240.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.63
|
| Rate for Payer: Cigna of WY Commercial |
$337.07
|
| Rate for Payer: Entrust Commercial |
$326.75
|
| Rate for Payer: First Choice Health Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$199.49
|
| Rate for Payer: HealthUtah PPO |
$343.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.63
|
| Rate for Payer: Multiplan Medicare/VA |
$189.52
|
| Rate for Payer: One Health Plan of WY PPO |
$337.07
|
| Rate for Payer: PacificSource Commercial |
$309.56
|
| Rate for Payer: PHCS PPO |
$337.07
|
| Rate for Payer: Three Rivers PPO |
$257.96
|
| Rate for Payer: TriWest Veterans Administration |
$199.49
|
| Rate for Payer: United Healthcare Commercial |
$299.24
|
| Rate for Payer: United Healthcare Medicare |
$199.49
|
| Rate for Payer: WINHealth Partners Commercial |
$337.07
|
| Rate for Payer: Wise Provider Network Commercial |
$326.75
|
|
|
MEASLES,MUMPS,RUBEL,VARICEL LIV(PF)10E3-4.3-3-3.99TCID50/0.5 ML SUBCUT [39310]
|
Facility
|
IP
|
$343.95
|
|
|
Service Code
|
NDC 0006417101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.66 |
| Max. Negotiated Rate |
$343.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$337.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$330.19
|
| Rate for Payer: Altius Commercial |
$330.19
|
| Rate for Payer: Beech Street Commercial |
$337.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$282.38
|
| Rate for Payer: Cash Price |
$240.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$333.63
|
| Rate for Payer: Cigna of WY Commercial |
$337.07
|
| Rate for Payer: Entrust Commercial |
$326.75
|
| Rate for Payer: First Choice Health Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$326.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$227.01
|
| Rate for Payer: HealthUtah PPO |
$343.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$333.63
|
| Rate for Payer: Multiplan Medicare/VA |
$215.66
|
| Rate for Payer: One Health Plan of WY PPO |
$337.07
|
| Rate for Payer: PacificSource Commercial |
$309.56
|
| Rate for Payer: PHCS PPO |
$337.07
|
| Rate for Payer: Three Rivers PPO |
$257.96
|
| Rate for Payer: TriWest Veterans Administration |
$227.01
|
| Rate for Payer: United Healthcare Commercial |
$299.24
|
| Rate for Payer: United Healthcare Medicare |
$227.01
|
| Rate for Payer: WINHealth Partners Commercial |
$326.75
|
| Rate for Payer: Wise Provider Network Commercial |
$326.75
|
|
|
MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
51798
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$221.48
|
| Rate for Payer: Aetna of WY Medicare |
$11.05
|
| Rate for Payer: Beech Street Commercial |
$214.70
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: Cash Price |
$158.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$219.22
|
| Rate for Payer: Cigna of WY Commercial |
$221.48
|
| Rate for Payer: First Choice Health Commercial |
$203.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$214.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.05
|
| Rate for Payer: HealthUtah PPO |
$226.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$219.22
|
| Rate for Payer: Multiplan Medicare/VA |
$9.39
|
| Rate for Payer: One Health Plan of WY PPO |
$221.48
|
| Rate for Payer: PacificSource Commercial |
$203.40
|
| Rate for Payer: PHCS PPO |
$214.70
|
| Rate for Payer: Three Rivers PPO |
$169.50
|
| Rate for Payer: TriWest Veterans Administration |
$11.05
|
| Rate for Payer: United Healthcare Commercial |
$196.62
|
| Rate for Payer: United Healthcare Medicare |
$11.05
|
| Rate for Payer: WINHealth Partners Commercial |
$192.10
|
|
