|
SEALTIGHT PED LEG LARGE
|
Facility
|
OP
|
$48.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.16
|
| Rate for Payer: Aetna of WY Medicare |
$31.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.20
|
| Rate for Payer: Altius Commercial |
$46.20
|
| Rate for Payer: Beech Street Commercial |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.51
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.68
|
| Rate for Payer: Cigna of WY Commercial |
$47.16
|
| Rate for Payer: Entrust Commercial |
$45.71
|
| Rate for Payer: First Choice Health Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.91
|
| Rate for Payer: HealthUtah PPO |
$48.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.68
|
| Rate for Payer: Multiplan Medicare/VA |
$26.51
|
| Rate for Payer: One Health Plan of WY PPO |
$47.16
|
| Rate for Payer: PacificSource Commercial |
$43.31
|
| Rate for Payer: PHCS PPO |
$47.16
|
| Rate for Payer: Three Rivers PPO |
$36.09
|
| Rate for Payer: TriWest Veterans Administration |
$27.91
|
| Rate for Payer: United Healthcare Commercial |
$41.86
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
| Rate for Payer: WINHealth Partners Commercial |
$47.16
|
| Rate for Payer: Wise Provider Network Commercial |
$45.71
|
|
|
SEALTIGHT PED LEG MEDIUM
|
Facility
|
OP
|
$48.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.16
|
| Rate for Payer: Aetna of WY Medicare |
$31.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.20
|
| Rate for Payer: Altius Commercial |
$46.20
|
| Rate for Payer: Beech Street Commercial |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.51
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.68
|
| Rate for Payer: Cigna of WY Commercial |
$47.16
|
| Rate for Payer: Entrust Commercial |
$45.71
|
| Rate for Payer: First Choice Health Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.91
|
| Rate for Payer: HealthUtah PPO |
$48.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.68
|
| Rate for Payer: Multiplan Medicare/VA |
$26.51
|
| Rate for Payer: One Health Plan of WY PPO |
$47.16
|
| Rate for Payer: PacificSource Commercial |
$43.31
|
| Rate for Payer: PHCS PPO |
$47.16
|
| Rate for Payer: Three Rivers PPO |
$36.09
|
| Rate for Payer: TriWest Veterans Administration |
$27.91
|
| Rate for Payer: United Healthcare Commercial |
$41.86
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
| Rate for Payer: WINHealth Partners Commercial |
$47.16
|
| Rate for Payer: Wise Provider Network Commercial |
$45.71
|
|
|
SEALTIGHT PED LEG MEDIUM
|
Facility
|
IP
|
$48.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.20
|
| Rate for Payer: Altius Commercial |
$46.20
|
| Rate for Payer: Beech Street Commercial |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.51
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.68
|
| Rate for Payer: Cigna of WY Commercial |
$47.16
|
| Rate for Payer: Entrust Commercial |
$45.71
|
| Rate for Payer: First Choice Health Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.76
|
| Rate for Payer: HealthUtah PPO |
$48.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.68
|
| Rate for Payer: Multiplan Medicare/VA |
$30.17
|
| Rate for Payer: One Health Plan of WY PPO |
$47.16
|
| Rate for Payer: PacificSource Commercial |
$43.31
|
| Rate for Payer: PHCS PPO |
$47.16
|
| Rate for Payer: Three Rivers PPO |
$36.09
|
| Rate for Payer: TriWest Veterans Administration |
$31.76
|
| Rate for Payer: United Healthcare Commercial |
$41.86
|
| Rate for Payer: United Healthcare Medicare |
$31.76
|
| Rate for Payer: WINHealth Partners Commercial |
$45.71
|
| Rate for Payer: Wise Provider Network Commercial |
$45.71
|
|
|
SEALTIGHT PED LEG SMALL
|
Facility
|
IP
|
$48.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.20
|
| Rate for Payer: Altius Commercial |
$46.20
|
| Rate for Payer: Beech Street Commercial |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.51
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.68
|
| Rate for Payer: Cigna of WY Commercial |
$47.16
|
| Rate for Payer: Entrust Commercial |
$45.71
|
| Rate for Payer: First Choice Health Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.76
|
| Rate for Payer: HealthUtah PPO |
$48.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.68
|
| Rate for Payer: Multiplan Medicare/VA |
$30.17
|
| Rate for Payer: One Health Plan of WY PPO |
$47.16
|
| Rate for Payer: PacificSource Commercial |
$43.31
|
| Rate for Payer: PHCS PPO |
$47.16
|
| Rate for Payer: Three Rivers PPO |
$36.09
|
| Rate for Payer: TriWest Veterans Administration |
$31.76
|
| Rate for Payer: United Healthcare Commercial |
$41.86
|
| Rate for Payer: United Healthcare Medicare |
$31.76
|
| Rate for Payer: WINHealth Partners Commercial |
$45.71
|
| Rate for Payer: Wise Provider Network Commercial |
$45.71
|
|
|
SEALTIGHT PED LEG SMALL
|
Facility
|
OP
|
$48.12
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$48.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.16
|
| Rate for Payer: Aetna of WY Medicare |
$31.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$46.20
|
| Rate for Payer: Altius Commercial |
$46.20
|
| Rate for Payer: Beech Street Commercial |
$47.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.51
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.68
|
| Rate for Payer: Cigna of WY Commercial |
$47.16
|
| Rate for Payer: Entrust Commercial |
$45.71
|
| Rate for Payer: First Choice Health Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.91
|
| Rate for Payer: HealthUtah PPO |
$48.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.68
|
| Rate for Payer: Multiplan Medicare/VA |
$26.51
|
| Rate for Payer: One Health Plan of WY PPO |
$47.16
|
| Rate for Payer: PacificSource Commercial |
$43.31
|
| Rate for Payer: PHCS PPO |
$47.16
|
| Rate for Payer: Three Rivers PPO |
$36.09
|
| Rate for Payer: TriWest Veterans Administration |
$27.91
|
| Rate for Payer: United Healthcare Commercial |
$41.86
|
| Rate for Payer: United Healthcare Medicare |
$27.91
|
| Rate for Payer: WINHealth Partners Commercial |
$47.16
|
| Rate for Payer: Wise Provider Network Commercial |
$45.71
|
|
|
SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$3,862.00
|
|
|
Service Code
|
HCPCS 49900 80
|
| Hospital Charge Code |
49900
|
| Min. Negotiated Rate |
$670.21 |
| Max. Negotiated Rate |
$3,862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,784.76
|
| Rate for Payer: Aetna of WY Medicare |
$788.48
|
| Rate for Payer: Beech Street Commercial |
$3,668.90
|
| Rate for Payer: Cash Price |
$2,703.40
|
| Rate for Payer: Cash Price |
$2,703.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,746.14
|
| Rate for Payer: Cigna of WY Commercial |
$3,784.76
|
| Rate for Payer: First Choice Health Commercial |
$3,475.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,668.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.48
|
| Rate for Payer: HealthUtah PPO |
$3,862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,746.14
|
| Rate for Payer: Multiplan Medicare/VA |
$670.21
|
| Rate for Payer: One Health Plan of WY PPO |
$3,784.76
|
| Rate for Payer: PacificSource Commercial |
$3,475.80
|
| Rate for Payer: PHCS PPO |
$3,668.90
|
| Rate for Payer: Three Rivers PPO |
$2,896.50
|
| Rate for Payer: TriWest Veterans Administration |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$3,359.94
|
| Rate for Payer: United Healthcare Medicare |
$788.48
|
| Rate for Payer: WINHealth Partners Commercial |
$3,282.70
|
|
|
SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$3,862.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
49900
|
| Min. Negotiated Rate |
$670.21 |
| Max. Negotiated Rate |
$3,862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,784.76
|
| Rate for Payer: Aetna of WY Medicare |
$788.48
|
| Rate for Payer: Beech Street Commercial |
$3,668.90
|
| Rate for Payer: Cash Price |
$2,703.40
|
| Rate for Payer: Cash Price |
$2,703.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,746.14
|
| Rate for Payer: Cigna of WY Commercial |
$3,784.76
|
| Rate for Payer: First Choice Health Commercial |
$3,475.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,668.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$788.48
|
| Rate for Payer: HealthUtah PPO |
$3,862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,746.14
|
| Rate for Payer: Multiplan Medicare/VA |
$670.21
|
| Rate for Payer: One Health Plan of WY PPO |
$3,784.76
|
| Rate for Payer: PacificSource Commercial |
$3,475.80
|
| Rate for Payer: PHCS PPO |
$3,668.90
|
| Rate for Payer: Three Rivers PPO |
$2,896.50
|
| Rate for Payer: TriWest Veterans Administration |
$788.48
|
| Rate for Payer: United Healthcare Commercial |
$3,359.94
|
| Rate for Payer: United Healthcare Medicare |
$788.48
|
| Rate for Payer: WINHealth Partners Commercial |
$3,282.70
|
|
|
SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$3,101.00
|
|
|
Service Code
|
HCPCS 13160 80
|
| Hospital Charge Code |
13160
|
| Min. Negotiated Rate |
$649.88 |
| Max. Negotiated Rate |
$3,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,038.98
|
| Rate for Payer: Aetna of WY Medicare |
$764.57
|
| Rate for Payer: Beech Street Commercial |
$2,945.95
|
| Rate for Payer: Cash Price |
$2,170.70
|
| Rate for Payer: Cash Price |
$2,170.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,007.97
|
| Rate for Payer: Cigna of WY Commercial |
$3,038.98
|
| Rate for Payer: First Choice Health Commercial |
$2,790.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,945.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$764.57
|
| Rate for Payer: HealthUtah PPO |
$3,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,007.97
|
| Rate for Payer: Multiplan Medicare/VA |
$649.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,038.98
|
| Rate for Payer: PacificSource Commercial |
$2,790.90
|
| Rate for Payer: PHCS PPO |
$2,945.95
|
| Rate for Payer: Three Rivers PPO |
$2,325.75
|
| Rate for Payer: TriWest Veterans Administration |
$764.57
|
| Rate for Payer: United Healthcare Commercial |
$2,697.87
|
| Rate for Payer: United Healthcare Medicare |
$764.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,635.85
|
|
|
SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$3,101.00
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
13160
|
| Min. Negotiated Rate |
$649.88 |
| Max. Negotiated Rate |
$3,101.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,038.98
|
| Rate for Payer: Aetna of WY Medicare |
$764.57
|
| Rate for Payer: Beech Street Commercial |
$2,945.95
|
| Rate for Payer: Cash Price |
$2,170.70
|
| Rate for Payer: Cash Price |
$2,170.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,007.97
|
| Rate for Payer: Cigna of WY Commercial |
$3,038.98
|
| Rate for Payer: First Choice Health Commercial |
$2,790.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,945.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$764.57
|
| Rate for Payer: HealthUtah PPO |
$3,101.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,007.97
|
| Rate for Payer: Multiplan Medicare/VA |
$649.88
|
| Rate for Payer: One Health Plan of WY PPO |
$3,038.98
|
| Rate for Payer: PacificSource Commercial |
$2,790.90
|
| Rate for Payer: PHCS PPO |
$2,945.95
|
| Rate for Payer: Three Rivers PPO |
$2,325.75
|
| Rate for Payer: TriWest Veterans Administration |
$764.57
|
| Rate for Payer: United Healthcare Commercial |
$2,697.87
|
| Rate for Payer: United Healthcare Medicare |
$764.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2,635.85
|
|
|
SEDIMENTATION RATE RBC NON-AUTOMATED
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 85651
|
| Hospital Charge Code |
85651
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Aetna of WY Medicare |
$4.27
|
| Rate for Payer: Beech Street Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: First Choice Health Commercial |
$18.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.27
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$3.63
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.00
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$4.27
|
| Rate for Payer: WINHealth Partners Commercial |
$19.00
|
|
|
SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
97535
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$188.16
|
| Rate for Payer: Aetna of WY Medicare |
$32.00
|
| Rate for Payer: Beech Street Commercial |
$182.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$186.24
|
| Rate for Payer: Cigna of WY Commercial |
$188.16
|
| Rate for Payer: First Choice Health Commercial |
$172.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$182.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.00
|
| Rate for Payer: HealthUtah PPO |
$192.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$186.24
|
| Rate for Payer: Multiplan Medicare/VA |
$27.20
|
| Rate for Payer: One Health Plan of WY PPO |
$188.16
|
| Rate for Payer: PacificSource Commercial |
$172.80
|
| Rate for Payer: PHCS PPO |
$182.40
|
| Rate for Payer: Three Rivers PPO |
$144.00
|
| Rate for Payer: TriWest Veterans Administration |
$32.00
|
| Rate for Payer: United Healthcare Commercial |
$167.04
|
| Rate for Payer: United Healthcare Medicare |
$32.00
|
| Rate for Payer: WINHealth Partners Commercial |
$182.40
|
|
|
SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 99473
|
| Hospital Charge Code |
99473
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$13.99
|
| Rate for Payer: Beech Street Commercial |
$47.50
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.99
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$11.89
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$47.50
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$13.99
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$13.99
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
|
|
SEMITENDINOSUS ASP ALLOGRAFT
|
Facility
|
IP
|
$7,595.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,762.06 |
| Max. Negotiated Rate |
$7,595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,443.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,291.20
|
| Rate for Payer: Altius Commercial |
$7,291.20
|
| Rate for Payer: Beech Street Commercial |
$7,443.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,235.50
|
| Rate for Payer: Cash Price |
$5,316.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,367.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,443.10
|
| Rate for Payer: Entrust Commercial |
$7,215.25
|
| Rate for Payer: First Choice Health Commercial |
$7,215.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,215.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,012.70
|
| Rate for Payer: HealthUtah PPO |
$7,595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,367.15
|
| Rate for Payer: Multiplan Medicare/VA |
$4,762.06
|
| Rate for Payer: One Health Plan of WY PPO |
$7,443.10
|
| Rate for Payer: PacificSource Commercial |
$6,835.50
|
| Rate for Payer: PHCS PPO |
$7,443.10
|
| Rate for Payer: Three Rivers PPO |
$5,696.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,012.70
|
| Rate for Payer: United Healthcare Commercial |
$6,607.65
|
| Rate for Payer: United Healthcare Medicare |
$5,012.70
|
| Rate for Payer: WINHealth Partners Commercial |
$7,215.25
|
| Rate for Payer: Wise Provider Network Commercial |
$7,215.25
|
|
|
SEMITENDINOSUS ASP ALLOGRAFT
|
Facility
|
OP
|
$7,595.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,184.84 |
| Max. Negotiated Rate |
$7,595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,443.10
|
| Rate for Payer: Aetna of WY Medicare |
$5,012.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7,291.20
|
| Rate for Payer: Altius Commercial |
$7,291.20
|
| Rate for Payer: Beech Street Commercial |
$7,443.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,235.50
|
| Rate for Payer: Cash Price |
$5,316.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,367.15
|
| Rate for Payer: Cigna of WY Commercial |
$7,443.10
|
| Rate for Payer: Entrust Commercial |
$7,215.25
|
| Rate for Payer: First Choice Health Commercial |
$7,215.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,215.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,405.10
|
| Rate for Payer: HealthUtah PPO |
$7,595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,367.15
|
| Rate for Payer: Multiplan Medicare/VA |
$4,184.84
|
| Rate for Payer: One Health Plan of WY PPO |
$7,443.10
|
| Rate for Payer: PacificSource Commercial |
$6,835.50
|
| Rate for Payer: PHCS PPO |
$7,443.10
|
| Rate for Payer: Three Rivers PPO |
$5,696.25
|
| Rate for Payer: TriWest Veterans Administration |
$4,405.10
|
| Rate for Payer: United Healthcare Commercial |
$6,607.65
|
| Rate for Payer: United Healthcare Medicare |
$4,405.10
|
| Rate for Payer: WINHealth Partners Commercial |
$7,443.10
|
| Rate for Payer: Wise Provider Network Commercial |
$7,215.25
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
IP
|
$0.07
|
|
|
Service Code
|
NDC 0536124810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.07
|
| Rate for Payer: Altius Commercial |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.07
|
| Rate for Payer: Cigna of WY Commercial |
$0.07
|
| Rate for Payer: Entrust Commercial |
$0.07
|
| Rate for Payer: First Choice Health Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.07
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.07
|
| Rate for Payer: PacificSource Commercial |
$0.06
|
| Rate for Payer: PHCS PPO |
$0.07
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.07
|
| Rate for Payer: Wise Provider Network Commercial |
$0.07
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 6068762211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.63
|
| Rate for Payer: Aetna of WY Medicare |
$0.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.61
|
| Rate for Payer: Altius Commercial |
$0.61
|
| Rate for Payer: Beech Street Commercial |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.62
|
| Rate for Payer: Cigna of WY Commercial |
$0.63
|
| Rate for Payer: Entrust Commercial |
$0.61
|
| Rate for Payer: First Choice Health Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.37
|
| Rate for Payer: HealthUtah PPO |
$0.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.62
|
| Rate for Payer: Multiplan Medicare/VA |
$0.35
|
| Rate for Payer: One Health Plan of WY PPO |
$0.63
|
| Rate for Payer: PacificSource Commercial |
$0.58
|
| Rate for Payer: PHCS PPO |
$0.63
|
| Rate for Payer: Three Rivers PPO |
$0.48
|
| Rate for Payer: TriWest Veterans Administration |
$0.37
|
| Rate for Payer: United Healthcare Commercial |
$0.56
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WINHealth Partners Commercial |
$0.63
|
| Rate for Payer: Wise Provider Network Commercial |
$0.61
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 6068762201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.61
|
| Rate for Payer: Altius Commercial |
$0.61
|
| Rate for Payer: Beech Street Commercial |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.62
|
| Rate for Payer: Cigna of WY Commercial |
$0.63
|
| Rate for Payer: Entrust Commercial |
$0.61
|
| Rate for Payer: First Choice Health Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.62
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.63
|
| Rate for Payer: PacificSource Commercial |
$0.58
|
| Rate for Payer: PHCS PPO |
$0.63
|
| Rate for Payer: Three Rivers PPO |
$0.48
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.56
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.61
|
| Rate for Payer: Wise Provider Network Commercial |
$0.61
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 6068762211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.61
|
| Rate for Payer: Altius Commercial |
$0.61
|
| Rate for Payer: Beech Street Commercial |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.62
|
| Rate for Payer: Cigna of WY Commercial |
$0.63
|
| Rate for Payer: Entrust Commercial |
$0.61
|
| Rate for Payer: First Choice Health Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.62
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.63
|
| Rate for Payer: PacificSource Commercial |
$0.58
|
| Rate for Payer: PHCS PPO |
$0.63
|
| Rate for Payer: Three Rivers PPO |
$0.48
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.56
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.61
|
| Rate for Payer: Wise Provider Network Commercial |
$0.61
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
OP
|
$0.07
|
|
|
Service Code
|
NDC 0536124810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.07
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.07
|
| Rate for Payer: Altius Commercial |
$0.07
|
| Rate for Payer: Beech Street Commercial |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.07
|
| Rate for Payer: Cigna of WY Commercial |
$0.07
|
| Rate for Payer: Entrust Commercial |
$0.07
|
| Rate for Payer: First Choice Health Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.04
|
| Rate for Payer: HealthUtah PPO |
$0.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.07
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.07
|
| Rate for Payer: PacificSource Commercial |
$0.06
|
| Rate for Payer: PHCS PPO |
$0.07
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$0.06
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WINHealth Partners Commercial |
$0.07
|
| Rate for Payer: Wise Provider Network Commercial |
$0.07
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
IP
|
$0.09
|
|
|
Service Code
|
NDC 0536124801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 0536124801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.09
|
| Rate for Payer: Aetna of WY Medicare |
$0.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.09
|
| Rate for Payer: Altius Commercial |
$0.09
|
| Rate for Payer: Beech Street Commercial |
$0.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.09
|
| Rate for Payer: Cigna of WY Commercial |
$0.09
|
| Rate for Payer: Entrust Commercial |
$0.09
|
| Rate for Payer: First Choice Health Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.09
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.09
|
| Rate for Payer: PacificSource Commercial |
$0.08
|
| Rate for Payer: PHCS PPO |
$0.09
|
| Rate for Payer: Three Rivers PPO |
$0.07
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.09
|
| Rate for Payer: Wise Provider Network Commercial |
$0.09
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [5111]
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 6068762201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.63
|
| Rate for Payer: Aetna of WY Medicare |
$0.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.61
|
| Rate for Payer: Altius Commercial |
$0.61
|
| Rate for Payer: Beech Street Commercial |
$0.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.62
|
| Rate for Payer: Cigna of WY Commercial |
$0.63
|
| Rate for Payer: Entrust Commercial |
$0.61
|
| Rate for Payer: First Choice Health Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.37
|
| Rate for Payer: HealthUtah PPO |
$0.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.62
|
| Rate for Payer: Multiplan Medicare/VA |
$0.35
|
| Rate for Payer: One Health Plan of WY PPO |
$0.63
|
| Rate for Payer: PacificSource Commercial |
$0.58
|
| Rate for Payer: PHCS PPO |
$0.63
|
| Rate for Payer: Three Rivers PPO |
$0.48
|
| Rate for Payer: TriWest Veterans Administration |
$0.37
|
| Rate for Payer: United Healthcare Commercial |
$0.56
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WINHealth Partners Commercial |
$0.63
|
| Rate for Payer: Wise Provider Network Commercial |
$0.61
|
|
|
SEPTAL/OTHER INTRANASAL DERMATOPLASTY
|
Professional
|
Both
|
$3,316.00
|
|
|
Service Code
|
HCPCS 30620
|
| Hospital Charge Code |
30620
|
| Min. Negotiated Rate |
$561.80 |
| Max. Negotiated Rate |
$3,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,249.68
|
| Rate for Payer: Aetna of WY Medicare |
$660.94
|
| Rate for Payer: Beech Street Commercial |
$3,150.20
|
| Rate for Payer: Cash Price |
$2,321.20
|
| Rate for Payer: Cash Price |
$2,321.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,216.52
|
| Rate for Payer: Cigna of WY Commercial |
$3,249.68
|
| Rate for Payer: First Choice Health Commercial |
$2,984.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,150.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.94
|
| Rate for Payer: HealthUtah PPO |
$3,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,216.52
|
| Rate for Payer: Multiplan Medicare/VA |
$561.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3,249.68
|
| Rate for Payer: PacificSource Commercial |
$2,984.40
|
| Rate for Payer: PHCS PPO |
$3,150.20
|
| Rate for Payer: Three Rivers PPO |
$2,487.00
|
| Rate for Payer: TriWest Veterans Administration |
$660.94
|
| Rate for Payer: United Healthcare Commercial |
$2,884.92
|
| Rate for Payer: United Healthcare Medicare |
$660.94
|
| Rate for Payer: WINHealth Partners Commercial |
$2,818.60
|
|
|
SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF
|
Professional
|
Both
|
$4,969.00
|
|
|
Service Code
|
HCPCS 30520
|
| Hospital Charge Code |
30520
|
| Min. Negotiated Rate |
$561.07 |
| Max. Negotiated Rate |
$4,969.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,869.62
|
| Rate for Payer: Aetna of WY Medicare |
$660.08
|
| Rate for Payer: Beech Street Commercial |
$4,720.55
|
| Rate for Payer: Cash Price |
$3,478.30
|
| Rate for Payer: Cash Price |
$3,478.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,819.93
|
| Rate for Payer: Cigna of WY Commercial |
$4,869.62
|
| Rate for Payer: First Choice Health Commercial |
$4,472.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,720.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$660.08
|
| Rate for Payer: HealthUtah PPO |
$4,969.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,819.93
|
| Rate for Payer: Multiplan Medicare/VA |
$561.07
|
| Rate for Payer: One Health Plan of WY PPO |
$4,869.62
|
| Rate for Payer: PacificSource Commercial |
$4,472.10
|
| Rate for Payer: PHCS PPO |
$4,720.55
|
| Rate for Payer: Three Rivers PPO |
$3,726.75
|
| Rate for Payer: TriWest Veterans Administration |
$660.08
|
| Rate for Payer: United Healthcare Commercial |
$4,323.03
|
| Rate for Payer: United Healthcare Medicare |
$660.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4,223.65
|
|
|
SERTRALINE 50 MG TABLET [18988]
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 6068724211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.54
|
| Rate for Payer: Aetna of WY Medicare |
$1.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.51
|
| Rate for Payer: Altius Commercial |
$1.51
|
| Rate for Payer: Beech Street Commercial |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.52
|
| Rate for Payer: Cigna of WY Commercial |
$1.54
|
| Rate for Payer: Entrust Commercial |
$1.49
|
| Rate for Payer: First Choice Health Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.91
|
| Rate for Payer: HealthUtah PPO |
$1.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.52
|
| Rate for Payer: Multiplan Medicare/VA |
$0.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1.54
|
| Rate for Payer: PacificSource Commercial |
$1.41
|
| Rate for Payer: PHCS PPO |
$1.54
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
| Rate for Payer: WINHealth Partners Commercial |
$1.54
|
| Rate for Payer: Wise Provider Network Commercial |
$1.49
|
|
