|
CATH FOGARTY OCCLUSION 4FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.32
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.32
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.47
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$81.20
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$85.47
|
| Rate for Payer: United Healthcare Commercial |
$112.66
|
| Rate for Payer: United Healthcare Medicare |
$85.47
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOGARTY OCCLUSION 5FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.32
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.32
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.47
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$81.20
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$85.47
|
| Rate for Payer: United Healthcare Commercial |
$112.66
|
| Rate for Payer: United Healthcare Medicare |
$85.47
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOGARTY OCCLUSION 5FR
|
Facility
|
OP
|
$129.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$85.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.32
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.32
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.11
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$71.35
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$75.11
|
| Rate for Payer: United Healthcare Commercial |
$112.66
|
| Rate for Payer: United Healthcare Medicare |
$75.11
|
| Rate for Payer: WINHealth Partners Commercial |
$126.91
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOL COUDE TIP 18FR 5CC
|
Facility
|
IP
|
$41.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.53
|
| Rate for Payer: Altius Commercial |
$39.53
|
| Rate for Payer: Beech Street Commercial |
$40.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.81
|
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.94
|
| Rate for Payer: Cigna of WY Commercial |
$40.36
|
| Rate for Payer: Entrust Commercial |
$39.12
|
| Rate for Payer: First Choice Health Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.18
|
| Rate for Payer: HealthUtah PPO |
$41.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.94
|
| Rate for Payer: Multiplan Medicare/VA |
$25.82
|
| Rate for Payer: One Health Plan of WY PPO |
$40.36
|
| Rate for Payer: PacificSource Commercial |
$37.06
|
| Rate for Payer: PHCS PPO |
$40.36
|
| Rate for Payer: Three Rivers PPO |
$30.88
|
| Rate for Payer: TriWest Veterans Administration |
$27.18
|
| Rate for Payer: United Healthcare Commercial |
$35.83
|
| Rate for Payer: United Healthcare Medicare |
$27.18
|
| Rate for Payer: WINHealth Partners Commercial |
$39.12
|
| Rate for Payer: Wise Provider Network Commercial |
$39.12
|
|
|
CATH FOL COUDE TIP 18FR 5CC
|
Facility
|
OP
|
$41.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.36
|
| Rate for Payer: Aetna of WY Medicare |
$27.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.53
|
| Rate for Payer: Altius Commercial |
$39.53
|
| Rate for Payer: Beech Street Commercial |
$40.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.81
|
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.94
|
| Rate for Payer: Cigna of WY Commercial |
$40.36
|
| Rate for Payer: Entrust Commercial |
$39.12
|
| Rate for Payer: First Choice Health Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.88
|
| Rate for Payer: HealthUtah PPO |
$41.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.94
|
| Rate for Payer: Multiplan Medicare/VA |
$22.69
|
| Rate for Payer: One Health Plan of WY PPO |
$40.36
|
| Rate for Payer: PacificSource Commercial |
$37.06
|
| Rate for Payer: PHCS PPO |
$40.36
|
| Rate for Payer: Three Rivers PPO |
$30.88
|
| Rate for Payer: TriWest Veterans Administration |
$23.88
|
| Rate for Payer: United Healthcare Commercial |
$35.83
|
| Rate for Payer: United Healthcare Medicare |
$23.88
|
| Rate for Payer: WINHealth Partners Commercial |
$40.36
|
| Rate for Payer: Wise Provider Network Commercial |
$39.12
|
|
|
CATH FOLEY 18F 30CC 3-WAY
|
Facility
|
IP
|
$148.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$145.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$142.81
|
| Rate for Payer: Altius Commercial |
$142.81
|
| Rate for Payer: Beech Street Commercial |
$145.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.13
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.30
|
| Rate for Payer: Cigna of WY Commercial |
$145.78
|
| Rate for Payer: Entrust Commercial |
$141.32
|
| Rate for Payer: First Choice Health Commercial |
$141.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.18
|
| Rate for Payer: HealthUtah PPO |
$148.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.30
|
| Rate for Payer: Multiplan Medicare/VA |
$93.27
|
| Rate for Payer: One Health Plan of WY PPO |
$145.78
|
| Rate for Payer: PacificSource Commercial |
$133.88
|
| Rate for Payer: PHCS PPO |
$145.78
|
| Rate for Payer: Three Rivers PPO |
$111.57
|
| Rate for Payer: TriWest Veterans Administration |
$98.18
|
| Rate for Payer: United Healthcare Commercial |
$129.42
|
| Rate for Payer: United Healthcare Medicare |
$98.18
|
| Rate for Payer: WINHealth Partners Commercial |
$141.32
|
| Rate for Payer: Wise Provider Network Commercial |
$141.32
|
|
|
CATH FOLEY 18F 30CC 3-WAY
|
Facility
|
OP
|
$148.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.97 |
| Max. Negotiated Rate |
$148.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$145.78
|
| Rate for Payer: Aetna of WY Medicare |
$98.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$142.81
|
| Rate for Payer: Altius Commercial |
$142.81
|
| Rate for Payer: Beech Street Commercial |
$145.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$122.13
|
| Rate for Payer: Cash Price |
$104.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$144.30
|
| Rate for Payer: Cigna of WY Commercial |
$145.78
|
| Rate for Payer: Entrust Commercial |
$141.32
|
| Rate for Payer: First Choice Health Commercial |
$141.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$141.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.28
|
| Rate for Payer: HealthUtah PPO |
$148.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$144.30
|
| Rate for Payer: Multiplan Medicare/VA |
$81.97
|
| Rate for Payer: One Health Plan of WY PPO |
$145.78
|
| Rate for Payer: PacificSource Commercial |
$133.88
|
| Rate for Payer: PHCS PPO |
$145.78
|
| Rate for Payer: Three Rivers PPO |
$111.57
|
| Rate for Payer: TriWest Veterans Administration |
$86.28
|
| Rate for Payer: United Healthcare Commercial |
$129.42
|
| Rate for Payer: United Healthcare Medicare |
$86.28
|
| Rate for Payer: WINHealth Partners Commercial |
$145.78
|
| Rate for Payer: Wise Provider Network Commercial |
$141.32
|
|
|
CATH FOLEY 20F 30CC 3-WAY
|
Facility
|
OP
|
$24.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.29
|
| Rate for Payer: Aetna of WY Medicare |
$16.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.80
|
| Rate for Payer: Altius Commercial |
$23.80
|
| Rate for Payer: Beech Street Commercial |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.35
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.05
|
| Rate for Payer: Cigna of WY Commercial |
$24.29
|
| Rate for Payer: Entrust Commercial |
$23.55
|
| Rate for Payer: First Choice Health Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.38
|
| Rate for Payer: HealthUtah PPO |
$24.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.05
|
| Rate for Payer: Multiplan Medicare/VA |
$13.66
|
| Rate for Payer: One Health Plan of WY PPO |
$24.29
|
| Rate for Payer: PacificSource Commercial |
$22.31
|
| Rate for Payer: PHCS PPO |
$24.29
|
| Rate for Payer: Three Rivers PPO |
$18.59
|
| Rate for Payer: TriWest Veterans Administration |
$14.38
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare |
$14.38
|
| Rate for Payer: WINHealth Partners Commercial |
$24.29
|
| Rate for Payer: Wise Provider Network Commercial |
$23.55
|
|
|
CATH FOLEY 20F 30CC 3-WAY
|
Facility
|
IP
|
$24.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.80
|
| Rate for Payer: Altius Commercial |
$23.80
|
| Rate for Payer: Beech Street Commercial |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.35
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.05
|
| Rate for Payer: Cigna of WY Commercial |
$24.29
|
| Rate for Payer: Entrust Commercial |
$23.55
|
| Rate for Payer: First Choice Health Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.36
|
| Rate for Payer: HealthUtah PPO |
$24.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.05
|
| Rate for Payer: Multiplan Medicare/VA |
$15.54
|
| Rate for Payer: One Health Plan of WY PPO |
$24.29
|
| Rate for Payer: PacificSource Commercial |
$22.31
|
| Rate for Payer: PHCS PPO |
$24.29
|
| Rate for Payer: Three Rivers PPO |
$18.59
|
| Rate for Payer: TriWest Veterans Administration |
$16.36
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare |
$16.36
|
| Rate for Payer: WINHealth Partners Commercial |
$23.55
|
| Rate for Payer: Wise Provider Network Commercial |
$23.55
|
|
|
CATH FOLEY 22F 30CC 3-WAY
|
Facility
|
OP
|
$92.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.23 |
| Max. Negotiated Rate |
$92.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.12
|
| Rate for Payer: Aetna of WY Medicare |
$61.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.26
|
| Rate for Payer: Altius Commercial |
$89.26
|
| Rate for Payer: Beech Street Commercial |
$91.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.34
|
| Rate for Payer: Cash Price |
$65.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.19
|
| Rate for Payer: Cigna of WY Commercial |
$91.12
|
| Rate for Payer: Entrust Commercial |
$88.33
|
| Rate for Payer: First Choice Health Commercial |
$88.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.93
|
| Rate for Payer: HealthUtah PPO |
$92.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.19
|
| Rate for Payer: Multiplan Medicare/VA |
$51.23
|
| Rate for Payer: One Health Plan of WY PPO |
$91.12
|
| Rate for Payer: PacificSource Commercial |
$83.68
|
| Rate for Payer: PHCS PPO |
$91.12
|
| Rate for Payer: Three Rivers PPO |
$69.74
|
| Rate for Payer: TriWest Veterans Administration |
$53.93
|
| Rate for Payer: United Healthcare Commercial |
$80.89
|
| Rate for Payer: United Healthcare Medicare |
$53.93
|
| Rate for Payer: WINHealth Partners Commercial |
$91.12
|
| Rate for Payer: Wise Provider Network Commercial |
$88.33
|
|
|
CATH FOLEY 22F 30CC 3-WAY
|
Facility
|
IP
|
$92.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$92.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.26
|
| Rate for Payer: Altius Commercial |
$89.26
|
| Rate for Payer: Beech Street Commercial |
$91.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.34
|
| Rate for Payer: Cash Price |
$65.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.19
|
| Rate for Payer: Cigna of WY Commercial |
$91.12
|
| Rate for Payer: Entrust Commercial |
$88.33
|
| Rate for Payer: First Choice Health Commercial |
$88.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.37
|
| Rate for Payer: HealthUtah PPO |
$92.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.19
|
| Rate for Payer: Multiplan Medicare/VA |
$58.30
|
| Rate for Payer: One Health Plan of WY PPO |
$91.12
|
| Rate for Payer: PacificSource Commercial |
$83.68
|
| Rate for Payer: PHCS PPO |
$91.12
|
| Rate for Payer: Three Rivers PPO |
$69.74
|
| Rate for Payer: TriWest Veterans Administration |
$61.37
|
| Rate for Payer: United Healthcare Commercial |
$80.89
|
| Rate for Payer: United Healthcare Medicare |
$61.37
|
| Rate for Payer: WINHealth Partners Commercial |
$88.33
|
| Rate for Payer: Wise Provider Network Commercial |
$88.33
|
|
|
CATH IV 20G 1" NEXIVA 383536
|
Facility
|
IP
|
$15.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.13
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.40
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| Rate for Payer: Multiplan Medicare/VA |
$9.88
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$13.71
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WINHealth Partners Commercial |
$14.97
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
|
CATH IV 20G 1" NEXIVA 383536
|
Facility
|
OP
|
$15.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.13
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.14
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| Rate for Payer: Multiplan Medicare/VA |
$8.68
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$9.14
|
| Rate for Payer: United Healthcare Commercial |
$13.71
|
| Rate for Payer: United Healthcare Medicare |
$9.14
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
|
CATH IV 22G 1" NEXIVA 383532
|
Facility
|
IP
|
$15.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.13
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.40
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| Rate for Payer: Multiplan Medicare/VA |
$9.88
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$10.40
|
| Rate for Payer: United Healthcare Commercial |
$13.71
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
| Rate for Payer: WINHealth Partners Commercial |
$14.97
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
|
CATH IV 22G 1" NEXIVA 383532
|
Facility
|
OP
|
$15.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.13
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.94
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.14
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| Rate for Payer: Multiplan Medicare/VA |
$8.68
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$9.14
|
| Rate for Payer: United Healthcare Commercial |
$13.71
|
| Rate for Payer: United Healthcare Medicare |
$9.14
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
|
CATH IV 24G .75" NEXIVA
|
Facility
|
IP
|
$15.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.28
|
| Rate for Payer: Altius Commercial |
$15.28
|
| Rate for Payer: Beech Street Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.44
|
| Rate for Payer: Cigna of WY Commercial |
$15.60
|
| Rate for Payer: Entrust Commercial |
$15.12
|
| Rate for Payer: First Choice Health Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.51
|
| Rate for Payer: HealthUtah PPO |
$15.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.44
|
| Rate for Payer: Multiplan Medicare/VA |
$9.98
|
| Rate for Payer: One Health Plan of WY PPO |
$15.60
|
| Rate for Payer: PacificSource Commercial |
$14.33
|
| Rate for Payer: PHCS PPO |
$15.60
|
| Rate for Payer: Three Rivers PPO |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$10.51
|
| Rate for Payer: United Healthcare Commercial |
$13.85
|
| Rate for Payer: United Healthcare Medicare |
$10.51
|
| Rate for Payer: WINHealth Partners Commercial |
$15.12
|
| Rate for Payer: Wise Provider Network Commercial |
$15.12
|
|
|
CATH IV 24G .75" NEXIVA
|
Facility
|
OP
|
$15.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.60
|
| Rate for Payer: Aetna of WY Medicare |
$10.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.28
|
| Rate for Payer: Altius Commercial |
$15.28
|
| Rate for Payer: Beech Street Commercial |
$15.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.44
|
| Rate for Payer: Cigna of WY Commercial |
$15.60
|
| Rate for Payer: Entrust Commercial |
$15.12
|
| Rate for Payer: First Choice Health Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.23
|
| Rate for Payer: HealthUtah PPO |
$15.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.44
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: One Health Plan of WY PPO |
$15.60
|
| Rate for Payer: PacificSource Commercial |
$14.33
|
| Rate for Payer: PHCS PPO |
$15.60
|
| Rate for Payer: Three Rivers PPO |
$11.94
|
| Rate for Payer: TriWest Veterans Administration |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$13.85
|
| Rate for Payer: United Healthcare Medicare |
$9.23
|
| Rate for Payer: WINHealth Partners Commercial |
$15.60
|
| Rate for Payer: Wise Provider Network Commercial |
$15.12
|
|
|
CATH IV ANGIO ORANGE 14G 5.25"
|
Facility
|
OP
|
$47.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.70
|
| Rate for Payer: Aetna of WY Medicare |
$31.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.74
|
| Rate for Payer: Altius Commercial |
$45.74
|
| Rate for Payer: Beech Street Commercial |
$46.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.12
|
| Rate for Payer: Cash Price |
$33.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.22
|
| Rate for Payer: Cigna of WY Commercial |
$46.70
|
| Rate for Payer: Entrust Commercial |
$45.27
|
| Rate for Payer: First Choice Health Commercial |
$45.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.64
|
| Rate for Payer: HealthUtah PPO |
$47.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.22
|
| Rate for Payer: Multiplan Medicare/VA |
$26.26
|
| Rate for Payer: One Health Plan of WY PPO |
$46.70
|
| Rate for Payer: PacificSource Commercial |
$42.88
|
| Rate for Payer: PHCS PPO |
$46.70
|
| Rate for Payer: Three Rivers PPO |
$35.74
|
| Rate for Payer: TriWest Veterans Administration |
$27.64
|
| Rate for Payer: United Healthcare Commercial |
$41.46
|
| Rate for Payer: United Healthcare Medicare |
$27.64
|
| Rate for Payer: WINHealth Partners Commercial |
$46.70
|
| Rate for Payer: Wise Provider Network Commercial |
$45.27
|
|
|
CATH IV ANGIO ORANGE 14G 5.25"
|
Facility
|
IP
|
$47.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.74
|
| Rate for Payer: Altius Commercial |
$45.74
|
| Rate for Payer: Beech Street Commercial |
$46.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.12
|
| Rate for Payer: Cash Price |
$33.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.22
|
| Rate for Payer: Cigna of WY Commercial |
$46.70
|
| Rate for Payer: Entrust Commercial |
$45.27
|
| Rate for Payer: First Choice Health Commercial |
$45.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.45
|
| Rate for Payer: HealthUtah PPO |
$47.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.22
|
| Rate for Payer: Multiplan Medicare/VA |
$29.88
|
| Rate for Payer: One Health Plan of WY PPO |
$46.70
|
| Rate for Payer: PacificSource Commercial |
$42.88
|
| Rate for Payer: PHCS PPO |
$46.70
|
| Rate for Payer: Three Rivers PPO |
$35.74
|
| Rate for Payer: TriWest Veterans Administration |
$31.45
|
| Rate for Payer: United Healthcare Commercial |
$41.46
|
| Rate for Payer: United Healthcare Medicare |
$31.45
|
| Rate for Payer: WINHealth Partners Commercial |
$45.27
|
| Rate for Payer: Wise Provider Network Commercial |
$45.27
|
|
|
CATHJ UMBILICAL VEIN DX/THER NB
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
36510
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.44
|
| Rate for Payer: Aetna of WY Medicare |
$50.72
|
| Rate for Payer: Beech Street Commercial |
$264.10
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: Cash Price |
$194.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$269.66
|
| Rate for Payer: Cigna of WY Commercial |
$272.44
|
| Rate for Payer: First Choice Health Commercial |
$250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$264.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.72
|
| Rate for Payer: HealthUtah PPO |
$278.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.66
|
| Rate for Payer: Multiplan Medicare/VA |
$43.11
|
| Rate for Payer: One Health Plan of WY PPO |
$272.44
|
| Rate for Payer: PacificSource Commercial |
$250.20
|
| Rate for Payer: PHCS PPO |
$264.10
|
| Rate for Payer: Three Rivers PPO |
$208.50
|
| Rate for Payer: TriWest Veterans Administration |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$241.86
|
| Rate for Payer: United Healthcare Medicare |
$50.72
|
| Rate for Payer: WINHealth Partners Commercial |
$236.30
|
|
|
CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$3,256.00
|
|
|
Service Code
|
HCPCS 93459
|
| Hospital Charge Code |
93459
|
| Min. Negotiated Rate |
$911.75 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,190.88
|
| Rate for Payer: Aetna of WY Medicare |
$1,072.65
|
| Rate for Payer: Beech Street Commercial |
$3,093.20
|
| Rate for Payer: Cash Price |
$2,279.20
|
| Rate for Payer: Cash Price |
$2,279.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,158.32
|
| Rate for Payer: Cigna of WY Commercial |
$3,190.88
|
| Rate for Payer: First Choice Health Commercial |
$2,930.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,093.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,072.65
|
| Rate for Payer: HealthUtah PPO |
$3,256.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,158.32
|
| Rate for Payer: Multiplan Medicare/VA |
$911.75
|
| Rate for Payer: One Health Plan of WY PPO |
$3,190.88
|
| Rate for Payer: PacificSource Commercial |
$2,930.40
|
| Rate for Payer: PHCS PPO |
$3,093.20
|
| Rate for Payer: Three Rivers PPO |
$2,442.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,072.65
|
| Rate for Payer: United Healthcare Commercial |
$2,832.72
|
| Rate for Payer: United Healthcare Medicare |
$1,072.65
|
| Rate for Payer: WINHealth Partners Commercial |
$3,093.20
|
|
|
CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$4,461.00
|
|
|
Service Code
|
HCPCS 93458
|
| Hospital Charge Code |
93458
|
| Min. Negotiated Rate |
$847.99 |
| Max. Negotiated Rate |
$4,461.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,371.78
|
| Rate for Payer: Aetna of WY Medicare |
$997.64
|
| Rate for Payer: Beech Street Commercial |
$4,237.95
|
| Rate for Payer: Cash Price |
$3,122.70
|
| Rate for Payer: Cash Price |
$3,122.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,327.17
|
| Rate for Payer: Cigna of WY Commercial |
$4,371.78
|
| Rate for Payer: First Choice Health Commercial |
$4,014.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,237.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$997.64
|
| Rate for Payer: HealthUtah PPO |
$4,461.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,327.17
|
| Rate for Payer: Multiplan Medicare/VA |
$847.99
|
| Rate for Payer: One Health Plan of WY PPO |
$4,371.78
|
| Rate for Payer: PacificSource Commercial |
$4,014.90
|
| Rate for Payer: PHCS PPO |
$4,237.95
|
| Rate for Payer: Three Rivers PPO |
$3,345.75
|
| Rate for Payer: TriWest Veterans Administration |
$997.64
|
| Rate for Payer: United Healthcare Commercial |
$3,881.07
|
| Rate for Payer: United Healthcare Medicare |
$997.64
|
| Rate for Payer: WINHealth Partners Commercial |
$4,237.95
|
|
|
CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
58340
|
| Min. Negotiated Rate |
$47.13 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$534.10
|
| Rate for Payer: Aetna of WY Medicare |
$55.45
|
| Rate for Payer: Beech Street Commercial |
$517.75
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$528.65
|
| Rate for Payer: Cigna of WY Commercial |
$534.10
|
| Rate for Payer: First Choice Health Commercial |
$490.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$517.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.45
|
| Rate for Payer: HealthUtah PPO |
$545.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$528.65
|
| Rate for Payer: Multiplan Medicare/VA |
$47.13
|
| Rate for Payer: One Health Plan of WY PPO |
$534.10
|
| Rate for Payer: PacificSource Commercial |
$490.50
|
| Rate for Payer: PHCS PPO |
$517.75
|
| Rate for Payer: Three Rivers PPO |
$408.75
|
| Rate for Payer: TriWest Veterans Administration |
$55.45
|
| Rate for Payer: United Healthcare Commercial |
$474.15
|
| Rate for Payer: United Healthcare Medicare |
$55.45
|
| Rate for Payer: WINHealth Partners Commercial |
$463.25
|
|
|
CATH SUPRAPUBIC INTRO 16F
|
Facility
|
IP
|
$66.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.84
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.89
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$41.70
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$43.89
|
| Rate for Payer: United Healthcare Commercial |
$57.86
|
| Rate for Payer: United Healthcare Medicare |
$43.89
|
| Rate for Payer: WINHealth Partners Commercial |
$63.18
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
|
CATH SUPRAPUBIC INTRO 16F
|
Facility
|
OP
|
$66.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.17
|
| Rate for Payer: Aetna of WY Medicare |
$43.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.84
|
| Rate for Payer: Altius Commercial |
$63.84
|
| Rate for Payer: Beech Street Commercial |
$65.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$46.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.50
|
| Rate for Payer: Cigna of WY Commercial |
$65.17
|
| Rate for Payer: Entrust Commercial |
$63.18
|
| Rate for Payer: First Choice Health Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.57
|
| Rate for Payer: HealthUtah PPO |
$66.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.50
|
| Rate for Payer: Multiplan Medicare/VA |
$36.64
|
| Rate for Payer: One Health Plan of WY PPO |
$65.17
|
| Rate for Payer: PacificSource Commercial |
$59.85
|
| Rate for Payer: PHCS PPO |
$65.17
|
| Rate for Payer: Three Rivers PPO |
$49.88
|
| Rate for Payer: TriWest Veterans Administration |
$38.57
|
| Rate for Payer: United Healthcare Commercial |
$57.86
|
| Rate for Payer: United Healthcare Medicare |
$38.57
|
| Rate for Payer: WINHealth Partners Commercial |
$65.17
|
| Rate for Payer: Wise Provider Network Commercial |
$63.18
|
|
