|
VITAMIN A PALMITATE 50,000 UNIT/ML INTRAMUSCULAR SOLUTION [38075]
|
Facility
|
OP
|
$374.38
|
|
|
Service Code
|
NDC 7019902611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$206.28 |
| Max. Negotiated Rate |
$374.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.89
|
| Rate for Payer: Aetna of WY Medicare |
$247.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$359.40
|
| Rate for Payer: Altius Commercial |
$359.40
|
| Rate for Payer: Beech Street Commercial |
$366.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.37
|
| Rate for Payer: Cash Price |
$262.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.15
|
| Rate for Payer: Cigna of WY Commercial |
$366.89
|
| Rate for Payer: Entrust Commercial |
$355.66
|
| Rate for Payer: First Choice Health Commercial |
$355.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$355.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$217.14
|
| Rate for Payer: HealthUtah PPO |
$374.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.15
|
| Rate for Payer: Multiplan Medicare/VA |
$206.28
|
| Rate for Payer: One Health Plan of WY PPO |
$366.89
|
| Rate for Payer: PacificSource Commercial |
$336.94
|
| Rate for Payer: PHCS PPO |
$366.89
|
| Rate for Payer: Three Rivers PPO |
$280.78
|
| Rate for Payer: TriWest Veterans Administration |
$217.14
|
| Rate for Payer: United Healthcare Commercial |
$325.71
|
| Rate for Payer: United Healthcare Medicare |
$217.14
|
| Rate for Payer: WINHealth Partners Commercial |
$366.89
|
| Rate for Payer: Wise Provider Network Commercial |
$355.66
|
|
|
VITAMIN B12 INJECTION
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
J3420
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.42
|
| Rate for Payer: Aetna of WY Medicare |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$27.55
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.13
|
| Rate for Payer: Cigna of WY Commercial |
$28.42
|
| Rate for Payer: First Choice Health Commercial |
$26.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.42
|
| Rate for Payer: HealthUtah PPO |
$29.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.13
|
| Rate for Payer: Multiplan Medicare/VA |
$1.21
|
| Rate for Payer: One Health Plan of WY PPO |
$28.42
|
| Rate for Payer: PacificSource Commercial |
$26.10
|
| Rate for Payer: PHCS PPO |
$27.55
|
| Rate for Payer: Three Rivers PPO |
$21.75
|
| Rate for Payer: TriWest Veterans Administration |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$25.23
|
| Rate for Payer: United Healthcare Medicare |
$1.42
|
| Rate for Payer: WINHealth Partners Commercial |
$27.55
|
|
|
VITAMIN B COMPLEX-FOLIC ACID 0.4 MG TABLET [36428]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 3076800601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
VITAMIN B COMPLEX-FOLIC ACID 0.4 MG TABLET [36428]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 3076800601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
J3430
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.82
|
| Rate for Payer: Aetna of WY Medicare |
$2.80
|
| Rate for Payer: Beech Street Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.73
|
| Rate for Payer: Cigna of WY Commercial |
$8.82
|
| Rate for Payer: First Choice Health Commercial |
$8.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.80
|
| Rate for Payer: HealthUtah PPO |
$9.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.73
|
| Rate for Payer: Multiplan Medicare/VA |
$2.38
|
| Rate for Payer: One Health Plan of WY PPO |
$8.82
|
| Rate for Payer: PacificSource Commercial |
$8.10
|
| Rate for Payer: PHCS PPO |
$8.55
|
| Rate for Payer: Three Rivers PPO |
$6.75
|
| Rate for Payer: TriWest Veterans Administration |
$2.80
|
| Rate for Payer: United Healthcare Commercial |
$7.83
|
| Rate for Payer: United Healthcare Medicare |
$2.80
|
| Rate for Payer: WINHealth Partners Commercial |
$8.55
|
|
|
VIT C 250 MG-E 90 MG-ZINC 40 MG-COPPER 1 MG-LUTEIN-ZEAXAN CHEW TABLET [163339]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
NDC 2420869763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.07
|
| Rate for Payer: Altius Commercial |
$1.07
|
| Rate for Payer: Beech Street Commercial |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.08
|
| Rate for Payer: Cigna of WY Commercial |
$1.09
|
| Rate for Payer: Entrust Commercial |
$1.05
|
| Rate for Payer: First Choice Health Commercial |
$1.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.73
|
| Rate for Payer: HealthUtah PPO |
$1.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.70
|
| Rate for Payer: One Health Plan of WY PPO |
$1.09
|
| Rate for Payer: PacificSource Commercial |
$1.00
|
| Rate for Payer: PHCS PPO |
$1.09
|
| Rate for Payer: Three Rivers PPO |
$0.83
|
| Rate for Payer: TriWest Veterans Administration |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
| Rate for Payer: WINHealth Partners Commercial |
$1.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1.05
|
|
|
VIT C 250 MG-E 90 MG-ZINC 40 MG-COPPER 1 MG-LUTEIN-ZEAXAN CHEW TABLET [163339]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
NDC 2420869763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.09
|
| Rate for Payer: Aetna of WY Medicare |
$0.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.07
|
| Rate for Payer: Altius Commercial |
$1.07
|
| Rate for Payer: Beech Street Commercial |
$1.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.08
|
| Rate for Payer: Cigna of WY Commercial |
$1.09
|
| Rate for Payer: Entrust Commercial |
$1.05
|
| Rate for Payer: First Choice Health Commercial |
$1.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.64
|
| Rate for Payer: HealthUtah PPO |
$1.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1.09
|
| Rate for Payer: PacificSource Commercial |
$1.00
|
| Rate for Payer: PHCS PPO |
$1.09
|
| Rate for Payer: Three Rivers PPO |
$0.83
|
| Rate for Payer: TriWest Veterans Administration |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1.09
|
| Rate for Payer: Wise Provider Network Commercial |
$1.05
|
|
|
VIT C 250 MG-VIT E 90 MG-ZINC 40 MG-COPPER 1 MG-LUTEIN-ZEAXAN CAPSULE [131022]
|
Facility
|
IP
|
$0.82
|
|
|
Service Code
|
NDC 2420869762
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.79
|
| Rate for Payer: Altius Commercial |
$0.79
|
| Rate for Payer: Beech Street Commercial |
$0.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.80
|
| Rate for Payer: Cigna of WY Commercial |
$0.80
|
| Rate for Payer: Entrust Commercial |
$0.78
|
| Rate for Payer: First Choice Health Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.54
|
| Rate for Payer: HealthUtah PPO |
$0.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.80
|
| Rate for Payer: Multiplan Medicare/VA |
$0.51
|
| Rate for Payer: One Health Plan of WY PPO |
$0.80
|
| Rate for Payer: PacificSource Commercial |
$0.74
|
| Rate for Payer: PHCS PPO |
$0.80
|
| Rate for Payer: Three Rivers PPO |
$0.62
|
| Rate for Payer: TriWest Veterans Administration |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$0.71
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
| Rate for Payer: WINHealth Partners Commercial |
$0.78
|
| Rate for Payer: Wise Provider Network Commercial |
$0.78
|
|
|
VIT C 250 MG-VIT E 90 MG-ZINC 40 MG-COPPER 1 MG-LUTEIN-ZEAXAN CAPSULE [131022]
|
Facility
|
OP
|
$0.82
|
|
|
Service Code
|
NDC 2420869762
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.80
|
| Rate for Payer: Aetna of WY Medicare |
$0.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.79
|
| Rate for Payer: Altius Commercial |
$0.79
|
| Rate for Payer: Beech Street Commercial |
$0.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.67
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.80
|
| Rate for Payer: Cigna of WY Commercial |
$0.80
|
| Rate for Payer: Entrust Commercial |
$0.78
|
| Rate for Payer: First Choice Health Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.80
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.80
|
| Rate for Payer: PacificSource Commercial |
$0.74
|
| Rate for Payer: PHCS PPO |
$0.80
|
| Rate for Payer: Three Rivers PPO |
$0.62
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.71
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.80
|
| Rate for Payer: Wise Provider Network Commercial |
$0.78
|
|
|
VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 36410
|
| Hospital Charge Code |
36410
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.54
|
| Rate for Payer: Aetna of WY Medicare |
$8.67
|
| Rate for Payer: Beech Street Commercial |
$69.35
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.81
|
| Rate for Payer: Cigna of WY Commercial |
$71.54
|
| Rate for Payer: First Choice Health Commercial |
$65.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.67
|
| Rate for Payer: HealthUtah PPO |
$73.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.81
|
| Rate for Payer: Multiplan Medicare/VA |
$7.37
|
| Rate for Payer: One Health Plan of WY PPO |
$71.54
|
| Rate for Payer: PacificSource Commercial |
$65.70
|
| Rate for Payer: PHCS PPO |
$69.35
|
| Rate for Payer: Three Rivers PPO |
$54.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.67
|
| Rate for Payer: United Healthcare Commercial |
$63.51
|
| Rate for Payer: United Healthcare Medicare |
$8.67
|
| Rate for Payer: WINHealth Partners Commercial |
$62.05
|
|
|
VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 36406
|
| Hospital Charge Code |
36406
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$62.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.76
|
| Rate for Payer: Aetna of WY Medicare |
$8.43
|
| Rate for Payer: Beech Street Commercial |
$58.90
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$60.14
|
| Rate for Payer: Cigna of WY Commercial |
$60.76
|
| Rate for Payer: First Choice Health Commercial |
$55.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.43
|
| Rate for Payer: HealthUtah PPO |
$62.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$60.14
|
| Rate for Payer: Multiplan Medicare/VA |
$7.17
|
| Rate for Payer: One Health Plan of WY PPO |
$60.76
|
| Rate for Payer: PacificSource Commercial |
$55.80
|
| Rate for Payer: PHCS PPO |
$58.90
|
| Rate for Payer: Three Rivers PPO |
$46.50
|
| Rate for Payer: TriWest Veterans Administration |
$8.43
|
| Rate for Payer: United Healthcare Commercial |
$53.94
|
| Rate for Payer: United Healthcare Medicare |
$8.43
|
| Rate for Payer: WINHealth Partners Commercial |
$52.70
|
|
|
VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 36405
|
| Hospital Charge Code |
36405
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.32
|
| Rate for Payer: Aetna of WY Medicare |
$14.24
|
| Rate for Payer: Beech Street Commercial |
$79.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.48
|
| Rate for Payer: Cigna of WY Commercial |
$82.32
|
| Rate for Payer: First Choice Health Commercial |
$75.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.24
|
| Rate for Payer: HealthUtah PPO |
$84.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.48
|
| Rate for Payer: Multiplan Medicare/VA |
$12.10
|
| Rate for Payer: One Health Plan of WY PPO |
$82.32
|
| Rate for Payer: PacificSource Commercial |
$75.60
|
| Rate for Payer: PHCS PPO |
$79.80
|
| Rate for Payer: Three Rivers PPO |
$63.00
|
| Rate for Payer: TriWest Veterans Administration |
$14.24
|
| Rate for Payer: United Healthcare Commercial |
$73.08
|
| Rate for Payer: United Healthcare Medicare |
$14.24
|
| Rate for Payer: WINHealth Partners Commercial |
$71.40
|
|
|
VNUS 11CM MICRO INTRO MIS-7F11
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Aetna of WY Medicare |
$46.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$40.60
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$38.57
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$40.60
|
| Rate for Payer: WINHealth Partners Commercial |
$68.60
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
VNUS 11CM MICRO INTRO MIS-7F11
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$67.20
|
| Rate for Payer: Altius Commercial |
$67.20
|
| Rate for Payer: Beech Street Commercial |
$68.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: Entrust Commercial |
$66.50
|
| Rate for Payer: First Choice Health Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.20
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: Multiplan Medicare/VA |
$43.89
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$68.60
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: TriWest Veterans Administration |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$60.90
|
| Rate for Payer: United Healthcare Medicare |
$46.20
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
| Rate for Payer: Wise Provider Network Commercial |
$66.50
|
|
|
VNUS 60 CM CATH CF7-7-60
|
Facility
|
IP
|
$1,571.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$985.33 |
| Max. Negotiated Rate |
$1,571.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,508.64
|
| Rate for Payer: Altius Commercial |
$1,508.64
|
| Rate for Payer: Beech Street Commercial |
$1,540.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,290.20
|
| Rate for Payer: Cash Price |
$1,100.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.07
|
| Rate for Payer: Entrust Commercial |
$1,492.92
|
| Rate for Payer: First Choice Health Commercial |
$1,492.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,492.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,037.19
|
| Rate for Payer: HealthUtah PPO |
$1,571.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.36
|
| Rate for Payer: Multiplan Medicare/VA |
$985.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.07
|
| Rate for Payer: PacificSource Commercial |
$1,414.35
|
| Rate for Payer: PHCS PPO |
$1,540.07
|
| Rate for Payer: Three Rivers PPO |
$1,178.62
|
| Rate for Payer: TriWest Veterans Administration |
$1,037.19
|
| Rate for Payer: United Healthcare Commercial |
$1,367.20
|
| Rate for Payer: United Healthcare Medicare |
$1,037.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1,492.92
|
| Rate for Payer: Wise Provider Network Commercial |
$1,492.92
|
|
|
VNUS 60 CM CATH CF7-7-60
|
Facility
|
OP
|
$1,571.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$865.90 |
| Max. Negotiated Rate |
$1,571.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,540.07
|
| Rate for Payer: Aetna of WY Medicare |
$1,037.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,508.64
|
| Rate for Payer: Altius Commercial |
$1,508.64
|
| Rate for Payer: Beech Street Commercial |
$1,540.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,290.20
|
| Rate for Payer: Cash Price |
$1,100.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,524.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,540.07
|
| Rate for Payer: Entrust Commercial |
$1,492.92
|
| Rate for Payer: First Choice Health Commercial |
$1,492.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,492.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$911.47
|
| Rate for Payer: HealthUtah PPO |
$1,571.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,524.36
|
| Rate for Payer: Multiplan Medicare/VA |
$865.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,540.07
|
| Rate for Payer: PacificSource Commercial |
$1,414.35
|
| Rate for Payer: PHCS PPO |
$1,540.07
|
| Rate for Payer: Three Rivers PPO |
$1,178.62
|
| Rate for Payer: TriWest Veterans Administration |
$911.47
|
| Rate for Payer: United Healthcare Commercial |
$1,367.20
|
| Rate for Payer: United Healthcare Medicare |
$911.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,540.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1,492.92
|
|
|
VNUS 7 CM MICRO INTRO MIS-7F07
|
Facility
|
OP
|
$106.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.62
|
| Rate for Payer: Aetna of WY Medicare |
$70.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.48
|
| Rate for Payer: Altius Commercial |
$102.48
|
| Rate for Payer: Beech Street Commercial |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.64
|
| Rate for Payer: Cash Price |
$74.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.55
|
| Rate for Payer: Cigna of WY Commercial |
$104.62
|
| Rate for Payer: Entrust Commercial |
$101.41
|
| Rate for Payer: First Choice Health Commercial |
$101.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.92
|
| Rate for Payer: HealthUtah PPO |
$106.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.55
|
| Rate for Payer: Multiplan Medicare/VA |
$58.82
|
| Rate for Payer: One Health Plan of WY PPO |
$104.62
|
| Rate for Payer: PacificSource Commercial |
$96.08
|
| Rate for Payer: PHCS PPO |
$104.62
|
| Rate for Payer: Three Rivers PPO |
$80.06
|
| Rate for Payer: TriWest Veterans Administration |
$61.92
|
| Rate for Payer: United Healthcare Commercial |
$92.87
|
| Rate for Payer: United Healthcare Medicare |
$61.92
|
| Rate for Payer: WINHealth Partners Commercial |
$104.62
|
| Rate for Payer: Wise Provider Network Commercial |
$101.41
|
|
|
VNUS 7 CM MICRO INTRO MIS-7F07
|
Facility
|
IP
|
$106.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$102.48
|
| Rate for Payer: Altius Commercial |
$102.48
|
| Rate for Payer: Beech Street Commercial |
$104.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$87.64
|
| Rate for Payer: Cash Price |
$74.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.55
|
| Rate for Payer: Cigna of WY Commercial |
$104.62
|
| Rate for Payer: Entrust Commercial |
$101.41
|
| Rate for Payer: First Choice Health Commercial |
$101.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$101.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.46
|
| Rate for Payer: HealthUtah PPO |
$106.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.55
|
| Rate for Payer: Multiplan Medicare/VA |
$66.93
|
| Rate for Payer: One Health Plan of WY PPO |
$104.62
|
| Rate for Payer: PacificSource Commercial |
$96.08
|
| Rate for Payer: PHCS PPO |
$104.62
|
| Rate for Payer: Three Rivers PPO |
$80.06
|
| Rate for Payer: TriWest Veterans Administration |
$70.46
|
| Rate for Payer: United Healthcare Commercial |
$92.87
|
| Rate for Payer: United Healthcare Medicare |
$70.46
|
| Rate for Payer: WINHealth Partners Commercial |
$101.41
|
| Rate for Payer: Wise Provider Network Commercial |
$101.41
|
|
|
VNUS HK KLEIN INFILTRATION TUBING SET
|
Facility
|
IP
|
$52.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.92 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.40
|
| Rate for Payer: Altius Commercial |
$50.40
|
| Rate for Payer: Beech Street Commercial |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.10
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.92
|
| Rate for Payer: Cigna of WY Commercial |
$51.45
|
| Rate for Payer: Entrust Commercial |
$49.88
|
| Rate for Payer: First Choice Health Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.65
|
| Rate for Payer: HealthUtah PPO |
$52.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.92
|
| Rate for Payer: Multiplan Medicare/VA |
$32.92
|
| Rate for Payer: One Health Plan of WY PPO |
$51.45
|
| Rate for Payer: PacificSource Commercial |
$47.25
|
| Rate for Payer: PHCS PPO |
$51.45
|
| Rate for Payer: Three Rivers PPO |
$39.38
|
| Rate for Payer: TriWest Veterans Administration |
$34.65
|
| Rate for Payer: United Healthcare Commercial |
$45.68
|
| Rate for Payer: United Healthcare Medicare |
$34.65
|
| Rate for Payer: WINHealth Partners Commercial |
$49.88
|
| Rate for Payer: Wise Provider Network Commercial |
$49.88
|
|
|
VNUS HK KLEIN INFILTRATION TUBING SET
|
Facility
|
OP
|
$52.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51.45
|
| Rate for Payer: Aetna of WY Medicare |
$34.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50.40
|
| Rate for Payer: Altius Commercial |
$50.40
|
| Rate for Payer: Beech Street Commercial |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.10
|
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$50.92
|
| Rate for Payer: Cigna of WY Commercial |
$51.45
|
| Rate for Payer: Entrust Commercial |
$49.88
|
| Rate for Payer: First Choice Health Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.45
|
| Rate for Payer: HealthUtah PPO |
$52.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50.92
|
| Rate for Payer: Multiplan Medicare/VA |
$28.93
|
| Rate for Payer: One Health Plan of WY PPO |
$51.45
|
| Rate for Payer: PacificSource Commercial |
$47.25
|
| Rate for Payer: PHCS PPO |
$51.45
|
| Rate for Payer: Three Rivers PPO |
$39.38
|
| Rate for Payer: TriWest Veterans Administration |
$30.45
|
| Rate for Payer: United Healthcare Commercial |
$45.68
|
| Rate for Payer: United Healthcare Medicare |
$30.45
|
| Rate for Payer: WINHealth Partners Commercial |
$51.45
|
| Rate for Payer: Wise Provider Network Commercial |
$49.88
|
|
|
VNUS PROCEDURE PACK CFP
|
Facility
|
OP
|
$313.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.60 |
| Max. Negotiated Rate |
$313.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.98
|
| Rate for Payer: Aetna of WY Medicare |
$206.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$300.72
|
| Rate for Payer: Altius Commercial |
$300.72
|
| Rate for Payer: Beech Street Commercial |
$306.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.18
|
| Rate for Payer: Cash Price |
$219.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.85
|
| Rate for Payer: Cigna of WY Commercial |
$306.98
|
| Rate for Payer: Entrust Commercial |
$297.59
|
| Rate for Payer: First Choice Health Commercial |
$297.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$297.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.68
|
| Rate for Payer: HealthUtah PPO |
$313.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.85
|
| Rate for Payer: Multiplan Medicare/VA |
$172.60
|
| Rate for Payer: One Health Plan of WY PPO |
$306.98
|
| Rate for Payer: PacificSource Commercial |
$281.92
|
| Rate for Payer: PHCS PPO |
$306.98
|
| Rate for Payer: Three Rivers PPO |
$234.94
|
| Rate for Payer: TriWest Veterans Administration |
$181.68
|
| Rate for Payer: United Healthcare Commercial |
$272.53
|
| Rate for Payer: United Healthcare Medicare |
$181.68
|
| Rate for Payer: WINHealth Partners Commercial |
$306.98
|
| Rate for Payer: Wise Provider Network Commercial |
$297.59
|
|
|
VNUS PROCEDURE PACK CFP
|
Facility
|
IP
|
$313.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.41 |
| Max. Negotiated Rate |
$313.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$300.72
|
| Rate for Payer: Altius Commercial |
$300.72
|
| Rate for Payer: Beech Street Commercial |
$306.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.18
|
| Rate for Payer: Cash Price |
$219.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.85
|
| Rate for Payer: Cigna of WY Commercial |
$306.98
|
| Rate for Payer: Entrust Commercial |
$297.59
|
| Rate for Payer: First Choice Health Commercial |
$297.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$297.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.74
|
| Rate for Payer: HealthUtah PPO |
$313.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.85
|
| Rate for Payer: Multiplan Medicare/VA |
$196.41
|
| Rate for Payer: One Health Plan of WY PPO |
$306.98
|
| Rate for Payer: PacificSource Commercial |
$281.92
|
| Rate for Payer: PHCS PPO |
$306.98
|
| Rate for Payer: Three Rivers PPO |
$234.94
|
| Rate for Payer: TriWest Veterans Administration |
$206.74
|
| Rate for Payer: United Healthcare Commercial |
$272.53
|
| Rate for Payer: United Healthcare Medicare |
$206.74
|
| Rate for Payer: WINHealth Partners Commercial |
$297.59
|
| Rate for Payer: Wise Provider Network Commercial |
$297.59
|
|
|
VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
51797
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$789.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$773.22
|
| Rate for Payer: Aetna of WY Medicare |
$184.98
|
| Rate for Payer: Beech Street Commercial |
$749.55
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$765.33
|
| Rate for Payer: Cigna of WY Commercial |
$773.22
|
| Rate for Payer: First Choice Health Commercial |
$710.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$749.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$184.98
|
| Rate for Payer: HealthUtah PPO |
$789.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$765.33
|
| Rate for Payer: Multiplan Medicare/VA |
$157.23
|
| Rate for Payer: One Health Plan of WY PPO |
$773.22
|
| Rate for Payer: PacificSource Commercial |
$710.10
|
| Rate for Payer: PHCS PPO |
$749.55
|
| Rate for Payer: Three Rivers PPO |
$591.75
|
| Rate for Payer: TriWest Veterans Administration |
$184.98
|
| Rate for Payer: United Healthcare Commercial |
$686.43
|
| Rate for Payer: United Healthcare Medicare |
$184.98
|
| Rate for Payer: WINHealth Partners Commercial |
$670.65
|
|
|
WALTER DISTAL UNLOCK BUTTON
|
Facility
|
IP
|
$1,802.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,130.17 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,766.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,730.40
|
| Rate for Payer: Altius Commercial |
$1,730.40
|
| Rate for Payer: Beech Street Commercial |
$1,766.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,479.85
|
| Rate for Payer: Cash Price |
$1,261.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,748.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,766.45
|
| Rate for Payer: Entrust Commercial |
$1,712.38
|
| Rate for Payer: First Choice Health Commercial |
$1,712.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,712.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,189.65
|
| Rate for Payer: HealthUtah PPO |
$1,802.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,748.42
|
| Rate for Payer: Multiplan Medicare/VA |
$1,130.17
|
| Rate for Payer: One Health Plan of WY PPO |
$1,766.45
|
| Rate for Payer: PacificSource Commercial |
$1,622.25
|
| Rate for Payer: PHCS PPO |
$1,766.45
|
| Rate for Payer: Three Rivers PPO |
$1,351.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,189.65
|
| Rate for Payer: United Healthcare Commercial |
$1,568.18
|
| Rate for Payer: United Healthcare Medicare |
$1,189.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,712.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1,712.38
|
|
|
WALTER DISTAL UNLOCK BUTTON
|
Facility
|
OP
|
$1,802.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$993.18 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,766.45
|
| Rate for Payer: Aetna of WY Medicare |
$1,189.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,730.40
|
| Rate for Payer: Altius Commercial |
$1,730.40
|
| Rate for Payer: Beech Street Commercial |
$1,766.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,479.85
|
| Rate for Payer: Cash Price |
$1,261.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,748.42
|
| Rate for Payer: Cigna of WY Commercial |
$1,766.45
|
| Rate for Payer: Entrust Commercial |
$1,712.38
|
| Rate for Payer: First Choice Health Commercial |
$1,712.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,712.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,045.45
|
| Rate for Payer: HealthUtah PPO |
$1,802.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,748.42
|
| Rate for Payer: Multiplan Medicare/VA |
$993.18
|
| Rate for Payer: One Health Plan of WY PPO |
$1,766.45
|
| Rate for Payer: PacificSource Commercial |
$1,622.25
|
| Rate for Payer: PHCS PPO |
$1,766.45
|
| Rate for Payer: Three Rivers PPO |
$1,351.88
|
| Rate for Payer: TriWest Veterans Administration |
$1,045.45
|
| Rate for Payer: United Healthcare Commercial |
$1,568.18
|
| Rate for Payer: United Healthcare Medicare |
$1,045.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,766.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1,712.38
|
|
