|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X2) SUBCUTANEOUS SYRINGE KIT [86986]
|
Facility
|
OP
|
$9,014.15
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,966.80 |
| Max. Negotiated Rate |
$9,014.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,833.87
|
| Rate for Payer: Aetna of WY Medicare |
$5,949.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,653.58
|
| Rate for Payer: Altius Commercial |
$8,653.58
|
| Rate for Payer: Beech Street Commercial |
$8,833.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,400.62
|
| Rate for Payer: Cash Price |
$6,309.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,743.73
|
| Rate for Payer: Cigna of WY Commercial |
$8,833.87
|
| Rate for Payer: Entrust Commercial |
$8,563.44
|
| Rate for Payer: First Choice Health Commercial |
$8,563.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,563.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,228.21
|
| Rate for Payer: HealthUtah PPO |
$9,014.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,743.73
|
| Rate for Payer: Multiplan Medicare/VA |
$4,966.80
|
| Rate for Payer: One Health Plan of WY PPO |
$8,833.87
|
| Rate for Payer: PacificSource Commercial |
$8,112.74
|
| Rate for Payer: PHCS PPO |
$8,833.87
|
| Rate for Payer: Three Rivers PPO |
$6,760.61
|
| Rate for Payer: TriWest Veterans Administration |
$5,228.21
|
| Rate for Payer: United Healthcare Commercial |
$7,842.31
|
| Rate for Payer: United Healthcare Medicare |
$5,228.21
|
| Rate for Payer: WINHealth Partners Commercial |
$8,833.87
|
| Rate for Payer: Wise Provider Network Commercial |
$8,563.44
|
|
|
CERTOLIZUMAB PEGOL (CIMZIA) 200 MG/ML SUBCUTANEOUS SYRINGE [40886986]
|
Facility
|
OP
|
$9,014.15
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,966.80 |
| Max. Negotiated Rate |
$9,014.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,833.87
|
| Rate for Payer: Aetna of WY Medicare |
$5,949.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,653.58
|
| Rate for Payer: Altius Commercial |
$8,653.58
|
| Rate for Payer: Beech Street Commercial |
$8,833.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,400.62
|
| Rate for Payer: Cash Price |
$6,309.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,743.73
|
| Rate for Payer: Cigna of WY Commercial |
$8,833.87
|
| Rate for Payer: Entrust Commercial |
$8,563.44
|
| Rate for Payer: First Choice Health Commercial |
$8,563.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,563.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,228.21
|
| Rate for Payer: HealthUtah PPO |
$9,014.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,743.73
|
| Rate for Payer: Multiplan Medicare/VA |
$4,966.80
|
| Rate for Payer: One Health Plan of WY PPO |
$8,833.87
|
| Rate for Payer: PacificSource Commercial |
$8,112.74
|
| Rate for Payer: PHCS PPO |
$8,833.87
|
| Rate for Payer: Three Rivers PPO |
$6,760.61
|
| Rate for Payer: TriWest Veterans Administration |
$5,228.21
|
| Rate for Payer: United Healthcare Commercial |
$7,842.31
|
| Rate for Payer: United Healthcare Medicare |
$5,228.21
|
| Rate for Payer: WINHealth Partners Commercial |
$8,833.87
|
| Rate for Payer: Wise Provider Network Commercial |
$8,563.44
|
|
|
CERTOLIZUMAB PEGOL (CIMZIA) 200 MG/ML SUBCUTANEOUS SYRINGE [40886986]
|
Facility
|
IP
|
$9,014.15
|
|
|
Service Code
|
HCPCS J0717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,651.87 |
| Max. Negotiated Rate |
$9,014.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,833.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8,653.58
|
| Rate for Payer: Altius Commercial |
$8,653.58
|
| Rate for Payer: Beech Street Commercial |
$8,833.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7,400.62
|
| Rate for Payer: Cash Price |
$6,309.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,743.73
|
| Rate for Payer: Cigna of WY Commercial |
$8,833.87
|
| Rate for Payer: Entrust Commercial |
$8,563.44
|
| Rate for Payer: First Choice Health Commercial |
$8,563.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,563.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,949.34
|
| Rate for Payer: HealthUtah PPO |
$9,014.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,743.73
|
| Rate for Payer: Multiplan Medicare/VA |
$5,651.87
|
| Rate for Payer: One Health Plan of WY PPO |
$8,833.87
|
| Rate for Payer: PacificSource Commercial |
$8,112.74
|
| Rate for Payer: PHCS PPO |
$8,833.87
|
| Rate for Payer: Three Rivers PPO |
$6,760.61
|
| Rate for Payer: TriWest Veterans Administration |
$5,949.34
|
| Rate for Payer: United Healthcare Commercial |
$7,842.31
|
| Rate for Payer: United Healthcare Medicare |
$5,949.34
|
| Rate for Payer: WINHealth Partners Commercial |
$8,563.44
|
| Rate for Payer: Wise Provider Network Commercial |
$8,563.44
|
|
|
CERV BALLOON W/ STYLET G198191
|
Facility
|
IP
|
$234.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.26 |
| Max. Negotiated Rate |
$234.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.47
|
| Rate for Payer: Altius Commercial |
$225.47
|
| Rate for Payer: Beech Street Commercial |
$230.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.82
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.81
|
| Rate for Payer: Cigna of WY Commercial |
$230.16
|
| Rate for Payer: Entrust Commercial |
$223.12
|
| Rate for Payer: First Choice Health Commercial |
$223.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.01
|
| Rate for Payer: HealthUtah PPO |
$234.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.81
|
| Rate for Payer: Multiplan Medicare/VA |
$147.26
|
| Rate for Payer: One Health Plan of WY PPO |
$230.16
|
| Rate for Payer: PacificSource Commercial |
$211.37
|
| Rate for Payer: PHCS PPO |
$230.16
|
| Rate for Payer: Three Rivers PPO |
$176.14
|
| Rate for Payer: TriWest Veterans Administration |
$155.01
|
| Rate for Payer: United Healthcare Commercial |
$204.33
|
| Rate for Payer: United Healthcare Medicare |
$155.01
|
| Rate for Payer: WINHealth Partners Commercial |
$223.12
|
| Rate for Payer: Wise Provider Network Commercial |
$223.12
|
|
|
CERV BALLOON W/ STYLET G198191
|
Facility
|
OP
|
$234.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.41 |
| Max. Negotiated Rate |
$234.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.16
|
| Rate for Payer: Aetna of WY Medicare |
$155.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.47
|
| Rate for Payer: Altius Commercial |
$225.47
|
| Rate for Payer: Beech Street Commercial |
$230.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.82
|
| Rate for Payer: Cash Price |
$164.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.81
|
| Rate for Payer: Cigna of WY Commercial |
$230.16
|
| Rate for Payer: Entrust Commercial |
$223.12
|
| Rate for Payer: First Choice Health Commercial |
$223.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.22
|
| Rate for Payer: HealthUtah PPO |
$234.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.81
|
| Rate for Payer: Multiplan Medicare/VA |
$129.41
|
| Rate for Payer: One Health Plan of WY PPO |
$230.16
|
| Rate for Payer: PacificSource Commercial |
$211.37
|
| Rate for Payer: PHCS PPO |
$230.16
|
| Rate for Payer: Three Rivers PPO |
$176.14
|
| Rate for Payer: TriWest Veterans Administration |
$136.22
|
| Rate for Payer: United Healthcare Commercial |
$204.33
|
| Rate for Payer: United Healthcare Medicare |
$136.22
|
| Rate for Payer: WINHealth Partners Commercial |
$230.16
|
| Rate for Payer: Wise Provider Network Commercial |
$223.12
|
|
|
CERV COLLAR ADJ. ADLT 79-83131
|
Facility
|
OP
|
$18.06
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.34
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.47
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.95
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
| Rate for Payer: WINHealth Partners Commercial |
$17.70
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR ADJ. ADLT 79-83131
|
Facility
|
IP
|
$18.06
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.34
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.92
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$11.32
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$11.92
|
| Rate for Payer: WINHealth Partners Commercial |
$17.16
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR ADJ. PED 79-83130
|
Facility
|
OP
|
$18.06
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Aetna of WY Medicare |
$11.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.34
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.47
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$9.95
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
| Rate for Payer: WINHealth Partners Commercial |
$17.70
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV COLLAR ADJ. PED 79-83130
|
Facility
|
IP
|
$18.06
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$18.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.34
|
| Rate for Payer: Altius Commercial |
$17.34
|
| Rate for Payer: Beech Street Commercial |
$17.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.52
|
| Rate for Payer: Cigna of WY Commercial |
$17.70
|
| Rate for Payer: Entrust Commercial |
$17.16
|
| Rate for Payer: First Choice Health Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.92
|
| Rate for Payer: HealthUtah PPO |
$18.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.52
|
| Rate for Payer: Multiplan Medicare/VA |
$11.32
|
| Rate for Payer: One Health Plan of WY PPO |
$17.70
|
| Rate for Payer: PacificSource Commercial |
$16.25
|
| Rate for Payer: PHCS PPO |
$17.70
|
| Rate for Payer: Three Rivers PPO |
$13.54
|
| Rate for Payer: TriWest Veterans Administration |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$15.71
|
| Rate for Payer: United Healthcare Medicare |
$11.92
|
| Rate for Payer: WINHealth Partners Commercial |
$17.16
|
| Rate for Payer: Wise Provider Network Commercial |
$17.16
|
|
|
CERV FLEX N/ADJ FOAM PRE OTS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS L0120
|
| Hospital Charge Code |
L0120
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.14
|
| Rate for Payer: Aetna of WY Medicare |
$29.20
|
| Rate for Payer: Beech Street Commercial |
$40.85
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.71
|
| Rate for Payer: Cigna of WY Commercial |
$42.14
|
| Rate for Payer: First Choice Health Commercial |
$38.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.20
|
| Rate for Payer: HealthUtah PPO |
$43.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.71
|
| Rate for Payer: Multiplan Medicare/VA |
$24.82
|
| Rate for Payer: One Health Plan of WY PPO |
$42.14
|
| Rate for Payer: PacificSource Commercial |
$38.70
|
| Rate for Payer: PHCS PPO |
$40.85
|
| Rate for Payer: Three Rivers PPO |
$32.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.20
|
| Rate for Payer: United Healthcare Commercial |
$37.41
|
| Rate for Payer: United Healthcare Medicare |
$29.20
|
| Rate for Payer: WINHealth Partners Commercial |
$40.85
|
|
|
CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$7,438.00
|
|
|
Service Code
|
HCPCS 38724
|
| Hospital Charge Code |
38724
|
| Min. Negotiated Rate |
$1,186.40 |
| Max. Negotiated Rate |
$7,438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,289.24
|
| Rate for Payer: Aetna of WY Medicare |
$1,395.77
|
| Rate for Payer: Beech Street Commercial |
$7,066.10
|
| Rate for Payer: Cash Price |
$5,206.60
|
| Rate for Payer: Cash Price |
$5,206.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,214.86
|
| Rate for Payer: Cigna of WY Commercial |
$7,289.24
|
| Rate for Payer: First Choice Health Commercial |
$6,694.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,066.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,395.77
|
| Rate for Payer: HealthUtah PPO |
$7,438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,214.86
|
| Rate for Payer: Multiplan Medicare/VA |
$1,186.40
|
| Rate for Payer: One Health Plan of WY PPO |
$7,289.24
|
| Rate for Payer: PacificSource Commercial |
$6,694.20
|
| Rate for Payer: PHCS PPO |
$7,066.10
|
| Rate for Payer: Three Rivers PPO |
$5,578.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,395.77
|
| Rate for Payer: United Healthcare Commercial |
$6,471.06
|
| Rate for Payer: United Healthcare Medicare |
$1,395.77
|
| Rate for Payer: WINHealth Partners Commercial |
$6,322.30
|
|
|
CERVICAL MIAMI J MJ200-L STOUT
|
Facility
|
OP
|
$134.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.64
|
| Rate for Payer: Aetna of WY Medicare |
$88.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.96
|
| Rate for Payer: Altius Commercial |
$128.96
|
| Rate for Payer: Beech Street Commercial |
$131.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.28
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.30
|
| Rate for Payer: Cigna of WY Commercial |
$131.64
|
| Rate for Payer: Entrust Commercial |
$127.61
|
| Rate for Payer: First Choice Health Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.91
|
| Rate for Payer: HealthUtah PPO |
$134.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.30
|
| Rate for Payer: Multiplan Medicare/VA |
$74.02
|
| Rate for Payer: One Health Plan of WY PPO |
$131.64
|
| Rate for Payer: PacificSource Commercial |
$120.90
|
| Rate for Payer: PHCS PPO |
$131.64
|
| Rate for Payer: Three Rivers PPO |
$100.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.91
|
| Rate for Payer: United Healthcare Commercial |
$116.87
|
| Rate for Payer: United Healthcare Medicare |
$77.91
|
| Rate for Payer: WINHealth Partners Commercial |
$131.64
|
| Rate for Payer: Wise Provider Network Commercial |
$127.61
|
|
|
CERVICAL MIAMI J MJ200-L STOUT
|
Facility
|
IP
|
$134.33
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.22 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.96
|
| Rate for Payer: Altius Commercial |
$128.96
|
| Rate for Payer: Beech Street Commercial |
$131.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.28
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.30
|
| Rate for Payer: Cigna of WY Commercial |
$131.64
|
| Rate for Payer: Entrust Commercial |
$127.61
|
| Rate for Payer: First Choice Health Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.66
|
| Rate for Payer: HealthUtah PPO |
$134.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.30
|
| Rate for Payer: Multiplan Medicare/VA |
$84.22
|
| Rate for Payer: One Health Plan of WY PPO |
$131.64
|
| Rate for Payer: PacificSource Commercial |
$120.90
|
| Rate for Payer: PHCS PPO |
$131.64
|
| Rate for Payer: Three Rivers PPO |
$100.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.66
|
| Rate for Payer: United Healthcare Commercial |
$116.87
|
| Rate for Payer: United Healthcare Medicare |
$88.66
|
| Rate for Payer: WINHealth Partners Commercial |
$127.61
|
| Rate for Payer: Wise Provider Network Commercial |
$127.61
|
|
|
CERVICAL MIAMI J MJ300 SHORT
|
Facility
|
IP
|
$141.05
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.41
|
| Rate for Payer: Altius Commercial |
$135.41
|
| Rate for Payer: Beech Street Commercial |
$138.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.80
|
| Rate for Payer: Cash Price |
$98.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.82
|
| Rate for Payer: Cigna of WY Commercial |
$138.23
|
| Rate for Payer: Entrust Commercial |
$134.00
|
| Rate for Payer: First Choice Health Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.09
|
| Rate for Payer: HealthUtah PPO |
$141.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.82
|
| Rate for Payer: Multiplan Medicare/VA |
$88.44
|
| Rate for Payer: One Health Plan of WY PPO |
$138.23
|
| Rate for Payer: PacificSource Commercial |
$126.94
|
| Rate for Payer: PHCS PPO |
$138.23
|
| Rate for Payer: Three Rivers PPO |
$105.79
|
| Rate for Payer: TriWest Veterans Administration |
$93.09
|
| Rate for Payer: United Healthcare Commercial |
$122.71
|
| Rate for Payer: United Healthcare Medicare |
$93.09
|
| Rate for Payer: WINHealth Partners Commercial |
$134.00
|
| Rate for Payer: Wise Provider Network Commercial |
$134.00
|
|
|
CERVICAL MIAMI J MJ300 SHORT
|
Facility
|
OP
|
$141.05
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.72 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.23
|
| Rate for Payer: Aetna of WY Medicare |
$93.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.41
|
| Rate for Payer: Altius Commercial |
$135.41
|
| Rate for Payer: Beech Street Commercial |
$138.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.80
|
| Rate for Payer: Cash Price |
$98.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.82
|
| Rate for Payer: Cigna of WY Commercial |
$138.23
|
| Rate for Payer: Entrust Commercial |
$134.00
|
| Rate for Payer: First Choice Health Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.81
|
| Rate for Payer: HealthUtah PPO |
$141.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.82
|
| Rate for Payer: Multiplan Medicare/VA |
$77.72
|
| Rate for Payer: One Health Plan of WY PPO |
$138.23
|
| Rate for Payer: PacificSource Commercial |
$126.94
|
| Rate for Payer: PHCS PPO |
$138.23
|
| Rate for Payer: Three Rivers PPO |
$105.79
|
| Rate for Payer: TriWest Veterans Administration |
$81.81
|
| Rate for Payer: United Healthcare Commercial |
$122.71
|
| Rate for Payer: United Healthcare Medicare |
$81.81
|
| Rate for Payer: WINHealth Partners Commercial |
$138.23
|
| Rate for Payer: Wise Provider Network Commercial |
$134.00
|
|
|
CERVICAL MIAMI J MJ400 REG
|
Facility
|
OP
|
$141.05
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.72 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.23
|
| Rate for Payer: Aetna of WY Medicare |
$93.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.41
|
| Rate for Payer: Altius Commercial |
$135.41
|
| Rate for Payer: Beech Street Commercial |
$138.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.80
|
| Rate for Payer: Cash Price |
$98.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.82
|
| Rate for Payer: Cigna of WY Commercial |
$138.23
|
| Rate for Payer: Entrust Commercial |
$134.00
|
| Rate for Payer: First Choice Health Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.81
|
| Rate for Payer: HealthUtah PPO |
$141.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.82
|
| Rate for Payer: Multiplan Medicare/VA |
$77.72
|
| Rate for Payer: One Health Plan of WY PPO |
$138.23
|
| Rate for Payer: PacificSource Commercial |
$126.94
|
| Rate for Payer: PHCS PPO |
$138.23
|
| Rate for Payer: Three Rivers PPO |
$105.79
|
| Rate for Payer: TriWest Veterans Administration |
$81.81
|
| Rate for Payer: United Healthcare Commercial |
$122.71
|
| Rate for Payer: United Healthcare Medicare |
$81.81
|
| Rate for Payer: WINHealth Partners Commercial |
$138.23
|
| Rate for Payer: Wise Provider Network Commercial |
$134.00
|
|
|
CERVICAL MIAMI J MJ400 REG
|
Facility
|
IP
|
$141.05
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$135.41
|
| Rate for Payer: Altius Commercial |
$135.41
|
| Rate for Payer: Beech Street Commercial |
$138.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$115.80
|
| Rate for Payer: Cash Price |
$98.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$136.82
|
| Rate for Payer: Cigna of WY Commercial |
$138.23
|
| Rate for Payer: Entrust Commercial |
$134.00
|
| Rate for Payer: First Choice Health Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.09
|
| Rate for Payer: HealthUtah PPO |
$141.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$136.82
|
| Rate for Payer: Multiplan Medicare/VA |
$88.44
|
| Rate for Payer: One Health Plan of WY PPO |
$138.23
|
| Rate for Payer: PacificSource Commercial |
$126.94
|
| Rate for Payer: PHCS PPO |
$138.23
|
| Rate for Payer: Three Rivers PPO |
$105.79
|
| Rate for Payer: TriWest Veterans Administration |
$93.09
|
| Rate for Payer: United Healthcare Commercial |
$122.71
|
| Rate for Payer: United Healthcare Medicare |
$93.09
|
| Rate for Payer: WINHealth Partners Commercial |
$134.00
|
| Rate for Payer: Wise Provider Network Commercial |
$134.00
|
|
|
CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,843.00
|
|
|
Service Code
|
HCPCS 59620
|
| Hospital Charge Code |
59620
|
| Min. Negotiated Rate |
$747.48 |
| Max. Negotiated Rate |
$2,843.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,786.14
|
| Rate for Payer: Aetna of WY Medicare |
$879.39
|
| Rate for Payer: Beech Street Commercial |
$2,700.85
|
| Rate for Payer: Cash Price |
$1,990.10
|
| Rate for Payer: Cash Price |
$1,990.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,757.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,786.14
|
| Rate for Payer: First Choice Health Commercial |
$2,558.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,700.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$879.39
|
| Rate for Payer: HealthUtah PPO |
$2,843.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,757.71
|
| Rate for Payer: Multiplan Medicare/VA |
$747.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,786.14
|
| Rate for Payer: PacificSource Commercial |
$2,558.70
|
| Rate for Payer: PHCS PPO |
$2,700.85
|
| Rate for Payer: Three Rivers PPO |
$2,132.25
|
| Rate for Payer: TriWest Veterans Administration |
$879.39
|
| Rate for Payer: United Healthcare Commercial |
$2,473.41
|
| Rate for Payer: United Healthcare Medicare |
$879.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,416.55
|
|
|
CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,843.00
|
|
|
Service Code
|
HCPCS 59620 80
|
| Hospital Charge Code |
59620
|
| Min. Negotiated Rate |
$747.48 |
| Max. Negotiated Rate |
$2,843.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,786.14
|
| Rate for Payer: Aetna of WY Medicare |
$879.39
|
| Rate for Payer: Beech Street Commercial |
$2,700.85
|
| Rate for Payer: Cash Price |
$1,990.10
|
| Rate for Payer: Cash Price |
$1,990.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,757.71
|
| Rate for Payer: Cigna of WY Commercial |
$2,786.14
|
| Rate for Payer: First Choice Health Commercial |
$2,558.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,700.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$879.39
|
| Rate for Payer: HealthUtah PPO |
$2,843.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,757.71
|
| Rate for Payer: Multiplan Medicare/VA |
$747.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,786.14
|
| Rate for Payer: PacificSource Commercial |
$2,558.70
|
| Rate for Payer: PHCS PPO |
$2,700.85
|
| Rate for Payer: Three Rivers PPO |
$2,132.25
|
| Rate for Payer: TriWest Veterans Administration |
$879.39
|
| Rate for Payer: United Healthcare Commercial |
$2,473.41
|
| Rate for Payer: United Healthcare Medicare |
$879.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2,416.55
|
|
|
CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,745.00
|
|
|
Service Code
|
HCPCS 59514 AS
|
| Hospital Charge Code |
59514
|
| Min. Negotiated Rate |
$723.15 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,690.10
|
| Rate for Payer: Aetna of WY Medicare |
$850.77
|
| Rate for Payer: Beech Street Commercial |
$2,607.75
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,662.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,690.10
|
| Rate for Payer: First Choice Health Commercial |
$2,470.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,607.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$850.77
|
| Rate for Payer: HealthUtah PPO |
$1,762.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,662.65
|
| Rate for Payer: Multiplan Medicare/VA |
$723.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,690.10
|
| Rate for Payer: PacificSource Commercial |
$2,470.50
|
| Rate for Payer: PHCS PPO |
$2,607.75
|
| Rate for Payer: Three Rivers PPO |
$2,058.75
|
| Rate for Payer: TriWest Veterans Administration |
$850.77
|
| Rate for Payer: United Healthcare Commercial |
$2,388.15
|
| Rate for Payer: United Healthcare Medicare |
$850.77
|
| Rate for Payer: WINHealth Partners Commercial |
$2,333.25
|
|
|
CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,745.00
|
|
|
Service Code
|
HCPCS 59514 80
|
| Hospital Charge Code |
59514
|
| Min. Negotiated Rate |
$723.15 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,690.10
|
| Rate for Payer: Aetna of WY Medicare |
$850.77
|
| Rate for Payer: Beech Street Commercial |
$2,607.75
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,662.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,690.10
|
| Rate for Payer: First Choice Health Commercial |
$2,470.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,607.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$850.77
|
| Rate for Payer: HealthUtah PPO |
$1,762.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,662.65
|
| Rate for Payer: Multiplan Medicare/VA |
$723.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,690.10
|
| Rate for Payer: PacificSource Commercial |
$2,470.50
|
| Rate for Payer: PHCS PPO |
$2,607.75
|
| Rate for Payer: Three Rivers PPO |
$2,058.75
|
| Rate for Payer: TriWest Veterans Administration |
$850.77
|
| Rate for Payer: United Healthcare Commercial |
$2,388.15
|
| Rate for Payer: United Healthcare Medicare |
$850.77
|
| Rate for Payer: WINHealth Partners Commercial |
$2,333.25
|
|
|
CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,745.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
59514
|
| Min. Negotiated Rate |
$723.15 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,690.10
|
| Rate for Payer: Aetna of WY Medicare |
$850.77
|
| Rate for Payer: Beech Street Commercial |
$2,607.75
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: Cash Price |
$1,921.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,662.65
|
| Rate for Payer: Cigna of WY Commercial |
$2,690.10
|
| Rate for Payer: First Choice Health Commercial |
$2,470.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,607.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$850.77
|
| Rate for Payer: HealthUtah PPO |
$1,762.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,662.65
|
| Rate for Payer: Multiplan Medicare/VA |
$723.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2,690.10
|
| Rate for Payer: PacificSource Commercial |
$2,470.50
|
| Rate for Payer: PHCS PPO |
$2,607.75
|
| Rate for Payer: Three Rivers PPO |
$2,058.75
|
| Rate for Payer: TriWest Veterans Administration |
$850.77
|
| Rate for Payer: United Healthcare Commercial |
$2,388.15
|
| Rate for Payer: United Healthcare Medicare |
$850.77
|
| Rate for Payer: WINHealth Partners Commercial |
$2,333.25
|
|
|
CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$3,811.00
|
|
|
Service Code
|
HCPCS 59515
|
| Hospital Charge Code |
59515
|
| Min. Negotiated Rate |
$1,073.55 |
| Max. Negotiated Rate |
$3,811.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,734.78
|
| Rate for Payer: Aetna of WY Medicare |
$1,263.00
|
| Rate for Payer: Beech Street Commercial |
$3,620.45
|
| Rate for Payer: Cash Price |
$2,667.70
|
| Rate for Payer: Cash Price |
$2,667.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,696.67
|
| Rate for Payer: Cigna of WY Commercial |
$3,734.78
|
| Rate for Payer: First Choice Health Commercial |
$3,429.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,620.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,263.00
|
| Rate for Payer: HealthUtah PPO |
$3,811.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,696.67
|
| Rate for Payer: Multiplan Medicare/VA |
$1,073.55
|
| Rate for Payer: One Health Plan of WY PPO |
$3,734.78
|
| Rate for Payer: PacificSource Commercial |
$3,429.90
|
| Rate for Payer: PHCS PPO |
$3,620.45
|
| Rate for Payer: Three Rivers PPO |
$2,858.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,263.00
|
| Rate for Payer: United Healthcare Commercial |
$3,315.57
|
| Rate for Payer: United Healthcare Medicare |
$1,263.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3,239.35
|
|
|
CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$3,167.00
|
|
|
Service Code
|
HCPCS 59622
|
| Hospital Charge Code |
59622
|
| Min. Negotiated Rate |
$1,112.71 |
| Max. Negotiated Rate |
$3,167.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,103.66
|
| Rate for Payer: Aetna of WY Medicare |
$1,309.07
|
| Rate for Payer: Beech Street Commercial |
$3,008.65
|
| Rate for Payer: Cash Price |
$2,216.90
|
| Rate for Payer: Cash Price |
$2,216.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,071.99
|
| Rate for Payer: Cigna of WY Commercial |
$3,103.66
|
| Rate for Payer: First Choice Health Commercial |
$2,850.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,008.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,309.07
|
| Rate for Payer: HealthUtah PPO |
$3,167.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,071.99
|
| Rate for Payer: Multiplan Medicare/VA |
$1,112.71
|
| Rate for Payer: One Health Plan of WY PPO |
$3,103.66
|
| Rate for Payer: PacificSource Commercial |
$2,850.30
|
| Rate for Payer: PHCS PPO |
$3,008.65
|
| Rate for Payer: Three Rivers PPO |
$2,375.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,309.07
|
| Rate for Payer: United Healthcare Commercial |
$2,755.29
|
| Rate for Payer: United Healthcare Medicare |
$1,309.07
|
| Rate for Payer: WINHealth Partners Commercial |
$2,691.95
|
|
|
CETIRIZINE 10 MG TABLET [2857]
|
Facility
|
IP
|
$0.67
|
|
|
Service Code
|
NDC 6800143697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.64
|
| Rate for Payer: Altius Commercial |
$0.64
|
| Rate for Payer: Beech Street Commercial |
$0.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.65
|
| Rate for Payer: Cigna of WY Commercial |
$0.66
|
| Rate for Payer: Entrust Commercial |
$0.64
|
| Rate for Payer: First Choice Health Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.44
|
| Rate for Payer: HealthUtah PPO |
$0.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.65
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.66
|
| Rate for Payer: PacificSource Commercial |
$0.60
|
| Rate for Payer: PHCS PPO |
$0.66
|
| Rate for Payer: Three Rivers PPO |
$0.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.44
|
| Rate for Payer: United Healthcare Commercial |
$0.58
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
| Rate for Payer: WINHealth Partners Commercial |
$0.64
|
| Rate for Payer: Wise Provider Network Commercial |
$0.64
|
|
