|
CAST TAPE 3" RED DELTA LITE
|
Facility
|
IP
|
$7.42
|
|
| Hospital Charge Code |
2250020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.75
|
| Rate for Payer: Altius Commercial |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.20
|
| Rate for Payer: Cigna of WY Commercial |
$7.27
|
| Rate for Payer: Entrust Commercial |
$7.05
|
| Rate for Payer: First Choice Health Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.53
|
| Rate for Payer: HealthUtah PPO |
$7.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4.30
|
| Rate for Payer: One Health Plan of WY PPO |
$7.27
|
| Rate for Payer: PacificSource Commercial |
$6.68
|
| Rate for Payer: PHCS PPO |
$7.27
|
| Rate for Payer: Three Rivers PPO |
$5.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.53
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare |
$4.53
|
| Rate for Payer: WINHealth Partners Commercial |
$7.05
|
| Rate for Payer: Wise Provider Network Commercial |
$7.05
|
|
|
CAST TAPE 3" RED DELTA LITE
|
Facility
|
OP
|
$7.42
|
|
| Hospital Charge Code |
2250020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.90
|
| Rate for Payer: Altius Commercial |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.20
|
| Rate for Payer: Cigna of WY Commercial |
$7.27
|
| Rate for Payer: Entrust Commercial |
$7.05
|
| Rate for Payer: First Choice Health Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.23
|
| Rate for Payer: HealthUtah PPO |
$7.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.27
|
| Rate for Payer: PacificSource Commercial |
$6.68
|
| Rate for Payer: PHCS PPO |
$7.27
|
| Rate for Payer: Three Rivers PPO |
$5.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare |
$4.23
|
| Rate for Payer: WINHealth Partners Commercial |
$7.27
|
| Rate for Payer: Wise Provider Network Commercial |
$7.05
|
|
|
CAST TAPE 3" WHITE DELTA LITE
|
Facility
|
IP
|
$7.42
|
|
| Hospital Charge Code |
2250017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.75
|
| Rate for Payer: Altius Commercial |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.20
|
| Rate for Payer: Cigna of WY Commercial |
$7.27
|
| Rate for Payer: Entrust Commercial |
$7.05
|
| Rate for Payer: First Choice Health Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.53
|
| Rate for Payer: HealthUtah PPO |
$7.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4.30
|
| Rate for Payer: One Health Plan of WY PPO |
$7.27
|
| Rate for Payer: PacificSource Commercial |
$6.68
|
| Rate for Payer: PHCS PPO |
$7.27
|
| Rate for Payer: Three Rivers PPO |
$5.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.53
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare |
$4.53
|
| Rate for Payer: WINHealth Partners Commercial |
$7.05
|
| Rate for Payer: Wise Provider Network Commercial |
$7.05
|
|
|
CAST TAPE 3" WHITE DELTA LITE
|
Facility
|
OP
|
$7.42
|
|
| Hospital Charge Code |
2250017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.90
|
| Rate for Payer: Altius Commercial |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.20
|
| Rate for Payer: Cigna of WY Commercial |
$7.27
|
| Rate for Payer: Entrust Commercial |
$7.05
|
| Rate for Payer: First Choice Health Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.23
|
| Rate for Payer: HealthUtah PPO |
$7.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.27
|
| Rate for Payer: PacificSource Commercial |
$6.68
|
| Rate for Payer: PHCS PPO |
$7.27
|
| Rate for Payer: Three Rivers PPO |
$5.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare |
$4.23
|
| Rate for Payer: WINHealth Partners Commercial |
$7.27
|
| Rate for Payer: Wise Provider Network Commercial |
$7.05
|
|
|
CAST TAPE 3" YELLOW DELTA LITE
|
Facility
|
OP
|
$7.42
|
|
| Hospital Charge Code |
2250114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.90
|
| Rate for Payer: Altius Commercial |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.20
|
| Rate for Payer: Cigna of WY Commercial |
$7.27
|
| Rate for Payer: Entrust Commercial |
$7.05
|
| Rate for Payer: First Choice Health Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.23
|
| Rate for Payer: HealthUtah PPO |
$7.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4.02
|
| Rate for Payer: One Health Plan of WY PPO |
$7.27
|
| Rate for Payer: PacificSource Commercial |
$6.68
|
| Rate for Payer: PHCS PPO |
$7.27
|
| Rate for Payer: Three Rivers PPO |
$5.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare |
$4.23
|
| Rate for Payer: WINHealth Partners Commercial |
$7.27
|
| Rate for Payer: Wise Provider Network Commercial |
$7.05
|
|
|
CAST TAPE 3" YELLOW DELTA LITE
|
Facility
|
IP
|
$7.42
|
|
| Hospital Charge Code |
2250114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$7.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.75
|
| Rate for Payer: Altius Commercial |
$7.12
|
| Rate for Payer: Beech Street Commercial |
$7.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.20
|
| Rate for Payer: Cigna of WY Commercial |
$7.27
|
| Rate for Payer: Entrust Commercial |
$7.05
|
| Rate for Payer: First Choice Health Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.53
|
| Rate for Payer: HealthUtah PPO |
$7.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.20
|
| Rate for Payer: Multiplan Medicare/VA |
$4.30
|
| Rate for Payer: One Health Plan of WY PPO |
$7.27
|
| Rate for Payer: PacificSource Commercial |
$6.68
|
| Rate for Payer: PHCS PPO |
$7.27
|
| Rate for Payer: Three Rivers PPO |
$5.56
|
| Rate for Payer: TriWest Veterans Administration |
$4.53
|
| Rate for Payer: United Healthcare Commercial |
$7.09
|
| Rate for Payer: United Healthcare Medicare |
$4.53
|
| Rate for Payer: WINHealth Partners Commercial |
$7.05
|
| Rate for Payer: Wise Provider Network Commercial |
$7.05
|
|
|
CAST TAPE 4" BLUE DELTA LITE
|
Facility
|
OP
|
$9.63
|
|
| Hospital Charge Code |
2250025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: United Healthcare Commercial |
$9.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.44
|
| Rate for Payer: Aetna of WY Medicare |
$6.36
|
| Rate for Payer: Altius Commercial |
$9.24
|
| Rate for Payer: Beech Street Commercial |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.34
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.34
|
| Rate for Payer: Cigna of WY Commercial |
$9.44
|
| Rate for Payer: Entrust Commercial |
$9.15
|
| Rate for Payer: First Choice Health Commercial |
$9.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.49
|
| Rate for Payer: HealthUtah PPO |
$9.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.34
|
| Rate for Payer: Multiplan Medicare/VA |
$5.21
|
| Rate for Payer: One Health Plan of WY PPO |
$9.44
|
| Rate for Payer: PacificSource Commercial |
$8.67
|
| Rate for Payer: PHCS PPO |
$9.44
|
| Rate for Payer: Three Rivers PPO |
$7.22
|
| Rate for Payer: TriWest Veterans Administration |
$5.49
|
| Rate for Payer: United Healthcare Medicare |
$5.49
|
| Rate for Payer: WINHealth Partners Commercial |
$9.44
|
| Rate for Payer: Wise Provider Network Commercial |
$9.15
|
|
|
CAST TAPE 4" BLUE DELTA LITE
|
Facility
|
IP
|
$9.63
|
|
| Hospital Charge Code |
2250025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.44
|
| Rate for Payer: Aetna of WY Medicare |
$6.16
|
| Rate for Payer: Altius Commercial |
$9.24
|
| Rate for Payer: Beech Street Commercial |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.34
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.34
|
| Rate for Payer: Cigna of WY Commercial |
$9.44
|
| Rate for Payer: Entrust Commercial |
$9.15
|
| Rate for Payer: First Choice Health Commercial |
$9.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.87
|
| Rate for Payer: HealthUtah PPO |
$9.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.34
|
| Rate for Payer: Multiplan Medicare/VA |
$5.58
|
| Rate for Payer: One Health Plan of WY PPO |
$9.44
|
| Rate for Payer: PacificSource Commercial |
$8.67
|
| Rate for Payer: PHCS PPO |
$9.44
|
| Rate for Payer: Three Rivers PPO |
$7.22
|
| Rate for Payer: TriWest Veterans Administration |
$5.87
|
| Rate for Payer: United Healthcare Commercial |
$9.20
|
| Rate for Payer: United Healthcare Medicare |
$5.87
|
| Rate for Payer: WINHealth Partners Commercial |
$9.15
|
| Rate for Payer: Wise Provider Network Commercial |
$9.15
|
|
|
CATH 4FR FOGARTY 12TLW404F
|
Facility
|
OP
|
$250.98
|
|
| Hospital Charge Code |
2650837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$165.65
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.06
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$135.91
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$143.06
|
| Rate for Payer: WINHealth Partners Commercial |
$245.96
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 4FR FOGARTY 12TLW404F
|
Facility
|
IP
|
$250.98
|
|
| Hospital Charge Code |
2650837
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$160.63
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.10
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$145.44
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$153.10
|
| Rate for Payer: WINHealth Partners Commercial |
$238.43
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 5.5FR FOGARTY 12TLW405F35
|
Facility
|
IP
|
$250.98
|
|
| Hospital Charge Code |
2650838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$160.63
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.10
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$145.44
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$153.10
|
| Rate for Payer: WINHealth Partners Commercial |
$238.43
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 5.5FR FOGARTY 12TLW405F35
|
Facility
|
OP
|
$250.98
|
|
| Hospital Charge Code |
2650838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$165.65
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.06
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$135.91
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$143.06
|
| Rate for Payer: WINHealth Partners Commercial |
$245.96
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 6FR FOGARTY 12TLW406F
|
Facility
|
OP
|
$250.98
|
|
| Hospital Charge Code |
2650839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$165.65
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.06
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$135.91
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$143.06
|
| Rate for Payer: WINHealth Partners Commercial |
$245.96
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 6FR FOGARTY 12TLW406F
|
Facility
|
IP
|
$250.98
|
|
| Hospital Charge Code |
2650839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$160.63
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.10
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$145.44
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$153.10
|
| Rate for Payer: WINHealth Partners Commercial |
$238.43
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 7FR FOGARTY 12TLW807F
|
Facility
|
IP
|
$250.98
|
|
| Hospital Charge Code |
2650840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$160.63
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$153.10
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$145.44
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$153.10
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$153.10
|
| Rate for Payer: WINHealth Partners Commercial |
$238.43
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 7FR FOGARTY 12TLW807F
|
Facility
|
OP
|
$250.98
|
|
| Hospital Charge Code |
2650840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$250.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.96
|
| Rate for Payer: Aetna of WY Medicare |
$165.65
|
| Rate for Payer: Altius Commercial |
$240.94
|
| Rate for Payer: Beech Street Commercial |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.45
|
| Rate for Payer: Cash Price |
$175.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.45
|
| Rate for Payer: Cigna of WY Commercial |
$245.96
|
| Rate for Payer: Entrust Commercial |
$238.43
|
| Rate for Payer: First Choice Health Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.06
|
| Rate for Payer: HealthUtah PPO |
$250.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.45
|
| Rate for Payer: Multiplan Medicare/VA |
$135.91
|
| Rate for Payer: One Health Plan of WY PPO |
$245.96
|
| Rate for Payer: PacificSource Commercial |
$225.88
|
| Rate for Payer: PHCS PPO |
$245.96
|
| Rate for Payer: Three Rivers PPO |
$188.24
|
| Rate for Payer: TriWest Veterans Administration |
$143.06
|
| Rate for Payer: United Healthcare Commercial |
$239.69
|
| Rate for Payer: United Healthcare Medicare |
$143.06
|
| Rate for Payer: WINHealth Partners Commercial |
$245.96
|
| Rate for Payer: Wise Provider Network Commercial |
$238.43
|
|
|
CATH 7FR FOGARTY 80CM 12A0807F
|
Facility
|
IP
|
$112.14
|
|
| Hospital Charge Code |
2650832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.99 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.90
|
| Rate for Payer: Aetna of WY Medicare |
$71.77
|
| Rate for Payer: Altius Commercial |
$107.65
|
| Rate for Payer: Beech Street Commercial |
$109.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.78
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.78
|
| Rate for Payer: Cigna of WY Commercial |
$109.90
|
| Rate for Payer: Entrust Commercial |
$106.53
|
| Rate for Payer: First Choice Health Commercial |
$106.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.41
|
| Rate for Payer: HealthUtah PPO |
$112.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.78
|
| Rate for Payer: Multiplan Medicare/VA |
$64.99
|
| Rate for Payer: One Health Plan of WY PPO |
$109.90
|
| Rate for Payer: PacificSource Commercial |
$100.93
|
| Rate for Payer: PHCS PPO |
$109.90
|
| Rate for Payer: Three Rivers PPO |
$84.10
|
| Rate for Payer: TriWest Veterans Administration |
$68.41
|
| Rate for Payer: United Healthcare Commercial |
$107.09
|
| Rate for Payer: United Healthcare Medicare |
$68.41
|
| Rate for Payer: WINHealth Partners Commercial |
$106.53
|
| Rate for Payer: Wise Provider Network Commercial |
$106.53
|
|
|
CATH 7FR FOGARTY 80CM 12A0807F
|
Facility
|
OP
|
$112.14
|
|
| Hospital Charge Code |
2650832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$112.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$109.90
|
| Rate for Payer: Aetna of WY Medicare |
$74.01
|
| Rate for Payer: Altius Commercial |
$107.65
|
| Rate for Payer: Beech Street Commercial |
$109.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.78
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$108.78
|
| Rate for Payer: Cigna of WY Commercial |
$109.90
|
| Rate for Payer: Entrust Commercial |
$106.53
|
| Rate for Payer: First Choice Health Commercial |
$106.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$106.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.92
|
| Rate for Payer: HealthUtah PPO |
$112.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$108.78
|
| Rate for Payer: Multiplan Medicare/VA |
$60.72
|
| Rate for Payer: One Health Plan of WY PPO |
$109.90
|
| Rate for Payer: PacificSource Commercial |
$100.93
|
| Rate for Payer: PHCS PPO |
$109.90
|
| Rate for Payer: Three Rivers PPO |
$84.10
|
| Rate for Payer: TriWest Veterans Administration |
$63.92
|
| Rate for Payer: United Healthcare Commercial |
$107.09
|
| Rate for Payer: United Healthcare Medicare |
$63.92
|
| Rate for Payer: WINHealth Partners Commercial |
$109.90
|
| Rate for Payer: Wise Provider Network Commercial |
$106.53
|
|
|
CATH CONN 2 PC TITANIUM
|
Facility
|
IP
|
$422.80
|
|
| Hospital Charge Code |
2650935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.01 |
| Max. Negotiated Rate |
$422.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$414.34
|
| Rate for Payer: Aetna of WY Medicare |
$270.59
|
| Rate for Payer: Altius Commercial |
$405.89
|
| Rate for Payer: Beech Street Commercial |
$414.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.12
|
| Rate for Payer: Cash Price |
$295.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$410.12
|
| Rate for Payer: Cigna of WY Commercial |
$414.34
|
| Rate for Payer: Entrust Commercial |
$401.66
|
| Rate for Payer: First Choice Health Commercial |
$401.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$401.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.91
|
| Rate for Payer: HealthUtah PPO |
$422.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$410.12
|
| Rate for Payer: Multiplan Medicare/VA |
$245.01
|
| Rate for Payer: One Health Plan of WY PPO |
$414.34
|
| Rate for Payer: PacificSource Commercial |
$380.52
|
| Rate for Payer: PHCS PPO |
$414.34
|
| Rate for Payer: Three Rivers PPO |
$317.10
|
| Rate for Payer: TriWest Veterans Administration |
$257.91
|
| Rate for Payer: United Healthcare Commercial |
$403.77
|
| Rate for Payer: United Healthcare Medicare |
$257.91
|
| Rate for Payer: WINHealth Partners Commercial |
$401.66
|
| Rate for Payer: Wise Provider Network Commercial |
$401.66
|
|
|
CATH CONN 2 PC TITANIUM
|
Facility
|
OP
|
$422.80
|
|
| Hospital Charge Code |
2650935
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$422.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$414.34
|
| Rate for Payer: Aetna of WY Medicare |
$279.05
|
| Rate for Payer: Altius Commercial |
$405.89
|
| Rate for Payer: Beech Street Commercial |
$414.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$410.12
|
| Rate for Payer: Cash Price |
$295.96
|
| Rate for Payer: ChoiceCare Network Commercial |
$410.12
|
| Rate for Payer: Cigna of WY Commercial |
$414.34
|
| Rate for Payer: Entrust Commercial |
$401.66
|
| Rate for Payer: First Choice Health Commercial |
$401.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$401.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$241.00
|
| Rate for Payer: HealthUtah PPO |
$422.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$410.12
|
| Rate for Payer: Multiplan Medicare/VA |
$228.95
|
| Rate for Payer: One Health Plan of WY PPO |
$414.34
|
| Rate for Payer: PacificSource Commercial |
$380.52
|
| Rate for Payer: PHCS PPO |
$414.34
|
| Rate for Payer: Three Rivers PPO |
$317.10
|
| Rate for Payer: TriWest Veterans Administration |
$241.00
|
| Rate for Payer: United Healthcare Commercial |
$403.77
|
| Rate for Payer: United Healthcare Medicare |
$241.00
|
| Rate for Payer: WINHealth Partners Commercial |
$414.34
|
| Rate for Payer: Wise Provider Network Commercial |
$401.66
|
|
|
CATH EPIDURAL VERSA-KATH 12"
|
Facility
|
IP
|
$235.94
|
|
| Hospital Charge Code |
2500196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.73 |
| Max. Negotiated Rate |
$235.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.22
|
| Rate for Payer: Aetna of WY Medicare |
$151.00
|
| Rate for Payer: Altius Commercial |
$226.50
|
| Rate for Payer: Beech Street Commercial |
$231.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.86
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.86
|
| Rate for Payer: Cigna of WY Commercial |
$231.22
|
| Rate for Payer: Entrust Commercial |
$224.14
|
| Rate for Payer: First Choice Health Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.92
|
| Rate for Payer: HealthUtah PPO |
$235.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.86
|
| Rate for Payer: Multiplan Medicare/VA |
$136.73
|
| Rate for Payer: One Health Plan of WY PPO |
$231.22
|
| Rate for Payer: PacificSource Commercial |
$212.35
|
| Rate for Payer: PHCS PPO |
$231.22
|
| Rate for Payer: Three Rivers PPO |
$176.96
|
| Rate for Payer: TriWest Veterans Administration |
$143.92
|
| Rate for Payer: United Healthcare Commercial |
$225.32
|
| Rate for Payer: United Healthcare Medicare |
$143.92
|
| Rate for Payer: WINHealth Partners Commercial |
$224.14
|
| Rate for Payer: Wise Provider Network Commercial |
$224.14
|
|
|
CATH EPIDURAL VERSA-KATH 12"
|
Facility
|
OP
|
$235.94
|
|
| Hospital Charge Code |
2500196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$235.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.22
|
| Rate for Payer: Aetna of WY Medicare |
$155.72
|
| Rate for Payer: Altius Commercial |
$226.50
|
| Rate for Payer: Beech Street Commercial |
$231.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.86
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.86
|
| Rate for Payer: Cigna of WY Commercial |
$231.22
|
| Rate for Payer: Entrust Commercial |
$224.14
|
| Rate for Payer: First Choice Health Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$134.49
|
| Rate for Payer: HealthUtah PPO |
$235.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.86
|
| Rate for Payer: Multiplan Medicare/VA |
$127.76
|
| Rate for Payer: One Health Plan of WY PPO |
$231.22
|
| Rate for Payer: PacificSource Commercial |
$212.35
|
| Rate for Payer: PHCS PPO |
$231.22
|
| Rate for Payer: Three Rivers PPO |
$176.96
|
| Rate for Payer: TriWest Veterans Administration |
$134.49
|
| Rate for Payer: United Healthcare Commercial |
$225.32
|
| Rate for Payer: United Healthcare Medicare |
$134.49
|
| Rate for Payer: WINHealth Partners Commercial |
$231.22
|
| Rate for Payer: Wise Provider Network Commercial |
$224.14
|
|
|
CATHETER CPNB FLEXBLOCK KIT
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
3004510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.75 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$138.88
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.49
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$132.37
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$125.75
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$132.37
|
| Rate for Payer: United Healthcare Commercial |
$207.24
|
| Rate for Payer: United Healthcare Medicare |
$132.37
|
| Rate for Payer: WINHealth Partners Commercial |
$206.15
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
CATHETER CPNB FLEXBLOCK KIT
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
3004510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.51 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$143.22
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.49
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$123.69
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$117.51
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$123.69
|
| Rate for Payer: United Healthcare Commercial |
$207.24
|
| Rate for Payer: United Healthcare Medicare |
$123.69
|
| Rate for Payer: WINHealth Partners Commercial |
$212.66
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
CATHETER EPIDURAL TUN-L-XL
|
Facility
|
IP
|
$267.36
|
|
| Hospital Charge Code |
2500195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.94 |
| Max. Negotiated Rate |
$267.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.01
|
| Rate for Payer: Aetna of WY Medicare |
$171.11
|
| Rate for Payer: Altius Commercial |
$256.67
|
| Rate for Payer: Beech Street Commercial |
$262.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$259.34
|
| Rate for Payer: Cash Price |
$187.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$259.34
|
| Rate for Payer: Cigna of WY Commercial |
$262.01
|
| Rate for Payer: Entrust Commercial |
$253.99
|
| Rate for Payer: First Choice Health Commercial |
$253.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$253.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$163.09
|
| Rate for Payer: HealthUtah PPO |
$267.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$259.34
|
| Rate for Payer: Multiplan Medicare/VA |
$154.94
|
| Rate for Payer: One Health Plan of WY PPO |
$262.01
|
| Rate for Payer: PacificSource Commercial |
$240.62
|
| Rate for Payer: PHCS PPO |
$262.01
|
| Rate for Payer: Three Rivers PPO |
$200.52
|
| Rate for Payer: TriWest Veterans Administration |
$163.09
|
| Rate for Payer: United Healthcare Commercial |
$255.33
|
| Rate for Payer: United Healthcare Medicare |
$163.09
|
| Rate for Payer: WINHealth Partners Commercial |
$253.99
|
| Rate for Payer: Wise Provider Network Commercial |
$253.99
|
|
