|
CATH FOGARTY OCCLUSION 3FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
2500250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$82.88
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.00
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$75.05
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOGARTY OCCLUSION 4FR
|
Facility
|
OP
|
$129.50
|
|
| Hospital Charge Code |
2500251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.12 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$85.47
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.82
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$70.12
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$73.82
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$73.82
|
| Rate for Payer: WINHealth Partners Commercial |
$126.91
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOGARTY OCCLUSION 4FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
2500251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$82.88
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.00
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$75.05
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOGARTY OCCLUSION 5FR
|
Facility
|
OP
|
$129.50
|
|
| Hospital Charge Code |
2500252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.12 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$85.47
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.82
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$70.12
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$73.82
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$73.82
|
| Rate for Payer: WINHealth Partners Commercial |
$126.91
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOGARTY OCCLUSION 5FR
|
Facility
|
IP
|
$129.50
|
|
| Hospital Charge Code |
2500252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$126.91
|
| Rate for Payer: Aetna of WY Medicare |
$82.88
|
| Rate for Payer: Altius Commercial |
$124.32
|
| Rate for Payer: Beech Street Commercial |
$126.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.62
|
| Rate for Payer: Cash Price |
$90.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$125.62
|
| Rate for Payer: Cigna of WY Commercial |
$126.91
|
| Rate for Payer: Entrust Commercial |
$123.02
|
| Rate for Payer: First Choice Health Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.00
|
| Rate for Payer: HealthUtah PPO |
$129.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$125.62
|
| Rate for Payer: Multiplan Medicare/VA |
$75.05
|
| Rate for Payer: One Health Plan of WY PPO |
$126.91
|
| Rate for Payer: PacificSource Commercial |
$116.55
|
| Rate for Payer: PHCS PPO |
$126.91
|
| Rate for Payer: Three Rivers PPO |
$97.12
|
| Rate for Payer: TriWest Veterans Administration |
$79.00
|
| Rate for Payer: United Healthcare Commercial |
$123.67
|
| Rate for Payer: United Healthcare Medicare |
$79.00
|
| Rate for Payer: WINHealth Partners Commercial |
$123.02
|
| Rate for Payer: Wise Provider Network Commercial |
$123.02
|
|
|
CATH FOL COUDE TIP 18FR 5CC
|
Facility
|
OP
|
$41.18
|
|
| Hospital Charge Code |
2750113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.36
|
| Rate for Payer: Aetna of WY Medicare |
$27.18
|
| Rate for Payer: Altius Commercial |
$39.53
|
| Rate for Payer: Beech Street Commercial |
$40.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.94
|
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.94
|
| Rate for Payer: Cigna of WY Commercial |
$40.36
|
| Rate for Payer: Entrust Commercial |
$39.12
|
| Rate for Payer: First Choice Health Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.47
|
| Rate for Payer: HealthUtah PPO |
$41.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.94
|
| Rate for Payer: Multiplan Medicare/VA |
$22.30
|
| Rate for Payer: One Health Plan of WY PPO |
$40.36
|
| Rate for Payer: PacificSource Commercial |
$37.06
|
| Rate for Payer: PHCS PPO |
$40.36
|
| Rate for Payer: Three Rivers PPO |
$30.88
|
| Rate for Payer: TriWest Veterans Administration |
$23.47
|
| Rate for Payer: United Healthcare Commercial |
$39.33
|
| Rate for Payer: United Healthcare Medicare |
$23.47
|
| Rate for Payer: WINHealth Partners Commercial |
$40.36
|
| Rate for Payer: Wise Provider Network Commercial |
$39.12
|
|
|
CATH FOL COUDE TIP 18FR 5CC
|
Facility
|
IP
|
$41.18
|
|
| Hospital Charge Code |
2750113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.36
|
| Rate for Payer: Aetna of WY Medicare |
$26.36
|
| Rate for Payer: Altius Commercial |
$39.53
|
| Rate for Payer: Beech Street Commercial |
$40.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.94
|
| Rate for Payer: Cash Price |
$28.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.94
|
| Rate for Payer: Cigna of WY Commercial |
$40.36
|
| Rate for Payer: Entrust Commercial |
$39.12
|
| Rate for Payer: First Choice Health Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.12
|
| Rate for Payer: HealthUtah PPO |
$41.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.94
|
| Rate for Payer: Multiplan Medicare/VA |
$23.86
|
| Rate for Payer: One Health Plan of WY PPO |
$40.36
|
| Rate for Payer: PacificSource Commercial |
$37.06
|
| Rate for Payer: PHCS PPO |
$40.36
|
| Rate for Payer: Three Rivers PPO |
$30.88
|
| Rate for Payer: TriWest Veterans Administration |
$25.12
|
| Rate for Payer: United Healthcare Commercial |
$39.33
|
| Rate for Payer: United Healthcare Medicare |
$25.12
|
| Rate for Payer: WINHealth Partners Commercial |
$39.12
|
| Rate for Payer: Wise Provider Network Commercial |
$39.12
|
|
|
CATH FOLEY 18F 30CC 3-WAY
|
Facility
|
IP
|
$37.30
|
|
| Hospital Charge Code |
2750082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$37.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.55
|
| Rate for Payer: Aetna of WY Medicare |
$23.87
|
| Rate for Payer: Altius Commercial |
$35.81
|
| Rate for Payer: Beech Street Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.18
|
| Rate for Payer: Cigna of WY Commercial |
$36.55
|
| Rate for Payer: Entrust Commercial |
$35.44
|
| Rate for Payer: First Choice Health Commercial |
$35.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.75
|
| Rate for Payer: HealthUtah PPO |
$37.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.18
|
| Rate for Payer: Multiplan Medicare/VA |
$21.62
|
| Rate for Payer: One Health Plan of WY PPO |
$36.55
|
| Rate for Payer: PacificSource Commercial |
$33.57
|
| Rate for Payer: PHCS PPO |
$36.55
|
| Rate for Payer: Three Rivers PPO |
$27.98
|
| Rate for Payer: TriWest Veterans Administration |
$22.75
|
| Rate for Payer: United Healthcare Commercial |
$35.62
|
| Rate for Payer: United Healthcare Medicare |
$22.75
|
| Rate for Payer: WINHealth Partners Commercial |
$35.44
|
| Rate for Payer: Wise Provider Network Commercial |
$35.44
|
|
|
CATH FOLEY 18F 30CC 3-WAY
|
Facility
|
OP
|
$37.30
|
|
| Hospital Charge Code |
2750082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$37.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.55
|
| Rate for Payer: Aetna of WY Medicare |
$24.62
|
| Rate for Payer: Altius Commercial |
$35.81
|
| Rate for Payer: Beech Street Commercial |
$36.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.18
|
| Rate for Payer: Cigna of WY Commercial |
$36.55
|
| Rate for Payer: Entrust Commercial |
$35.44
|
| Rate for Payer: First Choice Health Commercial |
$35.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.26
|
| Rate for Payer: HealthUtah PPO |
$37.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.18
|
| Rate for Payer: Multiplan Medicare/VA |
$20.20
|
| Rate for Payer: One Health Plan of WY PPO |
$36.55
|
| Rate for Payer: PacificSource Commercial |
$33.57
|
| Rate for Payer: PHCS PPO |
$36.55
|
| Rate for Payer: Three Rivers PPO |
$27.98
|
| Rate for Payer: TriWest Veterans Administration |
$21.26
|
| Rate for Payer: United Healthcare Commercial |
$35.62
|
| Rate for Payer: United Healthcare Medicare |
$21.26
|
| Rate for Payer: WINHealth Partners Commercial |
$36.55
|
| Rate for Payer: Wise Provider Network Commercial |
$35.44
|
|
|
CATH FOLEY 20F 30CC 3-WAY
|
Facility
|
OP
|
$37.35
|
|
| Hospital Charge Code |
2750083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$37.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.60
|
| Rate for Payer: Aetna of WY Medicare |
$24.65
|
| Rate for Payer: Altius Commercial |
$35.86
|
| Rate for Payer: Beech Street Commercial |
$36.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.23
|
| Rate for Payer: Cash Price |
$26.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.23
|
| Rate for Payer: Cigna of WY Commercial |
$36.60
|
| Rate for Payer: Entrust Commercial |
$35.48
|
| Rate for Payer: First Choice Health Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.29
|
| Rate for Payer: HealthUtah PPO |
$37.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.23
|
| Rate for Payer: Multiplan Medicare/VA |
$20.23
|
| Rate for Payer: One Health Plan of WY PPO |
$36.60
|
| Rate for Payer: PacificSource Commercial |
$33.62
|
| Rate for Payer: PHCS PPO |
$36.60
|
| Rate for Payer: Three Rivers PPO |
$28.01
|
| Rate for Payer: TriWest Veterans Administration |
$21.29
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$21.29
|
| Rate for Payer: WINHealth Partners Commercial |
$36.60
|
| Rate for Payer: Wise Provider Network Commercial |
$35.48
|
|
|
CATH FOLEY 20F 30CC 3-WAY
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
2750083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$37.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.60
|
| Rate for Payer: Aetna of WY Medicare |
$23.90
|
| Rate for Payer: Altius Commercial |
$35.86
|
| Rate for Payer: Beech Street Commercial |
$36.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.23
|
| Rate for Payer: Cash Price |
$26.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.23
|
| Rate for Payer: Cigna of WY Commercial |
$36.60
|
| Rate for Payer: Entrust Commercial |
$35.48
|
| Rate for Payer: First Choice Health Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.78
|
| Rate for Payer: HealthUtah PPO |
$37.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.23
|
| Rate for Payer: Multiplan Medicare/VA |
$21.64
|
| Rate for Payer: One Health Plan of WY PPO |
$36.60
|
| Rate for Payer: PacificSource Commercial |
$33.62
|
| Rate for Payer: PHCS PPO |
$36.60
|
| Rate for Payer: Three Rivers PPO |
$28.01
|
| Rate for Payer: TriWest Veterans Administration |
$22.78
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$22.78
|
| Rate for Payer: WINHealth Partners Commercial |
$35.48
|
| Rate for Payer: Wise Provider Network Commercial |
$35.48
|
|
|
CATH FOLEY 22F 30CC 3-WAY
|
Facility
|
IP
|
$37.35
|
|
| Hospital Charge Code |
2750038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$37.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.60
|
| Rate for Payer: Aetna of WY Medicare |
$23.90
|
| Rate for Payer: Altius Commercial |
$35.86
|
| Rate for Payer: Beech Street Commercial |
$36.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.23
|
| Rate for Payer: Cash Price |
$26.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.23
|
| Rate for Payer: Cigna of WY Commercial |
$36.60
|
| Rate for Payer: Entrust Commercial |
$35.48
|
| Rate for Payer: First Choice Health Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.78
|
| Rate for Payer: HealthUtah PPO |
$37.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.23
|
| Rate for Payer: Multiplan Medicare/VA |
$21.64
|
| Rate for Payer: One Health Plan of WY PPO |
$36.60
|
| Rate for Payer: PacificSource Commercial |
$33.62
|
| Rate for Payer: PHCS PPO |
$36.60
|
| Rate for Payer: Three Rivers PPO |
$28.01
|
| Rate for Payer: TriWest Veterans Administration |
$22.78
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$22.78
|
| Rate for Payer: WINHealth Partners Commercial |
$35.48
|
| Rate for Payer: Wise Provider Network Commercial |
$35.48
|
|
|
CATH FOLEY 22F 30CC 3-WAY
|
Facility
|
OP
|
$37.35
|
|
| Hospital Charge Code |
2750038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$37.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.60
|
| Rate for Payer: Aetna of WY Medicare |
$24.65
|
| Rate for Payer: Altius Commercial |
$35.86
|
| Rate for Payer: Beech Street Commercial |
$36.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.23
|
| Rate for Payer: Cash Price |
$26.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.23
|
| Rate for Payer: Cigna of WY Commercial |
$36.60
|
| Rate for Payer: Entrust Commercial |
$35.48
|
| Rate for Payer: First Choice Health Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.29
|
| Rate for Payer: HealthUtah PPO |
$37.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.23
|
| Rate for Payer: Multiplan Medicare/VA |
$20.23
|
| Rate for Payer: One Health Plan of WY PPO |
$36.60
|
| Rate for Payer: PacificSource Commercial |
$33.62
|
| Rate for Payer: PHCS PPO |
$36.60
|
| Rate for Payer: Three Rivers PPO |
$28.01
|
| Rate for Payer: TriWest Veterans Administration |
$21.29
|
| Rate for Payer: United Healthcare Commercial |
$35.67
|
| Rate for Payer: United Healthcare Medicare |
$21.29
|
| Rate for Payer: WINHealth Partners Commercial |
$36.60
|
| Rate for Payer: Wise Provider Network Commercial |
$35.48
|
|
|
CATH FOLEY 2WAY 24FR 30CC
|
Facility
|
OP
|
$0.56
|
|
| Hospital Charge Code |
2750123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.37
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
CATH FOLEY 2WAY 24FR 30CC
|
Facility
|
IP
|
$0.56
|
|
| Hospital Charge Code |
2750123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.53
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
CATH FOLEY TRAY KIT MEDLINE
|
Facility
|
IP
|
$51.40
|
|
| Hospital Charge Code |
2750098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.37
|
| Rate for Payer: Aetna of WY Medicare |
$32.90
|
| Rate for Payer: Altius Commercial |
$49.34
|
| Rate for Payer: Beech Street Commercial |
$50.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.86
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.86
|
| Rate for Payer: Cigna of WY Commercial |
$50.37
|
| Rate for Payer: Entrust Commercial |
$48.83
|
| Rate for Payer: First Choice Health Commercial |
$48.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$51.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.86
|
| Rate for Payer: Multiplan Medicare/VA |
$29.79
|
| Rate for Payer: One Health Plan of WY PPO |
$50.37
|
| Rate for Payer: PacificSource Commercial |
$46.26
|
| Rate for Payer: PHCS PPO |
$50.37
|
| Rate for Payer: Three Rivers PPO |
$38.55
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$49.09
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$48.83
|
| Rate for Payer: Wise Provider Network Commercial |
$48.83
|
|
|
CATH FOLEY TRAY KIT MEDLINE
|
Facility
|
OP
|
$51.40
|
|
| Hospital Charge Code |
2750098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.37
|
| Rate for Payer: Aetna of WY Medicare |
$33.92
|
| Rate for Payer: Altius Commercial |
$49.34
|
| Rate for Payer: Beech Street Commercial |
$50.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.86
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.86
|
| Rate for Payer: Cigna of WY Commercial |
$50.37
|
| Rate for Payer: Entrust Commercial |
$48.83
|
| Rate for Payer: First Choice Health Commercial |
$48.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.30
|
| Rate for Payer: HealthUtah PPO |
$51.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.86
|
| Rate for Payer: Multiplan Medicare/VA |
$27.83
|
| Rate for Payer: One Health Plan of WY PPO |
$50.37
|
| Rate for Payer: PacificSource Commercial |
$46.26
|
| Rate for Payer: PHCS PPO |
$50.37
|
| Rate for Payer: Three Rivers PPO |
$38.55
|
| Rate for Payer: TriWest Veterans Administration |
$29.30
|
| Rate for Payer: United Healthcare Commercial |
$49.09
|
| Rate for Payer: United Healthcare Medicare |
$29.30
|
| Rate for Payer: WINHealth Partners Commercial |
$50.37
|
| Rate for Payer: Wise Provider Network Commercial |
$48.83
|
|
|
CATH INTRAUTERINE PRESSURE
|
Facility
|
OP
|
$101.15
|
|
| Hospital Charge Code |
2450021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.13
|
| Rate for Payer: Aetna of WY Medicare |
$66.76
|
| Rate for Payer: Altius Commercial |
$97.10
|
| Rate for Payer: Beech Street Commercial |
$99.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.12
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.12
|
| Rate for Payer: Cigna of WY Commercial |
$99.13
|
| Rate for Payer: Entrust Commercial |
$96.09
|
| Rate for Payer: First Choice Health Commercial |
$96.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.66
|
| Rate for Payer: HealthUtah PPO |
$101.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.12
|
| Rate for Payer: Multiplan Medicare/VA |
$54.77
|
| Rate for Payer: One Health Plan of WY PPO |
$99.13
|
| Rate for Payer: PacificSource Commercial |
$91.04
|
| Rate for Payer: PHCS PPO |
$99.13
|
| Rate for Payer: Three Rivers PPO |
$75.86
|
| Rate for Payer: TriWest Veterans Administration |
$57.66
|
| Rate for Payer: United Healthcare Commercial |
$96.60
|
| Rate for Payer: United Healthcare Medicare |
$57.66
|
| Rate for Payer: WINHealth Partners Commercial |
$99.13
|
| Rate for Payer: Wise Provider Network Commercial |
$96.09
|
|
|
CATH INTRAUTERINE PRESSURE
|
Facility
|
IP
|
$101.15
|
|
| Hospital Charge Code |
2450021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$101.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.13
|
| Rate for Payer: Aetna of WY Medicare |
$64.74
|
| Rate for Payer: Altius Commercial |
$97.10
|
| Rate for Payer: Beech Street Commercial |
$99.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$98.12
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.12
|
| Rate for Payer: Cigna of WY Commercial |
$99.13
|
| Rate for Payer: Entrust Commercial |
$96.09
|
| Rate for Payer: First Choice Health Commercial |
$96.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.70
|
| Rate for Payer: HealthUtah PPO |
$101.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.12
|
| Rate for Payer: Multiplan Medicare/VA |
$58.62
|
| Rate for Payer: One Health Plan of WY PPO |
$99.13
|
| Rate for Payer: PacificSource Commercial |
$91.04
|
| Rate for Payer: PHCS PPO |
$99.13
|
| Rate for Payer: Three Rivers PPO |
$75.86
|
| Rate for Payer: TriWest Veterans Administration |
$61.70
|
| Rate for Payer: United Healthcare Commercial |
$96.60
|
| Rate for Payer: United Healthcare Medicare |
$61.70
|
| Rate for Payer: WINHealth Partners Commercial |
$96.09
|
| Rate for Payer: Wise Provider Network Commercial |
$96.09
|
|
|
CATH INTRAUTERINE PRESSURE
|
Facility
|
IP
|
$76.62
|
|
| Hospital Charge Code |
2450021A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.09
|
| Rate for Payer: Aetna of WY Medicare |
$49.04
|
| Rate for Payer: Altius Commercial |
$73.56
|
| Rate for Payer: Beech Street Commercial |
$75.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.32
|
| Rate for Payer: Cash Price |
$53.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.32
|
| Rate for Payer: Cigna of WY Commercial |
$75.09
|
| Rate for Payer: Entrust Commercial |
$72.79
|
| Rate for Payer: First Choice Health Commercial |
$72.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.74
|
| Rate for Payer: HealthUtah PPO |
$76.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.32
|
| Rate for Payer: Multiplan Medicare/VA |
$44.40
|
| Rate for Payer: One Health Plan of WY PPO |
$75.09
|
| Rate for Payer: PacificSource Commercial |
$68.96
|
| Rate for Payer: PHCS PPO |
$75.09
|
| Rate for Payer: Three Rivers PPO |
$57.46
|
| Rate for Payer: TriWest Veterans Administration |
$46.74
|
| Rate for Payer: United Healthcare Commercial |
$73.17
|
| Rate for Payer: United Healthcare Medicare |
$46.74
|
| Rate for Payer: WINHealth Partners Commercial |
$72.79
|
| Rate for Payer: Wise Provider Network Commercial |
$72.79
|
|
|
CATH INTRAUTERINE PRESSURE
|
Facility
|
OP
|
$76.62
|
|
| Hospital Charge Code |
2450021A
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$76.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$75.09
|
| Rate for Payer: Aetna of WY Medicare |
$50.57
|
| Rate for Payer: Altius Commercial |
$73.56
|
| Rate for Payer: Beech Street Commercial |
$75.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.32
|
| Rate for Payer: Cash Price |
$53.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$74.32
|
| Rate for Payer: Cigna of WY Commercial |
$75.09
|
| Rate for Payer: Entrust Commercial |
$72.79
|
| Rate for Payer: First Choice Health Commercial |
$72.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$72.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.67
|
| Rate for Payer: HealthUtah PPO |
$76.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$74.32
|
| Rate for Payer: Multiplan Medicare/VA |
$41.49
|
| Rate for Payer: One Health Plan of WY PPO |
$75.09
|
| Rate for Payer: PacificSource Commercial |
$68.96
|
| Rate for Payer: PHCS PPO |
$75.09
|
| Rate for Payer: Three Rivers PPO |
$57.46
|
| Rate for Payer: TriWest Veterans Administration |
$43.67
|
| Rate for Payer: United Healthcare Commercial |
$73.17
|
| Rate for Payer: United Healthcare Medicare |
$43.67
|
| Rate for Payer: WINHealth Partners Commercial |
$75.09
|
| Rate for Payer: Wise Provider Network Commercial |
$72.79
|
|
|
CATH IV 14G 2" JELCO 3358
|
Facility
|
IP
|
$6.51
|
|
| Hospital Charge Code |
2350004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.17
|
| Rate for Payer: Altius Commercial |
$6.25
|
| Rate for Payer: Beech Street Commercial |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.31
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.31
|
| Rate for Payer: Cigna of WY Commercial |
$6.38
|
| Rate for Payer: Entrust Commercial |
$6.18
|
| Rate for Payer: First Choice Health Commercial |
$6.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.97
|
| Rate for Payer: HealthUtah PPO |
$6.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.31
|
| Rate for Payer: Multiplan Medicare/VA |
$3.77
|
| Rate for Payer: One Health Plan of WY PPO |
$6.38
|
| Rate for Payer: PacificSource Commercial |
$5.86
|
| Rate for Payer: PHCS PPO |
$6.38
|
| Rate for Payer: Three Rivers PPO |
$4.88
|
| Rate for Payer: TriWest Veterans Administration |
$3.97
|
| Rate for Payer: United Healthcare Commercial |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$3.97
|
| Rate for Payer: WINHealth Partners Commercial |
$6.18
|
| Rate for Payer: Wise Provider Network Commercial |
$6.18
|
|
|
CATH IV 14G 2" JELCO 3358
|
Facility
|
OP
|
$6.51
|
|
| Hospital Charge Code |
2350004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.38
|
| Rate for Payer: Aetna of WY Medicare |
$4.30
|
| Rate for Payer: Altius Commercial |
$6.25
|
| Rate for Payer: Beech Street Commercial |
$6.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.31
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.31
|
| Rate for Payer: Cigna of WY Commercial |
$6.38
|
| Rate for Payer: Entrust Commercial |
$6.18
|
| Rate for Payer: First Choice Health Commercial |
$6.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.31
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.38
|
| Rate for Payer: PacificSource Commercial |
$5.86
|
| Rate for Payer: PHCS PPO |
$6.38
|
| Rate for Payer: Three Rivers PPO |
$4.88
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$6.22
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.38
|
| Rate for Payer: Wise Provider Network Commercial |
$6.18
|
|
|
CATH IV 18G 1.25 NEXIVA 383539
|
Facility
|
IP
|
$15.76
|
|
| Hospital Charge Code |
2350044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.09
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.61
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| Rate for Payer: Multiplan Medicare/VA |
$9.13
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$9.61
|
| Rate for Payer: United Healthcare Commercial |
$15.05
|
| Rate for Payer: United Healthcare Medicare |
$9.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.97
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
|
CATH IV 18G 1.25 NEXIVA 383539
|
Facility
|
OP
|
$15.76
|
|
| Hospital Charge Code |
2350044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: United Healthcare Commercial |
$15.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.98
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| Rate for Payer: Multiplan Medicare/VA |
$8.53
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$8.98
|
| Rate for Payer: United Healthcare Medicare |
$8.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
