|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
OP
|
$23.95
|
|
|
Service Code
|
NDC 5026816311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$23.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.47
|
| Rate for Payer: Aetna of WY Medicare |
$15.81
|
| Rate for Payer: Altius Commercial |
$22.99
|
| Rate for Payer: Beech Street Commercial |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.23
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.23
|
| Rate for Payer: Cigna of WY Commercial |
$23.47
|
| Rate for Payer: Entrust Commercial |
$22.75
|
| Rate for Payer: First Choice Health Commercial |
$22.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.65
|
| Rate for Payer: HealthUtah PPO |
$23.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.23
|
| Rate for Payer: Multiplan Medicare/VA |
$12.97
|
| Rate for Payer: One Health Plan of WY PPO |
$23.47
|
| Rate for Payer: PacificSource Commercial |
$21.56
|
| Rate for Payer: PHCS PPO |
$23.47
|
| Rate for Payer: Three Rivers PPO |
$17.96
|
| Rate for Payer: TriWest Veterans Administration |
$13.65
|
| Rate for Payer: United Healthcare Commercial |
$22.87
|
| Rate for Payer: United Healthcare Medicare |
$13.65
|
| Rate for Payer: WINHealth Partners Commercial |
$23.47
|
| Rate for Payer: Wise Provider Network Commercial |
$22.75
|
|
|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
IP
|
$23.95
|
|
|
Service Code
|
NDC 5026816311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.88 |
| Max. Negotiated Rate |
$23.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.47
|
| Rate for Payer: Aetna of WY Medicare |
$15.33
|
| Rate for Payer: Altius Commercial |
$22.99
|
| Rate for Payer: Beech Street Commercial |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.23
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.23
|
| Rate for Payer: Cigna of WY Commercial |
$23.47
|
| Rate for Payer: Entrust Commercial |
$22.75
|
| Rate for Payer: First Choice Health Commercial |
$22.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.61
|
| Rate for Payer: HealthUtah PPO |
$23.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.23
|
| Rate for Payer: Multiplan Medicare/VA |
$13.88
|
| Rate for Payer: One Health Plan of WY PPO |
$23.47
|
| Rate for Payer: PacificSource Commercial |
$21.56
|
| Rate for Payer: PHCS PPO |
$23.47
|
| Rate for Payer: Three Rivers PPO |
$17.96
|
| Rate for Payer: TriWest Veterans Administration |
$14.61
|
| Rate for Payer: United Healthcare Commercial |
$22.87
|
| Rate for Payer: United Healthcare Medicare |
$14.61
|
| Rate for Payer: WINHealth Partners Commercial |
$22.75
|
| Rate for Payer: Wise Provider Network Commercial |
$22.75
|
|
|
CHLORPROMAZINE 25 MG TABLET [12483]
|
Facility
|
OP
|
$23.95
|
|
|
Service Code
|
NDC 5026816315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$23.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.47
|
| Rate for Payer: Aetna of WY Medicare |
$15.81
|
| Rate for Payer: Altius Commercial |
$22.99
|
| Rate for Payer: Beech Street Commercial |
$23.47
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.23
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.23
|
| Rate for Payer: Cigna of WY Commercial |
$23.47
|
| Rate for Payer: Entrust Commercial |
$22.75
|
| Rate for Payer: First Choice Health Commercial |
$22.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.65
|
| Rate for Payer: HealthUtah PPO |
$23.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.23
|
| Rate for Payer: Multiplan Medicare/VA |
$12.97
|
| Rate for Payer: One Health Plan of WY PPO |
$23.47
|
| Rate for Payer: PacificSource Commercial |
$21.56
|
| Rate for Payer: PHCS PPO |
$23.47
|
| Rate for Payer: Three Rivers PPO |
$17.96
|
| Rate for Payer: TriWest Veterans Administration |
$13.65
|
| Rate for Payer: United Healthcare Commercial |
$22.87
|
| Rate for Payer: United Healthcare Medicare |
$13.65
|
| Rate for Payer: WINHealth Partners Commercial |
$23.47
|
| Rate for Payer: Wise Provider Network Commercial |
$22.75
|
|
|
CHOLANGIOGRAM CATH 20018-M55
|
Facility
|
OP
|
$106.26
|
|
| Hospital Charge Code |
2650724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.13
|
| Rate for Payer: Aetna of WY Medicare |
$70.13
|
| Rate for Payer: Altius Commercial |
$102.01
|
| Rate for Payer: Beech Street Commercial |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.07
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.07
|
| Rate for Payer: Cigna of WY Commercial |
$104.13
|
| Rate for Payer: Entrust Commercial |
$100.95
|
| Rate for Payer: First Choice Health Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.57
|
| Rate for Payer: HealthUtah PPO |
$106.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.07
|
| Rate for Payer: Multiplan Medicare/VA |
$57.54
|
| Rate for Payer: One Health Plan of WY PPO |
$104.13
|
| Rate for Payer: PacificSource Commercial |
$95.63
|
| Rate for Payer: PHCS PPO |
$104.13
|
| Rate for Payer: Three Rivers PPO |
$79.70
|
| Rate for Payer: TriWest Veterans Administration |
$60.57
|
| Rate for Payer: United Healthcare Commercial |
$101.48
|
| Rate for Payer: United Healthcare Medicare |
$60.57
|
| Rate for Payer: WINHealth Partners Commercial |
$104.13
|
| Rate for Payer: Wise Provider Network Commercial |
$100.95
|
|
|
CHOLANGIOGRAM CATH 20018-M55
|
Facility
|
IP
|
$106.26
|
|
| Hospital Charge Code |
2650724
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.58 |
| Max. Negotiated Rate |
$106.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$104.13
|
| Rate for Payer: Aetna of WY Medicare |
$68.01
|
| Rate for Payer: Altius Commercial |
$102.01
|
| Rate for Payer: Beech Street Commercial |
$104.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$103.07
|
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$103.07
|
| Rate for Payer: Cigna of WY Commercial |
$104.13
|
| Rate for Payer: Entrust Commercial |
$100.95
|
| Rate for Payer: First Choice Health Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.82
|
| Rate for Payer: HealthUtah PPO |
$106.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$103.07
|
| Rate for Payer: Multiplan Medicare/VA |
$61.58
|
| Rate for Payer: One Health Plan of WY PPO |
$104.13
|
| Rate for Payer: PacificSource Commercial |
$95.63
|
| Rate for Payer: PHCS PPO |
$104.13
|
| Rate for Payer: Three Rivers PPO |
$79.70
|
| Rate for Payer: TriWest Veterans Administration |
$64.82
|
| Rate for Payer: United Healthcare Commercial |
$101.48
|
| Rate for Payer: United Healthcare Medicare |
$64.82
|
| Rate for Payer: WINHealth Partners Commercial |
$100.95
|
| Rate for Payer: Wise Provider Network Commercial |
$100.95
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [19133]
|
Facility
|
IP
|
$15.94
|
|
|
Service Code
|
NDC 5026886311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.62
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Commercial |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.46
|
| Rate for Payer: Cigna of WY Commercial |
$15.62
|
| Rate for Payer: Entrust Commercial |
$15.14
|
| Rate for Payer: First Choice Health Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$15.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.24
|
| Rate for Payer: One Health Plan of WY PPO |
$15.62
|
| Rate for Payer: PacificSource Commercial |
$14.35
|
| Rate for Payer: PHCS PPO |
$15.62
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$15.14
|
| Rate for Payer: Wise Provider Network Commercial |
$15.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [19133]
|
Facility
|
OP
|
$15.94
|
|
|
Service Code
|
NDC 5026886311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.62
|
| Rate for Payer: Aetna of WY Medicare |
$10.52
|
| Rate for Payer: Altius Commercial |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.46
|
| Rate for Payer: Cigna of WY Commercial |
$15.62
|
| Rate for Payer: Entrust Commercial |
$15.14
|
| Rate for Payer: First Choice Health Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$15.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.46
|
| Rate for Payer: Multiplan Medicare/VA |
$8.63
|
| Rate for Payer: One Health Plan of WY PPO |
$15.62
|
| Rate for Payer: PacificSource Commercial |
$14.35
|
| Rate for Payer: PHCS PPO |
$15.62
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.62
|
| Rate for Payer: Wise Provider Network Commercial |
$15.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [19133]
|
Facility
|
IP
|
$15.94
|
|
|
Service Code
|
NDC 5026886315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.62
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Commercial |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.46
|
| Rate for Payer: Cigna of WY Commercial |
$15.62
|
| Rate for Payer: Entrust Commercial |
$15.14
|
| Rate for Payer: First Choice Health Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$15.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.46
|
| Rate for Payer: Multiplan Medicare/VA |
$9.24
|
| Rate for Payer: One Health Plan of WY PPO |
$15.62
|
| Rate for Payer: PacificSource Commercial |
$14.35
|
| Rate for Payer: PHCS PPO |
$15.62
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$15.14
|
| Rate for Payer: Wise Provider Network Commercial |
$15.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET [19133]
|
Facility
|
OP
|
$15.94
|
|
|
Service Code
|
NDC 5026886315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.62
|
| Rate for Payer: Aetna of WY Medicare |
$10.52
|
| Rate for Payer: Altius Commercial |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$15.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.46
|
| Rate for Payer: Cigna of WY Commercial |
$15.62
|
| Rate for Payer: Entrust Commercial |
$15.14
|
| Rate for Payer: First Choice Health Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.09
|
| Rate for Payer: HealthUtah PPO |
$15.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.46
|
| Rate for Payer: Multiplan Medicare/VA |
$8.63
|
| Rate for Payer: One Health Plan of WY PPO |
$15.62
|
| Rate for Payer: PacificSource Commercial |
$14.35
|
| Rate for Payer: PHCS PPO |
$15.62
|
| Rate for Payer: Three Rivers PPO |
$11.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.09
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$9.09
|
| Rate for Payer: WINHealth Partners Commercial |
$15.62
|
| Rate for Payer: Wise Provider Network Commercial |
$15.14
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 5026886815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Commercial |
$15.60
|
| Rate for Payer: Beech Street Commercial |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.76
|
| Rate for Payer: Cigna of WY Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.44
|
| Rate for Payer: First Choice Health Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$16.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.76
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$15.92
|
| Rate for Payer: PacificSource Commercial |
$14.62
|
| Rate for Payer: PHCS PPO |
$15.92
|
| Rate for Payer: Three Rivers PPO |
$12.19
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$15.52
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$15.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
IP
|
$16.25
|
|
|
Service Code
|
NDC 5026886811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Commercial |
$15.60
|
| Rate for Payer: Beech Street Commercial |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.76
|
| Rate for Payer: Cigna of WY Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.44
|
| Rate for Payer: First Choice Health Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.91
|
| Rate for Payer: HealthUtah PPO |
$16.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.76
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: One Health Plan of WY PPO |
$15.92
|
| Rate for Payer: PacificSource Commercial |
$14.62
|
| Rate for Payer: PHCS PPO |
$15.92
|
| Rate for Payer: Three Rivers PPO |
$12.19
|
| Rate for Payer: TriWest Veterans Administration |
$9.91
|
| Rate for Payer: United Healthcare Commercial |
$15.52
|
| Rate for Payer: United Healthcare Medicare |
$9.91
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$15.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 5026886815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.72
|
| Rate for Payer: Altius Commercial |
$15.60
|
| Rate for Payer: Beech Street Commercial |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.76
|
| Rate for Payer: Cigna of WY Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.44
|
| Rate for Payer: First Choice Health Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.26
|
| Rate for Payer: HealthUtah PPO |
$16.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.80
|
| Rate for Payer: One Health Plan of WY PPO |
$15.92
|
| Rate for Payer: PacificSource Commercial |
$14.62
|
| Rate for Payer: PHCS PPO |
$15.92
|
| Rate for Payer: Three Rivers PPO |
$12.19
|
| Rate for Payer: TriWest Veterans Administration |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$15.52
|
| Rate for Payer: United Healthcare Medicare |
$9.26
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [19327]
|
Facility
|
OP
|
$16.25
|
|
|
Service Code
|
NDC 5026886811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.92
|
| Rate for Payer: Aetna of WY Medicare |
$10.72
|
| Rate for Payer: Altius Commercial |
$15.60
|
| Rate for Payer: Beech Street Commercial |
$15.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$11.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.76
|
| Rate for Payer: Cigna of WY Commercial |
$15.92
|
| Rate for Payer: Entrust Commercial |
$15.44
|
| Rate for Payer: First Choice Health Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.26
|
| Rate for Payer: HealthUtah PPO |
$16.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.76
|
| Rate for Payer: Multiplan Medicare/VA |
$8.80
|
| Rate for Payer: One Health Plan of WY PPO |
$15.92
|
| Rate for Payer: PacificSource Commercial |
$14.62
|
| Rate for Payer: PHCS PPO |
$15.92
|
| Rate for Payer: Three Rivers PPO |
$12.19
|
| Rate for Payer: TriWest Veterans Administration |
$9.26
|
| Rate for Payer: United Healthcare Commercial |
$15.52
|
| Rate for Payer: United Healthcare Medicare |
$9.26
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.44
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
IP
|
$15.15
|
|
|
Service Code
|
NDC 5026886611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.85
|
| Rate for Payer: Aetna of WY Medicare |
$9.70
|
| Rate for Payer: Altius Commercial |
$14.54
|
| Rate for Payer: Beech Street Commercial |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.70
|
| Rate for Payer: Cigna of WY Commercial |
$14.85
|
| Rate for Payer: Entrust Commercial |
$14.39
|
| Rate for Payer: First Choice Health Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.24
|
| Rate for Payer: HealthUtah PPO |
$15.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$14.85
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.85
|
| Rate for Payer: Three Rivers PPO |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$9.24
|
| Rate for Payer: United Healthcare Commercial |
$14.47
|
| Rate for Payer: United Healthcare Medicare |
$9.24
|
| Rate for Payer: WINHealth Partners Commercial |
$14.39
|
| Rate for Payer: Wise Provider Network Commercial |
$14.39
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
OP
|
$15.15
|
|
|
Service Code
|
NDC 5026886611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.85
|
| Rate for Payer: Aetna of WY Medicare |
$10.00
|
| Rate for Payer: Altius Commercial |
$14.54
|
| Rate for Payer: Beech Street Commercial |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.70
|
| Rate for Payer: Cigna of WY Commercial |
$14.85
|
| Rate for Payer: Entrust Commercial |
$14.39
|
| Rate for Payer: First Choice Health Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$15.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.20
|
| Rate for Payer: One Health Plan of WY PPO |
$14.85
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.85
|
| Rate for Payer: Three Rivers PPO |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$14.47
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$14.85
|
| Rate for Payer: Wise Provider Network Commercial |
$14.39
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
IP
|
$16.08
|
|
|
Service Code
|
NDC 8770140752
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$16.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.29
|
| Rate for Payer: Altius Commercial |
$15.44
|
| Rate for Payer: Beech Street Commercial |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.60
|
| Rate for Payer: Cigna of WY Commercial |
$15.76
|
| Rate for Payer: Entrust Commercial |
$15.28
|
| Rate for Payer: First Choice Health Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
| Rate for Payer: HealthUtah PPO |
$16.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.60
|
| Rate for Payer: Multiplan Medicare/VA |
$9.32
|
| Rate for Payer: One Health Plan of WY PPO |
$15.76
|
| Rate for Payer: PacificSource Commercial |
$14.47
|
| Rate for Payer: PHCS PPO |
$15.76
|
| Rate for Payer: Three Rivers PPO |
$12.06
|
| Rate for Payer: TriWest Veterans Administration |
$9.81
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
| Rate for Payer: United Healthcare Medicare |
$9.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.28
|
| Rate for Payer: Wise Provider Network Commercial |
$15.28
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
OP
|
$16.08
|
|
|
Service Code
|
NDC 5026886615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$16.08 |
| Rate for Payer: United Healthcare Commercial |
$15.36
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.61
|
| Rate for Payer: Altius Commercial |
$15.44
|
| Rate for Payer: Beech Street Commercial |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.60
|
| Rate for Payer: Cigna of WY Commercial |
$15.76
|
| Rate for Payer: Entrust Commercial |
$15.28
|
| Rate for Payer: First Choice Health Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.17
|
| Rate for Payer: HealthUtah PPO |
$16.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.76
|
| Rate for Payer: PacificSource Commercial |
$14.47
|
| Rate for Payer: PHCS PPO |
$15.76
|
| Rate for Payer: Three Rivers PPO |
$12.06
|
| Rate for Payer: TriWest Veterans Administration |
$9.17
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
| Rate for Payer: WINHealth Partners Commercial |
$15.76
|
| Rate for Payer: Wise Provider Network Commercial |
$15.28
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
IP
|
$16.08
|
|
|
Service Code
|
NDC 5026886615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$16.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.29
|
| Rate for Payer: Altius Commercial |
$15.44
|
| Rate for Payer: Beech Street Commercial |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.60
|
| Rate for Payer: Cigna of WY Commercial |
$15.76
|
| Rate for Payer: Entrust Commercial |
$15.28
|
| Rate for Payer: First Choice Health Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.81
|
| Rate for Payer: HealthUtah PPO |
$16.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.60
|
| Rate for Payer: Multiplan Medicare/VA |
$9.32
|
| Rate for Payer: One Health Plan of WY PPO |
$15.76
|
| Rate for Payer: PacificSource Commercial |
$14.47
|
| Rate for Payer: PHCS PPO |
$15.76
|
| Rate for Payer: Three Rivers PPO |
$12.06
|
| Rate for Payer: TriWest Veterans Administration |
$9.81
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
| Rate for Payer: United Healthcare Medicare |
$9.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.28
|
| Rate for Payer: Wise Provider Network Commercial |
$15.28
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) TABLET [87117]
|
Facility
|
OP
|
$16.08
|
|
|
Service Code
|
NDC 8770140752
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$16.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.76
|
| Rate for Payer: Aetna of WY Medicare |
$10.61
|
| Rate for Payer: Altius Commercial |
$15.44
|
| Rate for Payer: Beech Street Commercial |
$15.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.60
|
| Rate for Payer: Cigna of WY Commercial |
$15.76
|
| Rate for Payer: Entrust Commercial |
$15.28
|
| Rate for Payer: First Choice Health Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.17
|
| Rate for Payer: HealthUtah PPO |
$16.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.76
|
| Rate for Payer: PacificSource Commercial |
$14.47
|
| Rate for Payer: PHCS PPO |
$15.76
|
| Rate for Payer: Three Rivers PPO |
$12.06
|
| Rate for Payer: TriWest Veterans Administration |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
| Rate for Payer: WINHealth Partners Commercial |
$15.76
|
| Rate for Payer: Wise Provider Network Commercial |
$15.28
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
OP
|
$15.16
|
|
|
Service Code
|
NDC 4098527139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.01
|
| Rate for Payer: Altius Commercial |
$14.55
|
| Rate for Payer: Beech Street Commercial |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.86
|
| Rate for Payer: Entrust Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$15.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$14.86
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.86
|
| Rate for Payer: Three Rivers PPO |
$11.37
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$14.48
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$14.86
|
| Rate for Payer: Wise Provider Network Commercial |
$14.40
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
IP
|
$15.16
|
|
|
Service Code
|
NDC 4098527139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.86
|
| Rate for Payer: Aetna of WY Medicare |
$9.70
|
| Rate for Payer: Altius Commercial |
$14.55
|
| Rate for Payer: Beech Street Commercial |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.86
|
| Rate for Payer: Entrust Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$15.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.79
|
| Rate for Payer: One Health Plan of WY PPO |
$14.86
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.86
|
| Rate for Payer: Three Rivers PPO |
$11.37
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$14.48
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$14.40
|
| Rate for Payer: Wise Provider Network Commercial |
$14.40
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 2055503300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Medicare |
$9.93
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.58
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.15
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$8.58
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$8.58
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 2055503300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.75
|
| Rate for Payer: Aetna of WY Medicare |
$9.63
|
| Rate for Payer: Altius Commercial |
$14.45
|
| Rate for Payer: Beech Street Commercial |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$10.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.60
|
| Rate for Payer: Cigna of WY Commercial |
$14.75
|
| Rate for Payer: Entrust Commercial |
$14.30
|
| Rate for Payer: First Choice Health Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.18
|
| Rate for Payer: HealthUtah PPO |
$15.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.72
|
| Rate for Payer: One Health Plan of WY PPO |
$14.75
|
| Rate for Payer: PacificSource Commercial |
$13.54
|
| Rate for Payer: PHCS PPO |
$14.75
|
| Rate for Payer: Three Rivers PPO |
$11.29
|
| Rate for Payer: TriWest Veterans Administration |
$9.18
|
| Rate for Payer: United Healthcare Commercial |
$14.37
|
| Rate for Payer: United Healthcare Medicare |
$9.18
|
| Rate for Payer: WINHealth Partners Commercial |
$14.30
|
| Rate for Payer: Wise Provider Network Commercial |
$14.30
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 47600 AS
|
| Min. Negotiated Rate |
$863.85 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,641.28
|
| Rate for Payer: Beech Street Commercial |
$4,499.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,593.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,641.28
|
| Rate for Payer: First Choice Health Commercial |
$4,262.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,499.20
|
| Rate for Payer: HealthUtah PPO |
$4,736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,593.92
|
| Rate for Payer: One Health Plan of WY PPO |
$4,641.28
|
| Rate for Payer: PacificSource Commercial |
$4,262.40
|
| Rate for Payer: PHCS PPO |
$4,499.20
|
| Rate for Payer: Three Rivers PPO |
$3,552.00
|
| Rate for Payer: United Healthcare Commercial |
$4,499.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,025.60
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$4,736.00
|
|
|
Service Code
|
HCPCS 47600
|
| Min. Negotiated Rate |
$863.85 |
| Max. Negotiated Rate |
$4,736.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,641.28
|
| Rate for Payer: Aetna of WY Medicare |
$1,016.29
|
| Rate for Payer: Beech Street Commercial |
$4,499.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,593.92
|
| Rate for Payer: Cigna of WY Commercial |
$4,641.28
|
| Rate for Payer: First Choice Health Commercial |
$4,262.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,499.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,016.29
|
| Rate for Payer: HealthUtah PPO |
$4,736.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,593.92
|
| Rate for Payer: Multiplan Medicare/VA |
$863.85
|
| Rate for Payer: One Health Plan of WY PPO |
$4,641.28
|
| Rate for Payer: PacificSource Commercial |
$4,262.40
|
| Rate for Payer: PHCS PPO |
$4,499.20
|
| Rate for Payer: Three Rivers PPO |
$3,552.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,016.29
|
| Rate for Payer: United Healthcare Commercial |
$4,499.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,025.60
|
|
