|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [2418]
|
Facility
|
IP
|
$15.38
|
|
|
Service Code
|
NDC 6068739583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$9.84
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.38
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.91
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$9.38
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$9.38
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [2418]
|
Facility
|
OP
|
$15.38
|
|
|
Service Code
|
NDC 6068739579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$10.15
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.77
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.33
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$8.77
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$8.77
|
| Rate for Payer: WINHealth Partners Commercial |
$15.07
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [2418]
|
Facility
|
IP
|
$15.38
|
|
|
Service Code
|
NDC 6068739579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$9.84
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.38
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.91
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$9.38
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$9.38
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [2418]
|
Facility
|
OP
|
$15.38
|
|
|
Service Code
|
NDC 6068739583
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$10.15
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.77
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.33
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$8.77
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$8.77
|
| Rate for Payer: WINHealth Partners Commercial |
$15.07
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
IP
|
$33.80
|
|
|
Service Code
|
NDC 6068766291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.12
|
| Rate for Payer: Aetna of WY Medicare |
$21.63
|
| Rate for Payer: Altius Commercial |
$32.45
|
| Rate for Payer: Beech Street Commercial |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.79
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.79
|
| Rate for Payer: Cigna of WY Commercial |
$33.12
|
| Rate for Payer: Entrust Commercial |
$32.11
|
| Rate for Payer: First Choice Health Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.62
|
| Rate for Payer: HealthUtah PPO |
$33.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.79
|
| Rate for Payer: Multiplan Medicare/VA |
$19.59
|
| Rate for Payer: One Health Plan of WY PPO |
$33.12
|
| Rate for Payer: PacificSource Commercial |
$30.42
|
| Rate for Payer: PHCS PPO |
$33.12
|
| Rate for Payer: Three Rivers PPO |
$25.35
|
| Rate for Payer: TriWest Veterans Administration |
$20.62
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: United Healthcare Medicare |
$20.62
|
| Rate for Payer: WINHealth Partners Commercial |
$32.11
|
| Rate for Payer: Wise Provider Network Commercial |
$32.11
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$33.80
|
|
|
Service Code
|
NDC 6068766291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.12
|
| Rate for Payer: Aetna of WY Medicare |
$22.31
|
| Rate for Payer: Altius Commercial |
$32.45
|
| Rate for Payer: Beech Street Commercial |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.79
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.79
|
| Rate for Payer: Cigna of WY Commercial |
$33.12
|
| Rate for Payer: Entrust Commercial |
$32.11
|
| Rate for Payer: First Choice Health Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.27
|
| Rate for Payer: HealthUtah PPO |
$33.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.79
|
| Rate for Payer: Multiplan Medicare/VA |
$18.30
|
| Rate for Payer: One Health Plan of WY PPO |
$33.12
|
| Rate for Payer: PacificSource Commercial |
$30.42
|
| Rate for Payer: PHCS PPO |
$33.12
|
| Rate for Payer: Three Rivers PPO |
$25.35
|
| Rate for Payer: TriWest Veterans Administration |
$19.27
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: United Healthcare Medicare |
$19.27
|
| Rate for Payer: WINHealth Partners Commercial |
$33.12
|
| Rate for Payer: Wise Provider Network Commercial |
$32.11
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$33.80
|
|
|
Service Code
|
NDC 0781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.12
|
| Rate for Payer: Aetna of WY Medicare |
$22.31
|
| Rate for Payer: Altius Commercial |
$32.45
|
| Rate for Payer: Beech Street Commercial |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.79
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.79
|
| Rate for Payer: Cigna of WY Commercial |
$33.12
|
| Rate for Payer: Entrust Commercial |
$32.11
|
| Rate for Payer: First Choice Health Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.27
|
| Rate for Payer: HealthUtah PPO |
$33.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.79
|
| Rate for Payer: Multiplan Medicare/VA |
$18.30
|
| Rate for Payer: One Health Plan of WY PPO |
$33.12
|
| Rate for Payer: PacificSource Commercial |
$30.42
|
| Rate for Payer: PHCS PPO |
$33.12
|
| Rate for Payer: Three Rivers PPO |
$25.35
|
| Rate for Payer: TriWest Veterans Administration |
$19.27
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: United Healthcare Medicare |
$19.27
|
| Rate for Payer: WINHealth Partners Commercial |
$33.12
|
| Rate for Payer: Wise Provider Network Commercial |
$32.11
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$28.99
|
|
|
Service Code
|
NDC 0173068224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: United Healthcare Commercial |
$27.69
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.41
|
| Rate for Payer: Aetna of WY Medicare |
$19.13
|
| Rate for Payer: Altius Commercial |
$27.83
|
| Rate for Payer: Beech Street Commercial |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$20.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.12
|
| Rate for Payer: Cigna of WY Commercial |
$28.41
|
| Rate for Payer: Entrust Commercial |
$27.54
|
| Rate for Payer: First Choice Health Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.52
|
| Rate for Payer: HealthUtah PPO |
$28.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.12
|
| Rate for Payer: Multiplan Medicare/VA |
$15.70
|
| Rate for Payer: One Health Plan of WY PPO |
$28.41
|
| Rate for Payer: PacificSource Commercial |
$26.09
|
| Rate for Payer: PHCS PPO |
$28.41
|
| Rate for Payer: Three Rivers PPO |
$21.74
|
| Rate for Payer: TriWest Veterans Administration |
$16.52
|
| Rate for Payer: United Healthcare Medicare |
$16.52
|
| Rate for Payer: WINHealth Partners Commercial |
$28.41
|
| Rate for Payer: Wise Provider Network Commercial |
$27.54
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$25.65
|
|
|
Service Code
|
NDC 0054074287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.14
|
| Rate for Payer: Aetna of WY Medicare |
$16.93
|
| Rate for Payer: Altius Commercial |
$24.62
|
| Rate for Payer: Beech Street Commercial |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.88
|
| Rate for Payer: Cigna of WY Commercial |
$25.14
|
| Rate for Payer: Entrust Commercial |
$24.37
|
| Rate for Payer: First Choice Health Commercial |
$24.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.62
|
| Rate for Payer: HealthUtah PPO |
$25.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.88
|
| Rate for Payer: Multiplan Medicare/VA |
$13.89
|
| Rate for Payer: One Health Plan of WY PPO |
$25.14
|
| Rate for Payer: PacificSource Commercial |
$23.08
|
| Rate for Payer: PHCS PPO |
$25.14
|
| Rate for Payer: Three Rivers PPO |
$19.24
|
| Rate for Payer: TriWest Veterans Administration |
$14.62
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare |
$14.62
|
| Rate for Payer: WINHealth Partners Commercial |
$25.14
|
| Rate for Payer: Wise Provider Network Commercial |
$24.37
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
IP
|
$28.99
|
|
|
Service Code
|
NDC 0173068224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$28.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.41
|
| Rate for Payer: Aetna of WY Medicare |
$18.55
|
| Rate for Payer: Altius Commercial |
$27.83
|
| Rate for Payer: Beech Street Commercial |
$28.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.12
|
| Rate for Payer: Cash Price |
$20.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.12
|
| Rate for Payer: Cigna of WY Commercial |
$28.41
|
| Rate for Payer: Entrust Commercial |
$27.54
|
| Rate for Payer: First Choice Health Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.68
|
| Rate for Payer: HealthUtah PPO |
$28.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.12
|
| Rate for Payer: Multiplan Medicare/VA |
$16.80
|
| Rate for Payer: One Health Plan of WY PPO |
$28.41
|
| Rate for Payer: PacificSource Commercial |
$26.09
|
| Rate for Payer: PHCS PPO |
$28.41
|
| Rate for Payer: Three Rivers PPO |
$21.74
|
| Rate for Payer: TriWest Veterans Administration |
$17.68
|
| Rate for Payer: United Healthcare Commercial |
$27.69
|
| Rate for Payer: United Healthcare Medicare |
$17.68
|
| Rate for Payer: WINHealth Partners Commercial |
$27.54
|
| Rate for Payer: Wise Provider Network Commercial |
$27.54
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
IP
|
$25.65
|
|
|
Service Code
|
NDC 0054074287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.14
|
| Rate for Payer: Aetna of WY Medicare |
$16.42
|
| Rate for Payer: Altius Commercial |
$24.62
|
| Rate for Payer: Beech Street Commercial |
$25.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.88
|
| Rate for Payer: Cigna of WY Commercial |
$25.14
|
| Rate for Payer: Entrust Commercial |
$24.37
|
| Rate for Payer: First Choice Health Commercial |
$24.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.65
|
| Rate for Payer: HealthUtah PPO |
$25.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.88
|
| Rate for Payer: Multiplan Medicare/VA |
$14.86
|
| Rate for Payer: One Health Plan of WY PPO |
$25.14
|
| Rate for Payer: PacificSource Commercial |
$23.08
|
| Rate for Payer: PHCS PPO |
$25.14
|
| Rate for Payer: Three Rivers PPO |
$19.24
|
| Rate for Payer: TriWest Veterans Administration |
$15.65
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare |
$15.65
|
| Rate for Payer: WINHealth Partners Commercial |
$24.37
|
| Rate for Payer: Wise Provider Network Commercial |
$24.37
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
IP
|
$33.80
|
|
|
Service Code
|
NDC 0781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.12
|
| Rate for Payer: Aetna of WY Medicare |
$21.63
|
| Rate for Payer: Altius Commercial |
$32.45
|
| Rate for Payer: Beech Street Commercial |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.79
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.79
|
| Rate for Payer: Cigna of WY Commercial |
$33.12
|
| Rate for Payer: Entrust Commercial |
$32.11
|
| Rate for Payer: First Choice Health Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.62
|
| Rate for Payer: HealthUtah PPO |
$33.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.79
|
| Rate for Payer: Multiplan Medicare/VA |
$19.59
|
| Rate for Payer: One Health Plan of WY PPO |
$33.12
|
| Rate for Payer: PacificSource Commercial |
$30.42
|
| Rate for Payer: PHCS PPO |
$33.12
|
| Rate for Payer: Three Rivers PPO |
$25.35
|
| Rate for Payer: TriWest Veterans Administration |
$20.62
|
| Rate for Payer: United Healthcare Commercial |
$32.28
|
| Rate for Payer: United Healthcare Medicare |
$20.62
|
| Rate for Payer: WINHealth Partners Commercial |
$32.11
|
| Rate for Payer: Wise Provider Network Commercial |
$32.11
|
|
|
ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.28
|
| Rate for Payer: Beech Street Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.92
|
| Rate for Payer: Cigna of WY Commercial |
$35.28
|
| Rate for Payer: First Choice Health Commercial |
$32.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.20
|
| Rate for Payer: HealthUtah PPO |
$36.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.92
|
| Rate for Payer: One Health Plan of WY PPO |
$35.28
|
| Rate for Payer: PacificSource Commercial |
$32.40
|
| Rate for Payer: PHCS PPO |
$34.20
|
| Rate for Payer: Three Rivers PPO |
$27.00
|
| Rate for Payer: United Healthcare Commercial |
$34.20
|
| Rate for Payer: WINHealth Partners Commercial |
$34.20
|
|
|
ALENDRONATE 70 MG TABLET [4785]
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
NDC 6498034214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Aetna of WY Medicare |
$11.20
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.98
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.68
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Multiplan Medicare/VA |
$10.14
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.68
|
| Rate for Payer: United Healthcare Commercial |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$10.68
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ALENDRONATE 70 MG TABLET [4785]
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
NDC 6498034214
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Aetna of WY Medicare |
$11.55
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.98
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.98
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Multiplan Medicare/VA |
$9.48
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$9.98
|
| Rate for Payer: United Healthcare Commercial |
$16.71
|
| Rate for Payer: United Healthcare Medicare |
$9.98
|
| Rate for Payer: WINHealth Partners Commercial |
$17.15
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
ALEXIS O RETRACTOR XLARGE
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
2650595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.29 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$103.95
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.78
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$85.29
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$89.78
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$89.78
|
| Rate for Payer: WINHealth Partners Commercial |
$154.35
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
ALEXIS O RETRACTOR XLARGE
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
2650595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.27 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$100.80
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$152.78
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.08
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$91.27
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$96.08
|
| Rate for Payer: United Healthcare Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicare |
$96.08
|
| Rate for Payer: WINHealth Partners Commercial |
$149.62
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
ALLERGAN I BALLOON
|
Facility
|
IP
|
$472.50
|
|
| Hospital Charge Code |
2650567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.81 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$463.05
|
| Rate for Payer: Aetna of WY Medicare |
$302.40
|
| Rate for Payer: Altius Commercial |
$453.60
|
| Rate for Payer: Beech Street Commercial |
$463.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$458.32
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$458.32
|
| Rate for Payer: Cigna of WY Commercial |
$463.05
|
| Rate for Payer: Entrust Commercial |
$448.88
|
| Rate for Payer: First Choice Health Commercial |
$448.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$448.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$288.22
|
| Rate for Payer: HealthUtah PPO |
$472.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$458.32
|
| Rate for Payer: Multiplan Medicare/VA |
$273.81
|
| Rate for Payer: One Health Plan of WY PPO |
$463.05
|
| Rate for Payer: PacificSource Commercial |
$425.25
|
| Rate for Payer: PHCS PPO |
$463.05
|
| Rate for Payer: Three Rivers PPO |
$354.38
|
| Rate for Payer: TriWest Veterans Administration |
$288.22
|
| Rate for Payer: United Healthcare Commercial |
$451.24
|
| Rate for Payer: United Healthcare Medicare |
$288.22
|
| Rate for Payer: WINHealth Partners Commercial |
$448.88
|
| Rate for Payer: Wise Provider Network Commercial |
$448.88
|
|
|
ALLERGAN I BALLOON
|
Facility
|
OP
|
$472.50
|
|
| Hospital Charge Code |
2650567
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.86 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$463.05
|
| Rate for Payer: Aetna of WY Medicare |
$311.85
|
| Rate for Payer: Altius Commercial |
$453.60
|
| Rate for Payer: Beech Street Commercial |
$463.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$458.32
|
| Rate for Payer: Cash Price |
$330.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$458.32
|
| Rate for Payer: Cigna of WY Commercial |
$463.05
|
| Rate for Payer: Entrust Commercial |
$448.88
|
| Rate for Payer: First Choice Health Commercial |
$448.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$448.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$269.32
|
| Rate for Payer: HealthUtah PPO |
$472.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$458.32
|
| Rate for Payer: Multiplan Medicare/VA |
$255.86
|
| Rate for Payer: One Health Plan of WY PPO |
$463.05
|
| Rate for Payer: PacificSource Commercial |
$425.25
|
| Rate for Payer: PHCS PPO |
$463.05
|
| Rate for Payer: Three Rivers PPO |
$354.38
|
| Rate for Payer: TriWest Veterans Administration |
$269.32
|
| Rate for Payer: United Healthcare Commercial |
$451.24
|
| Rate for Payer: United Healthcare Medicare |
$269.32
|
| Rate for Payer: WINHealth Partners Commercial |
$463.05
|
| Rate for Payer: Wise Provider Network Commercial |
$448.88
|
|
|
ALLERGAN TISSUE EXPAND 133MX-
|
Facility
|
IP
|
$4,357.50
|
|
| Hospital Charge Code |
2650910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,525.17 |
| Max. Negotiated Rate |
$4,357.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,270.35
|
| Rate for Payer: Aetna of WY Medicare |
$2,788.80
|
| Rate for Payer: Altius Commercial |
$4,183.20
|
| Rate for Payer: Beech Street Commercial |
$4,270.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,226.78
|
| Rate for Payer: Cash Price |
$3,050.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,226.78
|
| Rate for Payer: Cigna of WY Commercial |
$4,270.35
|
| Rate for Payer: Entrust Commercial |
$4,139.62
|
| Rate for Payer: First Choice Health Commercial |
$4,139.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,139.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,658.08
|
| Rate for Payer: HealthUtah PPO |
$4,357.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,226.78
|
| Rate for Payer: Multiplan Medicare/VA |
$2,525.17
|
| Rate for Payer: One Health Plan of WY PPO |
$4,270.35
|
| Rate for Payer: PacificSource Commercial |
$3,921.75
|
| Rate for Payer: PHCS PPO |
$4,270.35
|
| Rate for Payer: Three Rivers PPO |
$3,268.12
|
| Rate for Payer: TriWest Veterans Administration |
$2,658.08
|
| Rate for Payer: United Healthcare Commercial |
$4,161.41
|
| Rate for Payer: United Healthcare Medicare |
$2,658.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4,139.62
|
| Rate for Payer: Wise Provider Network Commercial |
$4,139.62
|
|
|
ALLERGAN TISSUE EXPAND 133MX-
|
Facility
|
OP
|
$4,357.50
|
|
| Hospital Charge Code |
2650910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.59 |
| Max. Negotiated Rate |
$4,357.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,270.35
|
| Rate for Payer: Aetna of WY Medicare |
$2,875.95
|
| Rate for Payer: Altius Commercial |
$4,183.20
|
| Rate for Payer: Beech Street Commercial |
$4,270.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,226.78
|
| Rate for Payer: Cash Price |
$3,050.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,226.78
|
| Rate for Payer: Cigna of WY Commercial |
$4,270.35
|
| Rate for Payer: Entrust Commercial |
$4,139.62
|
| Rate for Payer: First Choice Health Commercial |
$4,139.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,139.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,483.78
|
| Rate for Payer: HealthUtah PPO |
$4,357.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,226.78
|
| Rate for Payer: Multiplan Medicare/VA |
$2,359.59
|
| Rate for Payer: One Health Plan of WY PPO |
$4,270.35
|
| Rate for Payer: PacificSource Commercial |
$3,921.75
|
| Rate for Payer: PHCS PPO |
$4,270.35
|
| Rate for Payer: Three Rivers PPO |
$3,268.12
|
| Rate for Payer: TriWest Veterans Administration |
$2,483.78
|
| Rate for Payer: United Healthcare Commercial |
$4,161.41
|
| Rate for Payer: United Healthcare Medicare |
$2,483.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,270.35
|
| Rate for Payer: Wise Provider Network Commercial |
$4,139.62
|
|
|
ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 86003
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$5.22
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.22
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$4.44
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$45.60
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
ALLODERM DERMAL CL1516P
|
Facility
|
IP
|
$18,685.62
|
|
| Hospital Charge Code |
2650912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,828.32 |
| Max. Negotiated Rate |
$18,685.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18,311.91
|
| Rate for Payer: Aetna of WY Medicare |
$11,958.80
|
| Rate for Payer: Altius Commercial |
$17,938.20
|
| Rate for Payer: Beech Street Commercial |
$18,311.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18,125.05
|
| Rate for Payer: Cash Price |
$13,079.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$18,125.05
|
| Rate for Payer: Cigna of WY Commercial |
$18,311.91
|
| Rate for Payer: Entrust Commercial |
$17,751.34
|
| Rate for Payer: First Choice Health Commercial |
$17,751.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17,751.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11,398.23
|
| Rate for Payer: HealthUtah PPO |
$18,685.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18,125.05
|
| Rate for Payer: Multiplan Medicare/VA |
$10,828.32
|
| Rate for Payer: One Health Plan of WY PPO |
$18,311.91
|
| Rate for Payer: PacificSource Commercial |
$16,817.06
|
| Rate for Payer: PHCS PPO |
$18,311.91
|
| Rate for Payer: Three Rivers PPO |
$14,014.22
|
| Rate for Payer: TriWest Veterans Administration |
$11,398.23
|
| Rate for Payer: United Healthcare Commercial |
$17,844.77
|
| Rate for Payer: United Healthcare Medicare |
$11,398.23
|
| Rate for Payer: WINHealth Partners Commercial |
$17,751.34
|
| Rate for Payer: Wise Provider Network Commercial |
$17,751.34
|
|
|
ALLODERM DERMAL CL1516P
|
Facility
|
OP
|
$18,685.62
|
|
| Hospital Charge Code |
2650912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,118.26 |
| Max. Negotiated Rate |
$18,685.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18,311.91
|
| Rate for Payer: Aetna of WY Medicare |
$12,332.51
|
| Rate for Payer: Altius Commercial |
$17,938.20
|
| Rate for Payer: Beech Street Commercial |
$18,311.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18,125.05
|
| Rate for Payer: Cash Price |
$13,079.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$18,125.05
|
| Rate for Payer: Cigna of WY Commercial |
$18,311.91
|
| Rate for Payer: Entrust Commercial |
$17,751.34
|
| Rate for Payer: First Choice Health Commercial |
$17,751.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17,751.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10,650.80
|
| Rate for Payer: HealthUtah PPO |
$18,685.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18,125.05
|
| Rate for Payer: Multiplan Medicare/VA |
$10,118.26
|
| Rate for Payer: One Health Plan of WY PPO |
$18,311.91
|
| Rate for Payer: PacificSource Commercial |
$16,817.06
|
| Rate for Payer: PHCS PPO |
$18,311.91
|
| Rate for Payer: Three Rivers PPO |
$14,014.22
|
| Rate for Payer: TriWest Veterans Administration |
$10,650.80
|
| Rate for Payer: United Healthcare Commercial |
$17,844.77
|
| Rate for Payer: United Healthcare Medicare |
$10,650.80
|
| Rate for Payer: WINHealth Partners Commercial |
$18,311.91
|
| Rate for Payer: Wise Provider Network Commercial |
$17,751.34
|
|
|
ALLODERM DERMAL RL1518P
|
Facility
|
IP
|
$57,592.50
|
|
| Hospital Charge Code |
2650911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33,374.85 |
| Max. Negotiated Rate |
$57,592.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56,440.65
|
| Rate for Payer: Aetna of WY Medicare |
$36,859.20
|
| Rate for Payer: Altius Commercial |
$55,288.80
|
| Rate for Payer: Beech Street Commercial |
$56,440.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$55,864.72
|
| Rate for Payer: Cash Price |
$40,314.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$55,864.72
|
| Rate for Payer: Cigna of WY Commercial |
$56,440.65
|
| Rate for Payer: Entrust Commercial |
$54,712.88
|
| Rate for Payer: First Choice Health Commercial |
$54,712.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54,712.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35,131.42
|
| Rate for Payer: HealthUtah PPO |
$57,592.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55,864.72
|
| Rate for Payer: Multiplan Medicare/VA |
$33,374.85
|
| Rate for Payer: One Health Plan of WY PPO |
$56,440.65
|
| Rate for Payer: PacificSource Commercial |
$51,833.25
|
| Rate for Payer: PHCS PPO |
$56,440.65
|
| Rate for Payer: Three Rivers PPO |
$43,194.38
|
| Rate for Payer: TriWest Veterans Administration |
$35,131.42
|
| Rate for Payer: United Healthcare Commercial |
$55,000.84
|
| Rate for Payer: United Healthcare Medicare |
$35,131.42
|
| Rate for Payer: WINHealth Partners Commercial |
$54,712.88
|
| Rate for Payer: Wise Provider Network Commercial |
$54,712.88
|
|
