|
ALLOPURINOL 100 MG TABLET [7409]
|
Facility
|
IP
|
$16.66
|
|
|
Service Code
|
NDC 6068767711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$16.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.33
|
| Rate for Payer: Aetna of WY Medicare |
$10.66
|
| Rate for Payer: Altius Commercial |
$15.99
|
| Rate for Payer: Beech Street Commercial |
$16.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.16
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.16
|
| Rate for Payer: Cigna of WY Commercial |
$16.33
|
| Rate for Payer: Entrust Commercial |
$15.83
|
| Rate for Payer: First Choice Health Commercial |
$15.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.16
|
| Rate for Payer: HealthUtah PPO |
$16.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.16
|
| Rate for Payer: Multiplan Medicare/VA |
$9.65
|
| Rate for Payer: One Health Plan of WY PPO |
$16.33
|
| Rate for Payer: PacificSource Commercial |
$14.99
|
| Rate for Payer: PHCS PPO |
$16.33
|
| Rate for Payer: Three Rivers PPO |
$12.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.16
|
| Rate for Payer: United Healthcare Commercial |
$15.91
|
| Rate for Payer: United Healthcare Medicare |
$10.16
|
| Rate for Payer: WINHealth Partners Commercial |
$15.83
|
| Rate for Payer: Wise Provider Network Commercial |
$15.83
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$17.94
|
|
|
Service Code
|
NDC 6068768811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.58
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Altius Commercial |
$17.22
|
| Rate for Payer: Beech Street Commercial |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.40
|
| Rate for Payer: Cigna of WY Commercial |
$17.58
|
| Rate for Payer: Entrust Commercial |
$17.04
|
| Rate for Payer: First Choice Health Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.94
|
| Rate for Payer: HealthUtah PPO |
$17.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.40
|
| Rate for Payer: Multiplan Medicare/VA |
$10.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.58
|
| Rate for Payer: PacificSource Commercial |
$16.15
|
| Rate for Payer: PHCS PPO |
$17.58
|
| Rate for Payer: Three Rivers PPO |
$13.46
|
| Rate for Payer: TriWest Veterans Administration |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$17.13
|
| Rate for Payer: United Healthcare Medicare |
$10.94
|
| Rate for Payer: WINHealth Partners Commercial |
$17.04
|
| Rate for Payer: Wise Provider Network Commercial |
$17.04
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$17.94
|
|
|
Service Code
|
NDC 6068768811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.58
|
| Rate for Payer: Aetna of WY Medicare |
$11.84
|
| Rate for Payer: Altius Commercial |
$17.22
|
| Rate for Payer: Beech Street Commercial |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.40
|
| Rate for Payer: Cigna of WY Commercial |
$17.58
|
| Rate for Payer: Entrust Commercial |
$17.04
|
| Rate for Payer: First Choice Health Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.23
|
| Rate for Payer: HealthUtah PPO |
$17.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$17.58
|
| Rate for Payer: PacificSource Commercial |
$16.15
|
| Rate for Payer: PHCS PPO |
$17.58
|
| Rate for Payer: Three Rivers PPO |
$13.46
|
| Rate for Payer: TriWest Veterans Administration |
$10.23
|
| Rate for Payer: United Healthcare Commercial |
$17.13
|
| Rate for Payer: United Healthcare Medicare |
$10.23
|
| Rate for Payer: WINHealth Partners Commercial |
$17.58
|
| Rate for Payer: Wise Provider Network Commercial |
$17.04
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 0378018101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.48
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Altius Commercial |
$15.17
|
| Rate for Payer: Beech Street Commercial |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.33
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.33
|
| Rate for Payer: Cigna of WY Commercial |
$15.48
|
| Rate for Payer: Entrust Commercial |
$15.01
|
| Rate for Payer: First Choice Health Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.64
|
| Rate for Payer: HealthUtah PPO |
$15.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.33
|
| Rate for Payer: Multiplan Medicare/VA |
$9.16
|
| Rate for Payer: One Health Plan of WY PPO |
$15.48
|
| Rate for Payer: PacificSource Commercial |
$14.22
|
| Rate for Payer: PHCS PPO |
$15.48
|
| Rate for Payer: Three Rivers PPO |
$11.85
|
| Rate for Payer: TriWest Veterans Administration |
$9.64
|
| Rate for Payer: United Healthcare Commercial |
$15.09
|
| Rate for Payer: United Healthcare Medicare |
$9.64
|
| Rate for Payer: WINHealth Partners Commercial |
$15.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.01
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$17.28
|
|
|
Service Code
|
NDC 2315569405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.93
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Commercial |
$16.59
|
| Rate for Payer: Beech Street Commercial |
$16.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.76
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.76
|
| Rate for Payer: Cigna of WY Commercial |
$16.93
|
| Rate for Payer: Entrust Commercial |
$16.42
|
| Rate for Payer: First Choice Health Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.54
|
| Rate for Payer: HealthUtah PPO |
$17.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.76
|
| Rate for Payer: Multiplan Medicare/VA |
$10.01
|
| Rate for Payer: One Health Plan of WY PPO |
$16.93
|
| Rate for Payer: PacificSource Commercial |
$15.55
|
| Rate for Payer: PHCS PPO |
$16.93
|
| Rate for Payer: Three Rivers PPO |
$12.96
|
| Rate for Payer: TriWest Veterans Administration |
$10.54
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$10.54
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$16.42
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$17.94
|
|
|
Service Code
|
NDC 6068768801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.58
|
| Rate for Payer: Aetna of WY Medicare |
$11.84
|
| Rate for Payer: Altius Commercial |
$17.22
|
| Rate for Payer: Beech Street Commercial |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.40
|
| Rate for Payer: Cigna of WY Commercial |
$17.58
|
| Rate for Payer: Entrust Commercial |
$17.04
|
| Rate for Payer: First Choice Health Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.23
|
| Rate for Payer: HealthUtah PPO |
$17.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$17.58
|
| Rate for Payer: PacificSource Commercial |
$16.15
|
| Rate for Payer: PHCS PPO |
$17.58
|
| Rate for Payer: Three Rivers PPO |
$13.46
|
| Rate for Payer: TriWest Veterans Administration |
$10.23
|
| Rate for Payer: United Healthcare Commercial |
$17.13
|
| Rate for Payer: United Healthcare Medicare |
$10.23
|
| Rate for Payer: WINHealth Partners Commercial |
$17.58
|
| Rate for Payer: Wise Provider Network Commercial |
$17.04
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 0378018101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.48
|
| Rate for Payer: Aetna of WY Medicare |
$10.43
|
| Rate for Payer: Altius Commercial |
$15.17
|
| Rate for Payer: Beech Street Commercial |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.33
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.33
|
| Rate for Payer: Cigna of WY Commercial |
$15.48
|
| Rate for Payer: Entrust Commercial |
$15.01
|
| Rate for Payer: First Choice Health Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.01
|
| Rate for Payer: HealthUtah PPO |
$15.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.33
|
| Rate for Payer: Multiplan Medicare/VA |
$8.56
|
| Rate for Payer: One Health Plan of WY PPO |
$15.48
|
| Rate for Payer: PacificSource Commercial |
$14.22
|
| Rate for Payer: PHCS PPO |
$15.48
|
| Rate for Payer: Three Rivers PPO |
$11.85
|
| Rate for Payer: TriWest Veterans Administration |
$9.01
|
| Rate for Payer: United Healthcare Commercial |
$15.09
|
| Rate for Payer: United Healthcare Medicare |
$9.01
|
| Rate for Payer: WINHealth Partners Commercial |
$15.48
|
| Rate for Payer: Wise Provider Network Commercial |
$15.01
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$17.28
|
|
|
Service Code
|
NDC 2315569405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.93
|
| Rate for Payer: Aetna of WY Medicare |
$11.40
|
| Rate for Payer: Altius Commercial |
$16.59
|
| Rate for Payer: Beech Street Commercial |
$16.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.76
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.76
|
| Rate for Payer: Cigna of WY Commercial |
$16.93
|
| Rate for Payer: Entrust Commercial |
$16.42
|
| Rate for Payer: First Choice Health Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.85
|
| Rate for Payer: HealthUtah PPO |
$17.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.76
|
| Rate for Payer: Multiplan Medicare/VA |
$9.36
|
| Rate for Payer: One Health Plan of WY PPO |
$16.93
|
| Rate for Payer: PacificSource Commercial |
$15.55
|
| Rate for Payer: PHCS PPO |
$16.93
|
| Rate for Payer: Three Rivers PPO |
$12.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.85
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$9.85
|
| Rate for Payer: WINHealth Partners Commercial |
$16.93
|
| Rate for Payer: Wise Provider Network Commercial |
$16.42
|
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$17.94
|
|
|
Service Code
|
NDC 6068768801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.58
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Altius Commercial |
$17.22
|
| Rate for Payer: Beech Street Commercial |
$17.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.40
|
| Rate for Payer: Cigna of WY Commercial |
$17.58
|
| Rate for Payer: Entrust Commercial |
$17.04
|
| Rate for Payer: First Choice Health Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.94
|
| Rate for Payer: HealthUtah PPO |
$17.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.40
|
| Rate for Payer: Multiplan Medicare/VA |
$10.40
|
| Rate for Payer: One Health Plan of WY PPO |
$17.58
|
| Rate for Payer: PacificSource Commercial |
$16.15
|
| Rate for Payer: PHCS PPO |
$17.58
|
| Rate for Payer: Three Rivers PPO |
$13.46
|
| Rate for Payer: TriWest Veterans Administration |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$17.13
|
| Rate for Payer: United Healthcare Medicare |
$10.94
|
| Rate for Payer: WINHealth Partners Commercial |
$17.04
|
| Rate for Payer: Wise Provider Network Commercial |
$17.04
|
|
|
ALLOSYNC EXPAND FIBERS 5CC
|
Facility
|
IP
|
$3,066.00
|
|
| Hospital Charge Code |
3004606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,776.75 |
| Max. Negotiated Rate |
$3,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,004.68
|
| Rate for Payer: Aetna of WY Medicare |
$1,962.24
|
| Rate for Payer: Altius Commercial |
$2,943.36
|
| Rate for Payer: Beech Street Commercial |
$3,004.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,974.02
|
| Rate for Payer: Cash Price |
$2,146.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,974.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,004.68
|
| Rate for Payer: Entrust Commercial |
$2,912.70
|
| Rate for Payer: First Choice Health Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,870.26
|
| Rate for Payer: HealthUtah PPO |
$3,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,974.02
|
| Rate for Payer: Multiplan Medicare/VA |
$1,776.75
|
| Rate for Payer: One Health Plan of WY PPO |
$3,004.68
|
| Rate for Payer: PacificSource Commercial |
$2,759.40
|
| Rate for Payer: PHCS PPO |
$3,004.68
|
| Rate for Payer: Three Rivers PPO |
$2,299.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,870.26
|
| Rate for Payer: United Healthcare Commercial |
$2,928.03
|
| Rate for Payer: United Healthcare Medicare |
$1,870.26
|
| Rate for Payer: WINHealth Partners Commercial |
$2,912.70
|
| Rate for Payer: Wise Provider Network Commercial |
$2,912.70
|
|
|
ALLOSYNC EXPAND FIBERS 5CC
|
Facility
|
OP
|
$3,066.00
|
|
| Hospital Charge Code |
3004606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,660.24 |
| Max. Negotiated Rate |
$3,066.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,004.68
|
| Rate for Payer: Aetna of WY Medicare |
$2,023.56
|
| Rate for Payer: Altius Commercial |
$2,943.36
|
| Rate for Payer: Beech Street Commercial |
$3,004.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,974.02
|
| Rate for Payer: Cash Price |
$2,146.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,974.02
|
| Rate for Payer: Cigna of WY Commercial |
$3,004.68
|
| Rate for Payer: Entrust Commercial |
$2,912.70
|
| Rate for Payer: First Choice Health Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,912.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,747.62
|
| Rate for Payer: HealthUtah PPO |
$3,066.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,974.02
|
| Rate for Payer: Multiplan Medicare/VA |
$1,660.24
|
| Rate for Payer: One Health Plan of WY PPO |
$3,004.68
|
| Rate for Payer: PacificSource Commercial |
$2,759.40
|
| Rate for Payer: PHCS PPO |
$3,004.68
|
| Rate for Payer: Three Rivers PPO |
$2,299.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,747.62
|
| Rate for Payer: United Healthcare Commercial |
$2,928.03
|
| Rate for Payer: United Healthcare Medicare |
$1,747.62
|
| Rate for Payer: WINHealth Partners Commercial |
$3,004.68
|
| Rate for Payer: Wise Provider Network Commercial |
$2,912.70
|
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION [151394]
|
Facility
|
IP
|
$17.28
|
|
|
Service Code
|
HCPCS J0256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.93
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Commercial |
$16.59
|
| Rate for Payer: Beech Street Commercial |
$16.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.76
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.76
|
| Rate for Payer: Cigna of WY Commercial |
$16.93
|
| Rate for Payer: Entrust Commercial |
$16.42
|
| Rate for Payer: First Choice Health Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.54
|
| Rate for Payer: HealthUtah PPO |
$17.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.76
|
| Rate for Payer: Multiplan Medicare/VA |
$10.01
|
| Rate for Payer: One Health Plan of WY PPO |
$16.93
|
| Rate for Payer: PacificSource Commercial |
$15.55
|
| Rate for Payer: PHCS PPO |
$16.93
|
| Rate for Payer: Three Rivers PPO |
$12.96
|
| Rate for Payer: TriWest Veterans Administration |
$10.54
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$10.54
|
| Rate for Payer: Wise Provider Network Commercial |
$16.42
|
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION [151394]
|
Facility
|
OP
|
$17.28
|
|
|
Service Code
|
HCPCS J0256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.93
|
| Rate for Payer: Aetna of WY Medicare |
$11.40
|
| Rate for Payer: Altius Commercial |
$16.59
|
| Rate for Payer: Beech Street Commercial |
$16.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.76
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.76
|
| Rate for Payer: Cigna of WY Commercial |
$16.93
|
| Rate for Payer: Entrust Commercial |
$16.42
|
| Rate for Payer: First Choice Health Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.85
|
| Rate for Payer: HealthUtah PPO |
$17.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.76
|
| Rate for Payer: Multiplan Medicare/VA |
$9.36
|
| Rate for Payer: One Health Plan of WY PPO |
$16.93
|
| Rate for Payer: PacificSource Commercial |
$15.55
|
| Rate for Payer: PHCS PPO |
$16.93
|
| Rate for Payer: Three Rivers PPO |
$12.96
|
| Rate for Payer: TriWest Veterans Administration |
$9.85
|
| Rate for Payer: United Healthcare Commercial |
$16.50
|
| Rate for Payer: United Healthcare Medicare |
$9.85
|
| Rate for Payer: WINHealth Partners Commercial |
$16.93
|
| Rate for Payer: Wise Provider Network Commercial |
$16.42
|
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
NDC 6068738811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.14
|
| Rate for Payer: Aetna of WY Medicare |
$10.54
|
| Rate for Payer: Altius Commercial |
$15.81
|
| Rate for Payer: Beech Street Commercial |
$16.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.98
|
| Rate for Payer: Cigna of WY Commercial |
$16.14
|
| Rate for Payer: Entrust Commercial |
$15.65
|
| Rate for Payer: First Choice Health Commercial |
$15.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$16.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.98
|
| Rate for Payer: Multiplan Medicare/VA |
$9.54
|
| Rate for Payer: One Health Plan of WY PPO |
$16.14
|
| Rate for Payer: PacificSource Commercial |
$14.82
|
| Rate for Payer: PHCS PPO |
$16.14
|
| Rate for Payer: Three Rivers PPO |
$12.35
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.73
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.65
|
| Rate for Payer: Wise Provider Network Commercial |
$15.65
|
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
NDC 0228202910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.90
|
| Rate for Payer: Aetna of WY Medicare |
$9.73
|
| Rate for Payer: Altius Commercial |
$14.59
|
| Rate for Payer: Beech Street Commercial |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.74
|
| Rate for Payer: Cigna of WY Commercial |
$14.90
|
| Rate for Payer: Entrust Commercial |
$14.44
|
| Rate for Payer: First Choice Health Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.27
|
| Rate for Payer: HealthUtah PPO |
$15.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.81
|
| Rate for Payer: One Health Plan of WY PPO |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$13.68
|
| Rate for Payer: PHCS PPO |
$14.90
|
| Rate for Payer: Three Rivers PPO |
$11.40
|
| Rate for Payer: TriWest Veterans Administration |
$9.27
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$9.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.44
|
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 0228202910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.03
|
| Rate for Payer: Altius Commercial |
$14.59
|
| Rate for Payer: Beech Street Commercial |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.74
|
| Rate for Payer: Cigna of WY Commercial |
$14.90
|
| Rate for Payer: Entrust Commercial |
$14.44
|
| Rate for Payer: First Choice Health Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$15.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$13.68
|
| Rate for Payer: PHCS PPO |
$14.90
|
| Rate for Payer: Three Rivers PPO |
$11.40
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$14.90
|
| Rate for Payer: Wise Provider Network Commercial |
$14.44
|
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
NDC 6068738811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.14
|
| Rate for Payer: Aetna of WY Medicare |
$10.87
|
| Rate for Payer: Altius Commercial |
$15.81
|
| Rate for Payer: Beech Street Commercial |
$16.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.98
|
| Rate for Payer: Cigna of WY Commercial |
$16.14
|
| Rate for Payer: Entrust Commercial |
$15.65
|
| Rate for Payer: First Choice Health Commercial |
$15.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$16.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.98
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$16.14
|
| Rate for Payer: PacificSource Commercial |
$14.82
|
| Rate for Payer: PHCS PPO |
$16.14
|
| Rate for Payer: Three Rivers PPO |
$12.35
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$15.73
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$16.14
|
| Rate for Payer: Wise Provider Network Commercial |
$15.65
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
OP
|
$234.43
|
|
|
Service Code
|
NDC 0009316906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.74
|
| Rate for Payer: Aetna of WY Medicare |
$154.72
|
| Rate for Payer: Altius Commercial |
$225.05
|
| Rate for Payer: Beech Street Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.40
|
| Rate for Payer: Cigna of WY Commercial |
$229.74
|
| Rate for Payer: Entrust Commercial |
$222.71
|
| Rate for Payer: First Choice Health Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.63
|
| Rate for Payer: HealthUtah PPO |
$234.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.40
|
| Rate for Payer: Multiplan Medicare/VA |
$126.94
|
| Rate for Payer: One Health Plan of WY PPO |
$229.74
|
| Rate for Payer: PacificSource Commercial |
$210.99
|
| Rate for Payer: PHCS PPO |
$229.74
|
| Rate for Payer: Three Rivers PPO |
$175.82
|
| Rate for Payer: TriWest Veterans Administration |
$133.63
|
| Rate for Payer: United Healthcare Commercial |
$223.88
|
| Rate for Payer: United Healthcare Medicare |
$133.63
|
| Rate for Payer: WINHealth Partners Commercial |
$229.74
|
| Rate for Payer: Wise Provider Network Commercial |
$222.71
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
IP
|
$234.43
|
|
|
Service Code
|
NDC 0009316906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.74
|
| Rate for Payer: Aetna of WY Medicare |
$150.04
|
| Rate for Payer: Altius Commercial |
$225.05
|
| Rate for Payer: Beech Street Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.40
|
| Rate for Payer: Cigna of WY Commercial |
$229.74
|
| Rate for Payer: Entrust Commercial |
$222.71
|
| Rate for Payer: First Choice Health Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.00
|
| Rate for Payer: HealthUtah PPO |
$234.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.40
|
| Rate for Payer: Multiplan Medicare/VA |
$135.85
|
| Rate for Payer: One Health Plan of WY PPO |
$229.74
|
| Rate for Payer: PacificSource Commercial |
$210.99
|
| Rate for Payer: PHCS PPO |
$229.74
|
| Rate for Payer: Three Rivers PPO |
$175.82
|
| Rate for Payer: TriWest Veterans Administration |
$143.00
|
| Rate for Payer: United Healthcare Commercial |
$223.88
|
| Rate for Payer: United Healthcare Medicare |
$143.00
|
| Rate for Payer: WINHealth Partners Commercial |
$222.71
|
| Rate for Payer: Wise Provider Network Commercial |
$222.71
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
IP
|
$234.43
|
|
|
Service Code
|
NDC 0009316901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.85 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.74
|
| Rate for Payer: Aetna of WY Medicare |
$150.04
|
| Rate for Payer: Altius Commercial |
$225.05
|
| Rate for Payer: Beech Street Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.40
|
| Rate for Payer: Cigna of WY Commercial |
$229.74
|
| Rate for Payer: Entrust Commercial |
$222.71
|
| Rate for Payer: First Choice Health Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.00
|
| Rate for Payer: HealthUtah PPO |
$234.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.40
|
| Rate for Payer: Multiplan Medicare/VA |
$135.85
|
| Rate for Payer: One Health Plan of WY PPO |
$229.74
|
| Rate for Payer: PacificSource Commercial |
$210.99
|
| Rate for Payer: PHCS PPO |
$229.74
|
| Rate for Payer: Three Rivers PPO |
$175.82
|
| Rate for Payer: TriWest Veterans Administration |
$143.00
|
| Rate for Payer: United Healthcare Commercial |
$223.88
|
| Rate for Payer: United Healthcare Medicare |
$143.00
|
| Rate for Payer: WINHealth Partners Commercial |
$222.71
|
| Rate for Payer: Wise Provider Network Commercial |
$222.71
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
OP
|
$234.43
|
|
|
Service Code
|
NDC 0009316901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$234.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.74
|
| Rate for Payer: Aetna of WY Medicare |
$154.72
|
| Rate for Payer: Altius Commercial |
$225.05
|
| Rate for Payer: Beech Street Commercial |
$229.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.40
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.40
|
| Rate for Payer: Cigna of WY Commercial |
$229.74
|
| Rate for Payer: Entrust Commercial |
$222.71
|
| Rate for Payer: First Choice Health Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.63
|
| Rate for Payer: HealthUtah PPO |
$234.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.40
|
| Rate for Payer: Multiplan Medicare/VA |
$126.94
|
| Rate for Payer: One Health Plan of WY PPO |
$229.74
|
| Rate for Payer: PacificSource Commercial |
$210.99
|
| Rate for Payer: PHCS PPO |
$229.74
|
| Rate for Payer: Three Rivers PPO |
$175.82
|
| Rate for Payer: TriWest Veterans Administration |
$133.63
|
| Rate for Payer: United Healthcare Commercial |
$223.88
|
| Rate for Payer: United Healthcare Medicare |
$133.63
|
| Rate for Payer: WINHealth Partners Commercial |
$229.74
|
| Rate for Payer: Wise Provider Network Commercial |
$222.71
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [19101]
|
Facility
|
IP
|
$279.52
|
|
|
Service Code
|
HCPCS J2997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$161.98 |
| Max. Negotiated Rate |
$279.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$273.93
|
| Rate for Payer: Aetna of WY Medicare |
$178.89
|
| Rate for Payer: Altius Commercial |
$268.34
|
| Rate for Payer: Beech Street Commercial |
$273.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$195.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.13
|
| Rate for Payer: Cigna of WY Commercial |
$273.93
|
| Rate for Payer: Entrust Commercial |
$265.54
|
| Rate for Payer: First Choice Health Commercial |
$265.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$265.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.51
|
| Rate for Payer: HealthUtah PPO |
$279.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.13
|
| Rate for Payer: Multiplan Medicare/VA |
$161.98
|
| Rate for Payer: One Health Plan of WY PPO |
$273.93
|
| Rate for Payer: PacificSource Commercial |
$251.57
|
| Rate for Payer: PHCS PPO |
$273.93
|
| Rate for Payer: Three Rivers PPO |
$209.64
|
| Rate for Payer: TriWest Veterans Administration |
$170.51
|
| Rate for Payer: United Healthcare Commercial |
$266.94
|
| Rate for Payer: United Healthcare Medicare |
$170.51
|
| Rate for Payer: WINHealth Partners Commercial |
$265.54
|
| Rate for Payer: Wise Provider Network Commercial |
$265.54
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [19101]
|
Facility
|
OP
|
$279.52
|
|
|
Service Code
|
HCPCS J2997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.36 |
| Max. Negotiated Rate |
$279.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$273.93
|
| Rate for Payer: Aetna of WY Medicare |
$184.48
|
| Rate for Payer: Altius Commercial |
$268.34
|
| Rate for Payer: Beech Street Commercial |
$273.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$271.13
|
| Rate for Payer: Cash Price |
$195.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.13
|
| Rate for Payer: Cigna of WY Commercial |
$273.93
|
| Rate for Payer: Entrust Commercial |
$265.54
|
| Rate for Payer: First Choice Health Commercial |
$265.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$265.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.33
|
| Rate for Payer: HealthUtah PPO |
$279.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.13
|
| Rate for Payer: Multiplan Medicare/VA |
$151.36
|
| Rate for Payer: One Health Plan of WY PPO |
$273.93
|
| Rate for Payer: PacificSource Commercial |
$251.57
|
| Rate for Payer: PHCS PPO |
$273.93
|
| Rate for Payer: Three Rivers PPO |
$209.64
|
| Rate for Payer: TriWest Veterans Administration |
$159.33
|
| Rate for Payer: United Healthcare Commercial |
$266.94
|
| Rate for Payer: United Healthcare Medicare |
$159.33
|
| Rate for Payer: WINHealth Partners Commercial |
$273.93
|
| Rate for Payer: Wise Provider Network Commercial |
$265.54
|
|
|
ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$75.50 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$314.58
|
| Rate for Payer: Aetna of WY Medicare |
$88.82
|
| Rate for Payer: Beech Street Commercial |
$304.95
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$311.37
|
| Rate for Payer: Cigna of WY Commercial |
$314.58
|
| Rate for Payer: First Choice Health Commercial |
$288.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$304.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.82
|
| Rate for Payer: HealthUtah PPO |
$321.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$311.37
|
| Rate for Payer: Multiplan Medicare/VA |
$75.50
|
| Rate for Payer: One Health Plan of WY PPO |
$314.58
|
| Rate for Payer: PacificSource Commercial |
$288.90
|
| Rate for Payer: PHCS PPO |
$304.95
|
| Rate for Payer: Three Rivers PPO |
$240.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.82
|
| Rate for Payer: United Healthcare Commercial |
$304.95
|
| Rate for Payer: WINHealth Partners Commercial |
$304.95
|
|
|
ALTIS SLING COLOPLAST 519650
|
Facility
|
OP
|
$4,074.00
|
|
| Hospital Charge Code |
2750091
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.07 |
| Max. Negotiated Rate |
$4,074.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,992.52
|
| Rate for Payer: Aetna of WY Medicare |
$2,688.84
|
| Rate for Payer: Altius Commercial |
$3,911.04
|
| Rate for Payer: Beech Street Commercial |
$3,992.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,951.78
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,951.78
|
| Rate for Payer: Cigna of WY Commercial |
$3,992.52
|
| Rate for Payer: Entrust Commercial |
$3,870.30
|
| Rate for Payer: First Choice Health Commercial |
$3,870.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,870.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,322.18
|
| Rate for Payer: HealthUtah PPO |
$4,074.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,951.78
|
| Rate for Payer: Multiplan Medicare/VA |
$2,206.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,992.52
|
| Rate for Payer: PacificSource Commercial |
$3,666.60
|
| Rate for Payer: PHCS PPO |
$3,992.52
|
| Rate for Payer: Three Rivers PPO |
$3,055.50
|
| Rate for Payer: TriWest Veterans Administration |
$2,322.18
|
| Rate for Payer: United Healthcare Commercial |
$3,890.67
|
| Rate for Payer: United Healthcare Medicare |
$2,322.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3,992.52
|
| Rate for Payer: Wise Provider Network Commercial |
$3,870.30
|
|
