|
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
|
|
|
ALUMI-HAND XL STUCKI
|
Facility
|
IP
|
$142.62
|
|
| Hospital Charge Code |
3002235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$142.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.77
|
| Rate for Payer: Aetna of WY Medicare |
$91.28
|
| Rate for Payer: Altius Commercial |
$136.92
|
| Rate for Payer: Beech Street Commercial |
$139.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.34
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.34
|
| Rate for Payer: Cigna of WY Commercial |
$139.77
|
| Rate for Payer: Entrust Commercial |
$135.49
|
| Rate for Payer: First Choice Health Commercial |
$135.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.00
|
| Rate for Payer: HealthUtah PPO |
$142.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.34
|
| Rate for Payer: Multiplan Medicare/VA |
$82.65
|
| Rate for Payer: One Health Plan of WY PPO |
$139.77
|
| Rate for Payer: PacificSource Commercial |
$128.36
|
| Rate for Payer: PHCS PPO |
$139.77
|
| Rate for Payer: Three Rivers PPO |
$106.96
|
| Rate for Payer: TriWest Veterans Administration |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$136.20
|
| Rate for Payer: United Healthcare Medicare |
$87.00
|
| Rate for Payer: WINHealth Partners Commercial |
$135.49
|
| Rate for Payer: Wise Provider Network Commercial |
$135.49
|
|
|
ALUMI-HAND XL STUCKI
|
Facility
|
OP
|
$142.62
|
|
| Hospital Charge Code |
3002235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.23 |
| Max. Negotiated Rate |
$142.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$139.77
|
| Rate for Payer: Aetna of WY Medicare |
$94.13
|
| Rate for Payer: Altius Commercial |
$136.92
|
| Rate for Payer: Beech Street Commercial |
$139.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.34
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.34
|
| Rate for Payer: Cigna of WY Commercial |
$139.77
|
| Rate for Payer: Entrust Commercial |
$135.49
|
| Rate for Payer: First Choice Health Commercial |
$135.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.29
|
| Rate for Payer: HealthUtah PPO |
$142.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.34
|
| Rate for Payer: Multiplan Medicare/VA |
$77.23
|
| Rate for Payer: One Health Plan of WY PPO |
$139.77
|
| Rate for Payer: PacificSource Commercial |
$128.36
|
| Rate for Payer: PHCS PPO |
$139.77
|
| Rate for Payer: Three Rivers PPO |
$106.96
|
| Rate for Payer: TriWest Veterans Administration |
$81.29
|
| Rate for Payer: United Healthcare Commercial |
$136.20
|
| Rate for Payer: United Healthcare Medicare |
$81.29
|
| Rate for Payer: WINHealth Partners Commercial |
$139.77
|
| Rate for Payer: Wise Provider Network Commercial |
$135.49
|
|
|
ALUMINUM CHLORIDE 70% 1 OZ
|
Facility
|
IP
|
$64.40
|
|
| Hospital Charge Code |
2050114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.11
|
| Rate for Payer: Aetna of WY Medicare |
$41.22
|
| Rate for Payer: Altius Commercial |
$61.82
|
| Rate for Payer: Beech Street Commercial |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.47
|
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.47
|
| Rate for Payer: Cigna of WY Commercial |
$63.11
|
| Rate for Payer: Entrust Commercial |
$61.18
|
| Rate for Payer: First Choice Health Commercial |
$61.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.28
|
| Rate for Payer: HealthUtah PPO |
$64.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.47
|
| Rate for Payer: Multiplan Medicare/VA |
$37.32
|
| Rate for Payer: One Health Plan of WY PPO |
$63.11
|
| Rate for Payer: PacificSource Commercial |
$57.96
|
| Rate for Payer: PHCS PPO |
$63.11
|
| Rate for Payer: Three Rivers PPO |
$48.30
|
| Rate for Payer: TriWest Veterans Administration |
$39.28
|
| Rate for Payer: United Healthcare Commercial |
$61.50
|
| Rate for Payer: United Healthcare Medicare |
$39.28
|
| Rate for Payer: WINHealth Partners Commercial |
$61.18
|
| Rate for Payer: Wise Provider Network Commercial |
$61.18
|
|
|
ALUMINUM CHLORIDE 70% 1 OZ
|
Facility
|
OP
|
$64.40
|
|
| Hospital Charge Code |
2050114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$63.11
|
| Rate for Payer: Aetna of WY Medicare |
$42.50
|
| Rate for Payer: Altius Commercial |
$61.82
|
| Rate for Payer: Beech Street Commercial |
$63.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$62.47
|
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$62.47
|
| Rate for Payer: Cigna of WY Commercial |
$63.11
|
| Rate for Payer: Entrust Commercial |
$61.18
|
| Rate for Payer: First Choice Health Commercial |
$61.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$61.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.71
|
| Rate for Payer: HealthUtah PPO |
$64.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.47
|
| Rate for Payer: Multiplan Medicare/VA |
$34.87
|
| Rate for Payer: One Health Plan of WY PPO |
$63.11
|
| Rate for Payer: PacificSource Commercial |
$57.96
|
| Rate for Payer: PHCS PPO |
$63.11
|
| Rate for Payer: Three Rivers PPO |
$48.30
|
| Rate for Payer: TriWest Veterans Administration |
$36.71
|
| Rate for Payer: United Healthcare Commercial |
$61.50
|
| Rate for Payer: United Healthcare Medicare |
$36.71
|
| Rate for Payer: WINHealth Partners Commercial |
$63.11
|
| Rate for Payer: Wise Provider Network Commercial |
$61.18
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP [19884]
|
Facility
|
OP
|
$15.50
|
|
|
Service Code
|
NDC 0121176230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.19
|
| Rate for Payer: Aetna of WY Medicare |
$10.23
|
| Rate for Payer: Altius Commercial |
$14.88
|
| Rate for Payer: Beech Street Commercial |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.04
|
| Rate for Payer: Cigna of WY Commercial |
$15.19
|
| Rate for Payer: Entrust Commercial |
$14.72
|
| Rate for Payer: First Choice Health Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.04
|
| Rate for Payer: Multiplan Medicare/VA |
$8.39
|
| Rate for Payer: One Health Plan of WY PPO |
$15.19
|
| Rate for Payer: PacificSource Commercial |
$13.95
|
| Rate for Payer: PHCS PPO |
$15.19
|
| Rate for Payer: Three Rivers PPO |
$11.62
|
| Rate for Payer: TriWest Veterans Administration |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$14.80
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$15.19
|
| Rate for Payer: Wise Provider Network Commercial |
$14.72
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP [19884]
|
Facility
|
IP
|
$15.50
|
|
|
Service Code
|
NDC 0121176230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.19
|
| Rate for Payer: Aetna of WY Medicare |
$9.92
|
| Rate for Payer: Altius Commercial |
$14.88
|
| Rate for Payer: Beech Street Commercial |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.04
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.04
|
| Rate for Payer: Cigna of WY Commercial |
$15.19
|
| Rate for Payer: Entrust Commercial |
$14.72
|
| Rate for Payer: First Choice Health Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.46
|
| Rate for Payer: HealthUtah PPO |
$15.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.04
|
| Rate for Payer: Multiplan Medicare/VA |
$8.98
|
| Rate for Payer: One Health Plan of WY PPO |
$15.19
|
| Rate for Payer: PacificSource Commercial |
$13.95
|
| Rate for Payer: PHCS PPO |
$15.19
|
| Rate for Payer: Three Rivers PPO |
$11.62
|
| Rate for Payer: TriWest Veterans Administration |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$14.80
|
| Rate for Payer: United Healthcare Medicare |
$9.46
|
| Rate for Payer: WINHealth Partners Commercial |
$14.72
|
| Rate for Payer: Wise Provider Network Commercial |
$14.72
|
|
|
ALVIMOPAN 12 MG CAPSULE [54040]
|
Facility
|
IP
|
$250.66
|
|
|
Service Code
|
NDC 0591231245
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$145.26 |
| Max. Negotiated Rate |
$250.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.65
|
| Rate for Payer: Aetna of WY Medicare |
$160.42
|
| Rate for Payer: Altius Commercial |
$240.63
|
| Rate for Payer: Beech Street Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.14
|
| Rate for Payer: Cash Price |
$175.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.14
|
| Rate for Payer: Cigna of WY Commercial |
$245.65
|
| Rate for Payer: Entrust Commercial |
$238.13
|
| Rate for Payer: First Choice Health Commercial |
$238.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$152.90
|
| Rate for Payer: HealthUtah PPO |
$250.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.14
|
| Rate for Payer: Multiplan Medicare/VA |
$145.26
|
| Rate for Payer: One Health Plan of WY PPO |
$245.65
|
| Rate for Payer: PacificSource Commercial |
$225.59
|
| Rate for Payer: PHCS PPO |
$245.65
|
| Rate for Payer: Three Rivers PPO |
$188.00
|
| Rate for Payer: TriWest Veterans Administration |
$152.90
|
| Rate for Payer: United Healthcare Commercial |
$239.38
|
| Rate for Payer: United Healthcare Medicare |
$152.90
|
| Rate for Payer: WINHealth Partners Commercial |
$238.13
|
| Rate for Payer: Wise Provider Network Commercial |
$238.13
|
|
|
ALVIMOPAN 12 MG CAPSULE [54040]
|
Facility
|
OP
|
$250.66
|
|
|
Service Code
|
NDC 0591231245
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$250.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$245.65
|
| Rate for Payer: Aetna of WY Medicare |
$165.44
|
| Rate for Payer: Altius Commercial |
$240.63
|
| Rate for Payer: Beech Street Commercial |
$245.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$243.14
|
| Rate for Payer: Cash Price |
$175.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$243.14
|
| Rate for Payer: Cigna of WY Commercial |
$245.65
|
| Rate for Payer: Entrust Commercial |
$238.13
|
| Rate for Payer: First Choice Health Commercial |
$238.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$238.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.88
|
| Rate for Payer: HealthUtah PPO |
$250.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$243.14
|
| Rate for Payer: Multiplan Medicare/VA |
$135.73
|
| Rate for Payer: One Health Plan of WY PPO |
$245.65
|
| Rate for Payer: PacificSource Commercial |
$225.59
|
| Rate for Payer: PHCS PPO |
$245.65
|
| Rate for Payer: Three Rivers PPO |
$188.00
|
| Rate for Payer: TriWest Veterans Administration |
$142.88
|
| Rate for Payer: United Healthcare Commercial |
$239.38
|
| Rate for Payer: United Healthcare Medicare |
$142.88
|
| Rate for Payer: WINHealth Partners Commercial |
$245.65
|
| Rate for Payer: Wise Provider Network Commercial |
$238.13
|
|
|
AMBULATORY SURGICAL BOOT EAC
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS L3260
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Beech Street Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: First Choice Health Commercial |
$50.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$53.20
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$53.20
|
| Rate for Payer: WINHealth Partners Commercial |
$53.20
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION [160321]
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
NDC 0338020601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.69
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.25
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$8.69
|
| Rate for Payer: United Healthcare Commercial |
$14.55
|
| Rate for Payer: United Healthcare Medicare |
$8.69
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
AMINO ACIDS 8 %-DEXTROSE 14 %-ELECTROLYTES INTRAVENOUS SOLUTION [160321]
|
Facility
|
IP
|
$15.24
|
|
|
Service Code
|
NDC 0338020601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$9.75
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.30
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.83
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$9.30
|
| Rate for Payer: United Healthcare Commercial |
$14.55
|
| Rate for Payer: United Healthcare Medicare |
$9.30
|
| Rate for Payer: WINHealth Partners Commercial |
$14.48
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
AMINOPHYLLINE 25 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000723]
|
Facility
|
IP
|
$21.29
|
|
|
Service Code
|
HCPCS J0280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.86
|
| Rate for Payer: Aetna of WY Medicare |
$13.63
|
| Rate for Payer: Altius Commercial |
$20.44
|
| Rate for Payer: Beech Street Commercial |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.65
|
| Rate for Payer: Cash Price |
$14.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.65
|
| Rate for Payer: Cigna of WY Commercial |
$20.86
|
| Rate for Payer: Entrust Commercial |
$20.23
|
| Rate for Payer: First Choice Health Commercial |
$20.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.99
|
| Rate for Payer: HealthUtah PPO |
$21.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.65
|
| Rate for Payer: Multiplan Medicare/VA |
$12.34
|
| Rate for Payer: One Health Plan of WY PPO |
$20.86
|
| Rate for Payer: PacificSource Commercial |
$19.16
|
| Rate for Payer: PHCS PPO |
$20.86
|
| Rate for Payer: Three Rivers PPO |
$15.97
|
| Rate for Payer: TriWest Veterans Administration |
$12.99
|
| Rate for Payer: United Healthcare Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare |
$12.99
|
| Rate for Payer: WINHealth Partners Commercial |
$20.23
|
| Rate for Payer: Wise Provider Network Commercial |
$20.23
|
|
|
AMINOPHYLLINE 25 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000723]
|
Facility
|
OP
|
$21.29
|
|
|
Service Code
|
HCPCS J0280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.86
|
| Rate for Payer: Aetna of WY Medicare |
$14.05
|
| Rate for Payer: Altius Commercial |
$20.44
|
| Rate for Payer: Beech Street Commercial |
$20.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.65
|
| Rate for Payer: Cash Price |
$14.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.65
|
| Rate for Payer: Cigna of WY Commercial |
$20.86
|
| Rate for Payer: Entrust Commercial |
$20.23
|
| Rate for Payer: First Choice Health Commercial |
$20.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.14
|
| Rate for Payer: HealthUtah PPO |
$21.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.65
|
| Rate for Payer: Multiplan Medicare/VA |
$11.53
|
| Rate for Payer: One Health Plan of WY PPO |
$20.86
|
| Rate for Payer: PacificSource Commercial |
$19.16
|
| Rate for Payer: PHCS PPO |
$20.86
|
| Rate for Payer: Three Rivers PPO |
$15.97
|
| Rate for Payer: TriWest Veterans Administration |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare |
$12.14
|
| Rate for Payer: WINHealth Partners Commercial |
$20.86
|
| Rate for Payer: Wise Provider Network Commercial |
$20.23
|
|
|
AMIODARONE 200 MG TABLET [3536]
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
NDC 6068743701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.88
|
| Rate for Payer: Altius Commercial |
$15.82
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$15.66
|
| Rate for Payer: First Choice Health Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$16.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$16.15
|
| Rate for Payer: PacificSource Commercial |
$14.83
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.36
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$15.66
|
|
|
AMIODARONE 200 MG TABLET [3536]
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
NDC 6068743701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.55
|
| Rate for Payer: Altius Commercial |
$15.82
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$15.66
|
| Rate for Payer: First Choice Health Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$16.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$9.55
|
| Rate for Payer: One Health Plan of WY PPO |
$16.15
|
| Rate for Payer: PacificSource Commercial |
$14.83
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.36
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.66
|
| Rate for Payer: Wise Provider Network Commercial |
$15.66
|
|
|
AMIODARONE 200 MG TABLET [3536]
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
NDC 6068743711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.55
|
| Rate for Payer: Altius Commercial |
$15.82
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$15.66
|
| Rate for Payer: First Choice Health Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.05
|
| Rate for Payer: HealthUtah PPO |
$16.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$9.55
|
| Rate for Payer: One Health Plan of WY PPO |
$16.15
|
| Rate for Payer: PacificSource Commercial |
$14.83
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.36
|
| Rate for Payer: TriWest Veterans Administration |
$10.05
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$10.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.66
|
| Rate for Payer: Wise Provider Network Commercial |
$15.66
|
|
|
AMIODARONE 200 MG TABLET [3536]
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
NDC 6068743711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$16.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.88
|
| Rate for Payer: Altius Commercial |
$15.82
|
| Rate for Payer: Beech Street Commercial |
$16.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.99
|
| Rate for Payer: Cigna of WY Commercial |
$16.15
|
| Rate for Payer: Entrust Commercial |
$15.66
|
| Rate for Payer: First Choice Health Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$16.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$16.15
|
| Rate for Payer: PacificSource Commercial |
$14.83
|
| Rate for Payer: PHCS PPO |
$16.15
|
| Rate for Payer: Three Rivers PPO |
$12.36
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$15.74
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$16.15
|
| Rate for Payer: Wise Provider Network Commercial |
$15.66
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [17698]
|
Facility
|
OP
|
$17.67
|
|
|
Service Code
|
NDC 0143987525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.66
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$17.32
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [17698]
|
Facility
|
OP
|
$17.67
|
|
|
Service Code
|
NDC 6332361601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.66
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$17.32
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [17698]
|
Facility
|
IP
|
$17.67
|
|
|
Service Code
|
NDC 0143987525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.31
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.78
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$10.24
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.78
|
| Rate for Payer: WINHealth Partners Commercial |
$16.79
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [17698]
|
Facility
|
OP
|
$17.67
|
|
|
Service Code
|
NDC 0143987501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.66
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$17.32
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [17698]
|
Facility
|
IP
|
$17.67
|
|
|
Service Code
|
NDC 0143987501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.31
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.78
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$10.24
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.78
|
| Rate for Payer: WINHealth Partners Commercial |
$16.79
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION [17698]
|
Facility
|
IP
|
$17.67
|
|
|
Service Code
|
NDC 6332361601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.32
|
| Rate for Payer: Aetna of WY Medicare |
$11.31
|
| Rate for Payer: Altius Commercial |
$16.96
|
| Rate for Payer: Beech Street Commercial |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.14
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.14
|
| Rate for Payer: Cigna of WY Commercial |
$17.32
|
| Rate for Payer: Entrust Commercial |
$16.79
|
| Rate for Payer: First Choice Health Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.78
|
| Rate for Payer: HealthUtah PPO |
$17.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.14
|
| Rate for Payer: Multiplan Medicare/VA |
$10.24
|
| Rate for Payer: One Health Plan of WY PPO |
$17.32
|
| Rate for Payer: PacificSource Commercial |
$15.90
|
| Rate for Payer: PHCS PPO |
$17.32
|
| Rate for Payer: Three Rivers PPO |
$13.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare |
$10.78
|
| Rate for Payer: WINHealth Partners Commercial |
$16.79
|
| Rate for Payer: Wise Provider Network Commercial |
$16.79
|
|
|
AMITRIPTYLINE 25 MG TABLET [10227]
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
NDC 6068743301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.39
|
| Rate for Payer: Aetna of WY Medicare |
$11.04
|
| Rate for Payer: Altius Commercial |
$16.05
|
| Rate for Payer: Beech Street Commercial |
$16.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.22
|
| Rate for Payer: Cigna of WY Commercial |
$16.39
|
| Rate for Payer: Entrust Commercial |
$15.88
|
| Rate for Payer: First Choice Health Commercial |
$15.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.53
|
| Rate for Payer: HealthUtah PPO |
$16.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.22
|
| Rate for Payer: Multiplan Medicare/VA |
$9.05
|
| Rate for Payer: One Health Plan of WY PPO |
$16.39
|
| Rate for Payer: PacificSource Commercial |
$15.05
|
| Rate for Payer: PHCS PPO |
$16.39
|
| Rate for Payer: Three Rivers PPO |
$12.54
|
| Rate for Payer: TriWest Veterans Administration |
$9.53
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$9.53
|
| Rate for Payer: WINHealth Partners Commercial |
$16.39
|
| Rate for Payer: Wise Provider Network Commercial |
$15.88
|
|
