|
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
|
|
|
AMITRIPTYLINE 25 MG TABLET [10227]
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 6068743301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.39
|
| Rate for Payer: Aetna of WY Medicare |
$10.70
|
| 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 |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$16.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.22
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| 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 |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$15.88
|
| Rate for Payer: Wise Provider Network Commercial |
$15.88
|
|
|
AMITRIPTYLINE 25 MG TABLET [10227]
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 6068743311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.39
|
| Rate for Payer: Aetna of WY Medicare |
$10.70
|
| 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 |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$16.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.22
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| 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 |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$15.97
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$15.88
|
| Rate for Payer: Wise Provider Network Commercial |
$15.88
|
|
|
AMLODIPINE 2.5 MG TABLET [6826]
|
Facility
|
IP
|
$15.56
|
|
|
Service Code
|
NDC 0904636961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.25
|
| Rate for Payer: Aetna of WY Medicare |
$9.96
|
| Rate for Payer: Altius Commercial |
$14.94
|
| Rate for Payer: Beech Street Commercial |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.09
|
| Rate for Payer: Cigna of WY Commercial |
$15.25
|
| Rate for Payer: Entrust Commercial |
$14.78
|
| Rate for Payer: First Choice Health Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.49
|
| Rate for Payer: HealthUtah PPO |
$15.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.09
|
| Rate for Payer: Multiplan Medicare/VA |
$9.02
|
| Rate for Payer: One Health Plan of WY PPO |
$15.25
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.25
|
| Rate for Payer: Three Rivers PPO |
$11.67
|
| Rate for Payer: TriWest Veterans Administration |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$9.49
|
| Rate for Payer: WINHealth Partners Commercial |
$14.78
|
| Rate for Payer: Wise Provider Network Commercial |
$14.78
|
|
|
AMLODIPINE 2.5 MG TABLET [6826]
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 0904636961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.25
|
| Rate for Payer: Aetna of WY Medicare |
$10.27
|
| Rate for Payer: Altius Commercial |
$14.94
|
| Rate for Payer: Beech Street Commercial |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.09
|
| Rate for Payer: Cigna of WY Commercial |
$15.25
|
| Rate for Payer: Entrust Commercial |
$14.78
|
| Rate for Payer: First Choice Health Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.87
|
| Rate for Payer: HealthUtah PPO |
$15.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.09
|
| Rate for Payer: Multiplan Medicare/VA |
$8.43
|
| Rate for Payer: One Health Plan of WY PPO |
$15.25
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.25
|
| Rate for Payer: Three Rivers PPO |
$11.67
|
| Rate for Payer: TriWest Veterans Administration |
$8.87
|
| Rate for Payer: United Healthcare Commercial |
$14.86
|
| Rate for Payer: United Healthcare Medicare |
$8.87
|
| Rate for Payer: WINHealth Partners Commercial |
$15.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.78
|
|
|
AMLODIPINE 5 MG TABLET [7292]
|
Facility
|
IP
|
$15.63
|
|
|
Service Code
|
NDC 6068748811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.32
|
| Rate for Payer: Aetna of WY Medicare |
$10.00
|
| Rate for Payer: Altius Commercial |
$15.00
|
| Rate for Payer: Beech Street Commercial |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.16
|
| Rate for Payer: Cigna of WY Commercial |
$15.32
|
| Rate for Payer: Entrust Commercial |
$14.85
|
| Rate for Payer: First Choice Health Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.53
|
| Rate for Payer: HealthUtah PPO |
$15.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.16
|
| Rate for Payer: Multiplan Medicare/VA |
$9.06
|
| Rate for Payer: One Health Plan of WY PPO |
$15.32
|
| Rate for Payer: PacificSource Commercial |
$14.07
|
| Rate for Payer: PHCS PPO |
$15.32
|
| Rate for Payer: Three Rivers PPO |
$11.72
|
| Rate for Payer: TriWest Veterans Administration |
$9.53
|
| Rate for Payer: United Healthcare Commercial |
$14.93
|
| Rate for Payer: United Healthcare Medicare |
$9.53
|
| Rate for Payer: WINHealth Partners Commercial |
$14.85
|
| Rate for Payer: Wise Provider Network Commercial |
$14.85
|
|
|
AMLODIPINE 5 MG TABLET [7292]
|
Facility
|
OP
|
$15.63
|
|
|
Service Code
|
NDC 6068748801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.32
|
| Rate for Payer: Aetna of WY Medicare |
$10.32
|
| Rate for Payer: Altius Commercial |
$15.00
|
| Rate for Payer: Beech Street Commercial |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.16
|
| Rate for Payer: Cigna of WY Commercial |
$15.32
|
| Rate for Payer: Entrust Commercial |
$14.85
|
| Rate for Payer: First Choice Health Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.91
|
| Rate for Payer: HealthUtah PPO |
$15.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.16
|
| Rate for Payer: Multiplan Medicare/VA |
$8.46
|
| Rate for Payer: One Health Plan of WY PPO |
$15.32
|
| Rate for Payer: PacificSource Commercial |
$14.07
|
| Rate for Payer: PHCS PPO |
$15.32
|
| Rate for Payer: Three Rivers PPO |
$11.72
|
| Rate for Payer: TriWest Veterans Administration |
$8.91
|
| Rate for Payer: United Healthcare Commercial |
$14.93
|
| Rate for Payer: United Healthcare Medicare |
$8.91
|
| Rate for Payer: WINHealth Partners Commercial |
$15.32
|
| Rate for Payer: Wise Provider Network Commercial |
$14.85
|
|
|
AMLODIPINE 5 MG TABLET [7292]
|
Facility
|
OP
|
$15.63
|
|
|
Service Code
|
NDC 6068748811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: United Healthcare Commercial |
$14.93
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.32
|
| Rate for Payer: Aetna of WY Medicare |
$10.32
|
| Rate for Payer: Altius Commercial |
$15.00
|
| Rate for Payer: Beech Street Commercial |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.16
|
| Rate for Payer: Cigna of WY Commercial |
$15.32
|
| Rate for Payer: Entrust Commercial |
$14.85
|
| Rate for Payer: First Choice Health Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.91
|
| Rate for Payer: HealthUtah PPO |
$15.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.16
|
| Rate for Payer: Multiplan Medicare/VA |
$8.46
|
| Rate for Payer: One Health Plan of WY PPO |
$15.32
|
| Rate for Payer: PacificSource Commercial |
$14.07
|
| Rate for Payer: PHCS PPO |
$15.32
|
| Rate for Payer: Three Rivers PPO |
$11.72
|
| Rate for Payer: TriWest Veterans Administration |
$8.91
|
| Rate for Payer: United Healthcare Medicare |
$8.91
|
| Rate for Payer: WINHealth Partners Commercial |
$15.32
|
| Rate for Payer: Wise Provider Network Commercial |
$14.85
|
|
|
AMLODIPINE 5 MG TABLET [7292]
|
Facility
|
IP
|
$15.63
|
|
|
Service Code
|
NDC 6068748801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$15.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.32
|
| Rate for Payer: Aetna of WY Medicare |
$10.00
|
| Rate for Payer: Altius Commercial |
$15.00
|
| Rate for Payer: Beech Street Commercial |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.16
|
| Rate for Payer: Cash Price |
$10.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.16
|
| Rate for Payer: Cigna of WY Commercial |
$15.32
|
| Rate for Payer: Entrust Commercial |
$14.85
|
| Rate for Payer: First Choice Health Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.53
|
| Rate for Payer: HealthUtah PPO |
$15.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.16
|
| Rate for Payer: Multiplan Medicare/VA |
$9.06
|
| Rate for Payer: One Health Plan of WY PPO |
$15.32
|
| Rate for Payer: PacificSource Commercial |
$14.07
|
| Rate for Payer: PHCS PPO |
$15.32
|
| Rate for Payer: Three Rivers PPO |
$11.72
|
| Rate for Payer: TriWest Veterans Administration |
$9.53
|
| Rate for Payer: United Healthcare Commercial |
$14.93
|
| Rate for Payer: United Healthcare Medicare |
$9.53
|
| Rate for Payer: WINHealth Partners Commercial |
$14.85
|
| Rate for Payer: Wise Provider Network Commercial |
$14.85
|
|
|
AMMONIA SOLUTION FOR INHALATION [408138359]
|
Facility
|
IP
|
$16.75
|
|
|
Service Code
|
NDC 9999138359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$10.72
|
| Rate for Payer: Altius Commercial |
$16.08
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.25
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.25
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.91
|
| Rate for Payer: First Choice Health Commercial |
$15.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.22
|
| Rate for Payer: HealthUtah PPO |
$16.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.25
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.56
|
| Rate for Payer: TriWest Veterans Administration |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
| Rate for Payer: WINHealth Partners Commercial |
$15.91
|
| Rate for Payer: Wise Provider Network Commercial |
$15.91
|
|
|
AMMONIA SOLUTION FOR INHALATION [408138359]
|
Facility
|
OP
|
$16.75
|
|
|
Service Code
|
NDC 9999138359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Commercial |
$16.08
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.25
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.25
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.91
|
| Rate for Payer: First Choice Health Commercial |
$15.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.55
|
| Rate for Payer: HealthUtah PPO |
$16.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.25
|
| Rate for Payer: Multiplan Medicare/VA |
$9.07
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.56
|
| Rate for Payer: TriWest Veterans Administration |
$9.55
|
| Rate for Payer: United Healthcare Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicare |
$9.55
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.91
|
|
|
AMMONIUM LACTATE 12 % TOPICAL CREAM [16039]
|
Facility
|
OP
|
$15.13
|
|
|
Service Code
|
NDC 0904598348
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.83
|
| Rate for Payer: Aetna of WY Medicare |
$9.99
|
| Rate for Payer: Altius Commercial |
$14.52
|
| Rate for Payer: Beech Street Commercial |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.68
|
| Rate for Payer: Cash Price |
$10.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.68
|
| Rate for Payer: Cigna of WY Commercial |
$14.83
|
| Rate for Payer: Entrust Commercial |
$14.37
|
| Rate for Payer: First Choice Health Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.62
|
| Rate for Payer: HealthUtah PPO |
$15.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.68
|
| Rate for Payer: Multiplan Medicare/VA |
$8.19
|
| Rate for Payer: One Health Plan of WY PPO |
$14.83
|
| Rate for Payer: PacificSource Commercial |
$13.62
|
| Rate for Payer: PHCS PPO |
$14.83
|
| Rate for Payer: Three Rivers PPO |
$11.35
|
| Rate for Payer: TriWest Veterans Administration |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$14.45
|
| Rate for Payer: United Healthcare Medicare |
$8.62
|
| Rate for Payer: WINHealth Partners Commercial |
$14.83
|
| Rate for Payer: Wise Provider Network Commercial |
$14.37
|
|
|
AMMONIUM LACTATE 12 % TOPICAL CREAM [16039]
|
Facility
|
IP
|
$15.40
|
|
|
Service Code
|
NDC 6304440420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| Rate for Payer: Aetna of WY Medicare |
$9.86
|
| Rate for Payer: Altius Commercial |
$14.78
|
| Rate for Payer: Beech Street Commercial |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.09
|
| Rate for Payer: Entrust Commercial |
$14.63
|
| Rate for Payer: First Choice Health Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$15.09
|
| Rate for Payer: PacificSource Commercial |
$13.86
|
| Rate for Payer: PHCS PPO |
$15.09
|
| Rate for Payer: Three Rivers PPO |
$11.55
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$14.63
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
AMMONIUM LACTATE 12 % TOPICAL CREAM [16039]
|
Facility
|
IP
|
$15.19
|
|
|
Service Code
|
NDC 4580249398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.89
|
| Rate for Payer: Aetna of WY Medicare |
$9.72
|
| Rate for Payer: Altius Commercial |
$14.58
|
| Rate for Payer: Beech Street Commercial |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.73
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.89
|
| Rate for Payer: Entrust Commercial |
$14.43
|
| Rate for Payer: First Choice Health Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.27
|
| Rate for Payer: HealthUtah PPO |
$15.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.80
|
| Rate for Payer: One Health Plan of WY PPO |
$14.89
|
| Rate for Payer: PacificSource Commercial |
$13.67
|
| Rate for Payer: PHCS PPO |
$14.89
|
| Rate for Payer: Three Rivers PPO |
$11.39
|
| Rate for Payer: TriWest Veterans Administration |
$9.27
|
| Rate for Payer: United Healthcare Commercial |
$14.51
|
| Rate for Payer: United Healthcare Medicare |
$9.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.43
|
| Rate for Payer: Wise Provider Network Commercial |
$14.43
|
|
|
AMMONIUM LACTATE 12 % TOPICAL CREAM [16039]
|
Facility
|
OP
|
$15.40
|
|
|
Service Code
|
NDC 6304440420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| Rate for Payer: Aetna of WY Medicare |
$10.16
|
| Rate for Payer: Altius Commercial |
$14.78
|
| Rate for Payer: Beech Street Commercial |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.09
|
| Rate for Payer: Entrust Commercial |
$14.63
|
| Rate for Payer: First Choice Health Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.78
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$8.34
|
| Rate for Payer: One Health Plan of WY PPO |
$15.09
|
| Rate for Payer: PacificSource Commercial |
$13.86
|
| Rate for Payer: PHCS PPO |
$15.09
|
| Rate for Payer: Three Rivers PPO |
$11.55
|
| Rate for Payer: TriWest Veterans Administration |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.09
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
AMMONIUM LACTATE 12 % TOPICAL CREAM [16039]
|
Facility
|
IP
|
$15.13
|
|
|
Service Code
|
NDC 0904598348
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$15.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.83
|
| Rate for Payer: Aetna of WY Medicare |
$9.68
|
| Rate for Payer: Altius Commercial |
$14.52
|
| Rate for Payer: Beech Street Commercial |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.68
|
| Rate for Payer: Cash Price |
$10.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.68
|
| Rate for Payer: Cigna of WY Commercial |
$14.83
|
| Rate for Payer: Entrust Commercial |
$14.37
|
| Rate for Payer: First Choice Health Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.23
|
| Rate for Payer: HealthUtah PPO |
$15.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.68
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: One Health Plan of WY PPO |
$14.83
|
| Rate for Payer: PacificSource Commercial |
$13.62
|
| Rate for Payer: PHCS PPO |
$14.83
|
| Rate for Payer: Three Rivers PPO |
$11.35
|
| Rate for Payer: TriWest Veterans Administration |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$14.45
|
| Rate for Payer: United Healthcare Medicare |
$9.23
|
| Rate for Payer: WINHealth Partners Commercial |
$14.37
|
| Rate for Payer: Wise Provider Network Commercial |
$14.37
|
|
|
AMMONIUM LACTATE 12 % TOPICAL CREAM [16039]
|
Facility
|
OP
|
$15.19
|
|
|
Service Code
|
NDC 4580249398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.89
|
| Rate for Payer: Aetna of WY Medicare |
$10.03
|
| Rate for Payer: Altius Commercial |
$14.58
|
| Rate for Payer: Beech Street Commercial |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.73
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.73
|
| Rate for Payer: Cigna of WY Commercial |
$14.89
|
| Rate for Payer: Entrust Commercial |
$14.43
|
| Rate for Payer: First Choice Health Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$15.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$14.89
|
| Rate for Payer: PacificSource Commercial |
$13.67
|
| Rate for Payer: PHCS PPO |
$14.89
|
| Rate for Payer: Three Rivers PPO |
$11.39
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$14.51
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$14.89
|
| Rate for Payer: Wise Provider Network Commercial |
$14.43
|
|
|
AMNIOBAND MEMBRANE 4X6 CM
|
Facility
|
OP
|
$8,498.67
|
|
| Hospital Charge Code |
2800440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,602.03 |
| Max. Negotiated Rate |
$8,498.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,328.70
|
| Rate for Payer: Aetna of WY Medicare |
$5,609.12
|
| Rate for Payer: Altius Commercial |
$8,158.72
|
| Rate for Payer: Beech Street Commercial |
$8,328.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,243.71
|
| Rate for Payer: Cash Price |
$5,949.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,243.71
|
| Rate for Payer: Cigna of WY Commercial |
$8,328.70
|
| Rate for Payer: Entrust Commercial |
$8,073.74
|
| Rate for Payer: First Choice Health Commercial |
$8,073.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,073.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,844.24
|
| Rate for Payer: HealthUtah PPO |
$8,498.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,243.71
|
| Rate for Payer: Multiplan Medicare/VA |
$4,602.03
|
| Rate for Payer: One Health Plan of WY PPO |
$8,328.70
|
| Rate for Payer: PacificSource Commercial |
$7,648.80
|
| Rate for Payer: PHCS PPO |
$8,328.70
|
| Rate for Payer: Three Rivers PPO |
$6,374.00
|
| Rate for Payer: TriWest Veterans Administration |
$4,844.24
|
| Rate for Payer: United Healthcare Commercial |
$8,116.23
|
| Rate for Payer: United Healthcare Medicare |
$4,844.24
|
| Rate for Payer: WINHealth Partners Commercial |
$8,328.70
|
| Rate for Payer: Wise Provider Network Commercial |
$8,073.74
|
|
|
AMNIOBAND MEMBRANE 4X6 CM
|
Facility
|
IP
|
$8,498.67
|
|
| Hospital Charge Code |
2800440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,924.98 |
| Max. Negotiated Rate |
$8,498.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,328.70
|
| Rate for Payer: Aetna of WY Medicare |
$5,439.15
|
| Rate for Payer: Altius Commercial |
$8,158.72
|
| Rate for Payer: Beech Street Commercial |
$8,328.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,243.71
|
| Rate for Payer: Cash Price |
$5,949.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,243.71
|
| Rate for Payer: Cigna of WY Commercial |
$8,328.70
|
| Rate for Payer: Entrust Commercial |
$8,073.74
|
| Rate for Payer: First Choice Health Commercial |
$8,073.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,073.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,184.19
|
| Rate for Payer: HealthUtah PPO |
$8,498.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,243.71
|
| Rate for Payer: Multiplan Medicare/VA |
$4,924.98
|
| Rate for Payer: One Health Plan of WY PPO |
$8,328.70
|
| Rate for Payer: PacificSource Commercial |
$7,648.80
|
| Rate for Payer: PHCS PPO |
$8,328.70
|
| Rate for Payer: Three Rivers PPO |
$6,374.00
|
| Rate for Payer: TriWest Veterans Administration |
$5,184.19
|
| Rate for Payer: United Healthcare Commercial |
$8,116.23
|
| Rate for Payer: United Healthcare Medicare |
$5,184.19
|
| Rate for Payer: WINHealth Partners Commercial |
$8,073.74
|
| Rate for Payer: Wise Provider Network Commercial |
$8,073.74
|
|
|
AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$64.73 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$76.15
|
| Rate for Payer: Beech Street Commercial |
$195.70
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: First Choice Health Commercial |
$185.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.15
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$64.73
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$195.70
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$76.15
|
| Rate for Payer: United Healthcare Commercial |
$195.70
|
| Rate for Payer: WINHealth Partners Commercial |
$175.10
|
|
|
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [16449]
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
NDC 0143988701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Multiplan Medicare/VA |
$8.26
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
|
|
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [16449]
|
Facility
|
IP
|
$15.26
|
|
|
Service Code
|
NDC 0781615746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Aetna of WY Medicare |
$9.77
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Multiplan Medicare/VA |
$8.84
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$14.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
|
|
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [16449]
|
Facility
|
OP
|
$15.31
|
|
|
Service Code
|
NDC 6586207101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.00
|
| Rate for Payer: Aetna of WY Medicare |
$10.10
|
| Rate for Payer: Altius Commercial |
$14.70
|
| Rate for Payer: Beech Street Commercial |
$15.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.85
|
| Rate for Payer: Cash Price |
$10.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.85
|
| Rate for Payer: Cigna of WY Commercial |
$15.00
|
| Rate for Payer: Entrust Commercial |
$14.54
|
| Rate for Payer: First Choice Health Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.73
|
| Rate for Payer: HealthUtah PPO |
$15.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.29
|
| Rate for Payer: One Health Plan of WY PPO |
$15.00
|
| Rate for Payer: PacificSource Commercial |
$13.78
|
| Rate for Payer: PHCS PPO |
$15.00
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$8.73
|
| Rate for Payer: United Healthcare Medicare |
$8.73
|
| Rate for Payer: WINHealth Partners Commercial |
$15.00
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [16449]
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
NDC 0093416173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Aetna of WY Medicare |
$10.07
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Multiplan Medicare/VA |
$8.26
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
|
|
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [16449]
|
Facility
|
IP
|
$15.26
|
|
|
Service Code
|
NDC 0093416173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Aetna of WY Medicare |
$9.77
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.80
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Multiplan Medicare/VA |
$8.84
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$14.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
|
