|
ABDOMINAL BINDER MED 79-89325
|
Facility
|
IP
|
$38.88
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.32
|
| Rate for Payer: Altius Commercial |
$37.32
|
| Rate for Payer: Beech Street Commercial |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.92
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.71
|
| Rate for Payer: Cigna of WY Commercial |
$38.10
|
| Rate for Payer: Entrust Commercial |
$36.94
|
| Rate for Payer: First Choice Health Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.66
|
| Rate for Payer: HealthUtah PPO |
$38.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.71
|
| Rate for Payer: Multiplan Medicare/VA |
$24.38
|
| Rate for Payer: One Health Plan of WY PPO |
$38.10
|
| Rate for Payer: PacificSource Commercial |
$34.99
|
| Rate for Payer: PHCS PPO |
$38.10
|
| Rate for Payer: Three Rivers PPO |
$29.16
|
| Rate for Payer: TriWest Veterans Administration |
$25.66
|
| Rate for Payer: United Healthcare Commercial |
$33.83
|
| Rate for Payer: United Healthcare Medicare |
$25.66
|
| Rate for Payer: WINHealth Partners Commercial |
$36.94
|
| Rate for Payer: Wise Provider Network Commercial |
$36.94
|
|
|
ABDOMINAL BINDER UNIV 79-89080
|
Facility
|
OP
|
$16.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.05
|
| Rate for Payer: Aetna of WY Medicare |
$10.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.72
|
| Rate for Payer: Altius Commercial |
$15.72
|
| Rate for Payer: Beech Street Commercial |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.89
|
| Rate for Payer: Cigna of WY Commercial |
$16.05
|
| Rate for Payer: Entrust Commercial |
$15.56
|
| Rate for Payer: First Choice Health Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.50
|
| Rate for Payer: HealthUtah PPO |
$16.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.03
|
| Rate for Payer: One Health Plan of WY PPO |
$16.05
|
| Rate for Payer: PacificSource Commercial |
$14.74
|
| Rate for Payer: PHCS PPO |
$16.05
|
| Rate for Payer: Three Rivers PPO |
$12.28
|
| Rate for Payer: TriWest Veterans Administration |
$9.50
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$9.50
|
| Rate for Payer: WINHealth Partners Commercial |
$16.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.56
|
|
|
ABDOMINAL BINDER UNIV 79-89080
|
Facility
|
IP
|
$16.38
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.72
|
| Rate for Payer: Altius Commercial |
$15.72
|
| Rate for Payer: Beech Street Commercial |
$16.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.89
|
| Rate for Payer: Cigna of WY Commercial |
$16.05
|
| Rate for Payer: Entrust Commercial |
$15.56
|
| Rate for Payer: First Choice Health Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.81
|
| Rate for Payer: HealthUtah PPO |
$16.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.89
|
| Rate for Payer: Multiplan Medicare/VA |
$10.27
|
| Rate for Payer: One Health Plan of WY PPO |
$16.05
|
| Rate for Payer: PacificSource Commercial |
$14.74
|
| Rate for Payer: PHCS PPO |
$16.05
|
| Rate for Payer: Three Rivers PPO |
$12.28
|
| Rate for Payer: TriWest Veterans Administration |
$10.81
|
| Rate for Payer: United Healthcare Commercial |
$14.25
|
| Rate for Payer: United Healthcare Medicare |
$10.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.56
|
| Rate for Payer: Wise Provider Network Commercial |
$15.56
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
49083
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,205.40
|
| Rate for Payer: Aetna of WY Medicare |
$100.45
|
| Rate for Payer: Beech Street Commercial |
$1,168.50
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,193.10
|
| Rate for Payer: Cigna of WY Commercial |
$1,205.40
|
| Rate for Payer: First Choice Health Commercial |
$1,107.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,168.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.45
|
| Rate for Payer: HealthUtah PPO |
$1,230.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,193.10
|
| Rate for Payer: Multiplan Medicare/VA |
$85.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,205.40
|
| Rate for Payer: PacificSource Commercial |
$1,107.00
|
| Rate for Payer: PHCS PPO |
$1,168.50
|
| Rate for Payer: Three Rivers PPO |
$922.50
|
| Rate for Payer: TriWest Veterans Administration |
$100.45
|
| Rate for Payer: United Healthcare Commercial |
$1,070.10
|
| Rate for Payer: United Healthcare Medicare |
$100.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,045.50
|
|
|
ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
49082
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$376.32
|
| Rate for Payer: Aetna of WY Medicare |
$69.76
|
| Rate for Payer: Beech Street Commercial |
$364.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$372.48
|
| Rate for Payer: Cigna of WY Commercial |
$376.32
|
| Rate for Payer: First Choice Health Commercial |
$345.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$364.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.76
|
| Rate for Payer: HealthUtah PPO |
$384.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$372.48
|
| Rate for Payer: Multiplan Medicare/VA |
$59.30
|
| Rate for Payer: One Health Plan of WY PPO |
$376.32
|
| Rate for Payer: PacificSource Commercial |
$345.60
|
| Rate for Payer: PHCS PPO |
$364.80
|
| Rate for Payer: Three Rivers PPO |
$288.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.76
|
| Rate for Payer: United Healthcare Commercial |
$334.08
|
| Rate for Payer: United Healthcare Medicare |
$69.76
|
| Rate for Payer: WINHealth Partners Commercial |
$326.40
|
|
|
ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$2,329.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
30802
|
| Min. Negotiated Rate |
$1,746.75 |
| Max. Negotiated Rate |
$2,329.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,282.42
|
| Rate for Payer: Beech Street Commercial |
$2,212.55
|
| Rate for Payer: Cash Price |
$1,630.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,259.13
|
| Rate for Payer: Cigna of WY Commercial |
$2,282.42
|
| Rate for Payer: First Choice Health Commercial |
$2,096.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,212.55
|
| Rate for Payer: HealthUtah PPO |
$2,329.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,259.13
|
| Rate for Payer: One Health Plan of WY PPO |
$2,282.42
|
| Rate for Payer: PacificSource Commercial |
$2,096.10
|
| Rate for Payer: PHCS PPO |
$2,212.55
|
| Rate for Payer: Three Rivers PPO |
$1,746.75
|
| Rate for Payer: United Healthcare Commercial |
$2,026.23
|
| Rate for Payer: WINHealth Partners Commercial |
$1,979.65
|
|
|
ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
30801
|
| Min. Negotiated Rate |
$126.79 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$749.70
|
| Rate for Payer: Aetna of WY Medicare |
$149.17
|
| Rate for Payer: Beech Street Commercial |
$726.75
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$742.05
|
| Rate for Payer: Cigna of WY Commercial |
$749.70
|
| Rate for Payer: First Choice Health Commercial |
$688.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$726.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.17
|
| Rate for Payer: HealthUtah PPO |
$765.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$742.05
|
| Rate for Payer: Multiplan Medicare/VA |
$126.79
|
| Rate for Payer: One Health Plan of WY PPO |
$749.70
|
| Rate for Payer: PacificSource Commercial |
$688.50
|
| Rate for Payer: PHCS PPO |
$726.75
|
| Rate for Payer: Three Rivers PPO |
$573.75
|
| Rate for Payer: TriWest Veterans Administration |
$149.17
|
| Rate for Payer: United Healthcare Commercial |
$665.55
|
| Rate for Payer: United Healthcare Medicare |
$149.17
|
| Rate for Payer: WINHealth Partners Commercial |
$650.25
|
|
|
ABSORBATACK FIXATION DEVICE 15
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.68 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$806.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$689.64
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$554.40
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$526.68
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$554.40
|
| Rate for Payer: United Healthcare Commercial |
$730.80
|
| Rate for Payer: United Healthcare Medicare |
$554.40
|
| Rate for Payer: WINHealth Partners Commercial |
$798.00
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
ABSORBATACK FIXATION DEVICE 15
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.84 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$554.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$806.40
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$689.64
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$487.20
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$462.84
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$487.20
|
| Rate for Payer: United Healthcare Commercial |
$730.80
|
| Rate for Payer: United Healthcare Medicare |
$487.20
|
| Rate for Payer: WINHealth Partners Commercial |
$823.20
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
ACCLARENT SE INFLATION DEVICE
|
Facility
|
IP
|
$260.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.48
|
| Rate for Payer: Altius Commercial |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$255.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.22
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.09
|
| Rate for Payer: Cigna of WY Commercial |
$255.70
|
| Rate for Payer: Entrust Commercial |
$247.87
|
| Rate for Payer: First Choice Health Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.21
|
| Rate for Payer: HealthUtah PPO |
$260.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.09
|
| Rate for Payer: Multiplan Medicare/VA |
$163.60
|
| Rate for Payer: One Health Plan of WY PPO |
$255.70
|
| Rate for Payer: PacificSource Commercial |
$234.83
|
| Rate for Payer: PHCS PPO |
$255.70
|
| Rate for Payer: Three Rivers PPO |
$195.69
|
| Rate for Payer: TriWest Veterans Administration |
$172.21
|
| Rate for Payer: United Healthcare Commercial |
$227.00
|
| Rate for Payer: United Healthcare Medicare |
$172.21
|
| Rate for Payer: WINHealth Partners Commercial |
$247.87
|
| Rate for Payer: Wise Provider Network Commercial |
$247.87
|
|
|
ACCLARENT SE INFLATION DEVICE
|
Facility
|
OP
|
$260.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.77 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.70
|
| Rate for Payer: Aetna of WY Medicare |
$172.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$250.48
|
| Rate for Payer: Altius Commercial |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$255.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$214.22
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.09
|
| Rate for Payer: Cigna of WY Commercial |
$255.70
|
| Rate for Payer: Entrust Commercial |
$247.87
|
| Rate for Payer: First Choice Health Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$151.33
|
| Rate for Payer: HealthUtah PPO |
$260.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.09
|
| Rate for Payer: Multiplan Medicare/VA |
$143.77
|
| Rate for Payer: One Health Plan of WY PPO |
$255.70
|
| Rate for Payer: PacificSource Commercial |
$234.83
|
| Rate for Payer: PHCS PPO |
$255.70
|
| Rate for Payer: Three Rivers PPO |
$195.69
|
| Rate for Payer: TriWest Veterans Administration |
$151.33
|
| Rate for Payer: United Healthcare Commercial |
$227.00
|
| Rate for Payer: United Healthcare Medicare |
$151.33
|
| Rate for Payer: WINHealth Partners Commercial |
$255.70
|
| Rate for Payer: Wise Provider Network Commercial |
$247.87
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [91361]
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
NDC 0264410090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.11
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.61
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$10.11
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$10.11
|
| Rate for Payer: WINHealth Partners Commercial |
$14.55
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [91361]
|
Facility
|
OP
|
$15.32
|
|
|
Service Code
|
NDC 0264410090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.89
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$8.44
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.01
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [10410]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 4580273200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.18
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [10410]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 4580273230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.18
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.21
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [10410]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 4580273230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.18
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.81
|
| Rate for Payer: WINHealth Partners Commercial |
$1.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY [10410]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 4580273200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.18
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.01
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.71
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1.21
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [88532]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 6809423159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.71
|
| Rate for Payer: Aetna of WY Medicare |
$0.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.69
|
| Rate for Payer: Altius Commercial |
$0.69
|
| Rate for Payer: Beech Street Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.70
|
| Rate for Payer: Cigna of WY Commercial |
$0.71
|
| Rate for Payer: Entrust Commercial |
$0.68
|
| Rate for Payer: First Choice Health Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.42
|
| Rate for Payer: HealthUtah PPO |
$0.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.70
|
| Rate for Payer: Multiplan Medicare/VA |
$0.40
|
| Rate for Payer: One Health Plan of WY PPO |
$0.71
|
| Rate for Payer: PacificSource Commercial |
$0.65
|
| Rate for Payer: PHCS PPO |
$0.71
|
| Rate for Payer: Three Rivers PPO |
$0.54
|
| Rate for Payer: TriWest Veterans Administration |
$0.42
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare |
$0.42
|
| Rate for Payer: WINHealth Partners Commercial |
$0.71
|
| Rate for Payer: Wise Provider Network Commercial |
$0.68
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION [88532]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 6809423159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.69
|
| Rate for Payer: Altius Commercial |
$0.69
|
| Rate for Payer: Beech Street Commercial |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.59
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.70
|
| Rate for Payer: Cigna of WY Commercial |
$0.71
|
| Rate for Payer: Entrust Commercial |
$0.68
|
| Rate for Payer: First Choice Health Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.48
|
| Rate for Payer: HealthUtah PPO |
$0.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.70
|
| Rate for Payer: Multiplan Medicare/VA |
$0.45
|
| Rate for Payer: One Health Plan of WY PPO |
$0.71
|
| Rate for Payer: PacificSource Commercial |
$0.65
|
| Rate for Payer: PHCS PPO |
$0.71
|
| Rate for Payer: Three Rivers PPO |
$0.54
|
| Rate for Payer: TriWest Veterans Administration |
$0.48
|
| Rate for Payer: United Healthcare Commercial |
$0.63
|
| Rate for Payer: United Healthcare Medicare |
$0.48
|
| Rate for Payer: WINHealth Partners Commercial |
$0.68
|
| Rate for Payer: Wise Provider Network Commercial |
$0.68
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID [2530]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 5789616016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID [2530]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 0904701416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID [2530]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 0904701416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID [2530]
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 5789616016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.04
|
| Rate for Payer: Altius Commercial |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$0.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.04
|
| Rate for Payer: Cigna of WY Commercial |
$0.04
|
| Rate for Payer: Entrust Commercial |
$0.04
|
| Rate for Payer: First Choice Health Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.04
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.04
|
| Rate for Payer: PacificSource Commercial |
$0.04
|
| Rate for Payer: PHCS PPO |
$0.04
|
| Rate for Payer: Three Rivers PPO |
$0.03
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.04
|
| Rate for Payer: Wise Provider Network Commercial |
$0.04
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 0045016604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION [1179]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 8770182470
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
