|
FLOSEAL HEMOSTATIC MATRIX 5ML
|
Facility
|
OP
|
$786.04
|
|
| Hospital Charge Code |
2750037
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.64 |
| Max. Negotiated Rate |
$786.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$770.32
|
| Rate for Payer: Aetna of WY Medicare |
$518.79
|
| Rate for Payer: Altius Commercial |
$754.60
|
| Rate for Payer: Beech Street Commercial |
$770.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$762.46
|
| Rate for Payer: Cash Price |
$550.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$762.46
|
| Rate for Payer: Cigna of WY Commercial |
$770.32
|
| Rate for Payer: Entrust Commercial |
$746.74
|
| Rate for Payer: First Choice Health Commercial |
$746.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$746.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$448.04
|
| Rate for Payer: HealthUtah PPO |
$786.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$762.46
|
| Rate for Payer: Multiplan Medicare/VA |
$425.64
|
| Rate for Payer: One Health Plan of WY PPO |
$770.32
|
| Rate for Payer: PacificSource Commercial |
$707.44
|
| Rate for Payer: PHCS PPO |
$770.32
|
| Rate for Payer: Three Rivers PPO |
$589.53
|
| Rate for Payer: TriWest Veterans Administration |
$448.04
|
| Rate for Payer: United Healthcare Commercial |
$750.67
|
| Rate for Payer: United Healthcare Medicare |
$448.04
|
| Rate for Payer: WINHealth Partners Commercial |
$770.32
|
| Rate for Payer: Wise Provider Network Commercial |
$746.74
|
|
|
FLOXURIDINE 0.5 GRAM SOLUTION FOR INJECTION [3294]
|
Facility
|
OP
|
$3,655.61
|
|
|
Service Code
|
HCPCS J9200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,979.51 |
| Max. Negotiated Rate |
$3,655.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,582.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,412.70
|
| Rate for Payer: Altius Commercial |
$3,509.39
|
| Rate for Payer: Beech Street Commercial |
$3,582.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,545.94
|
| Rate for Payer: Cash Price |
$2,558.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,545.94
|
| Rate for Payer: Cigna of WY Commercial |
$3,582.50
|
| Rate for Payer: Entrust Commercial |
$3,472.83
|
| Rate for Payer: First Choice Health Commercial |
$3,472.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,472.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,083.70
|
| Rate for Payer: HealthUtah PPO |
$3,655.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,545.94
|
| Rate for Payer: Multiplan Medicare/VA |
$1,979.51
|
| Rate for Payer: One Health Plan of WY PPO |
$3,582.50
|
| Rate for Payer: PacificSource Commercial |
$3,290.05
|
| Rate for Payer: PHCS PPO |
$3,582.50
|
| Rate for Payer: Three Rivers PPO |
$2,741.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,083.70
|
| Rate for Payer: United Healthcare Commercial |
$3,491.11
|
| Rate for Payer: United Healthcare Medicare |
$2,083.70
|
| Rate for Payer: WINHealth Partners Commercial |
$3,582.50
|
| Rate for Payer: Wise Provider Network Commercial |
$3,472.83
|
|
|
FLOXURIDINE 0.5 GRAM SOLUTION FOR INJECTION [3294]
|
Facility
|
IP
|
$3,655.61
|
|
|
Service Code
|
HCPCS J9200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,118.43 |
| Max. Negotiated Rate |
$3,655.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,582.50
|
| Rate for Payer: Aetna of WY Medicare |
$2,339.59
|
| Rate for Payer: Altius Commercial |
$3,509.39
|
| Rate for Payer: Beech Street Commercial |
$3,582.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,545.94
|
| Rate for Payer: Cash Price |
$2,558.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,545.94
|
| Rate for Payer: Cigna of WY Commercial |
$3,582.50
|
| Rate for Payer: Entrust Commercial |
$3,472.83
|
| Rate for Payer: First Choice Health Commercial |
$3,472.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,472.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,229.92
|
| Rate for Payer: HealthUtah PPO |
$3,655.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,545.94
|
| Rate for Payer: Multiplan Medicare/VA |
$2,118.43
|
| Rate for Payer: One Health Plan of WY PPO |
$3,582.50
|
| Rate for Payer: PacificSource Commercial |
$3,290.05
|
| Rate for Payer: PHCS PPO |
$3,582.50
|
| Rate for Payer: Three Rivers PPO |
$2,741.71
|
| Rate for Payer: TriWest Veterans Administration |
$2,229.92
|
| Rate for Payer: United Healthcare Commercial |
$3,491.11
|
| Rate for Payer: United Healthcare Medicare |
$2,229.92
|
| Rate for Payer: WINHealth Partners Commercial |
$3,472.83
|
| Rate for Payer: Wise Provider Network Commercial |
$3,472.83
|
|
|
FLUCONAZOLE 100 MG TABLET [706]
|
Facility
|
IP
|
$21.80
|
|
|
Service Code
|
NDC 5026833711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$21.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.36
|
| Rate for Payer: Aetna of WY Medicare |
$13.95
|
| Rate for Payer: Altius Commercial |
$20.93
|
| Rate for Payer: Beech Street Commercial |
$21.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.15
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.15
|
| Rate for Payer: Cigna of WY Commercial |
$21.36
|
| Rate for Payer: Entrust Commercial |
$20.71
|
| Rate for Payer: First Choice Health Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.30
|
| Rate for Payer: HealthUtah PPO |
$21.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.15
|
| Rate for Payer: Multiplan Medicare/VA |
$12.63
|
| Rate for Payer: One Health Plan of WY PPO |
$21.36
|
| Rate for Payer: PacificSource Commercial |
$19.62
|
| Rate for Payer: PHCS PPO |
$21.36
|
| Rate for Payer: Three Rivers PPO |
$16.35
|
| Rate for Payer: TriWest Veterans Administration |
$13.30
|
| Rate for Payer: United Healthcare Commercial |
$20.82
|
| Rate for Payer: United Healthcare Medicare |
$13.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.71
|
| Rate for Payer: Wise Provider Network Commercial |
$20.71
|
|
|
FLUCONAZOLE 100 MG TABLET [706]
|
Facility
|
OP
|
$21.80
|
|
|
Service Code
|
NDC 5026833715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$21.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.36
|
| Rate for Payer: Aetna of WY Medicare |
$14.39
|
| Rate for Payer: Altius Commercial |
$20.93
|
| Rate for Payer: Beech Street Commercial |
$21.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.15
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.15
|
| Rate for Payer: Cigna of WY Commercial |
$21.36
|
| Rate for Payer: Entrust Commercial |
$20.71
|
| Rate for Payer: First Choice Health Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.43
|
| Rate for Payer: HealthUtah PPO |
$21.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.15
|
| Rate for Payer: Multiplan Medicare/VA |
$11.80
|
| Rate for Payer: One Health Plan of WY PPO |
$21.36
|
| Rate for Payer: PacificSource Commercial |
$19.62
|
| Rate for Payer: PHCS PPO |
$21.36
|
| Rate for Payer: Three Rivers PPO |
$16.35
|
| Rate for Payer: TriWest Veterans Administration |
$12.43
|
| Rate for Payer: United Healthcare Commercial |
$20.82
|
| Rate for Payer: United Healthcare Medicare |
$12.43
|
| Rate for Payer: WINHealth Partners Commercial |
$21.36
|
| Rate for Payer: Wise Provider Network Commercial |
$20.71
|
|
|
FLUCONAZOLE 100 MG TABLET [706]
|
Facility
|
OP
|
$21.80
|
|
|
Service Code
|
NDC 5026833711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$21.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.36
|
| Rate for Payer: Aetna of WY Medicare |
$14.39
|
| Rate for Payer: Altius Commercial |
$20.93
|
| Rate for Payer: Beech Street Commercial |
$21.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.15
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.15
|
| Rate for Payer: Cigna of WY Commercial |
$21.36
|
| Rate for Payer: Entrust Commercial |
$20.71
|
| Rate for Payer: First Choice Health Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.43
|
| Rate for Payer: HealthUtah PPO |
$21.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.15
|
| Rate for Payer: Multiplan Medicare/VA |
$11.80
|
| Rate for Payer: One Health Plan of WY PPO |
$21.36
|
| Rate for Payer: PacificSource Commercial |
$19.62
|
| Rate for Payer: PHCS PPO |
$21.36
|
| Rate for Payer: Three Rivers PPO |
$16.35
|
| Rate for Payer: TriWest Veterans Administration |
$12.43
|
| Rate for Payer: United Healthcare Commercial |
$20.82
|
| Rate for Payer: United Healthcare Medicare |
$12.43
|
| Rate for Payer: WINHealth Partners Commercial |
$21.36
|
| Rate for Payer: Wise Provider Network Commercial |
$20.71
|
|
|
FLUCONAZOLE 100 MG TABLET [706]
|
Facility
|
IP
|
$21.80
|
|
|
Service Code
|
NDC 5026833715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$21.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.36
|
| Rate for Payer: Aetna of WY Medicare |
$13.95
|
| Rate for Payer: Altius Commercial |
$20.93
|
| Rate for Payer: Beech Street Commercial |
$21.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.15
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.15
|
| Rate for Payer: Cigna of WY Commercial |
$21.36
|
| Rate for Payer: Entrust Commercial |
$20.71
|
| Rate for Payer: First Choice Health Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.30
|
| Rate for Payer: HealthUtah PPO |
$21.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.15
|
| Rate for Payer: Multiplan Medicare/VA |
$12.63
|
| Rate for Payer: One Health Plan of WY PPO |
$21.36
|
| Rate for Payer: PacificSource Commercial |
$19.62
|
| Rate for Payer: PHCS PPO |
$21.36
|
| Rate for Payer: Three Rivers PPO |
$16.35
|
| Rate for Payer: TriWest Veterans Administration |
$13.30
|
| Rate for Payer: United Healthcare Commercial |
$20.82
|
| Rate for Payer: United Healthcare Medicare |
$13.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.71
|
| Rate for Payer: Wise Provider Network Commercial |
$20.71
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [9173]
|
Facility
|
OP
|
$15.36
|
|
|
Service Code
|
HCPCS J1450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.05
|
| Rate for Payer: Aetna of WY Medicare |
$10.14
|
| Rate for Payer: Altius Commercial |
$14.75
|
| Rate for Payer: Beech Street Commercial |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.90
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.90
|
| Rate for Payer: Cigna of WY Commercial |
$15.05
|
| Rate for Payer: Entrust Commercial |
$14.59
|
| Rate for Payer: First Choice Health Commercial |
$14.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: HealthUtah PPO |
$15.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.90
|
| Rate for Payer: Multiplan Medicare/VA |
$8.32
|
| Rate for Payer: One Health Plan of WY PPO |
$15.05
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.05
|
| Rate for Payer: Three Rivers PPO |
$11.52
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$14.67
|
| Rate for Payer: United Healthcare Medicare |
$8.76
|
| Rate for Payer: WINHealth Partners Commercial |
$15.05
|
| Rate for Payer: Wise Provider Network Commercial |
$14.59
|
|
|
FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK [9173]
|
Facility
|
IP
|
$15.36
|
|
|
Service Code
|
HCPCS J1450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$15.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.05
|
| Rate for Payer: Aetna of WY Medicare |
$9.83
|
| Rate for Payer: Altius Commercial |
$14.75
|
| Rate for Payer: Beech Street Commercial |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.90
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.90
|
| Rate for Payer: Cigna of WY Commercial |
$15.05
|
| Rate for Payer: Entrust Commercial |
$14.59
|
| Rate for Payer: First Choice Health Commercial |
$14.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.37
|
| Rate for Payer: HealthUtah PPO |
$15.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.90
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$15.05
|
| Rate for Payer: PacificSource Commercial |
$13.82
|
| Rate for Payer: PHCS PPO |
$15.05
|
| Rate for Payer: Three Rivers PPO |
$11.52
|
| Rate for Payer: TriWest Veterans Administration |
$9.37
|
| Rate for Payer: United Healthcare Commercial |
$14.67
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WINHealth Partners Commercial |
$14.59
|
| Rate for Payer: Wise Provider Network Commercial |
$14.59
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 5026833015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.56
|
| Rate for Payer: Aetna of WY Medicare |
$11.15
|
| Rate for Payer: Altius Commercial |
$16.22
|
| Rate for Payer: Beech Street Commercial |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.39
|
| Rate for Payer: Cigna of WY Commercial |
$16.56
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.63
|
| Rate for Payer: HealthUtah PPO |
$16.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.15
|
| Rate for Payer: One Health Plan of WY PPO |
$16.56
|
| Rate for Payer: PacificSource Commercial |
$15.21
|
| Rate for Payer: PHCS PPO |
$16.56
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$9.63
|
| Rate for Payer: United Healthcare Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare |
$9.63
|
| Rate for Payer: WINHealth Partners Commercial |
$16.56
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
NDC 5026833015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.82
|
| Rate for Payer: Altius Commercial |
$16.22
|
| Rate for Payer: Beech Street Commercial |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.39
|
| Rate for Payer: Cigna of WY Commercial |
$16.56
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.31
|
| Rate for Payer: HealthUtah PPO |
$16.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.79
|
| Rate for Payer: One Health Plan of WY PPO |
$16.56
|
| Rate for Payer: PacificSource Commercial |
$15.21
|
| Rate for Payer: PHCS PPO |
$16.56
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$10.31
|
| Rate for Payer: United Healthcare Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare |
$10.31
|
| Rate for Payer: WINHealth Partners Commercial |
$16.06
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 5026833011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.56
|
| Rate for Payer: Aetna of WY Medicare |
$11.15
|
| Rate for Payer: Altius Commercial |
$16.22
|
| Rate for Payer: Beech Street Commercial |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.39
|
| Rate for Payer: Cigna of WY Commercial |
$16.56
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.63
|
| Rate for Payer: HealthUtah PPO |
$16.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.15
|
| Rate for Payer: One Health Plan of WY PPO |
$16.56
|
| Rate for Payer: PacificSource Commercial |
$15.21
|
| Rate for Payer: PHCS PPO |
$16.56
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$9.63
|
| Rate for Payer: United Healthcare Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare |
$9.63
|
| Rate for Payer: WINHealth Partners Commercial |
$16.56
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
|
FLUDROCORTISONE 0.1 MG TABLET [19026]
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
NDC 5026833011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.82
|
| Rate for Payer: Altius Commercial |
$16.22
|
| Rate for Payer: Beech Street Commercial |
$16.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.39
|
| Rate for Payer: Cigna of WY Commercial |
$16.56
|
| Rate for Payer: Entrust Commercial |
$16.06
|
| Rate for Payer: First Choice Health Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.31
|
| Rate for Payer: HealthUtah PPO |
$16.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.39
|
| Rate for Payer: Multiplan Medicare/VA |
$9.79
|
| Rate for Payer: One Health Plan of WY PPO |
$16.56
|
| Rate for Payer: PacificSource Commercial |
$15.21
|
| Rate for Payer: PHCS PPO |
$16.56
|
| Rate for Payer: Three Rivers PPO |
$12.68
|
| Rate for Payer: TriWest Veterans Administration |
$10.31
|
| Rate for Payer: United Healthcare Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare |
$10.31
|
| Rate for Payer: WINHealth Partners Commercial |
$16.06
|
| Rate for Payer: Wise Provider Network Commercial |
$16.06
|
|
|
FLUID FIGHTER SUCTION DISC
|
Facility
|
IP
|
$29.75
|
|
| Hospital Charge Code |
2650921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.16
|
| Rate for Payer: Aetna of WY Medicare |
$19.04
|
| Rate for Payer: Altius Commercial |
$28.56
|
| Rate for Payer: Beech Street Commercial |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.86
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.86
|
| Rate for Payer: Cigna of WY Commercial |
$29.16
|
| Rate for Payer: Entrust Commercial |
$28.26
|
| Rate for Payer: First Choice Health Commercial |
$28.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.15
|
| Rate for Payer: HealthUtah PPO |
$29.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.86
|
| Rate for Payer: Multiplan Medicare/VA |
$17.24
|
| Rate for Payer: One Health Plan of WY PPO |
$29.16
|
| Rate for Payer: PacificSource Commercial |
$26.78
|
| Rate for Payer: PHCS PPO |
$29.16
|
| Rate for Payer: Three Rivers PPO |
$22.31
|
| Rate for Payer: TriWest Veterans Administration |
$18.15
|
| Rate for Payer: United Healthcare Commercial |
$28.41
|
| Rate for Payer: United Healthcare Medicare |
$18.15
|
| Rate for Payer: WINHealth Partners Commercial |
$28.26
|
| Rate for Payer: Wise Provider Network Commercial |
$28.26
|
|
|
FLUID FIGHTER SUCTION DISC
|
Facility
|
OP
|
$29.75
|
|
| Hospital Charge Code |
2650921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.11 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.16
|
| Rate for Payer: Aetna of WY Medicare |
$19.64
|
| Rate for Payer: Altius Commercial |
$28.56
|
| Rate for Payer: Beech Street Commercial |
$29.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.86
|
| Rate for Payer: Cash Price |
$20.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.86
|
| Rate for Payer: Cigna of WY Commercial |
$29.16
|
| Rate for Payer: Entrust Commercial |
$28.26
|
| Rate for Payer: First Choice Health Commercial |
$28.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.96
|
| Rate for Payer: HealthUtah PPO |
$29.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.86
|
| Rate for Payer: Multiplan Medicare/VA |
$16.11
|
| Rate for Payer: One Health Plan of WY PPO |
$29.16
|
| Rate for Payer: PacificSource Commercial |
$26.78
|
| Rate for Payer: PHCS PPO |
$29.16
|
| Rate for Payer: Three Rivers PPO |
$22.31
|
| Rate for Payer: TriWest Veterans Administration |
$16.96
|
| Rate for Payer: United Healthcare Commercial |
$28.41
|
| Rate for Payer: United Healthcare Medicare |
$16.96
|
| Rate for Payer: WINHealth Partners Commercial |
$29.16
|
| Rate for Payer: Wise Provider Network Commercial |
$28.26
|
|
|
FLUID STICK USA-FS1
|
Facility
|
IP
|
$87.50
|
|
| Hospital Charge Code |
2650739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Aetna of WY Medicare |
$56.00
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.88
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.38
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$50.71
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$53.38
|
| Rate for Payer: United Healthcare Commercial |
$83.56
|
| Rate for Payer: United Healthcare Medicare |
$53.38
|
| Rate for Payer: WINHealth Partners Commercial |
$83.12
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
FLUID STICK USA-FS1
|
Facility
|
OP
|
$87.50
|
|
| Hospital Charge Code |
2650739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.75
|
| Rate for Payer: Aetna of WY Medicare |
$57.75
|
| Rate for Payer: Altius Commercial |
$84.00
|
| Rate for Payer: Beech Street Commercial |
$85.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.88
|
| Rate for Payer: Cash Price |
$61.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.88
|
| Rate for Payer: Cigna of WY Commercial |
$85.75
|
| Rate for Payer: Entrust Commercial |
$83.12
|
| Rate for Payer: First Choice Health Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$83.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.88
|
| Rate for Payer: HealthUtah PPO |
$87.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.88
|
| Rate for Payer: Multiplan Medicare/VA |
$47.38
|
| Rate for Payer: One Health Plan of WY PPO |
$85.75
|
| Rate for Payer: PacificSource Commercial |
$78.75
|
| Rate for Payer: PHCS PPO |
$85.75
|
| Rate for Payer: Three Rivers PPO |
$65.62
|
| Rate for Payer: TriWest Veterans Administration |
$49.88
|
| Rate for Payer: United Healthcare Commercial |
$83.56
|
| Rate for Payer: United Healthcare Medicare |
$49.88
|
| Rate for Payer: WINHealth Partners Commercial |
$85.75
|
| Rate for Payer: Wise Provider Network Commercial |
$83.12
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [20638]
|
Facility
|
IP
|
$20.94
|
|
|
Service Code
|
NDC 6332342405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.52
|
| Rate for Payer: Aetna of WY Medicare |
$13.40
|
| Rate for Payer: Altius Commercial |
$20.10
|
| Rate for Payer: Beech Street Commercial |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.31
|
| Rate for Payer: Cigna of WY Commercial |
$20.52
|
| Rate for Payer: Entrust Commercial |
$19.89
|
| Rate for Payer: First Choice Health Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.77
|
| Rate for Payer: HealthUtah PPO |
$20.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.31
|
| Rate for Payer: Multiplan Medicare/VA |
$12.13
|
| Rate for Payer: One Health Plan of WY PPO |
$20.52
|
| Rate for Payer: PacificSource Commercial |
$18.85
|
| Rate for Payer: PHCS PPO |
$20.52
|
| Rate for Payer: Three Rivers PPO |
$15.70
|
| Rate for Payer: TriWest Veterans Administration |
$12.77
|
| Rate for Payer: United Healthcare Commercial |
$20.00
|
| Rate for Payer: United Healthcare Medicare |
$12.77
|
| Rate for Payer: WINHealth Partners Commercial |
$19.89
|
| Rate for Payer: Wise Provider Network Commercial |
$19.89
|
|
|
FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION [20638]
|
Facility
|
OP
|
$20.94
|
|
|
Service Code
|
NDC 6332342405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.52
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Altius Commercial |
$20.10
|
| Rate for Payer: Beech Street Commercial |
$20.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.31
|
| Rate for Payer: Cigna of WY Commercial |
$20.52
|
| Rate for Payer: Entrust Commercial |
$19.89
|
| Rate for Payer: First Choice Health Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.94
|
| Rate for Payer: HealthUtah PPO |
$20.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.31
|
| Rate for Payer: Multiplan Medicare/VA |
$11.34
|
| Rate for Payer: One Health Plan of WY PPO |
$20.52
|
| Rate for Payer: PacificSource Commercial |
$18.85
|
| Rate for Payer: PHCS PPO |
$20.52
|
| Rate for Payer: Three Rivers PPO |
$15.70
|
| Rate for Payer: TriWest Veterans Administration |
$11.94
|
| Rate for Payer: United Healthcare Commercial |
$20.00
|
| Rate for Payer: United Healthcare Medicare |
$11.94
|
| Rate for Payer: WINHealth Partners Commercial |
$20.52
|
| Rate for Payer: Wise Provider Network Commercial |
$19.89
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [8442]
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 1723890011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Medicare |
$10.14
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.36
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.66
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$9.18
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$9.66
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Medicare |
$9.66
|
| Rate for Payer: WINHealth Partners Commercial |
$15.05
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
FLUORESCEIN 1 MG EYE STRIPS [8442]
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 1723890011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.52
|
| Rate for Payer: Aetna of WY Medicare |
$10.45
|
| Rate for Payer: Altius Commercial |
$15.21
|
| Rate for Payer: Beech Street Commercial |
$15.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.36
|
| Rate for Payer: Cash Price |
$11.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.36
|
| Rate for Payer: Cigna of WY Commercial |
$15.52
|
| Rate for Payer: Entrust Commercial |
$15.05
|
| Rate for Payer: First Choice Health Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.03
|
| Rate for Payer: HealthUtah PPO |
$15.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.36
|
| Rate for Payer: Multiplan Medicare/VA |
$8.58
|
| Rate for Payer: One Health Plan of WY PPO |
$15.52
|
| Rate for Payer: PacificSource Commercial |
$14.26
|
| Rate for Payer: PHCS PPO |
$15.52
|
| Rate for Payer: Three Rivers PPO |
$11.88
|
| Rate for Payer: TriWest Veterans Administration |
$9.03
|
| Rate for Payer: United Healthcare Commercial |
$15.13
|
| Rate for Payer: United Healthcare Medicare |
$9.03
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.05
|
|
|
FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 77003 26
|
| Min. Negotiated Rate |
$23.37 |
| Max. Negotiated Rate |
$743.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$728.14
|
| Rate for Payer: Aetna of WY Medicare |
$27.49
|
| Rate for Payer: Beech Street Commercial |
$705.85
|
| Rate for Payer: Cash Price |
$520.10
|
| Rate for Payer: Cash Price |
$520.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$720.71
|
| Rate for Payer: Cigna of WY Commercial |
$728.14
|
| Rate for Payer: First Choice Health Commercial |
$668.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$705.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.49
|
| Rate for Payer: HealthUtah PPO |
$743.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$720.71
|
| Rate for Payer: Multiplan Medicare/VA |
$23.37
|
| Rate for Payer: One Health Plan of WY PPO |
$728.14
|
| Rate for Payer: PacificSource Commercial |
$668.70
|
| Rate for Payer: PHCS PPO |
$705.85
|
| Rate for Payer: Three Rivers PPO |
$557.25
|
| Rate for Payer: TriWest Veterans Administration |
$27.49
|
| Rate for Payer: United Healthcare Commercial |
$705.85
|
| Rate for Payer: WINHealth Partners Commercial |
$705.85
|
|
|
FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$82.02 |
| Max. Negotiated Rate |
$427.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$418.46
|
| Rate for Payer: Aetna of WY Medicare |
$96.50
|
| Rate for Payer: Beech Street Commercial |
$405.65
|
| Rate for Payer: Cash Price |
$298.90
|
| Rate for Payer: Cash Price |
$298.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$414.19
|
| Rate for Payer: Cigna of WY Commercial |
$418.46
|
| Rate for Payer: First Choice Health Commercial |
$384.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$405.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.50
|
| Rate for Payer: HealthUtah PPO |
$427.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$414.19
|
| Rate for Payer: Multiplan Medicare/VA |
$82.02
|
| Rate for Payer: One Health Plan of WY PPO |
$418.46
|
| Rate for Payer: PacificSource Commercial |
$384.30
|
| Rate for Payer: PHCS PPO |
$405.65
|
| Rate for Payer: Three Rivers PPO |
$320.25
|
| Rate for Payer: TriWest Veterans Administration |
$96.50
|
| Rate for Payer: United Healthcare Commercial |
$405.65
|
| Rate for Payer: WINHealth Partners Commercial |
$405.65
|
|
|
FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$96.57 |
| Max. Negotiated Rate |
$854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.92
|
| Rate for Payer: Aetna of WY Medicare |
$113.61
|
| Rate for Payer: Beech Street Commercial |
$811.30
|
| Rate for Payer: Cash Price |
$597.80
|
| Rate for Payer: Cash Price |
$597.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.38
|
| Rate for Payer: Cigna of WY Commercial |
$836.92
|
| Rate for Payer: First Choice Health Commercial |
$768.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.61
|
| Rate for Payer: HealthUtah PPO |
$854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.38
|
| Rate for Payer: Multiplan Medicare/VA |
$96.57
|
| Rate for Payer: One Health Plan of WY PPO |
$836.92
|
| Rate for Payer: PacificSource Commercial |
$768.60
|
| Rate for Payer: PHCS PPO |
$811.30
|
| Rate for Payer: Three Rivers PPO |
$640.50
|
| Rate for Payer: TriWest Veterans Administration |
$113.61
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
| Rate for Payer: WINHealth Partners Commercial |
$811.30
|
|
|
FLUOROURACIL 50 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000719]
|
Facility
|
OP
|
$17.40
|
|
|
Service Code
|
HCPCS J9190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.72
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Aetna of WY Medicare |
$11.26
|
| Rate for Payer: Altius Commercial |
$16.38
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$16.72
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.55
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Cigna of WY Commercial |
$16.72
|
| Rate for Payer: Entrust Commercial |
$16.21
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.21
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$17.06
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$9.42
|
| Rate for Payer: Multiplan Medicare/VA |
$9.24
|
| Rate for Payer: One Health Plan of WY PPO |
$16.72
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PacificSource Commercial |
$15.35
|
| Rate for Payer: PHCS PPO |
$16.72
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$12.80
|
| Rate for Payer: TriWest Veterans Administration |
$9.92
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$16.29
|
| Rate for Payer: United Healthcare Commercial |
$16.62
|
| Rate for Payer: United Healthcare Medicare |
$9.92
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.72
|
| Rate for Payer: WINHealth Partners Commercial |
$17.05
|
| Rate for Payer: Wise Provider Network Commercial |
$16.21
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
