|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
NDC 5107907220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.99
|
| Rate for Payer: Aetna of WY Medicare |
$10.10
|
| Rate for Payer: Altius Commercial |
$14.69
|
| Rate for Payer: Beech Street Commercial |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.84
|
| Rate for Payer: Cigna of WY Commercial |
$14.99
|
| 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 |
$8.72
|
| Rate for Payer: HealthUtah PPO |
$15.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.28
|
| Rate for Payer: One Health Plan of WY PPO |
$14.99
|
| Rate for Payer: PacificSource Commercial |
$13.77
|
| Rate for Payer: PHCS PPO |
$14.99
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$8.72
|
| Rate for Payer: United Healthcare Commercial |
$14.61
|
| Rate for Payer: United Healthcare Medicare |
$8.72
|
| Rate for Payer: WINHealth Partners Commercial |
$14.99
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
OP
|
$15.15
|
|
|
Service Code
|
NDC 0054829725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.85
|
| Rate for Payer: Aetna of WY Medicare |
$10.00
|
| Rate for Payer: Altius Commercial |
$14.54
|
| Rate for Payer: Beech Street Commercial |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.70
|
| Rate for Payer: Cigna of WY Commercial |
$14.85
|
| Rate for Payer: Entrust Commercial |
$14.39
|
| Rate for Payer: First Choice Health Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$15.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.20
|
| Rate for Payer: One Health Plan of WY PPO |
$14.85
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.85
|
| Rate for Payer: Three Rivers PPO |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$14.47
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$14.85
|
| Rate for Payer: Wise Provider Network Commercial |
$14.39
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
NDC 5107907201
|
|
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
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
NDC 5107907220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.99
|
| Rate for Payer: Aetna of WY Medicare |
$9.79
|
| Rate for Payer: Altius Commercial |
$14.69
|
| Rate for Payer: Beech Street Commercial |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.84
|
| Rate for Payer: Cigna of WY Commercial |
$14.99
|
| 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 |
$9.33
|
| Rate for Payer: HealthUtah PPO |
$15.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.84
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| Rate for Payer: One Health Plan of WY PPO |
$14.99
|
| Rate for Payer: PacificSource Commercial |
$13.77
|
| Rate for Payer: PHCS PPO |
$14.99
|
| Rate for Payer: Three Rivers PPO |
$11.48
|
| Rate for Payer: TriWest Veterans Administration |
$9.33
|
| Rate for Payer: United Healthcare Commercial |
$14.61
|
| Rate for Payer: United Healthcare Medicare |
$9.33
|
| Rate for Payer: WINHealth Partners Commercial |
$14.54
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
IP
|
$15.26
|
|
|
Service Code
|
NDC 0904717761
|
|
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
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
NDC 0904717761
|
|
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
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
IP
|
$15.26
|
|
|
Service Code
|
NDC 5107907201
|
|
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
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
IP
|
$15.15
|
|
|
Service Code
|
NDC 0054829725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.85
|
| Rate for Payer: Aetna of WY Medicare |
$9.70
|
| Rate for Payer: Altius Commercial |
$14.54
|
| Rate for Payer: Beech Street Commercial |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.70
|
| Rate for Payer: Cigna of WY Commercial |
$14.85
|
| Rate for Payer: Entrust Commercial |
$14.39
|
| Rate for Payer: First Choice Health Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.24
|
| Rate for Payer: HealthUtah PPO |
$15.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.70
|
| Rate for Payer: Multiplan Medicare/VA |
$8.78
|
| Rate for Payer: One Health Plan of WY PPO |
$14.85
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.85
|
| Rate for Payer: Three Rivers PPO |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$9.24
|
| Rate for Payer: United Healthcare Commercial |
$14.47
|
| Rate for Payer: United Healthcare Medicare |
$9.24
|
| Rate for Payer: WINHealth Partners Commercial |
$14.39
|
| Rate for Payer: Wise Provider Network Commercial |
$14.39
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
OP
|
$15.67
|
|
|
Service Code
|
NDC 6931511601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.36
|
| Rate for Payer: Aetna of WY Medicare |
$10.34
|
| Rate for Payer: Altius Commercial |
$15.04
|
| Rate for Payer: Beech Street Commercial |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$10.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.20
|
| Rate for Payer: Cigna of WY Commercial |
$15.36
|
| Rate for Payer: Entrust Commercial |
$14.89
|
| Rate for Payer: First Choice Health Commercial |
$14.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.93
|
| Rate for Payer: HealthUtah PPO |
$15.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.20
|
| Rate for Payer: Multiplan Medicare/VA |
$8.49
|
| Rate for Payer: One Health Plan of WY PPO |
$15.36
|
| Rate for Payer: PacificSource Commercial |
$14.10
|
| Rate for Payer: PHCS PPO |
$15.36
|
| Rate for Payer: Three Rivers PPO |
$11.75
|
| Rate for Payer: TriWest Veterans Administration |
$8.93
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$8.93
|
| Rate for Payer: WINHealth Partners Commercial |
$15.36
|
| Rate for Payer: Wise Provider Network Commercial |
$14.89
|
|
|
FUROSEMIDE 20 MG TABLET [16605]
|
Facility
|
IP
|
$15.67
|
|
|
Service Code
|
NDC 6931511601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$15.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.36
|
| Rate for Payer: Aetna of WY Medicare |
$10.03
|
| Rate for Payer: Altius Commercial |
$15.04
|
| Rate for Payer: Beech Street Commercial |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$10.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.20
|
| Rate for Payer: Cigna of WY Commercial |
$15.36
|
| Rate for Payer: Entrust Commercial |
$14.89
|
| Rate for Payer: First Choice Health Commercial |
$14.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.56
|
| Rate for Payer: HealthUtah PPO |
$15.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.20
|
| Rate for Payer: Multiplan Medicare/VA |
$9.08
|
| Rate for Payer: One Health Plan of WY PPO |
$15.36
|
| Rate for Payer: PacificSource Commercial |
$14.10
|
| Rate for Payer: PHCS PPO |
$15.36
|
| Rate for Payer: Three Rivers PPO |
$11.75
|
| Rate for Payer: TriWest Veterans Administration |
$9.56
|
| Rate for Payer: United Healthcare Commercial |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$9.56
|
| Rate for Payer: WINHealth Partners Commercial |
$14.89
|
| Rate for Payer: Wise Provider Network Commercial |
$14.89
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
OP
|
$15.31
|
|
|
Service Code
|
NDC 5107907320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$15.31 |
| 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 Commercial |
$14.62
|
| 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
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
NDC 6931511701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.40
|
| Rate for Payer: Altius Commercial |
$15.12
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.28
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.96
|
| Rate for Payer: First Choice Health Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.98
|
| Rate for Payer: HealthUtah PPO |
$15.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.28
|
| Rate for Payer: Multiplan Medicare/VA |
$8.53
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.81
|
| Rate for Payer: TriWest Veterans Administration |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$8.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.96
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
NDC 0904717861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Medicare |
$9.77
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$14.51
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
NDC 0904717861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$8.27
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
IP
|
$15.31
|
|
|
Service Code
|
NDC 5107907320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.00
|
| Rate for Payer: Aetna of WY Medicare |
$9.80
|
| 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 |
$9.34
|
| Rate for Payer: HealthUtah PPO |
$15.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.85
|
| Rate for Payer: Multiplan Medicare/VA |
$8.87
|
| 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 |
$9.34
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare |
$9.34
|
| Rate for Payer: WINHealth Partners Commercial |
$14.54
|
| Rate for Payer: Wise Provider Network Commercial |
$14.54
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
IP
|
$15.16
|
|
|
Service Code
|
NDC 0054829925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.86
|
| Rate for Payer: Aetna of WY Medicare |
$9.70
|
| Rate for Payer: Altius Commercial |
$14.55
|
| Rate for Payer: Beech Street Commercial |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.86
|
| Rate for Payer: Entrust Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.25
|
| Rate for Payer: HealthUtah PPO |
$15.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.79
|
| Rate for Payer: One Health Plan of WY PPO |
$14.86
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.86
|
| Rate for Payer: Three Rivers PPO |
$11.37
|
| Rate for Payer: TriWest Veterans Administration |
$9.25
|
| Rate for Payer: United Healthcare Commercial |
$14.48
|
| Rate for Payer: United Healthcare Medicare |
$9.25
|
| Rate for Payer: WINHealth Partners Commercial |
$14.40
|
| Rate for Payer: Wise Provider Network Commercial |
$14.40
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
NDC 6931511701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Altius Commercial |
$15.12
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.28
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.96
|
| Rate for Payer: First Choice Health Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.61
|
| Rate for Payer: HealthUtah PPO |
$15.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.28
|
| Rate for Payer: Multiplan Medicare/VA |
$9.13
|
| Rate for Payer: One Health Plan of WY PPO |
$15.44
|
| Rate for Payer: PacificSource Commercial |
$14.18
|
| Rate for Payer: PHCS PPO |
$15.44
|
| Rate for Payer: Three Rivers PPO |
$11.81
|
| Rate for Payer: TriWest Veterans Administration |
$9.61
|
| Rate for Payer: United Healthcare Commercial |
$15.04
|
| Rate for Payer: United Healthcare Medicare |
$9.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: Wise Provider Network Commercial |
$14.96
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
OP
|
$15.16
|
|
|
Service Code
|
NDC 0054829925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.86
|
| Rate for Payer: Aetna of WY Medicare |
$10.01
|
| Rate for Payer: Altius Commercial |
$14.55
|
| Rate for Payer: Beech Street Commercial |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.71
|
| Rate for Payer: Cash Price |
$10.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.71
|
| Rate for Payer: Cigna of WY Commercial |
$14.86
|
| Rate for Payer: Entrust Commercial |
$14.40
|
| Rate for Payer: First Choice Health Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.64
|
| Rate for Payer: HealthUtah PPO |
$15.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.21
|
| Rate for Payer: One Health Plan of WY PPO |
$14.86
|
| Rate for Payer: PacificSource Commercial |
$13.64
|
| Rate for Payer: PHCS PPO |
$14.86
|
| Rate for Payer: Three Rivers PPO |
$11.37
|
| Rate for Payer: TriWest Veterans Administration |
$8.64
|
| Rate for Payer: United Healthcare Commercial |
$14.48
|
| Rate for Payer: United Healthcare Medicare |
$8.64
|
| Rate for Payer: WINHealth Partners Commercial |
$14.86
|
| Rate for Payer: Wise Provider Network Commercial |
$14.40
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
OP
|
$15.27
|
|
|
Service Code
|
NDC 5107907301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Medicare |
$10.08
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.70
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$8.27
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$8.70
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$8.70
|
| Rate for Payer: WINHealth Partners Commercial |
$14.96
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
FUROSEMIDE 40 MG TABLET [419]
|
Facility
|
IP
|
$15.27
|
|
|
Service Code
|
NDC 5107907301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.96
|
| Rate for Payer: Aetna of WY Medicare |
$9.77
|
| Rate for Payer: Altius Commercial |
$14.66
|
| Rate for Payer: Beech Street Commercial |
$14.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.81
|
| Rate for Payer: Cash Price |
$10.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.81
|
| Rate for Payer: Cigna of WY Commercial |
$14.96
|
| Rate for Payer: Entrust Commercial |
$14.51
|
| Rate for Payer: First Choice Health Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$15.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.81
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$14.96
|
| Rate for Payer: PacificSource Commercial |
$13.74
|
| Rate for Payer: PHCS PPO |
$14.96
|
| Rate for Payer: Three Rivers PPO |
$11.45
|
| Rate for Payer: TriWest Veterans Administration |
$9.31
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.31
|
| Rate for Payer: WINHealth Partners Commercial |
$14.51
|
| Rate for Payer: Wise Provider Network Commercial |
$14.51
|
|
|
FUROSEMIDE INJECTION
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Aetna of WY Medicare |
$0.61
|
| Rate for Payer: Beech Street Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: First Choice Health Commercial |
$2.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.61
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$0.52
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.85
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2.85
|
|
|
FUSION BLADE QUADCUT 4.3X13
|
Facility
|
OP
|
$1,213.20
|
|
| Hospital Charge Code |
3002833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.95 |
| Max. Negotiated Rate |
$1,213.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,188.94
|
| Rate for Payer: Aetna of WY Medicare |
$800.71
|
| Rate for Payer: Altius Commercial |
$1,164.67
|
| Rate for Payer: Beech Street Commercial |
$1,188.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,176.80
|
| Rate for Payer: Cash Price |
$849.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,176.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,188.94
|
| Rate for Payer: Entrust Commercial |
$1,152.54
|
| Rate for Payer: First Choice Health Commercial |
$1,152.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,152.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$691.52
|
| Rate for Payer: HealthUtah PPO |
$1,213.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,176.80
|
| Rate for Payer: Multiplan Medicare/VA |
$656.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1,188.94
|
| Rate for Payer: PacificSource Commercial |
$1,091.88
|
| Rate for Payer: PHCS PPO |
$1,188.94
|
| Rate for Payer: Three Rivers PPO |
$909.90
|
| Rate for Payer: TriWest Veterans Administration |
$691.52
|
| Rate for Payer: United Healthcare Commercial |
$1,158.61
|
| Rate for Payer: United Healthcare Medicare |
$691.52
|
| Rate for Payer: WINHealth Partners Commercial |
$1,188.94
|
| Rate for Payer: Wise Provider Network Commercial |
$1,152.54
|
|
|
FUSION BLADE QUADCUT 4.3X13
|
Facility
|
IP
|
$1,213.20
|
|
| Hospital Charge Code |
3002833
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.05 |
| Max. Negotiated Rate |
$1,213.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,188.94
|
| Rate for Payer: Aetna of WY Medicare |
$776.45
|
| Rate for Payer: Altius Commercial |
$1,164.67
|
| Rate for Payer: Beech Street Commercial |
$1,188.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,176.80
|
| Rate for Payer: Cash Price |
$849.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,176.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,188.94
|
| Rate for Payer: Entrust Commercial |
$1,152.54
|
| Rate for Payer: First Choice Health Commercial |
$1,152.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,152.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$740.05
|
| Rate for Payer: HealthUtah PPO |
$1,213.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,176.80
|
| Rate for Payer: Multiplan Medicare/VA |
$703.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1,188.94
|
| Rate for Payer: PacificSource Commercial |
$1,091.88
|
| Rate for Payer: PHCS PPO |
$1,188.94
|
| Rate for Payer: Three Rivers PPO |
$909.90
|
| Rate for Payer: TriWest Veterans Administration |
$740.05
|
| Rate for Payer: United Healthcare Commercial |
$1,158.61
|
| Rate for Payer: United Healthcare Medicare |
$740.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,152.54
|
| Rate for Payer: Wise Provider Network Commercial |
$1,152.54
|
|
|
FUSION CUP 10 HOLE 18MM TRIMED
|
Facility
|
OP
|
$3,244.50
|
|
| Hospital Charge Code |
3002545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,756.90 |
| Max. Negotiated Rate |
$3,244.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,179.61
|
| Rate for Payer: Aetna of WY Medicare |
$2,141.37
|
| Rate for Payer: Altius Commercial |
$3,114.72
|
| Rate for Payer: Beech Street Commercial |
$3,179.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,147.16
|
| Rate for Payer: Cash Price |
$2,271.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,147.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,179.61
|
| Rate for Payer: Entrust Commercial |
$3,082.28
|
| Rate for Payer: First Choice Health Commercial |
$3,082.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,082.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,849.36
|
| Rate for Payer: HealthUtah PPO |
$3,244.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,147.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1,756.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3,179.61
|
| Rate for Payer: PacificSource Commercial |
$2,920.05
|
| Rate for Payer: PHCS PPO |
$3,179.61
|
| Rate for Payer: Three Rivers PPO |
$2,433.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,849.36
|
| Rate for Payer: United Healthcare Commercial |
$3,098.50
|
| Rate for Payer: United Healthcare Medicare |
$1,849.36
|
| Rate for Payer: WINHealth Partners Commercial |
$3,179.61
|
| Rate for Payer: Wise Provider Network Commercial |
$3,082.28
|
|
|
FUSION CUP 10 HOLE 18MM TRIMED
|
Facility
|
IP
|
$3,244.50
|
|
| Hospital Charge Code |
3002545
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,880.19 |
| Max. Negotiated Rate |
$3,244.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,179.61
|
| Rate for Payer: Aetna of WY Medicare |
$2,076.48
|
| Rate for Payer: Altius Commercial |
$3,114.72
|
| Rate for Payer: Beech Street Commercial |
$3,179.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,147.16
|
| Rate for Payer: Cash Price |
$2,271.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,147.16
|
| Rate for Payer: Cigna of WY Commercial |
$3,179.61
|
| Rate for Payer: Entrust Commercial |
$3,082.28
|
| Rate for Payer: First Choice Health Commercial |
$3,082.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,082.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,979.14
|
| Rate for Payer: HealthUtah PPO |
$3,244.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,147.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1,880.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,179.61
|
| Rate for Payer: PacificSource Commercial |
$2,920.05
|
| Rate for Payer: PHCS PPO |
$3,179.61
|
| Rate for Payer: Three Rivers PPO |
$2,433.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,979.14
|
| Rate for Payer: United Healthcare Commercial |
$3,098.50
|
| Rate for Payer: United Healthcare Medicare |
$1,979.14
|
| Rate for Payer: WINHealth Partners Commercial |
$3,082.28
|
| Rate for Payer: Wise Provider Network Commercial |
$3,082.28
|
|
