|
GLIDESCOPE SZ 4 LOPRO SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
2600060
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$85.12
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.13
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$77.07
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.13
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$81.13
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIMEPIRIDE 2 MG TABLET [8242]
|
Facility
|
OP
|
$17.16
|
|
|
Service Code
|
NDC 6808432611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.82
|
| Rate for Payer: Aetna of WY Medicare |
$11.33
|
| Rate for Payer: Altius Commercial |
$16.47
|
| Rate for Payer: Beech Street Commercial |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.65
|
| Rate for Payer: Cigna of WY Commercial |
$16.82
|
| Rate for Payer: Entrust Commercial |
$16.30
|
| Rate for Payer: First Choice Health Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.78
|
| Rate for Payer: HealthUtah PPO |
$17.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.29
|
| Rate for Payer: One Health Plan of WY PPO |
$16.82
|
| Rate for Payer: PacificSource Commercial |
$15.44
|
| Rate for Payer: PHCS PPO |
$16.82
|
| Rate for Payer: Three Rivers PPO |
$12.87
|
| Rate for Payer: TriWest Veterans Administration |
$9.78
|
| Rate for Payer: United Healthcare Commercial |
$16.39
|
| Rate for Payer: United Healthcare Medicare |
$9.78
|
| Rate for Payer: WINHealth Partners Commercial |
$16.82
|
| Rate for Payer: Wise Provider Network Commercial |
$16.30
|
|
|
GLIMEPIRIDE 2 MG TABLET [8242]
|
Facility
|
IP
|
$17.16
|
|
|
Service Code
|
NDC 6808432601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.82
|
| Rate for Payer: Aetna of WY Medicare |
$10.98
|
| Rate for Payer: Altius Commercial |
$16.47
|
| Rate for Payer: Beech Street Commercial |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.65
|
| Rate for Payer: Cigna of WY Commercial |
$16.82
|
| Rate for Payer: Entrust Commercial |
$16.30
|
| Rate for Payer: First Choice Health Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.47
|
| Rate for Payer: HealthUtah PPO |
$17.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.94
|
| Rate for Payer: One Health Plan of WY PPO |
$16.82
|
| Rate for Payer: PacificSource Commercial |
$15.44
|
| Rate for Payer: PHCS PPO |
$16.82
|
| Rate for Payer: Three Rivers PPO |
$12.87
|
| Rate for Payer: TriWest Veterans Administration |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$16.39
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
| Rate for Payer: WINHealth Partners Commercial |
$16.30
|
| Rate for Payer: Wise Provider Network Commercial |
$16.30
|
|
|
GLIMEPIRIDE 2 MG TABLET [8242]
|
Facility
|
OP
|
$17.16
|
|
|
Service Code
|
NDC 6808432601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.82
|
| Rate for Payer: Aetna of WY Medicare |
$11.33
|
| Rate for Payer: Altius Commercial |
$16.47
|
| Rate for Payer: Beech Street Commercial |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.65
|
| Rate for Payer: Cigna of WY Commercial |
$16.82
|
| Rate for Payer: Entrust Commercial |
$16.30
|
| Rate for Payer: First Choice Health Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.78
|
| Rate for Payer: HealthUtah PPO |
$17.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.29
|
| Rate for Payer: One Health Plan of WY PPO |
$16.82
|
| Rate for Payer: PacificSource Commercial |
$15.44
|
| Rate for Payer: PHCS PPO |
$16.82
|
| Rate for Payer: Three Rivers PPO |
$12.87
|
| Rate for Payer: TriWest Veterans Administration |
$9.78
|
| Rate for Payer: United Healthcare Commercial |
$16.39
|
| Rate for Payer: United Healthcare Medicare |
$9.78
|
| Rate for Payer: WINHealth Partners Commercial |
$16.82
|
| Rate for Payer: Wise Provider Network Commercial |
$16.30
|
|
|
GLIMEPIRIDE 2 MG TABLET [8242]
|
Facility
|
IP
|
$17.16
|
|
|
Service Code
|
NDC 6808432611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.82
|
| Rate for Payer: Aetna of WY Medicare |
$10.98
|
| Rate for Payer: Altius Commercial |
$16.47
|
| Rate for Payer: Beech Street Commercial |
$16.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.65
|
| Rate for Payer: Cigna of WY Commercial |
$16.82
|
| Rate for Payer: Entrust Commercial |
$16.30
|
| Rate for Payer: First Choice Health Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.47
|
| Rate for Payer: HealthUtah PPO |
$17.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.94
|
| Rate for Payer: One Health Plan of WY PPO |
$16.82
|
| Rate for Payer: PacificSource Commercial |
$15.44
|
| Rate for Payer: PHCS PPO |
$16.82
|
| Rate for Payer: Three Rivers PPO |
$12.87
|
| Rate for Payer: TriWest Veterans Administration |
$10.47
|
| Rate for Payer: United Healthcare Commercial |
$16.39
|
| Rate for Payer: United Healthcare Medicare |
$10.47
|
| Rate for Payer: WINHealth Partners Commercial |
$16.30
|
| Rate for Payer: Wise Provider Network Commercial |
$16.30
|
|
|
GLIPIZIDE 5 MG TABLET [19751]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 6050501410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.03
|
| Rate for Payer: Altius Commercial |
$14.59
|
| Rate for Payer: Beech Street Commercial |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.74
|
| Rate for Payer: Cigna of WY Commercial |
$14.90
|
| Rate for Payer: Entrust Commercial |
$14.44
|
| Rate for Payer: First Choice Health Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$15.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$13.68
|
| Rate for Payer: PHCS PPO |
$14.90
|
| Rate for Payer: Three Rivers PPO |
$11.40
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$14.90
|
| Rate for Payer: Wise Provider Network Commercial |
$14.44
|
|
|
GLIPIZIDE 5 MG TABLET [19751]
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
NDC 6050501410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.90
|
| Rate for Payer: Aetna of WY Medicare |
$9.73
|
| Rate for Payer: Altius Commercial |
$14.59
|
| Rate for Payer: Beech Street Commercial |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.74
|
| Rate for Payer: Cigna of WY Commercial |
$14.90
|
| Rate for Payer: Entrust Commercial |
$14.44
|
| Rate for Payer: First Choice Health Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.27
|
| Rate for Payer: HealthUtah PPO |
$15.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.81
|
| Rate for Payer: One Health Plan of WY PPO |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$13.68
|
| Rate for Payer: PHCS PPO |
$14.90
|
| Rate for Payer: Three Rivers PPO |
$11.40
|
| Rate for Payer: TriWest Veterans Administration |
$9.27
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$9.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.44
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [5714]
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
NDC 6498028001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.22
|
| Rate for Payer: Aetna of WY Medicare |
$9.94
|
| Rate for Payer: Altius Commercial |
$14.91
|
| Rate for Payer: Beech Street Commercial |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.06
|
| Rate for Payer: Cigna of WY Commercial |
$15.22
|
| Rate for Payer: Entrust Commercial |
$14.75
|
| Rate for Payer: First Choice Health Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.47
|
| Rate for Payer: HealthUtah PPO |
$15.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.06
|
| Rate for Payer: Multiplan Medicare/VA |
$9.00
|
| Rate for Payer: One Health Plan of WY PPO |
$15.22
|
| Rate for Payer: PacificSource Commercial |
$13.98
|
| Rate for Payer: PHCS PPO |
$15.22
|
| Rate for Payer: Three Rivers PPO |
$11.65
|
| Rate for Payer: TriWest Veterans Administration |
$9.47
|
| Rate for Payer: United Healthcare Commercial |
$14.83
|
| Rate for Payer: United Healthcare Medicare |
$9.47
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: Wise Provider Network Commercial |
$14.75
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [5714]
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
NDC 6498028001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.22
|
| Rate for Payer: Aetna of WY Medicare |
$10.25
|
| Rate for Payer: Altius Commercial |
$14.91
|
| Rate for Payer: Beech Street Commercial |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.06
|
| Rate for Payer: Cigna of WY Commercial |
$15.22
|
| Rate for Payer: Entrust Commercial |
$14.75
|
| Rate for Payer: First Choice Health Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.85
|
| Rate for Payer: HealthUtah PPO |
$15.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.06
|
| Rate for Payer: Multiplan Medicare/VA |
$8.41
|
| Rate for Payer: One Health Plan of WY PPO |
$15.22
|
| Rate for Payer: PacificSource Commercial |
$13.98
|
| Rate for Payer: PHCS PPO |
$15.22
|
| Rate for Payer: Three Rivers PPO |
$11.65
|
| Rate for Payer: TriWest Veterans Administration |
$8.85
|
| Rate for Payer: United Healthcare Commercial |
$14.83
|
| Rate for Payer: United Healthcare Medicare |
$8.85
|
| Rate for Payer: WINHealth Partners Commercial |
$15.22
|
| Rate for Payer: Wise Provider Network Commercial |
$14.75
|
|
|
GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$4,672.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$870.45 |
| Max. Negotiated Rate |
$4,672.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,578.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,024.06
|
| Rate for Payer: Beech Street Commercial |
$4,438.40
|
| Rate for Payer: Cash Price |
$3,270.40
|
| Rate for Payer: Cash Price |
$3,270.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,531.84
|
| Rate for Payer: Cigna of WY Commercial |
$4,578.56
|
| Rate for Payer: First Choice Health Commercial |
$4,204.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,438.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,024.06
|
| Rate for Payer: HealthUtah PPO |
$4,672.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,531.84
|
| Rate for Payer: Multiplan Medicare/VA |
$870.45
|
| Rate for Payer: One Health Plan of WY PPO |
$4,578.56
|
| Rate for Payer: PacificSource Commercial |
$4,204.80
|
| Rate for Payer: PHCS PPO |
$4,438.40
|
| Rate for Payer: Three Rivers PPO |
$3,504.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,024.06
|
| Rate for Payer: United Healthcare Commercial |
$4,438.40
|
| Rate for Payer: WINHealth Partners Commercial |
$3,971.20
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [17275]
|
Facility
|
OP
|
$322.70
|
|
|
Service Code
|
HCPCS J1610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.74 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.25
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Medicare |
$212.98
|
| Rate for Payer: Aetna of WY Medicare |
$240.90
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Altius Commercial |
$309.79
|
| Rate for Payer: Beech Street Commercial |
$316.25
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$313.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$354.05
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$225.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.02
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Cigna of WY Commercial |
$316.25
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: Entrust Commercial |
$306.56
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$306.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$183.94
|
| Rate for Payer: HealthUtah PPO |
$322.70
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.02
|
| Rate for Payer: Multiplan Medicare/VA |
$174.74
|
| Rate for Payer: Multiplan Medicare/VA |
$197.65
|
| Rate for Payer: One Health Plan of WY PPO |
$316.25
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PacificSource Commercial |
$290.43
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: PHCS PPO |
$316.25
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: Three Rivers PPO |
$242.02
|
| Rate for Payer: TriWest Veterans Administration |
$208.05
|
| Rate for Payer: TriWest Veterans Administration |
$183.94
|
| Rate for Payer: United Healthcare Commercial |
$348.58
|
| Rate for Payer: United Healthcare Commercial |
$308.18
|
| Rate for Payer: United Healthcare Medicare |
$208.05
|
| Rate for Payer: United Healthcare Medicare |
$183.94
|
| Rate for Payer: WINHealth Partners Commercial |
$316.25
|
| Rate for Payer: WINHealth Partners Commercial |
$357.70
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
| Rate for Payer: Wise Provider Network Commercial |
$306.56
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION [17275]
|
Facility
|
IP
|
$322.70
|
|
|
Service Code
|
HCPCS J1610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.25
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$357.70
|
| Rate for Payer: Aetna of WY Medicare |
$206.53
|
| Rate for Payer: Aetna of WY Medicare |
$233.60
|
| Rate for Payer: Altius Commercial |
$350.40
|
| Rate for Payer: Altius Commercial |
$309.79
|
| Rate for Payer: Beech Street Commercial |
$316.25
|
| Rate for Payer: Beech Street Commercial |
$357.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$313.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$354.05
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$225.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$354.05
|
| Rate for Payer: Cigna of WY Commercial |
$357.70
|
| Rate for Payer: Cigna of WY Commercial |
$316.25
|
| Rate for Payer: Entrust Commercial |
$346.75
|
| Rate for Payer: Entrust Commercial |
$306.56
|
| Rate for Payer: First Choice Health Commercial |
$346.75
|
| Rate for Payer: First Choice Health Commercial |
$306.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$346.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$196.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.65
|
| Rate for Payer: HealthUtah PPO |
$322.70
|
| Rate for Payer: HealthUtah PPO |
$365.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$354.05
|
| Rate for Payer: Multiplan Medicare/VA |
$211.52
|
| Rate for Payer: Multiplan Medicare/VA |
$187.00
|
| Rate for Payer: One Health Plan of WY PPO |
$357.70
|
| Rate for Payer: One Health Plan of WY PPO |
$316.25
|
| Rate for Payer: PacificSource Commercial |
$290.43
|
| Rate for Payer: PacificSource Commercial |
$328.50
|
| Rate for Payer: PHCS PPO |
$357.70
|
| Rate for Payer: PHCS PPO |
$316.25
|
| Rate for Payer: Three Rivers PPO |
$242.02
|
| Rate for Payer: Three Rivers PPO |
$273.75
|
| Rate for Payer: TriWest Veterans Administration |
$196.85
|
| Rate for Payer: TriWest Veterans Administration |
$222.65
|
| Rate for Payer: United Healthcare Commercial |
$308.18
|
| Rate for Payer: United Healthcare Commercial |
$348.58
|
| Rate for Payer: United Healthcare Medicare |
$196.85
|
| Rate for Payer: United Healthcare Medicare |
$222.65
|
| Rate for Payer: WINHealth Partners Commercial |
$346.75
|
| Rate for Payer: WINHealth Partners Commercial |
$306.56
|
| Rate for Payer: Wise Provider Network Commercial |
$346.75
|
| Rate for Payer: Wise Provider Network Commercial |
$306.56
|
|
|
GLUCAGON HYDROCHLORIDE/1 MG
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS J1610
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$77.42
|
| Rate for Payer: Aetna of WY Medicare |
$191.52
|
| Rate for Payer: Beech Street Commercial |
$75.05
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$76.63
|
| Rate for Payer: Cigna of WY Commercial |
$77.42
|
| Rate for Payer: First Choice Health Commercial |
$71.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$75.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$191.52
|
| Rate for Payer: HealthUtah PPO |
$79.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$76.63
|
| Rate for Payer: Multiplan Medicare/VA |
$162.79
|
| Rate for Payer: One Health Plan of WY PPO |
$77.42
|
| Rate for Payer: PacificSource Commercial |
$71.10
|
| Rate for Payer: PHCS PPO |
$75.05
|
| Rate for Payer: Three Rivers PPO |
$59.25
|
| Rate for Payer: TriWest Veterans Administration |
$191.52
|
| Rate for Payer: United Healthcare Commercial |
$75.05
|
| Rate for Payer: WINHealth Partners Commercial |
$75.05
|
|
|
GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.80
|
| Rate for Payer: Aetna of WY Medicare |
$3.28
|
| Rate for Payer: Beech Street Commercial |
$9.50
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.70
|
| Rate for Payer: Cigna of WY Commercial |
$9.80
|
| Rate for Payer: First Choice Health Commercial |
$9.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.28
|
| Rate for Payer: HealthUtah PPO |
$10.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.70
|
| Rate for Payer: Multiplan Medicare/VA |
$2.79
|
| Rate for Payer: One Health Plan of WY PPO |
$9.80
|
| Rate for Payer: PacificSource Commercial |
$9.00
|
| Rate for Payer: PHCS PPO |
$9.50
|
| Rate for Payer: Three Rivers PPO |
$7.50
|
| Rate for Payer: TriWest Veterans Administration |
$3.28
|
| Rate for Payer: United Healthcare Commercial |
$9.50
|
| Rate for Payer: WINHealth Partners Commercial |
$9.50
|
|
|
GLUCOSAMINE-CHONDROITIN 500 MG-400 MG TABLET [19525]
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 4329256003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.14
|
| Rate for Payer: Aetna of WY Medicare |
$9.89
|
| Rate for Payer: Altius Commercial |
$14.83
|
| Rate for Payer: Beech Street Commercial |
$15.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.99
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.99
|
| Rate for Payer: Cigna of WY Commercial |
$15.14
|
| Rate for Payer: Entrust Commercial |
$14.68
|
| Rate for Payer: First Choice Health Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.42
|
| Rate for Payer: HealthUtah PPO |
$15.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.14
|
| Rate for Payer: PacificSource Commercial |
$13.90
|
| Rate for Payer: PHCS PPO |
$15.14
|
| Rate for Payer: Three Rivers PPO |
$11.59
|
| Rate for Payer: TriWest Veterans Administration |
$9.42
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$9.42
|
| Rate for Payer: WINHealth Partners Commercial |
$14.68
|
| Rate for Payer: Wise Provider Network Commercial |
$14.68
|
|
|
GLUCOSAMINE-CHONDROITIN 500 MG-400 MG TABLET [19525]
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 4329256003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.14
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Commercial |
$14.83
|
| Rate for Payer: Beech Street Commercial |
$15.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.99
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.99
|
| Rate for Payer: Cigna of WY Commercial |
$15.14
|
| Rate for Payer: Entrust Commercial |
$14.68
|
| Rate for Payer: First Choice Health Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.81
|
| Rate for Payer: HealthUtah PPO |
$15.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.37
|
| Rate for Payer: One Health Plan of WY PPO |
$15.14
|
| Rate for Payer: PacificSource Commercial |
$13.90
|
| Rate for Payer: PHCS PPO |
$15.14
|
| Rate for Payer: Three Rivers PPO |
$11.59
|
| Rate for Payer: TriWest Veterans Administration |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$8.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.14
|
| Rate for Payer: Wise Provider Network Commercial |
$14.68
|
|
|
GLUCOSE AMB
|
Facility
|
IP
|
$17.84
|
|
| Hospital Charge Code |
2050055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.48
|
| Rate for Payer: Aetna of WY Medicare |
$11.42
|
| Rate for Payer: Altius Commercial |
$17.13
|
| Rate for Payer: Beech Street Commercial |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.30
|
| Rate for Payer: Cigna of WY Commercial |
$17.48
|
| Rate for Payer: Entrust Commercial |
$16.95
|
| Rate for Payer: First Choice Health Commercial |
$16.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.88
|
| Rate for Payer: HealthUtah PPO |
$17.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.30
|
| Rate for Payer: Multiplan Medicare/VA |
$10.34
|
| Rate for Payer: One Health Plan of WY PPO |
$17.48
|
| Rate for Payer: PacificSource Commercial |
$16.06
|
| Rate for Payer: PHCS PPO |
$17.48
|
| Rate for Payer: Three Rivers PPO |
$13.38
|
| Rate for Payer: TriWest Veterans Administration |
$10.88
|
| Rate for Payer: United Healthcare Commercial |
$17.04
|
| Rate for Payer: United Healthcare Medicare |
$10.88
|
| Rate for Payer: WINHealth Partners Commercial |
$16.95
|
| Rate for Payer: Wise Provider Network Commercial |
$16.95
|
|
|
GLUCOSE AMB
|
Facility
|
OP
|
$17.84
|
|
| Hospital Charge Code |
2050055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.48
|
| Rate for Payer: Aetna of WY Medicare |
$11.77
|
| Rate for Payer: Altius Commercial |
$17.13
|
| Rate for Payer: Beech Street Commercial |
$17.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.30
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.30
|
| Rate for Payer: Cigna of WY Commercial |
$17.48
|
| Rate for Payer: Entrust Commercial |
$16.95
|
| Rate for Payer: First Choice Health Commercial |
$16.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.17
|
| Rate for Payer: HealthUtah PPO |
$17.84
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.66
|
| Rate for Payer: One Health Plan of WY PPO |
$17.48
|
| Rate for Payer: PacificSource Commercial |
$16.06
|
| Rate for Payer: PHCS PPO |
$17.48
|
| Rate for Payer: Three Rivers PPO |
$13.38
|
| Rate for Payer: TriWest Veterans Administration |
$10.17
|
| Rate for Payer: United Healthcare Commercial |
$17.04
|
| Rate for Payer: United Healthcare Medicare |
$10.17
|
| Rate for Payer: WINHealth Partners Commercial |
$17.48
|
| Rate for Payer: Wise Provider Network Commercial |
$16.95
|
|
|
GLUCOSE BLOOD REAGENT STRIP
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 82948
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$5.04
|
| Rate for Payer: Beech Street Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: First Choice Health Commercial |
$27.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.04
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$4.28
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$28.50
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$5.04
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
|
|
GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$3.93
|
| Rate for Payer: Beech Street Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: First Choice Health Commercial |
$27.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.93
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$3.34
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$28.50
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$3.93
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
|
|
GLYCERIN 99.5 % TOPICAL SOLUTION [40601]
|
Facility
|
IP
|
$15.14
|
|
|
Service Code
|
NDC 3172213747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.84
|
| Rate for Payer: Aetna of WY Medicare |
$9.69
|
| Rate for Payer: Altius Commercial |
$14.53
|
| Rate for Payer: Beech Street Commercial |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.69
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.69
|
| Rate for Payer: Cigna of WY Commercial |
$14.84
|
| Rate for Payer: Entrust Commercial |
$14.38
|
| Rate for Payer: First Choice Health Commercial |
$14.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.24
|
| Rate for Payer: HealthUtah PPO |
$15.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.69
|
| Rate for Payer: Multiplan Medicare/VA |
$8.77
|
| Rate for Payer: One Health Plan of WY PPO |
$14.84
|
| Rate for Payer: PacificSource Commercial |
$13.63
|
| Rate for Payer: PHCS PPO |
$14.84
|
| Rate for Payer: Three Rivers PPO |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$9.24
|
| Rate for Payer: United Healthcare Commercial |
$14.46
|
| Rate for Payer: United Healthcare Medicare |
$9.24
|
| Rate for Payer: WINHealth Partners Commercial |
$14.38
|
| Rate for Payer: Wise Provider Network Commercial |
$14.38
|
|
|
GLYCERIN 99.5 % TOPICAL SOLUTION [40601]
|
Facility
|
OP
|
$15.14
|
|
|
Service Code
|
NDC 3172213747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.84
|
| Rate for Payer: Aetna of WY Medicare |
$9.99
|
| Rate for Payer: Altius Commercial |
$14.53
|
| Rate for Payer: Beech Street Commercial |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.69
|
| Rate for Payer: Cash Price |
$10.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.69
|
| Rate for Payer: Cigna of WY Commercial |
$14.84
|
| Rate for Payer: Entrust Commercial |
$14.38
|
| Rate for Payer: First Choice Health Commercial |
$14.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.63
|
| Rate for Payer: HealthUtah PPO |
$15.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.69
|
| Rate for Payer: Multiplan Medicare/VA |
$8.20
|
| Rate for Payer: One Health Plan of WY PPO |
$14.84
|
| Rate for Payer: PacificSource Commercial |
$13.63
|
| Rate for Payer: PHCS PPO |
$14.84
|
| Rate for Payer: Three Rivers PPO |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$8.63
|
| Rate for Payer: United Healthcare Commercial |
$14.46
|
| Rate for Payer: United Healthcare Medicare |
$8.63
|
| Rate for Payer: WINHealth Partners Commercial |
$14.84
|
| Rate for Payer: Wise Provider Network Commercial |
$14.38
|
|
|
GLYCERIN 99.5 % TOPICAL SOLUTION [40601]
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 8770140072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.90
|
| Rate for Payer: Aetna of WY Medicare |
$10.03
|
| Rate for Payer: Altius Commercial |
$14.59
|
| Rate for Payer: Beech Street Commercial |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.74
|
| Rate for Payer: Cigna of WY Commercial |
$14.90
|
| Rate for Payer: Entrust Commercial |
$14.44
|
| Rate for Payer: First Choice Health Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$15.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$13.68
|
| Rate for Payer: PHCS PPO |
$14.90
|
| Rate for Payer: Three Rivers PPO |
$11.40
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$14.90
|
| Rate for Payer: Wise Provider Network Commercial |
$14.44
|
|
|
GLYCERIN 99.5 % TOPICAL SOLUTION [40601]
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
NDC 8770140072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.90
|
| Rate for Payer: Aetna of WY Medicare |
$9.73
|
| Rate for Payer: Altius Commercial |
$14.59
|
| Rate for Payer: Beech Street Commercial |
$14.90
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.74
|
| Rate for Payer: Cigna of WY Commercial |
$14.90
|
| Rate for Payer: Entrust Commercial |
$14.44
|
| Rate for Payer: First Choice Health Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.27
|
| Rate for Payer: HealthUtah PPO |
$15.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.74
|
| Rate for Payer: Multiplan Medicare/VA |
$8.81
|
| Rate for Payer: One Health Plan of WY PPO |
$14.90
|
| Rate for Payer: PacificSource Commercial |
$13.68
|
| Rate for Payer: PHCS PPO |
$14.90
|
| Rate for Payer: Three Rivers PPO |
$11.40
|
| Rate for Payer: TriWest Veterans Administration |
$9.27
|
| Rate for Payer: United Healthcare Commercial |
$14.52
|
| Rate for Payer: United Healthcare Medicare |
$9.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.44
|
| Rate for Payer: Wise Provider Network Commercial |
$14.44
|
|
|
GLYCERIN (LAXATIVE) 2.8 GRAM/2.7 ML RECTAL SOLUTION [88720]
|
Facility
|
IP
|
$15.76
|
|
|
Service Code
|
NDC 0132019012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.44
|
| Rate for Payer: Aetna of WY Medicare |
$10.09
|
| Rate for Payer: Altius Commercial |
$15.13
|
| Rate for Payer: Beech Street Commercial |
$15.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.44
|
| Rate for Payer: Entrust Commercial |
$14.97
|
| Rate for Payer: First Choice Health Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.61
|
| Rate for Payer: HealthUtah PPO |
$15.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.29
|
| 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 |
$11.82
|
| Rate for Payer: TriWest Veterans Administration |
$9.61
|
| Rate for Payer: United Healthcare Commercial |
$15.05
|
| Rate for Payer: United Healthcare Medicare |
$9.61
|
| Rate for Payer: WINHealth Partners Commercial |
$14.97
|
| Rate for Payer: Wise Provider Network Commercial |
$14.97
|
|
