|
LMA SZ 2.5 UNIQUE 105300000025
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 2 UNIQUE 105300-000020
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 2 UNIQUE 105300-000020
|
Facility
|
IP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$11.52
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.46
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 3 UNIQUE 105300-000030
|
Facility
|
IP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$11.52
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.46
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 3 UNIQUE 105300-000030
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 4 UNIQUE 105300-000040
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 4 UNIQUE 105300-000040
|
Facility
|
IP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$11.52
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.46
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 5 UNIQUE 105300-000050
|
Facility
|
IP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.13
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$11.52
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.13
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$12.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.46
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LMA SZ 5 UNIQUE 105300-000050
|
Facility
|
OP
|
$18.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.01
|
| Rate for Payer: Aetna of WY Medicare |
$12.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.64
|
| Rate for Payer: Altius Commercial |
$17.64
|
| Rate for Payer: Beech Street Commercial |
$18.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.09
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.83
|
| Rate for Payer: Cigna of WY Commercial |
$18.01
|
| Rate for Payer: Entrust Commercial |
$17.46
|
| Rate for Payer: First Choice Health Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$18.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.83
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.01
|
| Rate for Payer: PacificSource Commercial |
$16.54
|
| Rate for Payer: PHCS PPO |
$18.01
|
| Rate for Payer: Three Rivers PPO |
$13.78
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$15.99
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$18.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.46
|
|
|
LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 25280
|
| Hospital Charge Code |
25280
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$555.16
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$555.16
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$471.89
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$555.16
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$555.16
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$5,388.00
|
|
|
Service Code
|
HCPCS 25280 AS
|
| Hospital Charge Code |
25280
|
| Min. Negotiated Rate |
$471.89 |
| Max. Negotiated Rate |
$5,388.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,280.24
|
| Rate for Payer: Aetna of WY Medicare |
$555.16
|
| Rate for Payer: Beech Street Commercial |
$5,118.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: Cash Price |
$3,771.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,226.36
|
| Rate for Payer: Cigna of WY Commercial |
$5,280.24
|
| Rate for Payer: First Choice Health Commercial |
$4,849.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,118.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$555.16
|
| Rate for Payer: HealthUtah PPO |
$5,388.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,226.36
|
| Rate for Payer: Multiplan Medicare/VA |
$471.89
|
| Rate for Payer: One Health Plan of WY PPO |
$5,280.24
|
| Rate for Payer: PacificSource Commercial |
$4,849.20
|
| Rate for Payer: PHCS PPO |
$5,118.60
|
| Rate for Payer: Three Rivers PPO |
$4,041.00
|
| Rate for Payer: TriWest Veterans Administration |
$555.16
|
| Rate for Payer: United Healthcare Commercial |
$4,687.56
|
| Rate for Payer: United Healthcare Medicare |
$555.16
|
| Rate for Payer: WINHealth Partners Commercial |
$4,579.80
|
|
|
LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$3,353.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
27685
|
| Min. Negotiated Rate |
$387.63 |
| Max. Negotiated Rate |
$3,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,285.94
|
| Rate for Payer: Aetna of WY Medicare |
$456.04
|
| Rate for Payer: Beech Street Commercial |
$3,185.35
|
| Rate for Payer: Cash Price |
$2,347.10
|
| Rate for Payer: Cash Price |
$2,347.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,252.41
|
| Rate for Payer: Cigna of WY Commercial |
$3,285.94
|
| Rate for Payer: First Choice Health Commercial |
$3,017.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,185.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$456.04
|
| Rate for Payer: HealthUtah PPO |
$3,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,252.41
|
| Rate for Payer: Multiplan Medicare/VA |
$387.63
|
| Rate for Payer: One Health Plan of WY PPO |
$3,285.94
|
| Rate for Payer: PacificSource Commercial |
$3,017.70
|
| Rate for Payer: PHCS PPO |
$3,185.35
|
| Rate for Payer: Three Rivers PPO |
$2,514.75
|
| Rate for Payer: TriWest Veterans Administration |
$456.04
|
| Rate for Payer: United Healthcare Commercial |
$2,917.11
|
| Rate for Payer: United Healthcare Medicare |
$456.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,850.05
|
|
|
LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$3,353.00
|
|
|
Service Code
|
HCPCS 27685 AS
|
| Hospital Charge Code |
27685
|
| Min. Negotiated Rate |
$387.63 |
| Max. Negotiated Rate |
$3,353.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,285.94
|
| Rate for Payer: Aetna of WY Medicare |
$456.04
|
| Rate for Payer: Beech Street Commercial |
$3,185.35
|
| Rate for Payer: Cash Price |
$2,347.10
|
| Rate for Payer: Cash Price |
$2,347.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,252.41
|
| Rate for Payer: Cigna of WY Commercial |
$3,285.94
|
| Rate for Payer: First Choice Health Commercial |
$3,017.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,185.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$456.04
|
| Rate for Payer: HealthUtah PPO |
$3,353.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,252.41
|
| Rate for Payer: Multiplan Medicare/VA |
$387.63
|
| Rate for Payer: One Health Plan of WY PPO |
$3,285.94
|
| Rate for Payer: PacificSource Commercial |
$3,017.70
|
| Rate for Payer: PHCS PPO |
$3,185.35
|
| Rate for Payer: Three Rivers PPO |
$2,514.75
|
| Rate for Payer: TriWest Veterans Administration |
$456.04
|
| Rate for Payer: United Healthcare Commercial |
$2,917.11
|
| Rate for Payer: United Healthcare Medicare |
$456.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,850.05
|
|
|
LOOP RECORDER IV BIOMONITOR
|
Facility
|
IP
|
$13,300.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,339.10 |
| Max. Negotiated Rate |
$13,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,034.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,768.00
|
| Rate for Payer: Altius Commercial |
$12,768.00
|
| Rate for Payer: Beech Street Commercial |
$13,034.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,919.30
|
| Rate for Payer: Cash Price |
$9,310.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,901.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,034.00
|
| Rate for Payer: Entrust Commercial |
$12,635.00
|
| Rate for Payer: First Choice Health Commercial |
$12,635.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,635.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,778.00
|
| Rate for Payer: HealthUtah PPO |
$13,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,901.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8,339.10
|
| Rate for Payer: One Health Plan of WY PPO |
$13,034.00
|
| Rate for Payer: PacificSource Commercial |
$11,970.00
|
| Rate for Payer: PHCS PPO |
$13,034.00
|
| Rate for Payer: Three Rivers PPO |
$9,975.00
|
| Rate for Payer: TriWest Veterans Administration |
$8,778.00
|
| Rate for Payer: United Healthcare Commercial |
$11,571.00
|
| Rate for Payer: United Healthcare Medicare |
$8,778.00
|
| Rate for Payer: WINHealth Partners Commercial |
$12,635.00
|
| Rate for Payer: Wise Provider Network Commercial |
$12,635.00
|
|
|
LOOP RECORDER IV BIOMONITOR
|
Facility
|
OP
|
$13,300.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,328.30 |
| Max. Negotiated Rate |
$13,300.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,034.00
|
| Rate for Payer: Aetna of WY Medicare |
$8,778.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,768.00
|
| Rate for Payer: Altius Commercial |
$12,768.00
|
| Rate for Payer: Beech Street Commercial |
$13,034.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10,919.30
|
| Rate for Payer: Cash Price |
$9,310.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$12,901.00
|
| Rate for Payer: Cigna of WY Commercial |
$13,034.00
|
| Rate for Payer: Entrust Commercial |
$12,635.00
|
| Rate for Payer: First Choice Health Commercial |
$12,635.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,635.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,714.00
|
| Rate for Payer: HealthUtah PPO |
$13,300.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12,901.00
|
| Rate for Payer: Multiplan Medicare/VA |
$7,328.30
|
| Rate for Payer: One Health Plan of WY PPO |
$13,034.00
|
| Rate for Payer: PacificSource Commercial |
$11,970.00
|
| Rate for Payer: PHCS PPO |
$13,034.00
|
| Rate for Payer: Three Rivers PPO |
$9,975.00
|
| Rate for Payer: TriWest Veterans Administration |
$7,714.00
|
| Rate for Payer: United Healthcare Commercial |
$11,571.00
|
| Rate for Payer: United Healthcare Medicare |
$7,714.00
|
| Rate for Payer: WINHealth Partners Commercial |
$13,034.00
|
| Rate for Payer: Wise Provider Network Commercial |
$12,635.00
|
|
|
LOPERAMIDE 2 MG CAPSULE [2702]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 6068722901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.26
|
| Rate for Payer: Altius Commercial |
$3.26
|
| Rate for Payer: Beech Street Commercial |
$3.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.30
|
| Rate for Payer: Cigna of WY Commercial |
$3.33
|
| Rate for Payer: Entrust Commercial |
$3.23
|
| Rate for Payer: First Choice Health Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.24
|
| Rate for Payer: HealthUtah PPO |
$3.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.30
|
| Rate for Payer: Multiplan Medicare/VA |
$2.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3.33
|
| Rate for Payer: PacificSource Commercial |
$3.06
|
| Rate for Payer: PHCS PPO |
$3.33
|
| Rate for Payer: Three Rivers PPO |
$2.55
|
| Rate for Payer: TriWest Veterans Administration |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$2.24
|
| Rate for Payer: WINHealth Partners Commercial |
$3.23
|
| Rate for Payer: Wise Provider Network Commercial |
$3.23
|
|
|
LOPERAMIDE 2 MG CAPSULE [2702]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 6068722901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.33
|
| Rate for Payer: Aetna of WY Medicare |
$2.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.26
|
| Rate for Payer: Altius Commercial |
$3.26
|
| Rate for Payer: Beech Street Commercial |
$3.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.30
|
| Rate for Payer: Cigna of WY Commercial |
$3.33
|
| Rate for Payer: Entrust Commercial |
$3.23
|
| Rate for Payer: First Choice Health Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.97
|
| Rate for Payer: HealthUtah PPO |
$3.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3.33
|
| Rate for Payer: PacificSource Commercial |
$3.06
|
| Rate for Payer: PHCS PPO |
$3.33
|
| Rate for Payer: Three Rivers PPO |
$2.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$1.97
|
| Rate for Payer: WINHealth Partners Commercial |
$3.33
|
| Rate for Payer: Wise Provider Network Commercial |
$3.23
|
|
|
LOPERAMIDE 2 MG CAPSULE [2702]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 6068722911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.26
|
| Rate for Payer: Altius Commercial |
$3.26
|
| Rate for Payer: Beech Street Commercial |
$3.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.30
|
| Rate for Payer: Cigna of WY Commercial |
$3.33
|
| Rate for Payer: Entrust Commercial |
$3.23
|
| Rate for Payer: First Choice Health Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.24
|
| Rate for Payer: HealthUtah PPO |
$3.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.30
|
| Rate for Payer: Multiplan Medicare/VA |
$2.13
|
| Rate for Payer: One Health Plan of WY PPO |
$3.33
|
| Rate for Payer: PacificSource Commercial |
$3.06
|
| Rate for Payer: PHCS PPO |
$3.33
|
| Rate for Payer: Three Rivers PPO |
$2.55
|
| Rate for Payer: TriWest Veterans Administration |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$2.24
|
| Rate for Payer: WINHealth Partners Commercial |
$3.23
|
| Rate for Payer: Wise Provider Network Commercial |
$3.23
|
|
|
LOPERAMIDE 2 MG CAPSULE [2702]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 6068722911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.33
|
| Rate for Payer: Aetna of WY Medicare |
$2.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.26
|
| Rate for Payer: Altius Commercial |
$3.26
|
| Rate for Payer: Beech Street Commercial |
$3.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.30
|
| Rate for Payer: Cigna of WY Commercial |
$3.33
|
| Rate for Payer: Entrust Commercial |
$3.23
|
| Rate for Payer: First Choice Health Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.97
|
| Rate for Payer: HealthUtah PPO |
$3.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1.87
|
| Rate for Payer: One Health Plan of WY PPO |
$3.33
|
| Rate for Payer: PacificSource Commercial |
$3.06
|
| Rate for Payer: PHCS PPO |
$3.33
|
| Rate for Payer: Three Rivers PPO |
$2.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Medicare |
$1.97
|
| Rate for Payer: WINHealth Partners Commercial |
$3.33
|
| Rate for Payer: Wise Provider Network Commercial |
$3.23
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
NDC 6800143804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.32
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.32
|
| Rate for Payer: Altius Commercial |
$0.32
|
| Rate for Payer: Beech Street Commercial |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.32
|
| Rate for Payer: Cigna of WY Commercial |
$0.32
|
| Rate for Payer: Entrust Commercial |
$0.31
|
| Rate for Payer: First Choice Health Commercial |
$0.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.32
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.32
|
| Rate for Payer: PacificSource Commercial |
$0.30
|
| Rate for Payer: PHCS PPO |
$0.32
|
| Rate for Payer: Three Rivers PPO |
$0.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.29
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.31
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 6800143816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 6800143816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
NDC 6800143804
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.32
|
| Rate for Payer: Altius Commercial |
$0.32
|
| Rate for Payer: Beech Street Commercial |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.32
|
| Rate for Payer: Cigna of WY Commercial |
$0.32
|
| Rate for Payer: Entrust Commercial |
$0.31
|
| Rate for Payer: First Choice Health Commercial |
$0.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.32
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.32
|
| Rate for Payer: PacificSource Commercial |
$0.30
|
| Rate for Payer: PHCS PPO |
$0.32
|
| Rate for Payer: Three Rivers PPO |
$0.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.29
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.31
|
| Rate for Payer: Wise Provider Network Commercial |
$0.31
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 6800143896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
LORATADINE 10 MG TABLET [19719]
|
Facility
|
IP
|
$0.79
|
|
|
Service Code
|
NDC 5860270283
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.76
|
| Rate for Payer: Altius Commercial |
$0.76
|
| Rate for Payer: Beech Street Commercial |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.65
|
| Rate for Payer: Cash Price |
$0.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.77
|
| Rate for Payer: Cigna of WY Commercial |
$0.77
|
| Rate for Payer: Entrust Commercial |
$0.75
|
| Rate for Payer: First Choice Health Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.52
|
| Rate for Payer: HealthUtah PPO |
$0.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.77
|
| Rate for Payer: Multiplan Medicare/VA |
$0.50
|
| Rate for Payer: One Health Plan of WY PPO |
$0.77
|
| Rate for Payer: PacificSource Commercial |
$0.71
|
| Rate for Payer: PHCS PPO |
$0.77
|
| Rate for Payer: Three Rivers PPO |
$0.59
|
| Rate for Payer: TriWest Veterans Administration |
$0.52
|
| Rate for Payer: United Healthcare Commercial |
$0.69
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
| Rate for Payer: WINHealth Partners Commercial |
$0.75
|
| Rate for Payer: Wise Provider Network Commercial |
$0.75
|
|
