|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 5107998601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.54
|
| Rate for Payer: Aetna of WY Medicare |
$0.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.53
|
| Rate for Payer: Altius Commercial |
$0.53
|
| Rate for Payer: Beech Street Commercial |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.53
|
| Rate for Payer: Cigna of WY Commercial |
$0.54
|
| Rate for Payer: Entrust Commercial |
$0.52
|
| Rate for Payer: First Choice Health Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.54
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.54
|
| Rate for Payer: Three Rivers PPO |
$0.41
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.54
|
| Rate for Payer: Wise Provider Network Commercial |
$0.52
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 5107998620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.53
|
| Rate for Payer: Altius Commercial |
$0.53
|
| Rate for Payer: Beech Street Commercial |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.53
|
| Rate for Payer: Cigna of WY Commercial |
$0.54
|
| Rate for Payer: Entrust Commercial |
$0.52
|
| Rate for Payer: First Choice Health Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.36
|
| Rate for Payer: HealthUtah PPO |
$0.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.34
|
| Rate for Payer: One Health Plan of WY PPO |
$0.54
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.54
|
| Rate for Payer: Three Rivers PPO |
$0.41
|
| Rate for Payer: TriWest Veterans Administration |
$0.36
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$0.36
|
| Rate for Payer: WINHealth Partners Commercial |
$0.52
|
| Rate for Payer: Wise Provider Network Commercial |
$0.52
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 5107998601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.53
|
| Rate for Payer: Altius Commercial |
$0.53
|
| Rate for Payer: Beech Street Commercial |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.53
|
| Rate for Payer: Cigna of WY Commercial |
$0.54
|
| Rate for Payer: Entrust Commercial |
$0.52
|
| Rate for Payer: First Choice Health Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.36
|
| Rate for Payer: HealthUtah PPO |
$0.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.34
|
| Rate for Payer: One Health Plan of WY PPO |
$0.54
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.54
|
| Rate for Payer: Three Rivers PPO |
$0.41
|
| Rate for Payer: TriWest Veterans Administration |
$0.36
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$0.36
|
| Rate for Payer: WINHealth Partners Commercial |
$0.52
|
| Rate for Payer: Wise Provider Network Commercial |
$0.52
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 5107998620
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.54
|
| Rate for Payer: Aetna of WY Medicare |
$0.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.53
|
| Rate for Payer: Altius Commercial |
$0.53
|
| Rate for Payer: Beech Street Commercial |
$0.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.53
|
| Rate for Payer: Cigna of WY Commercial |
$0.54
|
| Rate for Payer: Entrust Commercial |
$0.52
|
| Rate for Payer: First Choice Health Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.54
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.54
|
| Rate for Payer: Three Rivers PPO |
$0.41
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.48
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.54
|
| Rate for Payer: Wise Provider Network Commercial |
$0.52
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
NDC 6068781211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.65
|
| Rate for Payer: Altius Commercial |
$0.65
|
| Rate for Payer: Beech Street Commercial |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.66
|
| Rate for Payer: Cigna of WY Commercial |
$0.67
|
| Rate for Payer: Entrust Commercial |
$0.65
|
| Rate for Payer: First Choice Health Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.66
|
| Rate for Payer: Multiplan Medicare/VA |
$0.43
|
| Rate for Payer: One Health Plan of WY PPO |
$0.67
|
| Rate for Payer: PacificSource Commercial |
$0.61
|
| Rate for Payer: PHCS PPO |
$0.67
|
| Rate for Payer: Three Rivers PPO |
$0.51
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.59
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.65
|
| Rate for Payer: Wise Provider Network Commercial |
$0.65
|
|
|
BUSPIRONE 10 MG TABLET [12823]
|
Facility
|
OP
|
$0.68
|
|
|
Service Code
|
NDC 6068781211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.67
|
| Rate for Payer: Aetna of WY Medicare |
$0.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.65
|
| Rate for Payer: Altius Commercial |
$0.65
|
| Rate for Payer: Beech Street Commercial |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.66
|
| Rate for Payer: Cigna of WY Commercial |
$0.67
|
| Rate for Payer: Entrust Commercial |
$0.65
|
| Rate for Payer: First Choice Health Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.66
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.67
|
| Rate for Payer: PacificSource Commercial |
$0.61
|
| Rate for Payer: PHCS PPO |
$0.67
|
| Rate for Payer: Three Rivers PPO |
$0.51
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.59
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.67
|
| Rate for Payer: Wise Provider Network Commercial |
$0.65
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 2930024601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
IP
|
$2.29
|
|
|
Service Code
|
NDC 5026813511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.20
|
| Rate for Payer: Altius Commercial |
$2.20
|
| Rate for Payer: Beech Street Commercial |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.22
|
| Rate for Payer: Cigna of WY Commercial |
$2.24
|
| Rate for Payer: Entrust Commercial |
$2.18
|
| Rate for Payer: First Choice Health Commercial |
$2.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.51
|
| Rate for Payer: HealthUtah PPO |
$2.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1.44
|
| Rate for Payer: One Health Plan of WY PPO |
$2.24
|
| Rate for Payer: PacificSource Commercial |
$2.06
|
| Rate for Payer: PHCS PPO |
$2.24
|
| Rate for Payer: Three Rivers PPO |
$1.72
|
| Rate for Payer: TriWest Veterans Administration |
$1.51
|
| Rate for Payer: United Healthcare Commercial |
$1.99
|
| Rate for Payer: United Healthcare Medicare |
$1.51
|
| Rate for Payer: WINHealth Partners Commercial |
$2.18
|
| Rate for Payer: Wise Provider Network Commercial |
$2.18
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
OP
|
$1.82
|
|
|
Service Code
|
NDC 5107996001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Aetna of WY Medicare |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.75
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.06
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
OP
|
$2.29
|
|
|
Service Code
|
NDC 5026813511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.24
|
| Rate for Payer: Aetna of WY Medicare |
$1.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.20
|
| Rate for Payer: Altius Commercial |
$2.20
|
| Rate for Payer: Beech Street Commercial |
$2.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.22
|
| Rate for Payer: Cigna of WY Commercial |
$2.24
|
| Rate for Payer: Entrust Commercial |
$2.18
|
| Rate for Payer: First Choice Health Commercial |
$2.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.33
|
| Rate for Payer: HealthUtah PPO |
$2.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2.24
|
| Rate for Payer: PacificSource Commercial |
$2.06
|
| Rate for Payer: PHCS PPO |
$2.24
|
| Rate for Payer: Three Rivers PPO |
$1.72
|
| Rate for Payer: TriWest Veterans Administration |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$1.99
|
| Rate for Payer: United Healthcare Medicare |
$1.33
|
| Rate for Payer: WINHealth Partners Commercial |
$2.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2.18
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 2930024601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Aetna of WY Medicare |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
BUSPIRONE 15 MG TABLET [20572]
|
Facility
|
IP
|
$1.82
|
|
|
Service Code
|
NDC 5107996001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.75
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8141]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
NDC 0527169501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.71
|
| Rate for Payer: Altius Commercial |
$0.71
|
| Rate for Payer: Beech Street Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.72
|
| Rate for Payer: Cigna of WY Commercial |
$0.73
|
| Rate for Payer: Entrust Commercial |
$0.70
|
| Rate for Payer: First Choice Health Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.49
|
| Rate for Payer: HealthUtah PPO |
$0.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.46
|
| Rate for Payer: One Health Plan of WY PPO |
$0.73
|
| Rate for Payer: PacificSource Commercial |
$0.67
|
| Rate for Payer: PHCS PPO |
$0.73
|
| Rate for Payer: Three Rivers PPO |
$0.56
|
| Rate for Payer: TriWest Veterans Administration |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.49
|
| Rate for Payer: WINHealth Partners Commercial |
$0.70
|
| Rate for Payer: Wise Provider Network Commercial |
$0.70
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET [8141]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 0527169501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.73
|
| Rate for Payer: Aetna of WY Medicare |
$0.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.71
|
| Rate for Payer: Altius Commercial |
$0.71
|
| Rate for Payer: Beech Street Commercial |
$0.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$0.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.72
|
| Rate for Payer: Cigna of WY Commercial |
$0.73
|
| Rate for Payer: Entrust Commercial |
$0.70
|
| Rate for Payer: First Choice Health Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.43
|
| Rate for Payer: HealthUtah PPO |
$0.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.41
|
| Rate for Payer: One Health Plan of WY PPO |
$0.73
|
| Rate for Payer: PacificSource Commercial |
$0.67
|
| Rate for Payer: PHCS PPO |
$0.73
|
| Rate for Payer: Three Rivers PPO |
$0.56
|
| Rate for Payer: TriWest Veterans Administration |
$0.43
|
| Rate for Payer: United Healthcare Commercial |
$0.64
|
| Rate for Payer: United Healthcare Medicare |
$0.43
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.70
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY [5766]
|
Facility
|
IP
|
$24.59
|
|
|
Service Code
|
NDC 1022302013
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$24.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.61
|
| Rate for Payer: Altius Commercial |
$23.61
|
| Rate for Payer: Beech Street Commercial |
$24.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.19
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.85
|
| Rate for Payer: Cigna of WY Commercial |
$24.10
|
| Rate for Payer: Entrust Commercial |
$23.36
|
| Rate for Payer: First Choice Health Commercial |
$23.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.23
|
| Rate for Payer: HealthUtah PPO |
$24.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.85
|
| Rate for Payer: Multiplan Medicare/VA |
$15.42
|
| Rate for Payer: One Health Plan of WY PPO |
$24.10
|
| Rate for Payer: PacificSource Commercial |
$22.13
|
| Rate for Payer: PHCS PPO |
$24.10
|
| Rate for Payer: Three Rivers PPO |
$18.44
|
| Rate for Payer: TriWest Veterans Administration |
$16.23
|
| Rate for Payer: United Healthcare Commercial |
$21.39
|
| Rate for Payer: United Healthcare Medicare |
$16.23
|
| Rate for Payer: WINHealth Partners Commercial |
$23.36
|
| Rate for Payer: Wise Provider Network Commercial |
$23.36
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY [5766]
|
Facility
|
OP
|
$24.59
|
|
|
Service Code
|
NDC 1022302013
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$24.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.10
|
| Rate for Payer: Aetna of WY Medicare |
$16.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.61
|
| Rate for Payer: Altius Commercial |
$23.61
|
| Rate for Payer: Beech Street Commercial |
$24.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.19
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.85
|
| Rate for Payer: Cigna of WY Commercial |
$24.10
|
| Rate for Payer: Entrust Commercial |
$23.36
|
| Rate for Payer: First Choice Health Commercial |
$23.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.26
|
| Rate for Payer: HealthUtah PPO |
$24.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.85
|
| Rate for Payer: Multiplan Medicare/VA |
$13.55
|
| Rate for Payer: One Health Plan of WY PPO |
$24.10
|
| Rate for Payer: PacificSource Commercial |
$22.13
|
| Rate for Payer: PHCS PPO |
$24.10
|
| Rate for Payer: Three Rivers PPO |
$18.44
|
| Rate for Payer: TriWest Veterans Administration |
$14.26
|
| Rate for Payer: United Healthcare Commercial |
$21.39
|
| Rate for Payer: United Healthcare Medicare |
$14.26
|
| Rate for Payer: WINHealth Partners Commercial |
$24.10
|
| Rate for Payer: Wise Provider Network Commercial |
$23.36
|
|
|
BVM AMBU HYPERINFLATION INF
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.88
|
| Rate for Payer: Altius Commercial |
$26.88
|
| Rate for Payer: Beech Street Commercial |
$27.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: Entrust Commercial |
$26.60
|
| Rate for Payer: First Choice Health Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.48
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$17.56
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$27.44
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$18.48
|
| Rate for Payer: United Healthcare Commercial |
$24.36
|
| Rate for Payer: United Healthcare Medicare |
$18.48
|
| Rate for Payer: WINHealth Partners Commercial |
$26.60
|
| Rate for Payer: Wise Provider Network Commercial |
$26.60
|
|
|
BVM AMBU HYPERINFLATION INF
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Aetna of WY Medicare |
$18.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.88
|
| Rate for Payer: Altius Commercial |
$26.88
|
| Rate for Payer: Beech Street Commercial |
$27.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.99
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: Entrust Commercial |
$26.60
|
| Rate for Payer: First Choice Health Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.24
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: Multiplan Medicare/VA |
$15.43
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$27.44
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: TriWest Veterans Administration |
$16.24
|
| Rate for Payer: United Healthcare Commercial |
$24.36
|
| Rate for Payer: United Healthcare Medicare |
$16.24
|
| Rate for Payer: WINHealth Partners Commercial |
$27.44
|
| Rate for Payer: Wise Provider Network Commercial |
$26.60
|
|
|
BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$4,012.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
45100
|
| Min. Negotiated Rate |
$250.05 |
| Max. Negotiated Rate |
$4,012.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,931.76
|
| Rate for Payer: Aetna of WY Medicare |
$294.18
|
| Rate for Payer: Beech Street Commercial |
$3,811.40
|
| Rate for Payer: Cash Price |
$2,808.40
|
| Rate for Payer: Cash Price |
$2,808.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,891.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,931.76
|
| Rate for Payer: First Choice Health Commercial |
$3,610.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,811.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$294.18
|
| Rate for Payer: HealthUtah PPO |
$4,012.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,891.64
|
| Rate for Payer: Multiplan Medicare/VA |
$250.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,931.76
|
| Rate for Payer: PacificSource Commercial |
$3,610.80
|
| Rate for Payer: PHCS PPO |
$3,811.40
|
| Rate for Payer: Three Rivers PPO |
$3,009.00
|
| Rate for Payer: TriWest Veterans Administration |
$294.18
|
| Rate for Payer: United Healthcare Commercial |
$3,490.44
|
| Rate for Payer: United Healthcare Medicare |
$294.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3,410.20
|
|
|
BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$55.08 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$350.84
|
| Rate for Payer: Aetna of WY Medicare |
$64.80
|
| Rate for Payer: Beech Street Commercial |
$340.10
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: Cash Price |
$250.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$347.26
|
| Rate for Payer: Cigna of WY Commercial |
$350.84
|
| Rate for Payer: First Choice Health Commercial |
$322.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$340.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.80
|
| Rate for Payer: HealthUtah PPO |
$358.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$347.26
|
| Rate for Payer: Multiplan Medicare/VA |
$55.08
|
| Rate for Payer: One Health Plan of WY PPO |
$350.84
|
| Rate for Payer: PacificSource Commercial |
$322.20
|
| Rate for Payer: PHCS PPO |
$340.10
|
| Rate for Payer: Three Rivers PPO |
$268.50
|
| Rate for Payer: TriWest Veterans Administration |
$64.80
|
| Rate for Payer: United Healthcare Commercial |
$311.46
|
| Rate for Payer: United Healthcare Medicare |
$64.80
|
| Rate for Payer: WINHealth Partners Commercial |
$304.30
|
|
|
BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$2,262.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$359.59 |
| Max. Negotiated Rate |
$2,262.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,216.76
|
| Rate for Payer: Aetna of WY Medicare |
$423.05
|
| Rate for Payer: Beech Street Commercial |
$2,148.90
|
| Rate for Payer: Cash Price |
$1,583.40
|
| Rate for Payer: Cash Price |
$1,583.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,194.14
|
| Rate for Payer: Cigna of WY Commercial |
$2,216.76
|
| Rate for Payer: First Choice Health Commercial |
$2,035.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,148.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$423.05
|
| Rate for Payer: HealthUtah PPO |
$2,262.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,194.14
|
| Rate for Payer: Multiplan Medicare/VA |
$359.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,216.76
|
| Rate for Payer: PacificSource Commercial |
$2,035.80
|
| Rate for Payer: PHCS PPO |
$2,148.90
|
| Rate for Payer: Three Rivers PPO |
$1,696.50
|
| Rate for Payer: TriWest Veterans Administration |
$423.05
|
| Rate for Payer: United Healthcare Commercial |
$1,967.94
|
| Rate for Payer: United Healthcare Medicare |
$423.05
|
| Rate for Payer: WINHealth Partners Commercial |
$1,922.70
|
|
|
BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
38510
|
| Min. Negotiated Rate |
$340.76 |
| Max. Negotiated Rate |
$2,159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,115.82
|
| Rate for Payer: Aetna of WY Medicare |
$400.90
|
| Rate for Payer: Beech Street Commercial |
$2,051.05
|
| Rate for Payer: Cash Price |
$1,511.30
|
| Rate for Payer: Cash Price |
$1,511.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,094.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,115.82
|
| Rate for Payer: First Choice Health Commercial |
$1,943.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,051.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$400.90
|
| Rate for Payer: HealthUtah PPO |
$2,159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,094.23
|
| Rate for Payer: Multiplan Medicare/VA |
$340.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,115.82
|
| Rate for Payer: PacificSource Commercial |
$1,943.10
|
| Rate for Payer: PHCS PPO |
$2,051.05
|
| Rate for Payer: Three Rivers PPO |
$1,619.25
|
| Rate for Payer: TriWest Veterans Administration |
$400.90
|
| Rate for Payer: United Healthcare Commercial |
$1,878.33
|
| Rate for Payer: United Healthcare Medicare |
$400.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1,835.15
|
|
|
BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
38500
|
| Min. Negotiated Rate |
$207.77 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,289.68
|
| Rate for Payer: Aetna of WY Medicare |
$244.44
|
| Rate for Payer: Beech Street Commercial |
$1,250.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,276.52
|
| Rate for Payer: Cigna of WY Commercial |
$1,289.68
|
| Rate for Payer: First Choice Health Commercial |
$1,184.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,250.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$244.44
|
| Rate for Payer: HealthUtah PPO |
$1,316.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,276.52
|
| Rate for Payer: Multiplan Medicare/VA |
$207.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,289.68
|
| Rate for Payer: PacificSource Commercial |
$1,184.40
|
| Rate for Payer: PHCS PPO |
$1,250.20
|
| Rate for Payer: Three Rivers PPO |
$987.00
|
| Rate for Payer: TriWest Veterans Administration |
$244.44
|
| Rate for Payer: United Healthcare Commercial |
$1,144.92
|
| Rate for Payer: United Healthcare Medicare |
$244.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,118.60
|
|
|
BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
47001
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$527.24
|
| Rate for Payer: Aetna of WY Medicare |
$96.51
|
| Rate for Payer: Beech Street Commercial |
$511.10
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$521.86
|
| Rate for Payer: Cigna of WY Commercial |
$527.24
|
| Rate for Payer: First Choice Health Commercial |
$484.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.51
|
| Rate for Payer: HealthUtah PPO |
$538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$521.86
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$527.24
|
| Rate for Payer: PacificSource Commercial |
$484.20
|
| Rate for Payer: PHCS PPO |
$511.10
|
| Rate for Payer: Three Rivers PPO |
$403.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.51
|
| Rate for Payer: United Healthcare Commercial |
$468.06
|
| Rate for Payer: United Healthcare Medicare |
$96.51
|
| Rate for Payer: WINHealth Partners Commercial |
$457.30
|
|
|
BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 47001 80
|
| Hospital Charge Code |
47001
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$527.24
|
| Rate for Payer: Aetna of WY Medicare |
$96.51
|
| Rate for Payer: Beech Street Commercial |
$511.10
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$521.86
|
| Rate for Payer: Cigna of WY Commercial |
$527.24
|
| Rate for Payer: First Choice Health Commercial |
$484.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$96.51
|
| Rate for Payer: HealthUtah PPO |
$538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$521.86
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$527.24
|
| Rate for Payer: PacificSource Commercial |
$484.20
|
| Rate for Payer: PHCS PPO |
$511.10
|
| Rate for Payer: Three Rivers PPO |
$403.50
|
| Rate for Payer: TriWest Veterans Administration |
$96.51
|
| Rate for Payer: United Healthcare Commercial |
$468.06
|
| Rate for Payer: United Healthcare Medicare |
$96.51
|
| Rate for Payer: WINHealth Partners Commercial |
$457.30
|
|
