|
POWER PORTACATH ACCESS
|
Facility
|
OP
|
$854.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.55 |
| Max. Negotiated Rate |
$854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.92
|
| Rate for Payer: Aetna of WY Medicare |
$563.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$819.84
|
| Rate for Payer: Altius Commercial |
$819.84
|
| Rate for Payer: Beech Street Commercial |
$836.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.13
|
| Rate for Payer: Cash Price |
$597.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.38
|
| Rate for Payer: Cigna of WY Commercial |
$836.92
|
| Rate for Payer: Entrust Commercial |
$811.30
|
| Rate for Payer: First Choice Health Commercial |
$811.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.32
|
| Rate for Payer: HealthUtah PPO |
$854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.38
|
| Rate for Payer: Multiplan Medicare/VA |
$470.55
|
| Rate for Payer: One Health Plan of WY PPO |
$836.92
|
| Rate for Payer: PacificSource Commercial |
$768.60
|
| Rate for Payer: PHCS PPO |
$836.92
|
| Rate for Payer: Three Rivers PPO |
$640.50
|
| Rate for Payer: TriWest Veterans Administration |
$495.32
|
| Rate for Payer: United Healthcare Commercial |
$742.98
|
| Rate for Payer: United Healthcare Medicare |
$495.32
|
| Rate for Payer: WINHealth Partners Commercial |
$836.92
|
| Rate for Payer: Wise Provider Network Commercial |
$811.30
|
|
|
POWER PORTACATH ACCESS
|
Facility
|
IP
|
$854.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.46 |
| Max. Negotiated Rate |
$854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$819.84
|
| Rate for Payer: Altius Commercial |
$819.84
|
| Rate for Payer: Beech Street Commercial |
$836.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.13
|
| Rate for Payer: Cash Price |
$597.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.38
|
| Rate for Payer: Cigna of WY Commercial |
$836.92
|
| Rate for Payer: Entrust Commercial |
$811.30
|
| Rate for Payer: First Choice Health Commercial |
$811.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$563.64
|
| Rate for Payer: HealthUtah PPO |
$854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.38
|
| Rate for Payer: Multiplan Medicare/VA |
$535.46
|
| Rate for Payer: One Health Plan of WY PPO |
$836.92
|
| Rate for Payer: PacificSource Commercial |
$768.60
|
| Rate for Payer: PHCS PPO |
$836.92
|
| Rate for Payer: Three Rivers PPO |
$640.50
|
| Rate for Payer: TriWest Veterans Administration |
$563.64
|
| Rate for Payer: United Healthcare Commercial |
$742.98
|
| Rate for Payer: United Healthcare Medicare |
$563.64
|
| Rate for Payer: WINHealth Partners Commercial |
$811.30
|
| Rate for Payer: Wise Provider Network Commercial |
$811.30
|
|
|
PPPS, INITIAL VISIT
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
G0438
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$361.62
|
| Rate for Payer: Aetna of WY Medicare |
$161.29
|
| Rate for Payer: Beech Street Commercial |
$350.55
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$357.93
|
| Rate for Payer: Cigna of WY Commercial |
$361.62
|
| Rate for Payer: First Choice Health Commercial |
$332.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$350.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.29
|
| Rate for Payer: HealthUtah PPO |
$369.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$357.93
|
| Rate for Payer: Multiplan Medicare/VA |
$137.10
|
| Rate for Payer: One Health Plan of WY PPO |
$361.62
|
| Rate for Payer: PacificSource Commercial |
$332.10
|
| Rate for Payer: PHCS PPO |
$350.55
|
| Rate for Payer: Three Rivers PPO |
$276.75
|
| Rate for Payer: TriWest Veterans Administration |
$161.29
|
| Rate for Payer: United Healthcare Commercial |
$321.03
|
| Rate for Payer: United Healthcare Medicare |
$161.29
|
| Rate for Payer: WINHealth Partners Commercial |
$350.55
|
|
|
PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
G0439
|
| Min. Negotiated Rate |
$107.88 |
| Max. Negotiated Rate |
$333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$326.34
|
| Rate for Payer: Aetna of WY Medicare |
$126.92
|
| Rate for Payer: Beech Street Commercial |
$316.35
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$323.01
|
| Rate for Payer: Cigna of WY Commercial |
$326.34
|
| Rate for Payer: First Choice Health Commercial |
$299.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$316.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.92
|
| Rate for Payer: HealthUtah PPO |
$333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$323.01
|
| Rate for Payer: Multiplan Medicare/VA |
$107.88
|
| Rate for Payer: One Health Plan of WY PPO |
$326.34
|
| Rate for Payer: PacificSource Commercial |
$299.70
|
| Rate for Payer: PHCS PPO |
$316.35
|
| Rate for Payer: Three Rivers PPO |
$249.75
|
| Rate for Payer: TriWest Veterans Administration |
$126.92
|
| Rate for Payer: United Healthcare Commercial |
$289.71
|
| Rate for Payer: United Healthcare Medicare |
$126.92
|
| Rate for Payer: WINHealth Partners Commercial |
$316.35
|
|
|
PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
90732
|
| Min. Negotiated Rate |
$113.45 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$318.50
|
| Rate for Payer: Aetna of WY Medicare |
$133.47
|
| Rate for Payer: Beech Street Commercial |
$308.75
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$315.25
|
| Rate for Payer: Cigna of WY Commercial |
$318.50
|
| Rate for Payer: First Choice Health Commercial |
$292.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$308.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.47
|
| Rate for Payer: HealthUtah PPO |
$325.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$315.25
|
| Rate for Payer: Multiplan Medicare/VA |
$113.45
|
| Rate for Payer: One Health Plan of WY PPO |
$318.50
|
| Rate for Payer: PacificSource Commercial |
$292.50
|
| Rate for Payer: PHCS PPO |
$308.75
|
| Rate for Payer: Three Rivers PPO |
$243.75
|
| Rate for Payer: TriWest Veterans Administration |
$133.47
|
| Rate for Payer: United Healthcare Commercial |
$282.75
|
| Rate for Payer: United Healthcare Medicare |
$133.47
|
| Rate for Payer: WINHealth Partners Commercial |
$325.00
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
J7613
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Aetna of WY Medicare |
$0.04
|
| Rate for Payer: Beech Street Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: First Choice Health Commercial |
$6.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.04
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.65
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: TriWest Veterans Administration |
$0.04
|
| Rate for Payer: United Healthcare Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicare |
$0.04
|
| Rate for Payer: WINHealth Partners Commercial |
$6.65
|
|
|
PRAMIPEXOLE 0.125 MG TABLET [14536]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 1366809190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.56
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
PRAMIPEXOLE 0.125 MG TABLET [14536]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 5723718090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Aetna of WY Medicare |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.43
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
PRAMIPEXOLE 0.125 MG TABLET [14536]
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 5723718090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.42
|
| Rate for Payer: Altius Commercial |
$0.42
|
| Rate for Payer: Beech Street Commercial |
$0.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.36
|
| Rate for Payer: Cash Price |
$0.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.43
|
| Rate for Payer: Cigna of WY Commercial |
$0.43
|
| Rate for Payer: Entrust Commercial |
$0.42
|
| Rate for Payer: First Choice Health Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.29
|
| Rate for Payer: HealthUtah PPO |
$0.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.28
|
| Rate for Payer: One Health Plan of WY PPO |
$0.43
|
| Rate for Payer: PacificSource Commercial |
$0.40
|
| Rate for Payer: PHCS PPO |
$0.43
|
| Rate for Payer: Three Rivers PPO |
$0.33
|
| Rate for Payer: TriWest Veterans Administration |
$0.29
|
| Rate for Payer: United Healthcare Commercial |
$0.38
|
| Rate for Payer: United Healthcare Medicare |
$0.29
|
| Rate for Payer: WINHealth Partners Commercial |
$0.42
|
| Rate for Payer: Wise Provider Network Commercial |
$0.42
|
|
|
PRAMIPEXOLE 0.125 MG TABLET [14536]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 1366809190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.58
|
| Rate for Payer: Aetna of WY Medicare |
$0.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.57
|
| Rate for Payer: Beech Street Commercial |
$0.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.57
|
| Rate for Payer: Cigna of WY Commercial |
$0.58
|
| Rate for Payer: Entrust Commercial |
$0.56
|
| Rate for Payer: First Choice Health Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.57
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.58
|
| Rate for Payer: PacificSource Commercial |
$0.53
|
| Rate for Payer: PHCS PPO |
$0.58
|
| Rate for Payer: Three Rivers PPO |
$0.44
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.58
|
| Rate for Payer: Wise Provider Network Commercial |
$0.56
|
|
|
PRAMIPEXOLE 0.5 MG TABLET [9051]
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 6068758111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.20
|
| Rate for Payer: Altius Commercial |
$3.20
|
| Rate for Payer: Beech Street Commercial |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.23
|
| Rate for Payer: Cigna of WY Commercial |
$3.26
|
| Rate for Payer: Entrust Commercial |
$3.16
|
| Rate for Payer: First Choice Health Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.20
|
| Rate for Payer: HealthUtah PPO |
$3.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.23
|
| Rate for Payer: Multiplan Medicare/VA |
$2.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3.26
|
| Rate for Payer: PacificSource Commercial |
$3.00
|
| Rate for Payer: PHCS PPO |
$3.26
|
| Rate for Payer: Three Rivers PPO |
$2.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$2.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3.16
|
| Rate for Payer: Wise Provider Network Commercial |
$3.16
|
|
|
PRAMIPEXOLE 0.5 MG TABLET [9051]
|
Facility
|
OP
|
$3.33
|
|
|
Service Code
|
NDC 6068758121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.26
|
| Rate for Payer: Aetna of WY Medicare |
$2.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.20
|
| Rate for Payer: Altius Commercial |
$3.20
|
| Rate for Payer: Beech Street Commercial |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.23
|
| Rate for Payer: Cigna of WY Commercial |
$3.26
|
| Rate for Payer: Entrust Commercial |
$3.16
|
| Rate for Payer: First Choice Health Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.93
|
| Rate for Payer: HealthUtah PPO |
$3.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.23
|
| Rate for Payer: Multiplan Medicare/VA |
$1.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3.26
|
| Rate for Payer: PacificSource Commercial |
$3.00
|
| Rate for Payer: PHCS PPO |
$3.26
|
| Rate for Payer: Three Rivers PPO |
$2.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.93
|
| Rate for Payer: United Healthcare Commercial |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$1.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3.26
|
| Rate for Payer: Wise Provider Network Commercial |
$3.16
|
|
|
PRAMIPEXOLE 0.5 MG TABLET [9051]
|
Facility
|
OP
|
$3.33
|
|
|
Service Code
|
NDC 6068758111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.26
|
| Rate for Payer: Aetna of WY Medicare |
$2.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.20
|
| Rate for Payer: Altius Commercial |
$3.20
|
| Rate for Payer: Beech Street Commercial |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.23
|
| Rate for Payer: Cigna of WY Commercial |
$3.26
|
| Rate for Payer: Entrust Commercial |
$3.16
|
| Rate for Payer: First Choice Health Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.93
|
| Rate for Payer: HealthUtah PPO |
$3.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.23
|
| Rate for Payer: Multiplan Medicare/VA |
$1.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3.26
|
| Rate for Payer: PacificSource Commercial |
$3.00
|
| Rate for Payer: PHCS PPO |
$3.26
|
| Rate for Payer: Three Rivers PPO |
$2.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.93
|
| Rate for Payer: United Healthcare Commercial |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$1.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3.26
|
| Rate for Payer: Wise Provider Network Commercial |
$3.16
|
|
|
PRAMIPEXOLE 0.5 MG TABLET [9051]
|
Facility
|
IP
|
$3.33
|
|
|
Service Code
|
NDC 6068758121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.20
|
| Rate for Payer: Altius Commercial |
$3.20
|
| Rate for Payer: Beech Street Commercial |
$3.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.23
|
| Rate for Payer: Cigna of WY Commercial |
$3.26
|
| Rate for Payer: Entrust Commercial |
$3.16
|
| Rate for Payer: First Choice Health Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.20
|
| Rate for Payer: HealthUtah PPO |
$3.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.23
|
| Rate for Payer: Multiplan Medicare/VA |
$2.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3.26
|
| Rate for Payer: PacificSource Commercial |
$3.00
|
| Rate for Payer: PHCS PPO |
$3.26
|
| Rate for Payer: Three Rivers PPO |
$2.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.90
|
| Rate for Payer: United Healthcare Medicare |
$2.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3.16
|
| Rate for Payer: Wise Provider Network Commercial |
$3.16
|
|
|
PRASUGREL HCL 10 MG TABLET [87361]
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 5140744530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.98
|
| Rate for Payer: Altius Commercial |
$0.98
|
| Rate for Payer: Beech Street Commercial |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.99
|
| Rate for Payer: Cigna of WY Commercial |
$1.00
|
| Rate for Payer: Entrust Commercial |
$0.97
|
| Rate for Payer: First Choice Health Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.99
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.00
|
| Rate for Payer: PacificSource Commercial |
$0.92
|
| Rate for Payer: PHCS PPO |
$1.00
|
| Rate for Payer: Three Rivers PPO |
$0.77
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$0.97
|
| Rate for Payer: Wise Provider Network Commercial |
$0.97
|
|
|
PRASUGREL HCL 10 MG TABLET [87361]
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 5140744530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.00
|
| Rate for Payer: Aetna of WY Medicare |
$0.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.98
|
| Rate for Payer: Altius Commercial |
$0.98
|
| Rate for Payer: Beech Street Commercial |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.99
|
| Rate for Payer: Cigna of WY Commercial |
$1.00
|
| Rate for Payer: Entrust Commercial |
$0.97
|
| Rate for Payer: First Choice Health Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.59
|
| Rate for Payer: HealthUtah PPO |
$1.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.99
|
| Rate for Payer: Multiplan Medicare/VA |
$0.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1.00
|
| Rate for Payer: PacificSource Commercial |
$0.92
|
| Rate for Payer: PHCS PPO |
$1.00
|
| Rate for Payer: Three Rivers PPO |
$0.77
|
| Rate for Payer: TriWest Veterans Administration |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.59
|
| Rate for Payer: WINHealth Partners Commercial |
$1.00
|
| Rate for Payer: Wise Provider Network Commercial |
$0.97
|
|
|
PRASUGREL HCL 10 MG TABLET [87361]
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 6050546433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.23
|
| Rate for Payer: Aetna of WY Medicare |
$2.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.17
|
| Rate for Payer: Altius Commercial |
$3.17
|
| Rate for Payer: Beech Street Commercial |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.20
|
| Rate for Payer: Cigna of WY Commercial |
$3.23
|
| Rate for Payer: Entrust Commercial |
$3.14
|
| Rate for Payer: First Choice Health Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.91
|
| Rate for Payer: HealthUtah PPO |
$3.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1.82
|
| Rate for Payer: One Health Plan of WY PPO |
$3.23
|
| Rate for Payer: PacificSource Commercial |
$2.97
|
| Rate for Payer: PHCS PPO |
$3.23
|
| Rate for Payer: Three Rivers PPO |
$2.48
|
| Rate for Payer: TriWest Veterans Administration |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$2.87
|
| Rate for Payer: United Healthcare Medicare |
$1.91
|
| Rate for Payer: WINHealth Partners Commercial |
$3.23
|
| Rate for Payer: Wise Provider Network Commercial |
$3.14
|
|
|
PRASUGREL HCL 10 MG TABLET [87361]
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 6050546433
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.17
|
| Rate for Payer: Altius Commercial |
$3.17
|
| Rate for Payer: Beech Street Commercial |
$3.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.71
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.20
|
| Rate for Payer: Cigna of WY Commercial |
$3.23
|
| Rate for Payer: Entrust Commercial |
$3.14
|
| Rate for Payer: First Choice Health Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.18
|
| Rate for Payer: HealthUtah PPO |
$3.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.20
|
| Rate for Payer: Multiplan Medicare/VA |
$2.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3.23
|
| Rate for Payer: PacificSource Commercial |
$2.97
|
| Rate for Payer: PHCS PPO |
$3.23
|
| Rate for Payer: Three Rivers PPO |
$2.48
|
| Rate for Payer: TriWest Veterans Administration |
$2.18
|
| Rate for Payer: United Healthcare Commercial |
$2.87
|
| Rate for Payer: United Healthcare Medicare |
$2.18
|
| Rate for Payer: WINHealth Partners Commercial |
$3.14
|
| Rate for Payer: Wise Provider Network Commercial |
$3.14
|
|
|
PRAVASTATIN 40 MG TABLET [3284]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
NDC 6050501709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.50
|
| Rate for Payer: Aetna of WY Medicare |
$1.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.47
|
| Rate for Payer: Altius Commercial |
$1.47
|
| Rate for Payer: Beech Street Commercial |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.48
|
| Rate for Payer: Cigna of WY Commercial |
$1.50
|
| Rate for Payer: Entrust Commercial |
$1.45
|
| Rate for Payer: First Choice Health Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.89
|
| Rate for Payer: HealthUtah PPO |
$1.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1.50
|
| Rate for Payer: PacificSource Commercial |
$1.38
|
| Rate for Payer: PHCS PPO |
$1.50
|
| Rate for Payer: Three Rivers PPO |
$1.15
|
| Rate for Payer: TriWest Veterans Administration |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$0.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1.45
|
|
|
PRAVASTATIN 40 MG TABLET [3284]
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 6068719011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.19
|
| Rate for Payer: Altius Commercial |
$3.19
|
| Rate for Payer: Beech Street Commercial |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.22
|
| Rate for Payer: Cigna of WY Commercial |
$3.25
|
| Rate for Payer: Entrust Commercial |
$3.15
|
| Rate for Payer: First Choice Health Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.19
|
| Rate for Payer: HealthUtah PPO |
$3.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3.25
|
| Rate for Payer: PacificSource Commercial |
$2.99
|
| Rate for Payer: PHCS PPO |
$3.25
|
| Rate for Payer: Three Rivers PPO |
$2.49
|
| Rate for Payer: TriWest Veterans Administration |
$2.19
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Medicare |
$2.19
|
| Rate for Payer: WINHealth Partners Commercial |
$3.15
|
| Rate for Payer: Wise Provider Network Commercial |
$3.15
|
|
|
PRAVASTATIN 40 MG TABLET [3284]
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 6068719001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.25
|
| Rate for Payer: Aetna of WY Medicare |
$2.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.19
|
| Rate for Payer: Altius Commercial |
$3.19
|
| Rate for Payer: Beech Street Commercial |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.22
|
| Rate for Payer: Cigna of WY Commercial |
$3.25
|
| Rate for Payer: Entrust Commercial |
$3.15
|
| Rate for Payer: First Choice Health Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.93
|
| Rate for Payer: HealthUtah PPO |
$3.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3.25
|
| Rate for Payer: PacificSource Commercial |
$2.99
|
| Rate for Payer: PHCS PPO |
$3.25
|
| Rate for Payer: Three Rivers PPO |
$2.49
|
| Rate for Payer: TriWest Veterans Administration |
$1.93
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Medicare |
$1.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3.15
|
|
|
PRAVASTATIN 40 MG TABLET [3284]
|
Facility
|
OP
|
$3.32
|
|
|
Service Code
|
NDC 6068719011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.25
|
| Rate for Payer: Aetna of WY Medicare |
$2.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.19
|
| Rate for Payer: Altius Commercial |
$3.19
|
| Rate for Payer: Beech Street Commercial |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.22
|
| Rate for Payer: Cigna of WY Commercial |
$3.25
|
| Rate for Payer: Entrust Commercial |
$3.15
|
| Rate for Payer: First Choice Health Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.93
|
| Rate for Payer: HealthUtah PPO |
$3.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3.25
|
| Rate for Payer: PacificSource Commercial |
$2.99
|
| Rate for Payer: PHCS PPO |
$3.25
|
| Rate for Payer: Three Rivers PPO |
$2.49
|
| Rate for Payer: TriWest Veterans Administration |
$1.93
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Medicare |
$1.93
|
| Rate for Payer: WINHealth Partners Commercial |
$3.25
|
| Rate for Payer: Wise Provider Network Commercial |
$3.15
|
|
|
PRAVASTATIN 40 MG TABLET [3284]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
NDC 6050501709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.47
|
| Rate for Payer: Altius Commercial |
$1.47
|
| Rate for Payer: Beech Street Commercial |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.48
|
| Rate for Payer: Cigna of WY Commercial |
$1.50
|
| Rate for Payer: Entrust Commercial |
$1.45
|
| Rate for Payer: First Choice Health Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.01
|
| Rate for Payer: HealthUtah PPO |
$1.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.48
|
| Rate for Payer: Multiplan Medicare/VA |
$0.96
|
| Rate for Payer: One Health Plan of WY PPO |
$1.50
|
| Rate for Payer: PacificSource Commercial |
$1.38
|
| Rate for Payer: PHCS PPO |
$1.50
|
| Rate for Payer: Three Rivers PPO |
$1.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$1.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1.45
|
|
|
PRAVASTATIN 40 MG TABLET [3284]
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 6068719001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.19
|
| Rate for Payer: Altius Commercial |
$3.19
|
| Rate for Payer: Beech Street Commercial |
$3.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.22
|
| Rate for Payer: Cigna of WY Commercial |
$3.25
|
| Rate for Payer: Entrust Commercial |
$3.15
|
| Rate for Payer: First Choice Health Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.19
|
| Rate for Payer: HealthUtah PPO |
$3.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.22
|
| Rate for Payer: Multiplan Medicare/VA |
$2.08
|
| Rate for Payer: One Health Plan of WY PPO |
$3.25
|
| Rate for Payer: PacificSource Commercial |
$2.99
|
| Rate for Payer: PHCS PPO |
$3.25
|
| Rate for Payer: Three Rivers PPO |
$2.49
|
| Rate for Payer: TriWest Veterans Administration |
$2.19
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Medicare |
$2.19
|
| Rate for Payer: WINHealth Partners Commercial |
$3.15
|
| Rate for Payer: Wise Provider Network Commercial |
$3.15
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION [10245]
|
Facility
|
IP
|
$28.76
|
|
|
Service Code
|
NDC 6131463705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$28.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.61
|
| Rate for Payer: Altius Commercial |
$27.61
|
| Rate for Payer: Beech Street Commercial |
$28.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$20.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.90
|
| Rate for Payer: Cigna of WY Commercial |
$28.18
|
| Rate for Payer: Entrust Commercial |
$27.32
|
| Rate for Payer: First Choice Health Commercial |
$27.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.98
|
| Rate for Payer: HealthUtah PPO |
$28.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.90
|
| Rate for Payer: Multiplan Medicare/VA |
$18.03
|
| Rate for Payer: One Health Plan of WY PPO |
$28.18
|
| Rate for Payer: PacificSource Commercial |
$25.88
|
| Rate for Payer: PHCS PPO |
$28.18
|
| Rate for Payer: Three Rivers PPO |
$21.57
|
| Rate for Payer: TriWest Veterans Administration |
$18.98
|
| Rate for Payer: United Healthcare Commercial |
$25.02
|
| Rate for Payer: United Healthcare Medicare |
$18.98
|
| Rate for Payer: WINHealth Partners Commercial |
$27.32
|
| Rate for Payer: Wise Provider Network Commercial |
$27.32
|
|
