|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [42671]
|
Facility
|
IP
|
$2.81
|
|
|
Service Code
|
NDC 1287000012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.70
|
| Rate for Payer: Altius Commercial |
$2.70
|
| Rate for Payer: Beech Street Commercial |
$2.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.73
|
| Rate for Payer: Cigna of WY Commercial |
$2.75
|
| Rate for Payer: Entrust Commercial |
$2.67
|
| Rate for Payer: First Choice Health Commercial |
$2.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.85
|
| Rate for Payer: HealthUtah PPO |
$2.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.73
|
| Rate for Payer: Multiplan Medicare/VA |
$1.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2.75
|
| Rate for Payer: PacificSource Commercial |
$2.53
|
| Rate for Payer: PHCS PPO |
$2.75
|
| Rate for Payer: Three Rivers PPO |
$2.11
|
| Rate for Payer: TriWest Veterans Administration |
$1.85
|
| Rate for Payer: United Healthcare Commercial |
$2.44
|
| Rate for Payer: United Healthcare Medicare |
$1.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2.67
|
| Rate for Payer: Wise Provider Network Commercial |
$2.67
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [42671]
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
NDC 1287000011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.90
|
| Rate for Payer: Altius Commercial |
$2.90
|
| Rate for Payer: Beech Street Commercial |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.48
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.93
|
| Rate for Payer: Cigna of WY Commercial |
$2.96
|
| Rate for Payer: Entrust Commercial |
$2.87
|
| Rate for Payer: First Choice Health Commercial |
$2.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.99
|
| Rate for Payer: HealthUtah PPO |
$3.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.93
|
| Rate for Payer: Multiplan Medicare/VA |
$1.89
|
| Rate for Payer: One Health Plan of WY PPO |
$2.96
|
| Rate for Payer: PacificSource Commercial |
$2.72
|
| Rate for Payer: PHCS PPO |
$2.96
|
| Rate for Payer: Three Rivers PPO |
$2.26
|
| Rate for Payer: TriWest Veterans Administration |
$1.99
|
| Rate for Payer: United Healthcare Commercial |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$1.99
|
| Rate for Payer: WINHealth Partners Commercial |
$2.87
|
| Rate for Payer: Wise Provider Network Commercial |
$2.87
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK [42671]
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
NDC 1287000011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.96
|
| Rate for Payer: Aetna of WY Medicare |
$1.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.90
|
| Rate for Payer: Altius Commercial |
$2.90
|
| Rate for Payer: Beech Street Commercial |
$2.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.48
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.93
|
| Rate for Payer: Cigna of WY Commercial |
$2.96
|
| Rate for Payer: Entrust Commercial |
$2.87
|
| Rate for Payer: First Choice Health Commercial |
$2.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.75
|
| Rate for Payer: HealthUtah PPO |
$3.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.93
|
| Rate for Payer: Multiplan Medicare/VA |
$1.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2.96
|
| Rate for Payer: PacificSource Commercial |
$2.72
|
| Rate for Payer: PHCS PPO |
$2.96
|
| Rate for Payer: Three Rivers PPO |
$2.26
|
| Rate for Payer: TriWest Veterans Administration |
$1.75
|
| Rate for Payer: United Healthcare Commercial |
$2.63
|
| Rate for Payer: United Healthcare Medicare |
$1.75
|
| Rate for Payer: WINHealth Partners Commercial |
$2.96
|
| Rate for Payer: Wise Provider Network Commercial |
$2.87
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM [814]
|
Facility
|
OP
|
$0.98
|
|
|
Service Code
|
NDC 6787712405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.96
|
| Rate for Payer: Aetna of WY Medicare |
$0.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.94
|
| Rate for Payer: Altius Commercial |
$0.94
|
| Rate for Payer: Beech Street Commercial |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.95
|
| Rate for Payer: Cigna of WY Commercial |
$0.96
|
| Rate for Payer: Entrust Commercial |
$0.93
|
| Rate for Payer: First Choice Health Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.57
|
| Rate for Payer: HealthUtah PPO |
$0.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.95
|
| Rate for Payer: Multiplan Medicare/VA |
$0.54
|
| Rate for Payer: One Health Plan of WY PPO |
$0.96
|
| Rate for Payer: PacificSource Commercial |
$0.88
|
| Rate for Payer: PHCS PPO |
$0.96
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare Medicare |
$0.57
|
| Rate for Payer: WINHealth Partners Commercial |
$0.96
|
| Rate for Payer: Wise Provider Network Commercial |
$0.93
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM [814]
|
Facility
|
IP
|
$0.99
|
|
|
Service Code
|
NDC 4359821050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.95
|
| Rate for Payer: Altius Commercial |
$0.95
|
| Rate for Payer: Beech Street Commercial |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.96
|
| Rate for Payer: Cigna of WY Commercial |
$0.97
|
| Rate for Payer: Entrust Commercial |
$0.94
|
| Rate for Payer: First Choice Health Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.65
|
| Rate for Payer: HealthUtah PPO |
$0.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.96
|
| Rate for Payer: Multiplan Medicare/VA |
$0.62
|
| Rate for Payer: One Health Plan of WY PPO |
$0.97
|
| Rate for Payer: PacificSource Commercial |
$0.89
|
| Rate for Payer: PHCS PPO |
$0.97
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$0.86
|
| Rate for Payer: United Healthcare Medicare |
$0.65
|
| Rate for Payer: WINHealth Partners Commercial |
$0.94
|
| Rate for Payer: Wise Provider Network Commercial |
$0.94
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM [814]
|
Facility
|
IP
|
$0.98
|
|
|
Service Code
|
NDC 6787712405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.94
|
| Rate for Payer: Altius Commercial |
$0.94
|
| Rate for Payer: Beech Street Commercial |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.95
|
| Rate for Payer: Cigna of WY Commercial |
$0.96
|
| Rate for Payer: Entrust Commercial |
$0.93
|
| Rate for Payer: First Choice Health Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.65
|
| Rate for Payer: HealthUtah PPO |
$0.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.95
|
| Rate for Payer: Multiplan Medicare/VA |
$0.61
|
| Rate for Payer: One Health Plan of WY PPO |
$0.96
|
| Rate for Payer: PacificSource Commercial |
$0.88
|
| Rate for Payer: PHCS PPO |
$0.96
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.65
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare Medicare |
$0.65
|
| Rate for Payer: WINHealth Partners Commercial |
$0.93
|
| Rate for Payer: Wise Provider Network Commercial |
$0.93
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM [814]
|
Facility
|
OP
|
$0.99
|
|
|
Service Code
|
NDC 4359821050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.97
|
| Rate for Payer: Aetna of WY Medicare |
$0.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.95
|
| Rate for Payer: Altius Commercial |
$0.95
|
| Rate for Payer: Beech Street Commercial |
$0.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.81
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.96
|
| Rate for Payer: Cigna of WY Commercial |
$0.97
|
| Rate for Payer: Entrust Commercial |
$0.94
|
| Rate for Payer: First Choice Health Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.57
|
| Rate for Payer: HealthUtah PPO |
$0.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.96
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.97
|
| Rate for Payer: PacificSource Commercial |
$0.89
|
| Rate for Payer: PHCS PPO |
$0.97
|
| Rate for Payer: Three Rivers PPO |
$0.74
|
| Rate for Payer: TriWest Veterans Administration |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.86
|
| Rate for Payer: United Healthcare Medicare |
$0.57
|
| Rate for Payer: WINHealth Partners Commercial |
$0.97
|
| Rate for Payer: Wise Provider Network Commercial |
$0.94
|
|
|
SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [15244]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 0536130375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.28
|
| Rate for Payer: Altius Commercial |
$0.28
|
| Rate for Payer: Beech Street Commercial |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.28
|
| Rate for Payer: Cigna of WY Commercial |
$0.28
|
| Rate for Payer: Entrust Commercial |
$0.28
|
| Rate for Payer: First Choice Health Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.28
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.28
|
| Rate for Payer: PacificSource Commercial |
$0.26
|
| Rate for Payer: PHCS PPO |
$0.28
|
| Rate for Payer: Three Rivers PPO |
$0.22
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.25
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.28
|
| Rate for Payer: Wise Provider Network Commercial |
$0.28
|
|
|
SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [15244]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 7139900411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.28
|
| Rate for Payer: Aetna of WY Medicare |
$0.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.28
|
| Rate for Payer: Altius Commercial |
$0.28
|
| Rate for Payer: Beech Street Commercial |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.28
|
| Rate for Payer: Cigna of WY Commercial |
$0.28
|
| Rate for Payer: Entrust Commercial |
$0.28
|
| Rate for Payer: First Choice Health Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.28
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.28
|
| Rate for Payer: PacificSource Commercial |
$0.26
|
| Rate for Payer: PHCS PPO |
$0.28
|
| Rate for Payer: Three Rivers PPO |
$0.22
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.25
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.28
|
| Rate for Payer: Wise Provider Network Commercial |
$0.28
|
|
|
SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [15244]
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
NDC 7139900411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.28
|
| Rate for Payer: Altius Commercial |
$0.28
|
| Rate for Payer: Beech Street Commercial |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.28
|
| Rate for Payer: Cigna of WY Commercial |
$0.28
|
| Rate for Payer: Entrust Commercial |
$0.28
|
| Rate for Payer: First Choice Health Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.19
|
| Rate for Payer: HealthUtah PPO |
$0.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.28
|
| Rate for Payer: Multiplan Medicare/VA |
$0.18
|
| Rate for Payer: One Health Plan of WY PPO |
$0.28
|
| Rate for Payer: PacificSource Commercial |
$0.26
|
| Rate for Payer: PHCS PPO |
$0.28
|
| Rate for Payer: Three Rivers PPO |
$0.22
|
| Rate for Payer: TriWest Veterans Administration |
$0.19
|
| Rate for Payer: United Healthcare Commercial |
$0.25
|
| Rate for Payer: United Healthcare Medicare |
$0.19
|
| Rate for Payer: WINHealth Partners Commercial |
$0.28
|
| Rate for Payer: Wise Provider Network Commercial |
$0.28
|
|
|
SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION [15244]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 0536130375
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.28
|
| Rate for Payer: Aetna of WY Medicare |
$0.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.28
|
| Rate for Payer: Altius Commercial |
$0.28
|
| Rate for Payer: Beech Street Commercial |
$0.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.28
|
| Rate for Payer: Cigna of WY Commercial |
$0.28
|
| Rate for Payer: Entrust Commercial |
$0.28
|
| Rate for Payer: First Choice Health Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.28
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.28
|
| Rate for Payer: PacificSource Commercial |
$0.26
|
| Rate for Payer: PHCS PPO |
$0.28
|
| Rate for Payer: Three Rivers PPO |
$0.22
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.25
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.28
|
| Rate for Payer: Wise Provider Network Commercial |
$0.28
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET [20556]
|
Facility
|
IP
|
$0.94
|
|
|
Service Code
|
NDC 7733381225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.90
|
| Rate for Payer: Altius Commercial |
$0.90
|
| Rate for Payer: Beech Street Commercial |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.91
|
| Rate for Payer: Cigna of WY Commercial |
$0.92
|
| Rate for Payer: Entrust Commercial |
$0.89
|
| Rate for Payer: First Choice Health Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.62
|
| Rate for Payer: HealthUtah PPO |
$0.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.91
|
| Rate for Payer: Multiplan Medicare/VA |
$0.59
|
| Rate for Payer: One Health Plan of WY PPO |
$0.92
|
| Rate for Payer: PacificSource Commercial |
$0.85
|
| Rate for Payer: PHCS PPO |
$0.92
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.62
|
| Rate for Payer: United Healthcare Commercial |
$0.82
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
| Rate for Payer: WINHealth Partners Commercial |
$0.89
|
| Rate for Payer: Wise Provider Network Commercial |
$0.89
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET [20556]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 8770170344
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET [20556]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 8770170344
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET [20556]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
NDC 7733381225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.92
|
| Rate for Payer: Aetna of WY Medicare |
$0.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.90
|
| Rate for Payer: Altius Commercial |
$0.90
|
| Rate for Payer: Beech Street Commercial |
$0.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.91
|
| Rate for Payer: Cigna of WY Commercial |
$0.92
|
| Rate for Payer: Entrust Commercial |
$0.89
|
| Rate for Payer: First Choice Health Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.91
|
| Rate for Payer: Multiplan Medicare/VA |
$0.52
|
| Rate for Payer: One Health Plan of WY PPO |
$0.92
|
| Rate for Payer: PacificSource Commercial |
$0.85
|
| Rate for Payer: PHCS PPO |
$0.92
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.82
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.92
|
| Rate for Payer: Wise Provider Network Commercial |
$0.89
|
|
|
SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
51725
|
| Min. Negotiated Rate |
$188.78 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$677.18
|
| Rate for Payer: Aetna of WY Medicare |
$222.10
|
| Rate for Payer: Beech Street Commercial |
$656.45
|
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: Cash Price |
$483.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$670.27
|
| Rate for Payer: Cigna of WY Commercial |
$677.18
|
| Rate for Payer: First Choice Health Commercial |
$621.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$656.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$222.10
|
| Rate for Payer: HealthUtah PPO |
$691.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$670.27
|
| Rate for Payer: Multiplan Medicare/VA |
$188.78
|
| Rate for Payer: One Health Plan of WY PPO |
$677.18
|
| Rate for Payer: PacificSource Commercial |
$621.90
|
| Rate for Payer: PHCS PPO |
$656.45
|
| Rate for Payer: Three Rivers PPO |
$518.25
|
| Rate for Payer: TriWest Veterans Administration |
$222.10
|
| Rate for Payer: United Healthcare Commercial |
$601.17
|
| Rate for Payer: United Healthcare Medicare |
$222.10
|
| Rate for Payer: WINHealth Partners Commercial |
$587.35
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
12011
|
| Min. Negotiated Rate |
$44.68 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$274.40
|
| Rate for Payer: Aetna of WY Medicare |
$52.56
|
| Rate for Payer: Beech Street Commercial |
$266.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$271.60
|
| Rate for Payer: Cigna of WY Commercial |
$274.40
|
| Rate for Payer: First Choice Health Commercial |
$252.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$266.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.56
|
| Rate for Payer: HealthUtah PPO |
$280.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$271.60
|
| Rate for Payer: Multiplan Medicare/VA |
$44.68
|
| Rate for Payer: One Health Plan of WY PPO |
$274.40
|
| Rate for Payer: PacificSource Commercial |
$252.00
|
| Rate for Payer: PHCS PPO |
$266.00
|
| Rate for Payer: Three Rivers PPO |
$210.00
|
| Rate for Payer: TriWest Veterans Administration |
$52.56
|
| Rate for Payer: United Healthcare Commercial |
$243.60
|
| Rate for Payer: United Healthcare Medicare |
$52.56
|
| Rate for Payer: WINHealth Partners Commercial |
$238.00
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
12013
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$291.06
|
| Rate for Payer: Aetna of WY Medicare |
$54.60
|
| Rate for Payer: Beech Street Commercial |
$282.15
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$288.09
|
| Rate for Payer: Cigna of WY Commercial |
$291.06
|
| Rate for Payer: First Choice Health Commercial |
$267.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$282.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.60
|
| Rate for Payer: HealthUtah PPO |
$297.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$288.09
|
| Rate for Payer: Multiplan Medicare/VA |
$46.41
|
| Rate for Payer: One Health Plan of WY PPO |
$291.06
|
| Rate for Payer: PacificSource Commercial |
$267.30
|
| Rate for Payer: PHCS PPO |
$282.15
|
| Rate for Payer: Three Rivers PPO |
$222.75
|
| Rate for Payer: TriWest Veterans Administration |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$258.39
|
| Rate for Payer: United Healthcare Medicare |
$54.60
|
| Rate for Payer: WINHealth Partners Commercial |
$252.45
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 12014
|
| Hospital Charge Code |
12014
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$379.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.42
|
| Rate for Payer: Aetna of WY Medicare |
$70.61
|
| Rate for Payer: Beech Street Commercial |
$360.05
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: Cash Price |
$265.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.63
|
| Rate for Payer: Cigna of WY Commercial |
$371.42
|
| Rate for Payer: First Choice Health Commercial |
$341.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$360.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$70.61
|
| Rate for Payer: HealthUtah PPO |
$379.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.63
|
| Rate for Payer: Multiplan Medicare/VA |
$60.02
|
| Rate for Payer: One Health Plan of WY PPO |
$371.42
|
| Rate for Payer: PacificSource Commercial |
$341.10
|
| Rate for Payer: PHCS PPO |
$360.05
|
| Rate for Payer: Three Rivers PPO |
$284.25
|
| Rate for Payer: TriWest Veterans Administration |
$70.61
|
| Rate for Payer: United Healthcare Commercial |
$329.73
|
| Rate for Payer: United Healthcare Medicare |
$70.61
|
| Rate for Payer: WINHealth Partners Commercial |
$322.15
|
|
|
SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 12015
|
| Hospital Charge Code |
12015
|
| Min. Negotiated Rate |
$75.30 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$471.38
|
| Rate for Payer: Aetna of WY Medicare |
$88.59
|
| Rate for Payer: Beech Street Commercial |
$456.95
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: Cash Price |
$336.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$466.57
|
| Rate for Payer: Cigna of WY Commercial |
$471.38
|
| Rate for Payer: First Choice Health Commercial |
$432.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$456.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.59
|
| Rate for Payer: HealthUtah PPO |
$481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$466.57
|
| Rate for Payer: Multiplan Medicare/VA |
$75.30
|
| Rate for Payer: One Health Plan of WY PPO |
$471.38
|
| Rate for Payer: PacificSource Commercial |
$432.90
|
| Rate for Payer: PHCS PPO |
$456.95
|
| Rate for Payer: Three Rivers PPO |
$360.75
|
| Rate for Payer: TriWest Veterans Administration |
$88.59
|
| Rate for Payer: United Healthcare Commercial |
$418.47
|
| Rate for Payer: United Healthcare Medicare |
$88.59
|
| Rate for Payer: WINHealth Partners Commercial |
$408.85
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 12001 80
|
| Hospital Charge Code |
12001
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$42.51
|
| Rate for Payer: Beech Street Commercial |
$361.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.51
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$36.13
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$361.00
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.51
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$42.51
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
12001
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$372.40
|
| Rate for Payer: Aetna of WY Medicare |
$42.51
|
| Rate for Payer: Beech Street Commercial |
$361.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: Cash Price |
$266.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$368.60
|
| Rate for Payer: Cigna of WY Commercial |
$372.40
|
| Rate for Payer: First Choice Health Commercial |
$342.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$361.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.51
|
| Rate for Payer: HealthUtah PPO |
$380.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$368.60
|
| Rate for Payer: Multiplan Medicare/VA |
$36.13
|
| Rate for Payer: One Health Plan of WY PPO |
$372.40
|
| Rate for Payer: PacificSource Commercial |
$342.00
|
| Rate for Payer: PHCS PPO |
$361.00
|
| Rate for Payer: Three Rivers PPO |
$285.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.51
|
| Rate for Payer: United Healthcare Commercial |
$330.60
|
| Rate for Payer: United Healthcare Medicare |
$42.51
|
| Rate for Payer: WINHealth Partners Commercial |
$323.00
|
|
|
SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
12007
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$783.02
|
| Rate for Payer: Aetna of WY Medicare |
$135.84
|
| Rate for Payer: Beech Street Commercial |
$759.05
|
| Rate for Payer: Cash Price |
$559.30
|
| Rate for Payer: Cash Price |
$559.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$775.03
|
| Rate for Payer: Cigna of WY Commercial |
$783.02
|
| Rate for Payer: First Choice Health Commercial |
$719.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$759.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.84
|
| Rate for Payer: HealthUtah PPO |
$799.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$775.03
|
| Rate for Payer: Multiplan Medicare/VA |
$115.46
|
| Rate for Payer: One Health Plan of WY PPO |
$783.02
|
| Rate for Payer: PacificSource Commercial |
$719.10
|
| Rate for Payer: PHCS PPO |
$759.05
|
| Rate for Payer: Three Rivers PPO |
$599.25
|
| Rate for Payer: TriWest Veterans Administration |
$135.84
|
| Rate for Payer: United Healthcare Commercial |
$695.13
|
| Rate for Payer: United Healthcare Medicare |
$135.84
|
| Rate for Payer: WINHealth Partners Commercial |
$679.15
|
|
|
SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 12004
|
| Hospital Charge Code |
12004
|
| Min. Negotiated Rate |
$59.13 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$450.80
|
| Rate for Payer: Aetna of WY Medicare |
$69.56
|
| Rate for Payer: Beech Street Commercial |
$437.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$446.20
|
| Rate for Payer: Cigna of WY Commercial |
$450.80
|
| Rate for Payer: First Choice Health Commercial |
$414.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$437.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.56
|
| Rate for Payer: HealthUtah PPO |
$460.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$446.20
|
| Rate for Payer: Multiplan Medicare/VA |
$59.13
|
| Rate for Payer: One Health Plan of WY PPO |
$450.80
|
| Rate for Payer: PacificSource Commercial |
$414.00
|
| Rate for Payer: PHCS PPO |
$437.00
|
| Rate for Payer: Three Rivers PPO |
$345.00
|
| Rate for Payer: TriWest Veterans Administration |
$69.56
|
| Rate for Payer: United Healthcare Commercial |
$400.20
|
| Rate for Payer: United Healthcare Medicare |
$69.56
|
| Rate for Payer: WINHealth Partners Commercial |
$391.00
|
|
|
SIMPLEX TOBRAMYCIN CEMENT
|
Facility
|
OP
|
$910.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.41 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$891.80
|
| Rate for Payer: Aetna of WY Medicare |
$600.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$873.60
|
| Rate for Payer: Altius Commercial |
$873.60
|
| Rate for Payer: Beech Street Commercial |
$891.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$747.11
|
| Rate for Payer: Cash Price |
$637.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$882.70
|
| Rate for Payer: Cigna of WY Commercial |
$891.80
|
| Rate for Payer: Entrust Commercial |
$864.50
|
| Rate for Payer: First Choice Health Commercial |
$864.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$864.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$527.80
|
| Rate for Payer: HealthUtah PPO |
$910.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$882.70
|
| Rate for Payer: Multiplan Medicare/VA |
$501.41
|
| Rate for Payer: One Health Plan of WY PPO |
$891.80
|
| Rate for Payer: PacificSource Commercial |
$819.00
|
| Rate for Payer: PHCS PPO |
$891.80
|
| Rate for Payer: Three Rivers PPO |
$682.50
|
| Rate for Payer: TriWest Veterans Administration |
$527.80
|
| Rate for Payer: United Healthcare Commercial |
$791.70
|
| Rate for Payer: United Healthcare Medicare |
$527.80
|
| Rate for Payer: WINHealth Partners Commercial |
$891.80
|
| Rate for Payer: Wise Provider Network Commercial |
$864.50
|
|
