|
STRYK E-SEP SLEEVE 125MM
|
Facility
|
OP
|
$11.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$11.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.68
|
| Rate for Payer: Aetna of WY Medicare |
$7.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.44
|
| Rate for Payer: Altius Commercial |
$11.44
|
| Rate for Payer: Beech Street Commercial |
$11.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.56
|
| Rate for Payer: Cigna of WY Commercial |
$11.68
|
| Rate for Payer: Entrust Commercial |
$11.32
|
| Rate for Payer: First Choice Health Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.91
|
| Rate for Payer: HealthUtah PPO |
$11.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.56
|
| Rate for Payer: Multiplan Medicare/VA |
$6.57
|
| Rate for Payer: One Health Plan of WY PPO |
$11.68
|
| Rate for Payer: PacificSource Commercial |
$10.73
|
| Rate for Payer: PHCS PPO |
$11.68
|
| Rate for Payer: Three Rivers PPO |
$8.94
|
| Rate for Payer: TriWest Veterans Administration |
$6.91
|
| Rate for Payer: United Healthcare Commercial |
$10.37
|
| Rate for Payer: United Healthcare Medicare |
$6.91
|
| Rate for Payer: WINHealth Partners Commercial |
$11.68
|
| Rate for Payer: Wise Provider Network Commercial |
$11.32
|
|
|
SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$481.00
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
15275
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$481.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$471.38
|
| Rate for Payer: Aetna of WY Medicare |
$89.08
|
| 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 |
$89.08
|
| Rate for Payer: HealthUtah PPO |
$481.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$466.57
|
| Rate for Payer: Multiplan Medicare/VA |
$75.72
|
| 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 |
$89.08
|
| Rate for Payer: United Healthcare Commercial |
$418.47
|
| Rate for Payer: United Healthcare Medicare |
$89.08
|
| Rate for Payer: WINHealth Partners Commercial |
$408.85
|
|
|
SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 30140
|
| Hospital Charge Code |
30140
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,422.96
|
| Rate for Payer: Aetna of WY Medicare |
$170.85
|
| Rate for Payer: Beech Street Commercial |
$1,379.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: Cash Price |
$1,016.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,408.44
|
| Rate for Payer: Cigna of WY Commercial |
$1,422.96
|
| Rate for Payer: First Choice Health Commercial |
$1,306.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,379.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.85
|
| Rate for Payer: HealthUtah PPO |
$1,452.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,408.44
|
| Rate for Payer: Multiplan Medicare/VA |
$145.22
|
| Rate for Payer: One Health Plan of WY PPO |
$1,422.96
|
| Rate for Payer: PacificSource Commercial |
$1,306.80
|
| Rate for Payer: PHCS PPO |
$1,379.40
|
| Rate for Payer: Three Rivers PPO |
$1,089.00
|
| Rate for Payer: TriWest Veterans Administration |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$1,263.24
|
| Rate for Payer: United Healthcare Medicare |
$170.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,234.20
|
|
|
SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$2,904.00
|
|
|
Service Code
|
HCPCS 30140 50
|
| Hospital Charge Code |
30140
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$2,904.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,845.92
|
| Rate for Payer: Aetna of WY Medicare |
$170.85
|
| Rate for Payer: Beech Street Commercial |
$2,758.80
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,816.88
|
| Rate for Payer: Cigna of WY Commercial |
$2,845.92
|
| Rate for Payer: First Choice Health Commercial |
$2,613.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,758.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$170.85
|
| Rate for Payer: HealthUtah PPO |
$2,904.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,816.88
|
| Rate for Payer: Multiplan Medicare/VA |
$145.22
|
| Rate for Payer: One Health Plan of WY PPO |
$2,845.92
|
| Rate for Payer: PacificSource Commercial |
$2,613.60
|
| Rate for Payer: PHCS PPO |
$2,758.80
|
| Rate for Payer: Three Rivers PPO |
$2,178.00
|
| Rate for Payer: TriWest Veterans Administration |
$170.85
|
| Rate for Payer: United Healthcare Commercial |
$2,526.48
|
| Rate for Payer: United Healthcare Medicare |
$170.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,468.40
|
|
|
SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99462
|
| Hospital Charge Code |
99462
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$145.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$142.10
|
| Rate for Payer: Aetna of WY Medicare |
$39.11
|
| Rate for Payer: Beech Street Commercial |
$137.75
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$140.65
|
| Rate for Payer: Cigna of WY Commercial |
$142.10
|
| Rate for Payer: First Choice Health Commercial |
$130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$137.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.11
|
| Rate for Payer: HealthUtah PPO |
$145.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$140.65
|
| Rate for Payer: Multiplan Medicare/VA |
$33.24
|
| Rate for Payer: One Health Plan of WY PPO |
$142.10
|
| Rate for Payer: PacificSource Commercial |
$130.50
|
| Rate for Payer: PHCS PPO |
$137.75
|
| Rate for Payer: Three Rivers PPO |
$108.75
|
| Rate for Payer: TriWest Veterans Administration |
$39.11
|
| Rate for Payer: United Healthcare Commercial |
$126.15
|
| Rate for Payer: United Healthcare Medicare |
$39.11
|
| Rate for Payer: WINHealth Partners Commercial |
$137.75
|
|
|
SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 99469
|
| Hospital Charge Code |
99469
|
| Min. Negotiated Rate |
$314.76 |
| Max. Negotiated Rate |
$718.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.64
|
| Rate for Payer: Aetna of WY Medicare |
$370.31
|
| Rate for Payer: Beech Street Commercial |
$682.10
|
| Rate for Payer: Cash Price |
$502.60
|
| Rate for Payer: Cash Price |
$502.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$696.46
|
| Rate for Payer: Cigna of WY Commercial |
$703.64
|
| Rate for Payer: First Choice Health Commercial |
$646.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$682.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$370.31
|
| Rate for Payer: HealthUtah PPO |
$718.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$696.46
|
| Rate for Payer: Multiplan Medicare/VA |
$314.76
|
| Rate for Payer: One Health Plan of WY PPO |
$703.64
|
| Rate for Payer: PacificSource Commercial |
$646.20
|
| Rate for Payer: PHCS PPO |
$682.10
|
| Rate for Payer: Three Rivers PPO |
$538.50
|
| Rate for Payer: TriWest Veterans Administration |
$370.31
|
| Rate for Payer: United Healthcare Commercial |
$624.66
|
| Rate for Payer: United Healthcare Medicare |
$370.31
|
| Rate for Payer: WINHealth Partners Commercial |
$682.10
|
|
|
SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 99479
|
| Hospital Charge Code |
99479
|
| Min. Negotiated Rate |
$98.68 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$413.56
|
| Rate for Payer: Aetna of WY Medicare |
$116.10
|
| Rate for Payer: Beech Street Commercial |
$400.90
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$409.34
|
| Rate for Payer: Cigna of WY Commercial |
$413.56
|
| Rate for Payer: First Choice Health Commercial |
$379.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$400.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$116.10
|
| Rate for Payer: HealthUtah PPO |
$422.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$409.34
|
| Rate for Payer: Multiplan Medicare/VA |
$98.68
|
| Rate for Payer: One Health Plan of WY PPO |
$413.56
|
| Rate for Payer: PacificSource Commercial |
$379.80
|
| Rate for Payer: PHCS PPO |
$400.90
|
| Rate for Payer: Three Rivers PPO |
$316.50
|
| Rate for Payer: TriWest Veterans Administration |
$116.10
|
| Rate for Payer: United Healthcare Commercial |
$367.14
|
| Rate for Payer: United Healthcare Medicare |
$116.10
|
| Rate for Payer: WINHealth Partners Commercial |
$400.90
|
|
|
SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 99480
|
| Hospital Charge Code |
99480
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$413.56
|
| Rate for Payer: Aetna of WY Medicare |
$111.51
|
| Rate for Payer: Beech Street Commercial |
$400.90
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: Cash Price |
$295.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$409.34
|
| Rate for Payer: Cigna of WY Commercial |
$413.56
|
| Rate for Payer: First Choice Health Commercial |
$379.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$400.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.51
|
| Rate for Payer: HealthUtah PPO |
$422.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$409.34
|
| Rate for Payer: Multiplan Medicare/VA |
$94.78
|
| Rate for Payer: One Health Plan of WY PPO |
$413.56
|
| Rate for Payer: PacificSource Commercial |
$379.80
|
| Rate for Payer: PHCS PPO |
$400.90
|
| Rate for Payer: Three Rivers PPO |
$316.50
|
| Rate for Payer: TriWest Veterans Administration |
$111.51
|
| Rate for Payer: United Healthcare Commercial |
$367.14
|
| Rate for Payer: United Healthcare Medicare |
$111.51
|
| Rate for Payer: WINHealth Partners Commercial |
$400.90
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [6983]
|
Facility
|
IP
|
$18.40
|
|
|
Service Code
|
NDC 7006930101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.66
|
| Rate for Payer: Altius Commercial |
$17.66
|
| Rate for Payer: Beech Street Commercial |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.11
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.85
|
| Rate for Payer: Cigna of WY Commercial |
$18.03
|
| Rate for Payer: Entrust Commercial |
$17.48
|
| Rate for Payer: First Choice Health Commercial |
$17.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.14
|
| Rate for Payer: HealthUtah PPO |
$18.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.85
|
| Rate for Payer: Multiplan Medicare/VA |
$11.54
|
| Rate for Payer: One Health Plan of WY PPO |
$18.03
|
| Rate for Payer: PacificSource Commercial |
$16.56
|
| Rate for Payer: PHCS PPO |
$18.03
|
| Rate for Payer: Three Rivers PPO |
$13.80
|
| Rate for Payer: TriWest Veterans Administration |
$12.14
|
| Rate for Payer: United Healthcare Commercial |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$12.14
|
| Rate for Payer: WINHealth Partners Commercial |
$17.48
|
| Rate for Payer: Wise Provider Network Commercial |
$17.48
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [6983]
|
Facility
|
IP
|
$17.40
|
|
|
Service Code
|
NDC 7006930125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.48
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$10.91
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$11.48
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$11.48
|
| Rate for Payer: WINHealth Partners Commercial |
$16.53
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [6983]
|
Facility
|
OP
|
$18.40
|
|
|
Service Code
|
NDC 7006930101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.03
|
| Rate for Payer: Aetna of WY Medicare |
$12.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.66
|
| Rate for Payer: Altius Commercial |
$17.66
|
| Rate for Payer: Beech Street Commercial |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.11
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.85
|
| Rate for Payer: Cigna of WY Commercial |
$18.03
|
| Rate for Payer: Entrust Commercial |
$17.48
|
| Rate for Payer: First Choice Health Commercial |
$17.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.67
|
| Rate for Payer: HealthUtah PPO |
$18.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.85
|
| Rate for Payer: Multiplan Medicare/VA |
$10.14
|
| Rate for Payer: One Health Plan of WY PPO |
$18.03
|
| Rate for Payer: PacificSource Commercial |
$16.56
|
| Rate for Payer: PHCS PPO |
$18.03
|
| Rate for Payer: Three Rivers PPO |
$13.80
|
| Rate for Payer: TriWest Veterans Administration |
$10.67
|
| Rate for Payer: United Healthcare Commercial |
$16.01
|
| Rate for Payer: United Healthcare Medicare |
$10.67
|
| Rate for Payer: WINHealth Partners Commercial |
$18.03
|
| Rate for Payer: Wise Provider Network Commercial |
$17.48
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [6983]
|
Facility
|
OP
|
$17.40
|
|
|
Service Code
|
NDC 7006930125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$17.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.05
|
| Rate for Payer: Aetna of WY Medicare |
$11.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.70
|
| Rate for Payer: Altius Commercial |
$16.70
|
| Rate for Payer: Beech Street Commercial |
$17.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.88
|
| Rate for Payer: Cigna of WY Commercial |
$17.05
|
| Rate for Payer: Entrust Commercial |
$16.53
|
| Rate for Payer: First Choice Health Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.09
|
| Rate for Payer: HealthUtah PPO |
$17.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.88
|
| Rate for Payer: Multiplan Medicare/VA |
$9.59
|
| Rate for Payer: One Health Plan of WY PPO |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$15.66
|
| Rate for Payer: PHCS PPO |
$17.05
|
| Rate for Payer: Three Rivers PPO |
$13.05
|
| Rate for Payer: TriWest Veterans Administration |
$10.09
|
| Rate for Payer: United Healthcare Commercial |
$15.14
|
| Rate for Payer: United Healthcare Medicare |
$10.09
|
| Rate for Payer: WINHealth Partners Commercial |
$17.05
|
| Rate for Payer: Wise Provider Network Commercial |
$16.53
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [4211]
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 6068773842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.51
|
| Rate for Payer: Altius Commercial |
$3.51
|
| Rate for Payer: Beech Street Commercial |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.55
|
| Rate for Payer: Cigna of WY Commercial |
$3.59
|
| Rate for Payer: Entrust Commercial |
$3.48
|
| Rate for Payer: First Choice Health Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.42
|
| Rate for Payer: HealthUtah PPO |
$3.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3.59
|
| Rate for Payer: PacificSource Commercial |
$3.29
|
| Rate for Payer: PHCS PPO |
$3.59
|
| Rate for Payer: Three Rivers PPO |
$2.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare |
$2.42
|
| Rate for Payer: WINHealth Partners Commercial |
$3.48
|
| Rate for Payer: Wise Provider Network Commercial |
$3.48
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [4211]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 5026873211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.15
|
| Rate for Payer: Altius Commercial |
$3.15
|
| Rate for Payer: Beech Street Commercial |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.18
|
| Rate for Payer: Cigna of WY Commercial |
$3.21
|
| Rate for Payer: Entrust Commercial |
$3.12
|
| Rate for Payer: First Choice Health Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.16
|
| Rate for Payer: HealthUtah PPO |
$3.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3.21
|
| Rate for Payer: PacificSource Commercial |
$2.95
|
| Rate for Payer: PHCS PPO |
$3.21
|
| Rate for Payer: Three Rivers PPO |
$2.46
|
| Rate for Payer: TriWest Veterans Administration |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Medicare |
$2.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3.12
|
| Rate for Payer: Wise Provider Network Commercial |
$3.12
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [4211]
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
NDC 5026873211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.21
|
| Rate for Payer: Aetna of WY Medicare |
$2.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.15
|
| Rate for Payer: Altius Commercial |
$3.15
|
| Rate for Payer: Beech Street Commercial |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.18
|
| Rate for Payer: Cigna of WY Commercial |
$3.21
|
| Rate for Payer: Entrust Commercial |
$3.12
|
| Rate for Payer: First Choice Health Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.90
|
| Rate for Payer: HealthUtah PPO |
$3.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.18
|
| Rate for Payer: Multiplan Medicare/VA |
$1.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3.21
|
| Rate for Payer: PacificSource Commercial |
$2.95
|
| Rate for Payer: PHCS PPO |
$3.21
|
| Rate for Payer: Three Rivers PPO |
$2.46
|
| Rate for Payer: TriWest Veterans Administration |
$1.90
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Medicare |
$1.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3.21
|
| Rate for Payer: Wise Provider Network Commercial |
$3.12
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [4211]
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
NDC 5026873212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.21
|
| Rate for Payer: Aetna of WY Medicare |
$2.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.15
|
| Rate for Payer: Altius Commercial |
$3.15
|
| Rate for Payer: Beech Street Commercial |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.18
|
| Rate for Payer: Cigna of WY Commercial |
$3.21
|
| Rate for Payer: Entrust Commercial |
$3.12
|
| Rate for Payer: First Choice Health Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.90
|
| Rate for Payer: HealthUtah PPO |
$3.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.18
|
| Rate for Payer: Multiplan Medicare/VA |
$1.81
|
| Rate for Payer: One Health Plan of WY PPO |
$3.21
|
| Rate for Payer: PacificSource Commercial |
$2.95
|
| Rate for Payer: PHCS PPO |
$3.21
|
| Rate for Payer: Three Rivers PPO |
$2.46
|
| Rate for Payer: TriWest Veterans Administration |
$1.90
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Medicare |
$1.90
|
| Rate for Payer: WINHealth Partners Commercial |
$3.21
|
| Rate for Payer: Wise Provider Network Commercial |
$3.12
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [4211]
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 5026873212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.15
|
| Rate for Payer: Altius Commercial |
$3.15
|
| Rate for Payer: Beech Street Commercial |
$3.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.18
|
| Rate for Payer: Cigna of WY Commercial |
$3.21
|
| Rate for Payer: Entrust Commercial |
$3.12
|
| Rate for Payer: First Choice Health Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.16
|
| Rate for Payer: HealthUtah PPO |
$3.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.06
|
| Rate for Payer: One Health Plan of WY PPO |
$3.21
|
| Rate for Payer: PacificSource Commercial |
$2.95
|
| Rate for Payer: PHCS PPO |
$3.21
|
| Rate for Payer: Three Rivers PPO |
$2.46
|
| Rate for Payer: TriWest Veterans Administration |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Medicare |
$2.16
|
| Rate for Payer: WINHealth Partners Commercial |
$3.12
|
| Rate for Payer: Wise Provider Network Commercial |
$3.12
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION [4211]
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 6068773842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.59
|
| Rate for Payer: Aetna of WY Medicare |
$2.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.51
|
| Rate for Payer: Altius Commercial |
$3.51
|
| Rate for Payer: Beech Street Commercial |
$3.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.55
|
| Rate for Payer: Cigna of WY Commercial |
$3.59
|
| Rate for Payer: Entrust Commercial |
$3.48
|
| Rate for Payer: First Choice Health Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.12
|
| Rate for Payer: HealthUtah PPO |
$3.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.55
|
| Rate for Payer: Multiplan Medicare/VA |
$2.02
|
| Rate for Payer: One Health Plan of WY PPO |
$3.59
|
| Rate for Payer: PacificSource Commercial |
$3.29
|
| Rate for Payer: PHCS PPO |
$3.59
|
| Rate for Payer: Three Rivers PPO |
$2.74
|
| Rate for Payer: TriWest Veterans Administration |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$3.18
|
| Rate for Payer: United Healthcare Medicare |
$2.12
|
| Rate for Payer: WINHealth Partners Commercial |
$3.59
|
| Rate for Payer: Wise Provider Network Commercial |
$3.48
|
|
|
SUCTION CATH DELEE 10FR
|
Facility
|
OP
|
$4.30
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.21
|
| Rate for Payer: Aetna of WY Medicare |
$2.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.13
|
| Rate for Payer: Altius Commercial |
$4.13
|
| Rate for Payer: Beech Street Commercial |
$4.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.17
|
| Rate for Payer: Cigna of WY Commercial |
$4.21
|
| Rate for Payer: Entrust Commercial |
$4.08
|
| Rate for Payer: First Choice Health Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.49
|
| Rate for Payer: HealthUtah PPO |
$4.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.17
|
| Rate for Payer: Multiplan Medicare/VA |
$2.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4.21
|
| Rate for Payer: PacificSource Commercial |
$3.87
|
| Rate for Payer: PHCS PPO |
$4.21
|
| Rate for Payer: Three Rivers PPO |
$3.22
|
| Rate for Payer: TriWest Veterans Administration |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Medicare |
$2.49
|
| Rate for Payer: WINHealth Partners Commercial |
$4.21
|
| Rate for Payer: Wise Provider Network Commercial |
$4.08
|
|
|
SUCTION CATH DELEE 10FR
|
Facility
|
IP
|
$4.30
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.13
|
| Rate for Payer: Altius Commercial |
$4.13
|
| Rate for Payer: Beech Street Commercial |
$4.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.17
|
| Rate for Payer: Cigna of WY Commercial |
$4.21
|
| Rate for Payer: Entrust Commercial |
$4.08
|
| Rate for Payer: First Choice Health Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.84
|
| Rate for Payer: HealthUtah PPO |
$4.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.17
|
| Rate for Payer: Multiplan Medicare/VA |
$2.70
|
| Rate for Payer: One Health Plan of WY PPO |
$4.21
|
| Rate for Payer: PacificSource Commercial |
$3.87
|
| Rate for Payer: PHCS PPO |
$4.21
|
| Rate for Payer: Three Rivers PPO |
$3.22
|
| Rate for Payer: TriWest Veterans Administration |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4.08
|
| Rate for Payer: Wise Provider Network Commercial |
$4.08
|
|
|
SUCTION COAG. TONSIL CAUT
|
Facility
|
OP
|
$20.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.37
|
| Rate for Payer: Aetna of WY Medicare |
$13.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.96
|
| Rate for Payer: Altius Commercial |
$19.96
|
| Rate for Payer: Beech Street Commercial |
$20.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.07
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.17
|
| Rate for Payer: Cigna of WY Commercial |
$20.37
|
| Rate for Payer: Entrust Commercial |
$19.75
|
| Rate for Payer: First Choice Health Commercial |
$19.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.06
|
| Rate for Payer: HealthUtah PPO |
$20.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.17
|
| Rate for Payer: Multiplan Medicare/VA |
$11.46
|
| Rate for Payer: One Health Plan of WY PPO |
$20.37
|
| Rate for Payer: PacificSource Commercial |
$18.71
|
| Rate for Payer: PHCS PPO |
$20.37
|
| Rate for Payer: Three Rivers PPO |
$15.59
|
| Rate for Payer: TriWest Veterans Administration |
$12.06
|
| Rate for Payer: United Healthcare Commercial |
$18.09
|
| Rate for Payer: United Healthcare Medicare |
$12.06
|
| Rate for Payer: WINHealth Partners Commercial |
$20.37
|
| Rate for Payer: Wise Provider Network Commercial |
$19.75
|
|
|
SUCTION COAG. TONSIL CAUT
|
Facility
|
IP
|
$20.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.96
|
| Rate for Payer: Altius Commercial |
$19.96
|
| Rate for Payer: Beech Street Commercial |
$20.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.07
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.17
|
| Rate for Payer: Cigna of WY Commercial |
$20.37
|
| Rate for Payer: Entrust Commercial |
$19.75
|
| Rate for Payer: First Choice Health Commercial |
$19.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.72
|
| Rate for Payer: HealthUtah PPO |
$20.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.17
|
| Rate for Payer: Multiplan Medicare/VA |
$13.04
|
| Rate for Payer: One Health Plan of WY PPO |
$20.37
|
| Rate for Payer: PacificSource Commercial |
$18.71
|
| Rate for Payer: PHCS PPO |
$20.37
|
| Rate for Payer: Three Rivers PPO |
$15.59
|
| Rate for Payer: TriWest Veterans Administration |
$13.72
|
| Rate for Payer: United Healthcare Commercial |
$18.09
|
| Rate for Payer: United Healthcare Medicare |
$13.72
|
| Rate for Payer: WINHealth Partners Commercial |
$19.75
|
| Rate for Payer: Wise Provider Network Commercial |
$19.75
|
|
|
SUCTION D&C CANISTER
|
Facility
|
IP
|
$21.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.80
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.79
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.30
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$13.59
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$14.30
|
| Rate for Payer: United Healthcare Commercial |
$18.85
|
| Rate for Payer: United Healthcare Medicare |
$14.30
|
| Rate for Payer: WINHealth Partners Commercial |
$20.59
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
SUCTION D&C CANISTER
|
Facility
|
OP
|
$21.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.24
|
| Rate for Payer: Aetna of WY Medicare |
$14.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.80
|
| Rate for Payer: Altius Commercial |
$20.80
|
| Rate for Payer: Beech Street Commercial |
$21.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.79
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.02
|
| Rate for Payer: Cigna of WY Commercial |
$21.24
|
| Rate for Payer: Entrust Commercial |
$20.59
|
| Rate for Payer: First Choice Health Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.57
|
| Rate for Payer: HealthUtah PPO |
$21.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.02
|
| Rate for Payer: Multiplan Medicare/VA |
$11.94
|
| Rate for Payer: One Health Plan of WY PPO |
$21.24
|
| Rate for Payer: PacificSource Commercial |
$19.50
|
| Rate for Payer: PHCS PPO |
$21.24
|
| Rate for Payer: Three Rivers PPO |
$16.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.57
|
| Rate for Payer: United Healthcare Commercial |
$18.85
|
| Rate for Payer: United Healthcare Medicare |
$12.57
|
| Rate for Payer: WINHealth Partners Commercial |
$21.24
|
| Rate for Payer: Wise Provider Network Commercial |
$20.59
|
|
|
SUCTION D&C CURVED CURETTE 10MM
|
Facility
|
IP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
