|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [34730]
|
Facility
|
IP
|
$41.47
|
|
|
Service Code
|
NDC 6818096411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.81
|
| Rate for Payer: Altius Commercial |
$39.81
|
| Rate for Payer: Beech Street Commercial |
$40.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.05
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.23
|
| Rate for Payer: Cigna of WY Commercial |
$40.64
|
| Rate for Payer: Entrust Commercial |
$39.40
|
| Rate for Payer: First Choice Health Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.37
|
| Rate for Payer: HealthUtah PPO |
$41.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.23
|
| Rate for Payer: Multiplan Medicare/VA |
$26.00
|
| Rate for Payer: One Health Plan of WY PPO |
$40.64
|
| Rate for Payer: PacificSource Commercial |
$37.32
|
| Rate for Payer: PHCS PPO |
$40.64
|
| Rate for Payer: Three Rivers PPO |
$31.10
|
| Rate for Payer: TriWest Veterans Administration |
$27.37
|
| Rate for Payer: United Healthcare Commercial |
$36.08
|
| Rate for Payer: United Healthcare Medicare |
$27.37
|
| Rate for Payer: WINHealth Partners Commercial |
$39.40
|
| Rate for Payer: Wise Provider Network Commercial |
$39.40
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [34730]
|
Facility
|
OP
|
$41.47
|
|
|
Service Code
|
NDC 6818096411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.64
|
| Rate for Payer: Aetna of WY Medicare |
$27.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.81
|
| Rate for Payer: Altius Commercial |
$39.81
|
| Rate for Payer: Beech Street Commercial |
$40.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.05
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.23
|
| Rate for Payer: Cigna of WY Commercial |
$40.64
|
| Rate for Payer: Entrust Commercial |
$39.40
|
| Rate for Payer: First Choice Health Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.05
|
| Rate for Payer: HealthUtah PPO |
$41.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.23
|
| Rate for Payer: Multiplan Medicare/VA |
$22.85
|
| Rate for Payer: One Health Plan of WY PPO |
$40.64
|
| Rate for Payer: PacificSource Commercial |
$37.32
|
| Rate for Payer: PHCS PPO |
$40.64
|
| Rate for Payer: Three Rivers PPO |
$31.10
|
| Rate for Payer: TriWest Veterans Administration |
$24.05
|
| Rate for Payer: United Healthcare Commercial |
$36.08
|
| Rate for Payer: United Healthcare Medicare |
$24.05
|
| Rate for Payer: WINHealth Partners Commercial |
$40.64
|
| Rate for Payer: Wise Provider Network Commercial |
$39.40
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [34730]
|
Facility
|
IP
|
$41.47
|
|
|
Service Code
|
NDC 6818096412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.81
|
| Rate for Payer: Altius Commercial |
$39.81
|
| Rate for Payer: Beech Street Commercial |
$40.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.05
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.23
|
| Rate for Payer: Cigna of WY Commercial |
$40.64
|
| Rate for Payer: Entrust Commercial |
$39.40
|
| Rate for Payer: First Choice Health Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.37
|
| Rate for Payer: HealthUtah PPO |
$41.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.23
|
| Rate for Payer: Multiplan Medicare/VA |
$26.00
|
| Rate for Payer: One Health Plan of WY PPO |
$40.64
|
| Rate for Payer: PacificSource Commercial |
$37.32
|
| Rate for Payer: PHCS PPO |
$40.64
|
| Rate for Payer: Three Rivers PPO |
$31.10
|
| Rate for Payer: TriWest Veterans Administration |
$27.37
|
| Rate for Payer: United Healthcare Commercial |
$36.08
|
| Rate for Payer: United Healthcare Medicare |
$27.37
|
| Rate for Payer: WINHealth Partners Commercial |
$39.40
|
| Rate for Payer: Wise Provider Network Commercial |
$39.40
|
|
|
TIOTROPIUM BROMIDE 18 MCG CAPSULE WITH INHALATION DEVICE [34730]
|
Facility
|
OP
|
$41.47
|
|
|
Service Code
|
NDC 6818096412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.64
|
| Rate for Payer: Aetna of WY Medicare |
$27.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.81
|
| Rate for Payer: Altius Commercial |
$39.81
|
| Rate for Payer: Beech Street Commercial |
$40.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$34.05
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.23
|
| Rate for Payer: Cigna of WY Commercial |
$40.64
|
| Rate for Payer: Entrust Commercial |
$39.40
|
| Rate for Payer: First Choice Health Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.05
|
| Rate for Payer: HealthUtah PPO |
$41.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.23
|
| Rate for Payer: Multiplan Medicare/VA |
$22.85
|
| Rate for Payer: One Health Plan of WY PPO |
$40.64
|
| Rate for Payer: PacificSource Commercial |
$37.32
|
| Rate for Payer: PHCS PPO |
$40.64
|
| Rate for Payer: Three Rivers PPO |
$31.10
|
| Rate for Payer: TriWest Veterans Administration |
$24.05
|
| Rate for Payer: United Healthcare Commercial |
$36.08
|
| Rate for Payer: United Healthcare Medicare |
$24.05
|
| Rate for Payer: WINHealth Partners Commercial |
$40.64
|
| Rate for Payer: Wise Provider Network Commercial |
$39.40
|
|
|
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [138058]
|
Facility
|
IP
|
$197.77
|
|
|
Service Code
|
NDC 0597010061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$197.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.86
|
| Rate for Payer: Altius Commercial |
$189.86
|
| Rate for Payer: Beech Street Commercial |
$193.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.37
|
| Rate for Payer: Cash Price |
$138.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.84
|
| Rate for Payer: Cigna of WY Commercial |
$193.81
|
| Rate for Payer: Entrust Commercial |
$187.88
|
| Rate for Payer: First Choice Health Commercial |
$187.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$130.53
|
| Rate for Payer: HealthUtah PPO |
$197.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.84
|
| Rate for Payer: Multiplan Medicare/VA |
$124.00
|
| Rate for Payer: One Health Plan of WY PPO |
$193.81
|
| Rate for Payer: PacificSource Commercial |
$177.99
|
| Rate for Payer: PHCS PPO |
$193.81
|
| Rate for Payer: Three Rivers PPO |
$148.33
|
| Rate for Payer: TriWest Veterans Administration |
$130.53
|
| Rate for Payer: United Healthcare Commercial |
$172.06
|
| Rate for Payer: United Healthcare Medicare |
$130.53
|
| Rate for Payer: WINHealth Partners Commercial |
$187.88
|
| Rate for Payer: Wise Provider Network Commercial |
$187.88
|
|
|
TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [138058]
|
Facility
|
OP
|
$197.77
|
|
|
Service Code
|
NDC 0597010061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.97 |
| Max. Negotiated Rate |
$197.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.81
|
| Rate for Payer: Aetna of WY Medicare |
$130.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$189.86
|
| Rate for Payer: Altius Commercial |
$189.86
|
| Rate for Payer: Beech Street Commercial |
$193.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$162.37
|
| Rate for Payer: Cash Price |
$138.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.84
|
| Rate for Payer: Cigna of WY Commercial |
$193.81
|
| Rate for Payer: Entrust Commercial |
$187.88
|
| Rate for Payer: First Choice Health Commercial |
$187.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.71
|
| Rate for Payer: HealthUtah PPO |
$197.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.84
|
| Rate for Payer: Multiplan Medicare/VA |
$108.97
|
| Rate for Payer: One Health Plan of WY PPO |
$193.81
|
| Rate for Payer: PacificSource Commercial |
$177.99
|
| Rate for Payer: PHCS PPO |
$193.81
|
| Rate for Payer: Three Rivers PPO |
$148.33
|
| Rate for Payer: TriWest Veterans Administration |
$114.71
|
| Rate for Payer: United Healthcare Commercial |
$172.06
|
| Rate for Payer: United Healthcare Medicare |
$114.71
|
| Rate for Payer: WINHealth Partners Commercial |
$193.81
|
| Rate for Payer: Wise Provider Network Commercial |
$187.88
|
|
|
TISSEEL FIBRIN SEALANT BAXTER
|
Facility
|
IP
|
$893.52
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.24 |
| Max. Negotiated Rate |
$893.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$875.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$857.78
|
| Rate for Payer: Altius Commercial |
$857.78
|
| Rate for Payer: Beech Street Commercial |
$875.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$733.58
|
| Rate for Payer: Cash Price |
$625.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$866.71
|
| Rate for Payer: Cigna of WY Commercial |
$875.65
|
| Rate for Payer: Entrust Commercial |
$848.84
|
| Rate for Payer: First Choice Health Commercial |
$848.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$848.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$589.72
|
| Rate for Payer: HealthUtah PPO |
$893.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$866.71
|
| Rate for Payer: Multiplan Medicare/VA |
$560.24
|
| Rate for Payer: One Health Plan of WY PPO |
$875.65
|
| Rate for Payer: PacificSource Commercial |
$804.17
|
| Rate for Payer: PHCS PPO |
$875.65
|
| Rate for Payer: Three Rivers PPO |
$670.14
|
| Rate for Payer: TriWest Veterans Administration |
$589.72
|
| Rate for Payer: United Healthcare Commercial |
$777.36
|
| Rate for Payer: United Healthcare Medicare |
$589.72
|
| Rate for Payer: WINHealth Partners Commercial |
$848.84
|
| Rate for Payer: Wise Provider Network Commercial |
$848.84
|
|
|
TISSEEL FIBRIN SEALANT BAXTER
|
Facility
|
OP
|
$893.52
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.33 |
| Max. Negotiated Rate |
$893.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$875.65
|
| Rate for Payer: Aetna of WY Medicare |
$589.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$857.78
|
| Rate for Payer: Altius Commercial |
$857.78
|
| Rate for Payer: Beech Street Commercial |
$875.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$733.58
|
| Rate for Payer: Cash Price |
$625.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$866.71
|
| Rate for Payer: Cigna of WY Commercial |
$875.65
|
| Rate for Payer: Entrust Commercial |
$848.84
|
| Rate for Payer: First Choice Health Commercial |
$848.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$848.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$518.24
|
| Rate for Payer: HealthUtah PPO |
$893.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$866.71
|
| Rate for Payer: Multiplan Medicare/VA |
$492.33
|
| Rate for Payer: One Health Plan of WY PPO |
$875.65
|
| Rate for Payer: PacificSource Commercial |
$804.17
|
| Rate for Payer: PHCS PPO |
$875.65
|
| Rate for Payer: Three Rivers PPO |
$670.14
|
| Rate for Payer: TriWest Veterans Administration |
$518.24
|
| Rate for Payer: United Healthcare Commercial |
$777.36
|
| Rate for Payer: United Healthcare Medicare |
$518.24
|
| Rate for Payer: WINHealth Partners Commercial |
$875.65
|
| Rate for Payer: Wise Provider Network Commercial |
$848.84
|
|
|
TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
87220
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$4.27
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.27
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$3.63
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$41.76
|
| Rate for Payer: United Healthcare Medicare |
$4.27
|
| Rate for Payer: WINHealth Partners Commercial |
$45.60
|
|
|
TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$7,771.00
|
|
|
Service Code
|
HCPCS 19357
|
| Hospital Charge Code |
19357
|
| Min. Negotiated Rate |
$951.37 |
| Max. Negotiated Rate |
$7,771.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,615.58
|
| Rate for Payer: Aetna of WY Medicare |
$1,119.26
|
| Rate for Payer: Beech Street Commercial |
$7,382.45
|
| Rate for Payer: Cash Price |
$5,439.70
|
| Rate for Payer: Cash Price |
$5,439.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,537.87
|
| Rate for Payer: Cigna of WY Commercial |
$7,615.58
|
| Rate for Payer: First Choice Health Commercial |
$6,993.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,382.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,119.26
|
| Rate for Payer: HealthUtah PPO |
$7,771.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,537.87
|
| Rate for Payer: Multiplan Medicare/VA |
$951.37
|
| Rate for Payer: One Health Plan of WY PPO |
$7,615.58
|
| Rate for Payer: PacificSource Commercial |
$6,993.90
|
| Rate for Payer: PHCS PPO |
$7,382.45
|
| Rate for Payer: Three Rivers PPO |
$5,828.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,119.26
|
| Rate for Payer: United Healthcare Commercial |
$6,760.77
|
| Rate for Payer: United Healthcare Medicare |
$1,119.26
|
| Rate for Payer: WINHealth Partners Commercial |
$6,605.35
|
|
|
TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$7,771.00
|
|
|
Service Code
|
HCPCS 19357 80
|
| Hospital Charge Code |
19357
|
| Min. Negotiated Rate |
$951.37 |
| Max. Negotiated Rate |
$7,771.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,615.58
|
| Rate for Payer: Aetna of WY Medicare |
$1,119.26
|
| Rate for Payer: Beech Street Commercial |
$7,382.45
|
| Rate for Payer: Cash Price |
$5,439.70
|
| Rate for Payer: Cash Price |
$5,439.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,537.87
|
| Rate for Payer: Cigna of WY Commercial |
$7,615.58
|
| Rate for Payer: First Choice Health Commercial |
$6,993.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,382.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,119.26
|
| Rate for Payer: HealthUtah PPO |
$7,771.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,537.87
|
| Rate for Payer: Multiplan Medicare/VA |
$951.37
|
| Rate for Payer: One Health Plan of WY PPO |
$7,615.58
|
| Rate for Payer: PacificSource Commercial |
$6,993.90
|
| Rate for Payer: PHCS PPO |
$7,382.45
|
| Rate for Payer: Three Rivers PPO |
$5,828.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,119.26
|
| Rate for Payer: United Healthcare Commercial |
$6,760.77
|
| Rate for Payer: United Healthcare Medicare |
$1,119.26
|
| Rate for Payer: WINHealth Partners Commercial |
$6,605.35
|
|
|
TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$15,542.00
|
|
|
Service Code
|
HCPCS 19357 50
|
| Hospital Charge Code |
19357
|
| Min. Negotiated Rate |
$951.37 |
| Max. Negotiated Rate |
$15,542.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15,231.16
|
| Rate for Payer: Aetna of WY Medicare |
$1,119.26
|
| Rate for Payer: Beech Street Commercial |
$14,764.90
|
| Rate for Payer: Cash Price |
$10,879.40
|
| Rate for Payer: Cash Price |
$10,879.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$15,075.74
|
| Rate for Payer: Cigna of WY Commercial |
$15,231.16
|
| Rate for Payer: First Choice Health Commercial |
$13,987.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14,764.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,119.26
|
| Rate for Payer: HealthUtah PPO |
$15,542.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15,075.74
|
| Rate for Payer: Multiplan Medicare/VA |
$951.37
|
| Rate for Payer: One Health Plan of WY PPO |
$15,231.16
|
| Rate for Payer: PacificSource Commercial |
$13,987.80
|
| Rate for Payer: PHCS PPO |
$14,764.90
|
| Rate for Payer: Three Rivers PPO |
$11,656.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,119.26
|
| Rate for Payer: United Healthcare Commercial |
$13,521.54
|
| Rate for Payer: United Healthcare Medicare |
$1,119.26
|
| Rate for Payer: WINHealth Partners Commercial |
$13,210.70
|
|
|
TIXAGEV AND CILGAV INJ
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
M0220
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$686.00
|
| Rate for Payer: Beech Street Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$679.00
|
| Rate for Payer: Cigna of WY Commercial |
$686.00
|
| Rate for Payer: First Choice Health Commercial |
$630.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$665.00
|
| Rate for Payer: HealthUtah PPO |
$700.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$679.00
|
| Rate for Payer: One Health Plan of WY PPO |
$686.00
|
| Rate for Payer: PacificSource Commercial |
$630.00
|
| Rate for Payer: PHCS PPO |
$665.00
|
| Rate for Payer: Three Rivers PPO |
$525.00
|
| Rate for Payer: United Healthcare Commercial |
$609.00
|
| Rate for Payer: WINHealth Partners Commercial |
$665.00
|
|
|
TIZANIDINE 2 MG TABLET [2370]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 6808477525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.14
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.84
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.70
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4.09
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
TIZANIDINE 2 MG TABLET [2370]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 6808477525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.14
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.50
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$2.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4.22
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
TIZANIDINE 2 MG TABLET [2370]
|
Facility
|
IP
|
$4.31
|
|
|
Service Code
|
NDC 6808477595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.14
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.84
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.70
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4.09
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
TIZANIDINE 2 MG TABLET [2370]
|
Facility
|
OP
|
$4.31
|
|
|
Service Code
|
NDC 6808477595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.22
|
| Rate for Payer: Aetna of WY Medicare |
$2.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.14
|
| Rate for Payer: Altius Commercial |
$4.14
|
| Rate for Payer: Beech Street Commercial |
$4.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.18
|
| Rate for Payer: Cigna of WY Commercial |
$4.22
|
| Rate for Payer: Entrust Commercial |
$4.09
|
| Rate for Payer: First Choice Health Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.50
|
| Rate for Payer: HealthUtah PPO |
$4.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.18
|
| Rate for Payer: Multiplan Medicare/VA |
$2.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4.22
|
| Rate for Payer: PacificSource Commercial |
$3.88
|
| Rate for Payer: PHCS PPO |
$4.22
|
| Rate for Payer: Three Rivers PPO |
$3.23
|
| Rate for Payer: TriWest Veterans Administration |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Medicare |
$2.50
|
| Rate for Payer: WINHealth Partners Commercial |
$4.22
|
| Rate for Payer: Wise Provider Network Commercial |
$4.09
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
NDC 5026876011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.52
|
| Rate for Payer: Altius Commercial |
$2.52
|
| Rate for Payer: Beech Street Commercial |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.55
|
| Rate for Payer: Cigna of WY Commercial |
$2.58
|
| Rate for Payer: Entrust Commercial |
$2.50
|
| Rate for Payer: First Choice Health Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.74
|
| Rate for Payer: HealthUtah PPO |
$2.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2.58
|
| Rate for Payer: PacificSource Commercial |
$2.37
|
| Rate for Payer: PHCS PPO |
$2.58
|
| Rate for Payer: Three Rivers PPO |
$1.97
|
| Rate for Payer: TriWest Veterans Administration |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2.50
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
NDC 5026876011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.58
|
| Rate for Payer: Aetna of WY Medicare |
$1.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.52
|
| Rate for Payer: Altius Commercial |
$2.52
|
| Rate for Payer: Beech Street Commercial |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.55
|
| Rate for Payer: Cigna of WY Commercial |
$2.58
|
| Rate for Payer: Entrust Commercial |
$2.50
|
| Rate for Payer: First Choice Health Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.53
|
| Rate for Payer: HealthUtah PPO |
$2.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2.58
|
| Rate for Payer: PacificSource Commercial |
$2.37
|
| Rate for Payer: PHCS PPO |
$2.58
|
| Rate for Payer: Three Rivers PPO |
$1.97
|
| Rate for Payer: TriWest Veterans Administration |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$1.53
|
| Rate for Payer: WINHealth Partners Commercial |
$2.58
|
| Rate for Payer: Wise Provider Network Commercial |
$2.50
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
NDC 5026876015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.52
|
| Rate for Payer: Altius Commercial |
$2.52
|
| Rate for Payer: Beech Street Commercial |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.55
|
| Rate for Payer: Cigna of WY Commercial |
$2.58
|
| Rate for Payer: Entrust Commercial |
$2.50
|
| Rate for Payer: First Choice Health Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.74
|
| Rate for Payer: HealthUtah PPO |
$2.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1.65
|
| Rate for Payer: One Health Plan of WY PPO |
$2.58
|
| Rate for Payer: PacificSource Commercial |
$2.37
|
| Rate for Payer: PHCS PPO |
$2.58
|
| Rate for Payer: Three Rivers PPO |
$1.97
|
| Rate for Payer: TriWest Veterans Administration |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
| Rate for Payer: WINHealth Partners Commercial |
$2.50
|
| Rate for Payer: Wise Provider Network Commercial |
$2.50
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
NDC 5026876015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.58
|
| Rate for Payer: Aetna of WY Medicare |
$1.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.52
|
| Rate for Payer: Altius Commercial |
$2.52
|
| Rate for Payer: Beech Street Commercial |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.55
|
| Rate for Payer: Cigna of WY Commercial |
$2.58
|
| Rate for Payer: Entrust Commercial |
$2.50
|
| Rate for Payer: First Choice Health Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.53
|
| Rate for Payer: HealthUtah PPO |
$2.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.55
|
| Rate for Payer: Multiplan Medicare/VA |
$1.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2.58
|
| Rate for Payer: PacificSource Commercial |
$2.37
|
| Rate for Payer: PHCS PPO |
$2.58
|
| Rate for Payer: Three Rivers PPO |
$1.97
|
| Rate for Payer: TriWest Veterans Administration |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$2.29
|
| Rate for Payer: United Healthcare Medicare |
$1.53
|
| Rate for Payer: WINHealth Partners Commercial |
$2.58
|
| Rate for Payer: Wise Provider Network Commercial |
$2.50
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 6808464501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.44
|
| Rate for Payer: Altius Commercial |
$2.44
|
| Rate for Payer: Beech Street Commercial |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.46
|
| Rate for Payer: Cigna of WY Commercial |
$2.49
|
| Rate for Payer: Entrust Commercial |
$2.41
|
| Rate for Payer: First Choice Health Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.68
|
| Rate for Payer: HealthUtah PPO |
$2.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2.49
|
| Rate for Payer: PacificSource Commercial |
$2.29
|
| Rate for Payer: PHCS PPO |
$2.49
|
| Rate for Payer: Three Rivers PPO |
$1.90
|
| Rate for Payer: TriWest Veterans Administration |
$1.68
|
| Rate for Payer: United Healthcare Commercial |
$2.21
|
| Rate for Payer: United Healthcare Medicare |
$1.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2.41
|
| Rate for Payer: Wise Provider Network Commercial |
$2.41
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 6808464501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.49
|
| Rate for Payer: Aetna of WY Medicare |
$1.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.44
|
| Rate for Payer: Altius Commercial |
$2.44
|
| Rate for Payer: Beech Street Commercial |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.46
|
| Rate for Payer: Cigna of WY Commercial |
$2.49
|
| Rate for Payer: Entrust Commercial |
$2.41
|
| Rate for Payer: First Choice Health Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.47
|
| Rate for Payer: HealthUtah PPO |
$2.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2.49
|
| Rate for Payer: PacificSource Commercial |
$2.29
|
| Rate for Payer: PHCS PPO |
$2.49
|
| Rate for Payer: Three Rivers PPO |
$1.90
|
| Rate for Payer: TriWest Veterans Administration |
$1.47
|
| Rate for Payer: United Healthcare Commercial |
$2.21
|
| Rate for Payer: United Healthcare Medicare |
$1.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2.49
|
| Rate for Payer: Wise Provider Network Commercial |
$2.41
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 6808464511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.44
|
| Rate for Payer: Altius Commercial |
$2.44
|
| Rate for Payer: Beech Street Commercial |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.46
|
| Rate for Payer: Cigna of WY Commercial |
$2.49
|
| Rate for Payer: Entrust Commercial |
$2.41
|
| Rate for Payer: First Choice Health Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.68
|
| Rate for Payer: HealthUtah PPO |
$2.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2.49
|
| Rate for Payer: PacificSource Commercial |
$2.29
|
| Rate for Payer: PHCS PPO |
$2.49
|
| Rate for Payer: Three Rivers PPO |
$1.90
|
| Rate for Payer: TriWest Veterans Administration |
$1.68
|
| Rate for Payer: United Healthcare Commercial |
$2.21
|
| Rate for Payer: United Healthcare Medicare |
$1.68
|
| Rate for Payer: WINHealth Partners Commercial |
$2.41
|
| Rate for Payer: Wise Provider Network Commercial |
$2.41
|
|
|
TIZANIDINE 4 MG TABLET [3516]
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 6808464511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.49
|
| Rate for Payer: Aetna of WY Medicare |
$1.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.44
|
| Rate for Payer: Altius Commercial |
$2.44
|
| Rate for Payer: Beech Street Commercial |
$2.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.46
|
| Rate for Payer: Cigna of WY Commercial |
$2.49
|
| Rate for Payer: Entrust Commercial |
$2.41
|
| Rate for Payer: First Choice Health Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.47
|
| Rate for Payer: HealthUtah PPO |
$2.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2.49
|
| Rate for Payer: PacificSource Commercial |
$2.29
|
| Rate for Payer: PHCS PPO |
$2.49
|
| Rate for Payer: Three Rivers PPO |
$1.90
|
| Rate for Payer: TriWest Veterans Administration |
$1.47
|
| Rate for Payer: United Healthcare Commercial |
$2.21
|
| Rate for Payer: United Healthcare Medicare |
$1.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2.49
|
| Rate for Payer: Wise Provider Network Commercial |
$2.41
|
|
