|
DTAP-IPV COMPONENT 1OF2(PF) 15 LF-48MCG-5 LF-62 DU/0.5ML IM SUSPENSION [158469]
|
Facility
|
OP
|
$268.88
|
|
|
Service Code
|
NDC 4928156101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.15 |
| Max. Negotiated Rate |
$268.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$263.50
|
| Rate for Payer: Aetna of WY Medicare |
$177.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$258.12
|
| Rate for Payer: Altius Commercial |
$258.12
|
| Rate for Payer: Beech Street Commercial |
$263.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$220.75
|
| Rate for Payer: Cash Price |
$188.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$260.81
|
| Rate for Payer: Cigna of WY Commercial |
$263.50
|
| Rate for Payer: Entrust Commercial |
$255.44
|
| Rate for Payer: First Choice Health Commercial |
$255.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$255.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.95
|
| Rate for Payer: HealthUtah PPO |
$268.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$260.81
|
| Rate for Payer: Multiplan Medicare/VA |
$148.15
|
| Rate for Payer: One Health Plan of WY PPO |
$263.50
|
| Rate for Payer: PacificSource Commercial |
$241.99
|
| Rate for Payer: PHCS PPO |
$263.50
|
| Rate for Payer: Three Rivers PPO |
$201.66
|
| Rate for Payer: TriWest Veterans Administration |
$155.95
|
| Rate for Payer: United Healthcare Commercial |
$233.93
|
| Rate for Payer: United Healthcare Medicare |
$155.95
|
| Rate for Payer: WINHealth Partners Commercial |
$263.50
|
| Rate for Payer: Wise Provider Network Commercial |
$255.44
|
|
|
DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 90698
|
| Hospital Charge Code |
90698
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Beech Street Commercial |
$208.05
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: First Choice Health Commercial |
$197.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$208.05
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: United Healthcare Commercial |
$190.53
|
| Rate for Payer: WINHealth Partners Commercial |
$219.00
|
|
|
DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
90696
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Beech Street Commercial |
$173.85
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: First Choice Health Commercial |
$164.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$173.85
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: WINHealth Partners Commercial |
$183.00
|
|
|
DTAP-POLIO-HIB CONJ-TET(PF) 15 LF-48MCG-5 LF-62 DU-10MCG/ 0.5ML IM KIT [158488]
|
Facility
|
IP
|
$174.47
|
|
|
Service Code
|
NDC 4928151105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$174.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$167.49
|
| Rate for Payer: Altius Commercial |
$167.49
|
| Rate for Payer: Beech Street Commercial |
$170.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.24
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.24
|
| Rate for Payer: Cigna of WY Commercial |
$170.98
|
| Rate for Payer: Entrust Commercial |
$165.75
|
| Rate for Payer: First Choice Health Commercial |
$165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.15
|
| Rate for Payer: HealthUtah PPO |
$174.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.24
|
| Rate for Payer: Multiplan Medicare/VA |
$109.39
|
| Rate for Payer: One Health Plan of WY PPO |
$170.98
|
| Rate for Payer: PacificSource Commercial |
$157.02
|
| Rate for Payer: PHCS PPO |
$170.98
|
| Rate for Payer: Three Rivers PPO |
$130.85
|
| Rate for Payer: TriWest Veterans Administration |
$115.15
|
| Rate for Payer: United Healthcare Commercial |
$151.79
|
| Rate for Payer: United Healthcare Medicare |
$115.15
|
| Rate for Payer: WINHealth Partners Commercial |
$165.75
|
| Rate for Payer: Wise Provider Network Commercial |
$165.75
|
|
|
DTAP-POLIO-HIB CONJ-TET(PF) 15 LF-48MCG-5 LF-62 DU-10MCG/ 0.5ML IM KIT [158488]
|
Facility
|
OP
|
$174.47
|
|
|
Service Code
|
NDC 4928151105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.13 |
| Max. Negotiated Rate |
$174.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.98
|
| Rate for Payer: Aetna of WY Medicare |
$115.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$167.49
|
| Rate for Payer: Altius Commercial |
$167.49
|
| Rate for Payer: Beech Street Commercial |
$170.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.24
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.24
|
| Rate for Payer: Cigna of WY Commercial |
$170.98
|
| Rate for Payer: Entrust Commercial |
$165.75
|
| Rate for Payer: First Choice Health Commercial |
$165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.19
|
| Rate for Payer: HealthUtah PPO |
$174.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.24
|
| Rate for Payer: Multiplan Medicare/VA |
$96.13
|
| Rate for Payer: One Health Plan of WY PPO |
$170.98
|
| Rate for Payer: PacificSource Commercial |
$157.02
|
| Rate for Payer: PHCS PPO |
$170.98
|
| Rate for Payer: Three Rivers PPO |
$130.85
|
| Rate for Payer: TriWest Veterans Administration |
$101.19
|
| Rate for Payer: United Healthcare Commercial |
$151.79
|
| Rate for Payer: United Healthcare Medicare |
$101.19
|
| Rate for Payer: WINHealth Partners Commercial |
$170.98
|
| Rate for Payer: Wise Provider Network Commercial |
$165.75
|
|
|
DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 90702
|
| Hospital Charge Code |
90702
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.44
|
| Rate for Payer: Beech Street Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.16
|
| Rate for Payer: Cigna of WY Commercial |
$27.44
|
| Rate for Payer: First Choice Health Commercial |
$25.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.60
|
| Rate for Payer: HealthUtah PPO |
$28.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.16
|
| Rate for Payer: One Health Plan of WY PPO |
$27.44
|
| Rate for Payer: PacificSource Commercial |
$25.20
|
| Rate for Payer: PHCS PPO |
$26.60
|
| Rate for Payer: Three Rivers PPO |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$24.36
|
| Rate for Payer: WINHealth Partners Commercial |
$28.00
|
|
|
DUAL SENSOR CATHETER
|
Facility
|
OP
|
$349.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$342.66
|
| Rate for Payer: Aetna of WY Medicare |
$230.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$335.66
|
| Rate for Payer: Altius Commercial |
$335.66
|
| Rate for Payer: Beech Street Commercial |
$342.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.06
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.16
|
| Rate for Payer: Cigna of WY Commercial |
$342.66
|
| Rate for Payer: Entrust Commercial |
$332.17
|
| Rate for Payer: First Choice Health Commercial |
$332.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$202.80
|
| Rate for Payer: HealthUtah PPO |
$349.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.16
|
| Rate for Payer: Multiplan Medicare/VA |
$192.66
|
| Rate for Payer: One Health Plan of WY PPO |
$342.66
|
| Rate for Payer: PacificSource Commercial |
$314.68
|
| Rate for Payer: PHCS PPO |
$342.66
|
| Rate for Payer: Three Rivers PPO |
$262.24
|
| Rate for Payer: TriWest Veterans Administration |
$202.80
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Medicare |
$202.80
|
| Rate for Payer: WINHealth Partners Commercial |
$342.66
|
| Rate for Payer: Wise Provider Network Commercial |
$332.17
|
|
|
DUAL SENSOR CATHETER
|
Facility
|
IP
|
$349.65
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.23 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$342.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$335.66
|
| Rate for Payer: Altius Commercial |
$335.66
|
| Rate for Payer: Beech Street Commercial |
$342.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.06
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.16
|
| Rate for Payer: Cigna of WY Commercial |
$342.66
|
| Rate for Payer: Entrust Commercial |
$332.17
|
| Rate for Payer: First Choice Health Commercial |
$332.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$230.77
|
| Rate for Payer: HealthUtah PPO |
$349.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.16
|
| Rate for Payer: Multiplan Medicare/VA |
$219.23
|
| Rate for Payer: One Health Plan of WY PPO |
$342.66
|
| Rate for Payer: PacificSource Commercial |
$314.68
|
| Rate for Payer: PHCS PPO |
$342.66
|
| Rate for Payer: Three Rivers PPO |
$262.24
|
| Rate for Payer: TriWest Veterans Administration |
$230.77
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Medicare |
$230.77
|
| Rate for Payer: WINHealth Partners Commercial |
$332.17
|
| Rate for Payer: Wise Provider Network Commercial |
$332.17
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 6068773411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 6068773401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 6808468301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 6808468311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 6808468301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 6068773411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 6068773401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 30 MG CAPSULE,DELAYED RELEASE [36478]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 6808468311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [36479]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 6068774511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [36479]
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
NDC 6068774501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.22
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$4.01
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$4.22
|
| Rate for Payer: WINHealth Partners Commercial |
$6.08
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [36479]
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
NDC 0904704561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.51
|
| Rate for Payer: Altius Commercial |
$5.51
|
| Rate for Payer: Beech Street Commercial |
$5.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.57
|
| Rate for Payer: Cigna of WY Commercial |
$5.63
|
| Rate for Payer: Entrust Commercial |
$5.45
|
| Rate for Payer: First Choice Health Commercial |
$5.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.79
|
| Rate for Payer: HealthUtah PPO |
$5.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.57
|
| Rate for Payer: Multiplan Medicare/VA |
$3.60
|
| Rate for Payer: One Health Plan of WY PPO |
$5.63
|
| Rate for Payer: PacificSource Commercial |
$5.17
|
| Rate for Payer: PHCS PPO |
$5.63
|
| Rate for Payer: Three Rivers PPO |
$4.30
|
| Rate for Payer: TriWest Veterans Administration |
$3.79
|
| Rate for Payer: United Healthcare Commercial |
$4.99
|
| Rate for Payer: United Healthcare Medicare |
$3.79
|
| Rate for Payer: WINHealth Partners Commercial |
$5.45
|
| Rate for Payer: Wise Provider Network Commercial |
$5.45
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [36479]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 6068774511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [36479]
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
NDC 0904704561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.63
|
| Rate for Payer: Aetna of WY Medicare |
$3.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.51
|
| Rate for Payer: Altius Commercial |
$5.51
|
| Rate for Payer: Beech Street Commercial |
$5.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.57
|
| Rate for Payer: Cigna of WY Commercial |
$5.63
|
| Rate for Payer: Entrust Commercial |
$5.45
|
| Rate for Payer: First Choice Health Commercial |
$5.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.33
|
| Rate for Payer: HealthUtah PPO |
$5.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.57
|
| Rate for Payer: Multiplan Medicare/VA |
$3.16
|
| Rate for Payer: One Health Plan of WY PPO |
$5.63
|
| Rate for Payer: PacificSource Commercial |
$5.17
|
| Rate for Payer: PHCS PPO |
$5.63
|
| Rate for Payer: Three Rivers PPO |
$4.30
|
| Rate for Payer: TriWest Veterans Administration |
$3.33
|
| Rate for Payer: United Healthcare Commercial |
$4.99
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WINHealth Partners Commercial |
$5.63
|
| Rate for Payer: Wise Provider Network Commercial |
$5.45
|
|
|
DULOXETINE 60 MG CAPSULE,DELAYED RELEASE [36479]
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
NDC 6068774501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.27
|
| Rate for Payer: Aetna of WY Medicare |
$4.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.14
|
| Rate for Payer: Altius Commercial |
$6.14
|
| Rate for Payer: Beech Street Commercial |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.21
|
| Rate for Payer: Cigna of WY Commercial |
$6.27
|
| Rate for Payer: Entrust Commercial |
$6.08
|
| Rate for Payer: First Choice Health Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.71
|
| Rate for Payer: HealthUtah PPO |
$6.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.21
|
| Rate for Payer: Multiplan Medicare/VA |
$3.53
|
| Rate for Payer: One Health Plan of WY PPO |
$6.27
|
| Rate for Payer: PacificSource Commercial |
$5.76
|
| Rate for Payer: PHCS PPO |
$6.27
|
| Rate for Payer: Three Rivers PPO |
$4.80
|
| Rate for Payer: TriWest Veterans Administration |
$3.71
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$3.71
|
| Rate for Payer: WINHealth Partners Commercial |
$6.27
|
| Rate for Payer: Wise Provider Network Commercial |
$6.08
|
|
|
DUO THERM PAD 24 X 60
|
Facility
|
IP
|
$54.22
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$54.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.05
|
| Rate for Payer: Altius Commercial |
$52.05
|
| Rate for Payer: Beech Street Commercial |
$53.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.51
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.59
|
| Rate for Payer: Cigna of WY Commercial |
$53.14
|
| Rate for Payer: Entrust Commercial |
$51.51
|
| Rate for Payer: First Choice Health Commercial |
$51.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.79
|
| Rate for Payer: HealthUtah PPO |
$54.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.59
|
| Rate for Payer: Multiplan Medicare/VA |
$34.00
|
| Rate for Payer: One Health Plan of WY PPO |
$53.14
|
| Rate for Payer: PacificSource Commercial |
$48.80
|
| Rate for Payer: PHCS PPO |
$53.14
|
| Rate for Payer: Three Rivers PPO |
$40.66
|
| Rate for Payer: TriWest Veterans Administration |
$35.79
|
| Rate for Payer: United Healthcare Commercial |
$47.17
|
| Rate for Payer: United Healthcare Medicare |
$35.79
|
| Rate for Payer: WINHealth Partners Commercial |
$51.51
|
| Rate for Payer: Wise Provider Network Commercial |
$51.51
|
|
|
DUO THERM PAD 24 X 60
|
Facility
|
OP
|
$54.22
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$54.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.14
|
| Rate for Payer: Aetna of WY Medicare |
$35.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.05
|
| Rate for Payer: Altius Commercial |
$52.05
|
| Rate for Payer: Beech Street Commercial |
$53.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.51
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.59
|
| Rate for Payer: Cigna of WY Commercial |
$53.14
|
| Rate for Payer: Entrust Commercial |
$51.51
|
| Rate for Payer: First Choice Health Commercial |
$51.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.45
|
| Rate for Payer: HealthUtah PPO |
$54.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.59
|
| Rate for Payer: Multiplan Medicare/VA |
$29.88
|
| Rate for Payer: One Health Plan of WY PPO |
$53.14
|
| Rate for Payer: PacificSource Commercial |
$48.80
|
| Rate for Payer: PHCS PPO |
$53.14
|
| Rate for Payer: Three Rivers PPO |
$40.66
|
| Rate for Payer: TriWest Veterans Administration |
$31.45
|
| Rate for Payer: United Healthcare Commercial |
$47.17
|
| Rate for Payer: United Healthcare Medicare |
$31.45
|
| Rate for Payer: WINHealth Partners Commercial |
$53.14
|
| Rate for Payer: Wise Provider Network Commercial |
$51.51
|
|
|
DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 93971 26
|
| Hospital Charge Code |
93971
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$844.76
|
| Rate for Payer: Aetna of WY Medicare |
$20.05
|
| Rate for Payer: Beech Street Commercial |
$818.90
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$836.14
|
| Rate for Payer: Cigna of WY Commercial |
$844.76
|
| Rate for Payer: First Choice Health Commercial |
$775.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$818.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.05
|
| Rate for Payer: HealthUtah PPO |
$862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$836.14
|
| Rate for Payer: Multiplan Medicare/VA |
$17.04
|
| Rate for Payer: One Health Plan of WY PPO |
$844.76
|
| Rate for Payer: PacificSource Commercial |
$775.80
|
| Rate for Payer: PHCS PPO |
$818.90
|
| Rate for Payer: Three Rivers PPO |
$646.50
|
| Rate for Payer: TriWest Veterans Administration |
$20.05
|
| Rate for Payer: United Healthcare Commercial |
$749.94
|
| Rate for Payer: United Healthcare Medicare |
$20.05
|
| Rate for Payer: WINHealth Partners Commercial |
$818.90
|
|
