|
EMG HUSH BIPOLAR BAR ELECTRODE
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
2400269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$333.56 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$603.68
|
| Rate for Payer: Aetna of WY Medicare |
$406.56
|
| Rate for Payer: Altius Commercial |
$591.36
|
| Rate for Payer: Beech Street Commercial |
$603.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$597.52
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$597.52
|
| Rate for Payer: Cigna of WY Commercial |
$603.68
|
| Rate for Payer: Entrust Commercial |
$585.20
|
| Rate for Payer: First Choice Health Commercial |
$585.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$585.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$351.12
|
| Rate for Payer: HealthUtah PPO |
$616.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$597.52
|
| Rate for Payer: Multiplan Medicare/VA |
$333.56
|
| Rate for Payer: One Health Plan of WY PPO |
$603.68
|
| Rate for Payer: PacificSource Commercial |
$554.40
|
| Rate for Payer: PHCS PPO |
$603.68
|
| Rate for Payer: Three Rivers PPO |
$462.00
|
| Rate for Payer: TriWest Veterans Administration |
$351.12
|
| Rate for Payer: United Healthcare Commercial |
$588.28
|
| Rate for Payer: United Healthcare Medicare |
$351.12
|
| Rate for Payer: WINHealth Partners Commercial |
$603.68
|
| Rate for Payer: Wise Provider Network Commercial |
$585.20
|
|
|
EMG HUSH DISK ELECTRODE 39"
|
Facility
|
IP
|
$595.00
|
|
| Hospital Charge Code |
2400265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$583.10
|
| Rate for Payer: Aetna of WY Medicare |
$380.80
|
| Rate for Payer: Altius Commercial |
$571.20
|
| Rate for Payer: Beech Street Commercial |
$583.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$577.15
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$577.15
|
| Rate for Payer: Cigna of WY Commercial |
$583.10
|
| Rate for Payer: Entrust Commercial |
$565.25
|
| Rate for Payer: First Choice Health Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$362.95
|
| Rate for Payer: HealthUtah PPO |
$595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$577.15
|
| Rate for Payer: Multiplan Medicare/VA |
$344.80
|
| Rate for Payer: One Health Plan of WY PPO |
$583.10
|
| Rate for Payer: PacificSource Commercial |
$535.50
|
| Rate for Payer: PHCS PPO |
$583.10
|
| Rate for Payer: Three Rivers PPO |
$446.25
|
| Rate for Payer: TriWest Veterans Administration |
$362.95
|
| Rate for Payer: United Healthcare Commercial |
$568.22
|
| Rate for Payer: United Healthcare Medicare |
$362.95
|
| Rate for Payer: WINHealth Partners Commercial |
$565.25
|
| Rate for Payer: Wise Provider Network Commercial |
$565.25
|
|
|
EMG HUSH DISK ELECTRODE 39"
|
Facility
|
OP
|
$595.00
|
|
| Hospital Charge Code |
2400265
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.19 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: United Healthcare Commercial |
$568.22
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$583.10
|
| Rate for Payer: Aetna of WY Medicare |
$392.70
|
| Rate for Payer: Altius Commercial |
$571.20
|
| Rate for Payer: Beech Street Commercial |
$583.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$577.15
|
| Rate for Payer: Cash Price |
$416.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$577.15
|
| Rate for Payer: Cigna of WY Commercial |
$583.10
|
| Rate for Payer: Entrust Commercial |
$565.25
|
| Rate for Payer: First Choice Health Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$565.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$339.15
|
| Rate for Payer: HealthUtah PPO |
$595.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$577.15
|
| Rate for Payer: Multiplan Medicare/VA |
$322.19
|
| Rate for Payer: One Health Plan of WY PPO |
$583.10
|
| Rate for Payer: PacificSource Commercial |
$535.50
|
| Rate for Payer: PHCS PPO |
$583.10
|
| Rate for Payer: Three Rivers PPO |
$446.25
|
| Rate for Payer: TriWest Veterans Administration |
$339.15
|
| Rate for Payer: United Healthcare Medicare |
$339.15
|
| Rate for Payer: WINHealth Partners Commercial |
$583.10
|
| Rate for Payer: Wise Provider Network Commercial |
$565.25
|
|
|
EMG HUSH RING ELECTRODE 39"
|
Facility
|
OP
|
$448.00
|
|
| Hospital Charge Code |
2400264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.59 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$439.04
|
| Rate for Payer: Aetna of WY Medicare |
$295.68
|
| Rate for Payer: Altius Commercial |
$430.08
|
| Rate for Payer: Beech Street Commercial |
$439.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$434.56
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$434.56
|
| Rate for Payer: Cigna of WY Commercial |
$439.04
|
| Rate for Payer: Entrust Commercial |
$425.60
|
| Rate for Payer: First Choice Health Commercial |
$425.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$425.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.36
|
| Rate for Payer: HealthUtah PPO |
$448.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$434.56
|
| Rate for Payer: Multiplan Medicare/VA |
$242.59
|
| Rate for Payer: One Health Plan of WY PPO |
$439.04
|
| Rate for Payer: PacificSource Commercial |
$403.20
|
| Rate for Payer: PHCS PPO |
$439.04
|
| Rate for Payer: Three Rivers PPO |
$336.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.36
|
| Rate for Payer: United Healthcare Commercial |
$427.84
|
| Rate for Payer: United Healthcare Medicare |
$255.36
|
| Rate for Payer: WINHealth Partners Commercial |
$439.04
|
| Rate for Payer: Wise Provider Network Commercial |
$425.60
|
|
|
EMG HUSH RING ELECTRODE 39"
|
Facility
|
IP
|
$448.00
|
|
| Hospital Charge Code |
2400264
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$439.04
|
| Rate for Payer: Aetna of WY Medicare |
$286.72
|
| Rate for Payer: Altius Commercial |
$430.08
|
| Rate for Payer: Beech Street Commercial |
$439.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$434.56
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$434.56
|
| Rate for Payer: Cigna of WY Commercial |
$439.04
|
| Rate for Payer: Entrust Commercial |
$425.60
|
| Rate for Payer: First Choice Health Commercial |
$425.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$425.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$273.28
|
| Rate for Payer: HealthUtah PPO |
$448.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$434.56
|
| Rate for Payer: Multiplan Medicare/VA |
$259.62
|
| Rate for Payer: One Health Plan of WY PPO |
$439.04
|
| Rate for Payer: PacificSource Commercial |
$403.20
|
| Rate for Payer: PHCS PPO |
$439.04
|
| Rate for Payer: Three Rivers PPO |
$336.00
|
| Rate for Payer: TriWest Veterans Administration |
$273.28
|
| Rate for Payer: United Healthcare Commercial |
$427.84
|
| Rate for Payer: United Healthcare Medicare |
$273.28
|
| Rate for Payer: WINHealth Partners Commercial |
$425.60
|
| Rate for Payer: Wise Provider Network Commercial |
$425.60
|
|
|
EMG RING ELECTRODE 19" LEAD
|
Facility
|
OP
|
$136.50
|
|
| Hospital Charge Code |
2400263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.77
|
| Rate for Payer: Aetna of WY Medicare |
$90.09
|
| Rate for Payer: Altius Commercial |
$131.04
|
| Rate for Payer: Beech Street Commercial |
$133.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.40
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.40
|
| Rate for Payer: Cigna of WY Commercial |
$133.77
|
| Rate for Payer: Entrust Commercial |
$129.68
|
| Rate for Payer: First Choice Health Commercial |
$129.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.80
|
| Rate for Payer: HealthUtah PPO |
$136.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.40
|
| Rate for Payer: Multiplan Medicare/VA |
$73.91
|
| Rate for Payer: One Health Plan of WY PPO |
$133.77
|
| Rate for Payer: PacificSource Commercial |
$122.85
|
| Rate for Payer: PHCS PPO |
$133.77
|
| Rate for Payer: Three Rivers PPO |
$102.38
|
| Rate for Payer: TriWest Veterans Administration |
$77.80
|
| Rate for Payer: United Healthcare Commercial |
$130.36
|
| Rate for Payer: United Healthcare Medicare |
$77.80
|
| Rate for Payer: WINHealth Partners Commercial |
$133.77
|
| Rate for Payer: Wise Provider Network Commercial |
$129.68
|
|
|
EMG RING ELECTRODE 19" LEAD
|
Facility
|
IP
|
$136.50
|
|
| Hospital Charge Code |
2400263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.77
|
| Rate for Payer: Aetna of WY Medicare |
$87.36
|
| Rate for Payer: Altius Commercial |
$131.04
|
| Rate for Payer: Beech Street Commercial |
$133.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.40
|
| Rate for Payer: Cash Price |
$95.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.40
|
| Rate for Payer: Cigna of WY Commercial |
$133.77
|
| Rate for Payer: Entrust Commercial |
$129.68
|
| Rate for Payer: First Choice Health Commercial |
$129.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$83.26
|
| Rate for Payer: HealthUtah PPO |
$136.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.40
|
| Rate for Payer: Multiplan Medicare/VA |
$79.10
|
| Rate for Payer: One Health Plan of WY PPO |
$133.77
|
| Rate for Payer: PacificSource Commercial |
$122.85
|
| Rate for Payer: PHCS PPO |
$133.77
|
| Rate for Payer: Three Rivers PPO |
$102.38
|
| Rate for Payer: TriWest Veterans Administration |
$83.26
|
| Rate for Payer: United Healthcare Commercial |
$130.36
|
| Rate for Payer: United Healthcare Medicare |
$83.26
|
| Rate for Payer: WINHealth Partners Commercial |
$129.68
|
| Rate for Payer: Wise Provider Network Commercial |
$129.68
|
|
|
EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$216.58
|
| Rate for Payer: Aetna of WY Medicare |
$62.51
|
| Rate for Payer: Beech Street Commercial |
$209.95
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: Cash Price |
$154.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$214.37
|
| Rate for Payer: Cigna of WY Commercial |
$216.58
|
| Rate for Payer: First Choice Health Commercial |
$198.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$209.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.51
|
| Rate for Payer: HealthUtah PPO |
$221.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$214.37
|
| Rate for Payer: Multiplan Medicare/VA |
$53.13
|
| Rate for Payer: One Health Plan of WY PPO |
$216.58
|
| Rate for Payer: PacificSource Commercial |
$198.90
|
| Rate for Payer: PHCS PPO |
$209.95
|
| Rate for Payer: Three Rivers PPO |
$165.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.51
|
| Rate for Payer: United Healthcare Commercial |
$209.95
|
| Rate for Payer: WINHealth Partners Commercial |
$187.85
|
|
|
EMPAGLIFLOZIN 25 MG TABLET [137121]
|
Facility
|
OP
|
$55.74
|
|
|
Service Code
|
NDC 0597015337
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$55.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.63
|
| Rate for Payer: Aetna of WY Medicare |
$36.79
|
| Rate for Payer: Altius Commercial |
$53.51
|
| Rate for Payer: Beech Street Commercial |
$54.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.07
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.07
|
| Rate for Payer: Cigna of WY Commercial |
$54.63
|
| Rate for Payer: Entrust Commercial |
$52.95
|
| Rate for Payer: First Choice Health Commercial |
$52.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.77
|
| Rate for Payer: HealthUtah PPO |
$55.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.07
|
| Rate for Payer: Multiplan Medicare/VA |
$30.18
|
| Rate for Payer: One Health Plan of WY PPO |
$54.63
|
| Rate for Payer: PacificSource Commercial |
$50.17
|
| Rate for Payer: PHCS PPO |
$54.63
|
| Rate for Payer: Three Rivers PPO |
$41.80
|
| Rate for Payer: TriWest Veterans Administration |
$31.77
|
| Rate for Payer: United Healthcare Commercial |
$53.23
|
| Rate for Payer: United Healthcare Medicare |
$31.77
|
| Rate for Payer: WINHealth Partners Commercial |
$54.63
|
| Rate for Payer: Wise Provider Network Commercial |
$52.95
|
|
|
EMPAGLIFLOZIN 25 MG TABLET [137121]
|
Facility
|
IP
|
$55.74
|
|
|
Service Code
|
NDC 0597015337
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$55.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.63
|
| Rate for Payer: Aetna of WY Medicare |
$35.67
|
| Rate for Payer: Altius Commercial |
$53.51
|
| Rate for Payer: Beech Street Commercial |
$54.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.07
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.07
|
| Rate for Payer: Cigna of WY Commercial |
$54.63
|
| Rate for Payer: Entrust Commercial |
$52.95
|
| Rate for Payer: First Choice Health Commercial |
$52.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.00
|
| Rate for Payer: HealthUtah PPO |
$55.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.07
|
| Rate for Payer: Multiplan Medicare/VA |
$32.30
|
| Rate for Payer: One Health Plan of WY PPO |
$54.63
|
| Rate for Payer: PacificSource Commercial |
$50.17
|
| Rate for Payer: PHCS PPO |
$54.63
|
| Rate for Payer: Three Rivers PPO |
$41.80
|
| Rate for Payer: TriWest Veterans Administration |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$53.23
|
| Rate for Payer: United Healthcare Medicare |
$34.00
|
| Rate for Payer: WINHealth Partners Commercial |
$52.95
|
| Rate for Payer: Wise Provider Network Commercial |
$52.95
|
|
|
EMS FILTER PTV AIR INLET
|
Facility
|
IP
|
$246.26
|
|
| Hospital Charge Code |
2100135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$246.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.33
|
| Rate for Payer: Aetna of WY Medicare |
$157.61
|
| Rate for Payer: Altius Commercial |
$236.41
|
| Rate for Payer: Beech Street Commercial |
$241.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.87
|
| Rate for Payer: Cash Price |
$172.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.87
|
| Rate for Payer: Cigna of WY Commercial |
$241.33
|
| Rate for Payer: Entrust Commercial |
$233.95
|
| Rate for Payer: First Choice Health Commercial |
$233.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.22
|
| Rate for Payer: HealthUtah PPO |
$246.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.87
|
| Rate for Payer: Multiplan Medicare/VA |
$142.71
|
| Rate for Payer: One Health Plan of WY PPO |
$241.33
|
| Rate for Payer: PacificSource Commercial |
$221.63
|
| Rate for Payer: PHCS PPO |
$241.33
|
| Rate for Payer: Three Rivers PPO |
$184.70
|
| Rate for Payer: TriWest Veterans Administration |
$150.22
|
| Rate for Payer: United Healthcare Commercial |
$235.18
|
| Rate for Payer: United Healthcare Medicare |
$150.22
|
| Rate for Payer: WINHealth Partners Commercial |
$233.95
|
| Rate for Payer: Wise Provider Network Commercial |
$233.95
|
|
|
EMS FILTER PTV AIR INLET
|
Facility
|
OP
|
$246.26
|
|
| Hospital Charge Code |
2100135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.35 |
| Max. Negotiated Rate |
$246.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$241.33
|
| Rate for Payer: Aetna of WY Medicare |
$162.53
|
| Rate for Payer: Altius Commercial |
$236.41
|
| Rate for Payer: Beech Street Commercial |
$241.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$238.87
|
| Rate for Payer: Cash Price |
$172.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$238.87
|
| Rate for Payer: Cigna of WY Commercial |
$241.33
|
| Rate for Payer: Entrust Commercial |
$233.95
|
| Rate for Payer: First Choice Health Commercial |
$233.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$233.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$140.37
|
| Rate for Payer: HealthUtah PPO |
$246.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$238.87
|
| Rate for Payer: Multiplan Medicare/VA |
$133.35
|
| Rate for Payer: One Health Plan of WY PPO |
$241.33
|
| Rate for Payer: PacificSource Commercial |
$221.63
|
| Rate for Payer: PHCS PPO |
$241.33
|
| Rate for Payer: Three Rivers PPO |
$184.70
|
| Rate for Payer: TriWest Veterans Administration |
$140.37
|
| Rate for Payer: United Healthcare Commercial |
$235.18
|
| Rate for Payer: United Healthcare Medicare |
$140.37
|
| Rate for Payer: WINHealth Partners Commercial |
$241.33
|
| Rate for Payer: Wise Provider Network Commercial |
$233.95
|
|
|
EMS FILTER PTV FAN
|
Facility
|
IP
|
$7.89
|
|
| Hospital Charge Code |
2100136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.73
|
| Rate for Payer: Aetna of WY Medicare |
$5.05
|
| Rate for Payer: Altius Commercial |
$7.57
|
| Rate for Payer: Beech Street Commercial |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.65
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.65
|
| Rate for Payer: Cigna of WY Commercial |
$7.73
|
| Rate for Payer: Entrust Commercial |
$7.50
|
| Rate for Payer: First Choice Health Commercial |
$7.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.81
|
| Rate for Payer: HealthUtah PPO |
$7.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.65
|
| Rate for Payer: Multiplan Medicare/VA |
$4.57
|
| Rate for Payer: One Health Plan of WY PPO |
$7.73
|
| Rate for Payer: PacificSource Commercial |
$7.10
|
| Rate for Payer: PHCS PPO |
$7.73
|
| Rate for Payer: Three Rivers PPO |
$5.92
|
| Rate for Payer: TriWest Veterans Administration |
$4.81
|
| Rate for Payer: United Healthcare Commercial |
$7.53
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WINHealth Partners Commercial |
$7.50
|
| Rate for Payer: Wise Provider Network Commercial |
$7.50
|
|
|
EMS FILTER PTV FAN
|
Facility
|
OP
|
$7.89
|
|
| Hospital Charge Code |
2100136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.73
|
| Rate for Payer: Aetna of WY Medicare |
$5.21
|
| Rate for Payer: Altius Commercial |
$7.57
|
| Rate for Payer: Beech Street Commercial |
$7.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.65
|
| Rate for Payer: Cash Price |
$5.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.65
|
| Rate for Payer: Cigna of WY Commercial |
$7.73
|
| Rate for Payer: Entrust Commercial |
$7.50
|
| Rate for Payer: First Choice Health Commercial |
$7.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.50
|
| Rate for Payer: HealthUtah PPO |
$7.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.65
|
| Rate for Payer: Multiplan Medicare/VA |
$4.27
|
| Rate for Payer: One Health Plan of WY PPO |
$7.73
|
| Rate for Payer: PacificSource Commercial |
$7.10
|
| Rate for Payer: PHCS PPO |
$7.73
|
| Rate for Payer: Three Rivers PPO |
$5.92
|
| Rate for Payer: TriWest Veterans Administration |
$4.50
|
| Rate for Payer: United Healthcare Commercial |
$7.53
|
| Rate for Payer: United Healthcare Medicare |
$4.50
|
| Rate for Payer: WINHealth Partners Commercial |
$7.73
|
| Rate for Payer: Wise Provider Network Commercial |
$7.50
|
|
|
EMS QINFLOW DISPOSABLE UNIT
|
Facility
|
IP
|
$255.05
|
|
| Hospital Charge Code |
2600001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$255.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.95
|
| Rate for Payer: Aetna of WY Medicare |
$163.23
|
| Rate for Payer: Altius Commercial |
$244.85
|
| Rate for Payer: Beech Street Commercial |
$249.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.40
|
| Rate for Payer: Cash Price |
$178.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.40
|
| Rate for Payer: Cigna of WY Commercial |
$249.95
|
| Rate for Payer: Entrust Commercial |
$242.30
|
| Rate for Payer: First Choice Health Commercial |
$242.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.58
|
| Rate for Payer: HealthUtah PPO |
$255.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.40
|
| Rate for Payer: Multiplan Medicare/VA |
$147.80
|
| Rate for Payer: One Health Plan of WY PPO |
$249.95
|
| Rate for Payer: PacificSource Commercial |
$229.54
|
| Rate for Payer: PHCS PPO |
$249.95
|
| Rate for Payer: Three Rivers PPO |
$191.29
|
| Rate for Payer: TriWest Veterans Administration |
$155.58
|
| Rate for Payer: United Healthcare Commercial |
$243.57
|
| Rate for Payer: United Healthcare Medicare |
$155.58
|
| Rate for Payer: WINHealth Partners Commercial |
$242.30
|
| Rate for Payer: Wise Provider Network Commercial |
$242.30
|
|
|
EMS QINFLOW DISPOSABLE UNIT
|
Facility
|
OP
|
$255.05
|
|
| Hospital Charge Code |
2600001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$255.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$249.95
|
| Rate for Payer: Aetna of WY Medicare |
$168.33
|
| Rate for Payer: Altius Commercial |
$244.85
|
| Rate for Payer: Beech Street Commercial |
$249.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$247.40
|
| Rate for Payer: Cash Price |
$178.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$247.40
|
| Rate for Payer: Cigna of WY Commercial |
$249.95
|
| Rate for Payer: Entrust Commercial |
$242.30
|
| Rate for Payer: First Choice Health Commercial |
$242.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$242.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$145.38
|
| Rate for Payer: HealthUtah PPO |
$255.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$247.40
|
| Rate for Payer: Multiplan Medicare/VA |
$138.11
|
| Rate for Payer: One Health Plan of WY PPO |
$249.95
|
| Rate for Payer: PacificSource Commercial |
$229.54
|
| Rate for Payer: PHCS PPO |
$249.95
|
| Rate for Payer: Three Rivers PPO |
$191.29
|
| Rate for Payer: TriWest Veterans Administration |
$145.38
|
| Rate for Payer: United Healthcare Commercial |
$243.57
|
| Rate for Payer: United Healthcare Medicare |
$145.38
|
| Rate for Payer: WINHealth Partners Commercial |
$249.95
|
| Rate for Payer: Wise Provider Network Commercial |
$242.30
|
|
|
EMS REVEL CIRCUIT 15MM PEDS
|
Facility
|
IP
|
$32.59
|
|
| Hospital Charge Code |
2100134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.94
|
| Rate for Payer: Aetna of WY Medicare |
$20.86
|
| Rate for Payer: Altius Commercial |
$31.29
|
| Rate for Payer: Beech Street Commercial |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.61
|
| Rate for Payer: Cigna of WY Commercial |
$31.94
|
| Rate for Payer: Entrust Commercial |
$30.96
|
| Rate for Payer: First Choice Health Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.88
|
| Rate for Payer: HealthUtah PPO |
$32.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.61
|
| Rate for Payer: Multiplan Medicare/VA |
$18.89
|
| Rate for Payer: One Health Plan of WY PPO |
$31.94
|
| Rate for Payer: PacificSource Commercial |
$29.33
|
| Rate for Payer: PHCS PPO |
$31.94
|
| Rate for Payer: Three Rivers PPO |
$24.44
|
| Rate for Payer: TriWest Veterans Administration |
$19.88
|
| Rate for Payer: United Healthcare Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare |
$19.88
|
| Rate for Payer: WINHealth Partners Commercial |
$30.96
|
| Rate for Payer: Wise Provider Network Commercial |
$30.96
|
|
|
EMS REVEL CIRCUIT 15MM PEDS
|
Facility
|
OP
|
$32.59
|
|
| Hospital Charge Code |
2100134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.94
|
| Rate for Payer: Aetna of WY Medicare |
$21.51
|
| Rate for Payer: Altius Commercial |
$31.29
|
| Rate for Payer: Beech Street Commercial |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.61
|
| Rate for Payer: Cigna of WY Commercial |
$31.94
|
| Rate for Payer: Entrust Commercial |
$30.96
|
| Rate for Payer: First Choice Health Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.58
|
| Rate for Payer: HealthUtah PPO |
$32.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.61
|
| Rate for Payer: Multiplan Medicare/VA |
$17.65
|
| Rate for Payer: One Health Plan of WY PPO |
$31.94
|
| Rate for Payer: PacificSource Commercial |
$29.33
|
| Rate for Payer: PHCS PPO |
$31.94
|
| Rate for Payer: Three Rivers PPO |
$24.44
|
| Rate for Payer: TriWest Veterans Administration |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare |
$18.58
|
| Rate for Payer: WINHealth Partners Commercial |
$31.94
|
| Rate for Payer: Wise Provider Network Commercial |
$30.96
|
|
|
EMS REVEL CIRCUIT 22MM ADULT
|
Facility
|
OP
|
$32.59
|
|
| Hospital Charge Code |
2100133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.94
|
| Rate for Payer: Aetna of WY Medicare |
$21.51
|
| Rate for Payer: Altius Commercial |
$31.29
|
| Rate for Payer: Beech Street Commercial |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.61
|
| Rate for Payer: Cigna of WY Commercial |
$31.94
|
| Rate for Payer: Entrust Commercial |
$30.96
|
| Rate for Payer: First Choice Health Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.58
|
| Rate for Payer: HealthUtah PPO |
$32.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.61
|
| Rate for Payer: Multiplan Medicare/VA |
$17.65
|
| Rate for Payer: One Health Plan of WY PPO |
$31.94
|
| Rate for Payer: PacificSource Commercial |
$29.33
|
| Rate for Payer: PHCS PPO |
$31.94
|
| Rate for Payer: Three Rivers PPO |
$24.44
|
| Rate for Payer: TriWest Veterans Administration |
$18.58
|
| Rate for Payer: United Healthcare Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare |
$18.58
|
| Rate for Payer: WINHealth Partners Commercial |
$31.94
|
| Rate for Payer: Wise Provider Network Commercial |
$30.96
|
|
|
EMS REVEL CIRCUIT 22MM ADULT
|
Facility
|
IP
|
$32.59
|
|
| Hospital Charge Code |
2100133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.94
|
| Rate for Payer: Aetna of WY Medicare |
$20.86
|
| Rate for Payer: Altius Commercial |
$31.29
|
| Rate for Payer: Beech Street Commercial |
$31.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.61
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$31.61
|
| Rate for Payer: Cigna of WY Commercial |
$31.94
|
| Rate for Payer: Entrust Commercial |
$30.96
|
| Rate for Payer: First Choice Health Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.88
|
| Rate for Payer: HealthUtah PPO |
$32.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.61
|
| Rate for Payer: Multiplan Medicare/VA |
$18.89
|
| Rate for Payer: One Health Plan of WY PPO |
$31.94
|
| Rate for Payer: PacificSource Commercial |
$29.33
|
| Rate for Payer: PHCS PPO |
$31.94
|
| Rate for Payer: Three Rivers PPO |
$24.44
|
| Rate for Payer: TriWest Veterans Administration |
$19.88
|
| Rate for Payer: United Healthcare Commercial |
$31.12
|
| Rate for Payer: United Healthcare Medicare |
$19.88
|
| Rate for Payer: WINHealth Partners Commercial |
$30.96
|
| Rate for Payer: Wise Provider Network Commercial |
$30.96
|
|
|
EMTRICITABINE 200 MG CAPSULE [28956]
|
Facility
|
OP
|
$55.24
|
|
|
Service Code
|
NDC 6195806011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.14
|
| Rate for Payer: Aetna of WY Medicare |
$36.46
|
| Rate for Payer: Altius Commercial |
$53.03
|
| Rate for Payer: Beech Street Commercial |
$54.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.58
|
| Rate for Payer: Cash Price |
$38.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.58
|
| Rate for Payer: Cigna of WY Commercial |
$54.14
|
| Rate for Payer: Entrust Commercial |
$52.48
|
| Rate for Payer: First Choice Health Commercial |
$52.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.49
|
| Rate for Payer: HealthUtah PPO |
$55.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.58
|
| Rate for Payer: Multiplan Medicare/VA |
$29.91
|
| Rate for Payer: One Health Plan of WY PPO |
$54.14
|
| Rate for Payer: PacificSource Commercial |
$49.72
|
| Rate for Payer: PHCS PPO |
$54.14
|
| Rate for Payer: Three Rivers PPO |
$41.43
|
| Rate for Payer: TriWest Veterans Administration |
$31.49
|
| Rate for Payer: United Healthcare Commercial |
$52.75
|
| Rate for Payer: United Healthcare Medicare |
$31.49
|
| Rate for Payer: WINHealth Partners Commercial |
$54.14
|
| Rate for Payer: Wise Provider Network Commercial |
$52.48
|
|
|
EMTRICITABINE 200 MG CAPSULE [28956]
|
Facility
|
IP
|
$55.24
|
|
|
Service Code
|
NDC 6195806011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.01 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.14
|
| Rate for Payer: Aetna of WY Medicare |
$35.35
|
| Rate for Payer: Altius Commercial |
$53.03
|
| Rate for Payer: Beech Street Commercial |
$54.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$53.58
|
| Rate for Payer: Cash Price |
$38.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.58
|
| Rate for Payer: Cigna of WY Commercial |
$54.14
|
| Rate for Payer: Entrust Commercial |
$52.48
|
| Rate for Payer: First Choice Health Commercial |
$52.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.70
|
| Rate for Payer: HealthUtah PPO |
$55.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.58
|
| Rate for Payer: Multiplan Medicare/VA |
$32.01
|
| Rate for Payer: One Health Plan of WY PPO |
$54.14
|
| Rate for Payer: PacificSource Commercial |
$49.72
|
| Rate for Payer: PHCS PPO |
$54.14
|
| Rate for Payer: Three Rivers PPO |
$41.43
|
| Rate for Payer: TriWest Veterans Administration |
$33.70
|
| Rate for Payer: United Healthcare Commercial |
$52.75
|
| Rate for Payer: United Healthcare Medicare |
$33.70
|
| Rate for Payer: WINHealth Partners Commercial |
$52.48
|
| Rate for Payer: Wise Provider Network Commercial |
$52.48
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
IP
|
$33.58
|
|
|
Service Code
|
NDC 0143978701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Aetna of WY Medicare |
$21.49
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.48
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$19.46
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$20.48
|
| Rate for Payer: United Healthcare Commercial |
$32.07
|
| Rate for Payer: United Healthcare Medicare |
$20.48
|
| Rate for Payer: WINHealth Partners Commercial |
$31.90
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
IP
|
$33.58
|
|
|
Service Code
|
NDC 0143978710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Aetna of WY Medicare |
$21.49
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.48
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$19.46
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$20.48
|
| Rate for Payer: United Healthcare Commercial |
$32.07
|
| Rate for Payer: United Healthcare Medicare |
$20.48
|
| Rate for Payer: WINHealth Partners Commercial |
$31.90
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
OP
|
$33.58
|
|
|
Service Code
|
NDC 0143978701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Aetna of WY Medicare |
$22.16
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.14
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$18.18
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$32.07
|
| Rate for Payer: United Healthcare Medicare |
$19.14
|
| Rate for Payer: WINHealth Partners Commercial |
$32.91
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
