|
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
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [2387]
|
Facility
|
OP
|
$15.88
|
|
|
Service Code
|
NDC 5167240391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.48
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.40
|
| Rate for Payer: Cigna of WY Commercial |
$15.56
|
| Rate for Payer: Entrust Commercial |
$15.09
|
| Rate for Payer: First Choice Health Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.05
|
| Rate for Payer: HealthUtah PPO |
$15.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.40
|
| Rate for Payer: Multiplan Medicare/VA |
$8.60
|
| Rate for Payer: One Health Plan of WY PPO |
$15.56
|
| Rate for Payer: PacificSource Commercial |
$14.29
|
| Rate for Payer: PHCS PPO |
$15.56
|
| Rate for Payer: Three Rivers PPO |
$11.91
|
| Rate for Payer: TriWest Veterans Administration |
$9.05
|
| Rate for Payer: United Healthcare Commercial |
$15.17
|
| Rate for Payer: United Healthcare Medicare |
$9.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.56
|
| Rate for Payer: Wise Provider Network Commercial |
$15.09
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [2387]
|
Facility
|
IP
|
$15.88
|
|
|
Service Code
|
NDC 5167240391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.56
|
| Rate for Payer: Aetna of WY Medicare |
$10.16
|
| Rate for Payer: Altius Commercial |
$15.24
|
| Rate for Payer: Beech Street Commercial |
$15.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.40
|
| Rate for Payer: Cigna of WY Commercial |
$15.56
|
| Rate for Payer: Entrust Commercial |
$15.09
|
| Rate for Payer: First Choice Health Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.69
|
| Rate for Payer: HealthUtah PPO |
$15.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.20
|
| Rate for Payer: One Health Plan of WY PPO |
$15.56
|
| Rate for Payer: PacificSource Commercial |
$14.29
|
| Rate for Payer: PHCS PPO |
$15.56
|
| Rate for Payer: Three Rivers PPO |
$11.91
|
| Rate for Payer: TriWest Veterans Administration |
$9.69
|
| Rate for Payer: United Healthcare Commercial |
$15.17
|
| Rate for Payer: United Healthcare Medicare |
$9.69
|
| Rate for Payer: WINHealth Partners Commercial |
$15.09
|
| Rate for Payer: Wise Provider Network Commercial |
$15.09
|
|
|
END CAP +10MM 1822-0010S
|
Facility
|
IP
|
$455.49
|
|
| Hospital Charge Code |
3100517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$455.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.38
|
| Rate for Payer: Aetna of WY Medicare |
$291.51
|
| Rate for Payer: Altius Commercial |
$437.27
|
| Rate for Payer: Beech Street Commercial |
$446.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$441.83
|
| Rate for Payer: Cash Price |
$318.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.83
|
| Rate for Payer: Cigna of WY Commercial |
$446.38
|
| Rate for Payer: Entrust Commercial |
$432.72
|
| Rate for Payer: First Choice Health Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.85
|
| Rate for Payer: HealthUtah PPO |
$455.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.83
|
| Rate for Payer: Multiplan Medicare/VA |
$263.96
|
| Rate for Payer: One Health Plan of WY PPO |
$446.38
|
| Rate for Payer: PacificSource Commercial |
$409.94
|
| Rate for Payer: PHCS PPO |
$446.38
|
| Rate for Payer: Three Rivers PPO |
$341.62
|
| Rate for Payer: TriWest Veterans Administration |
$277.85
|
| Rate for Payer: United Healthcare Commercial |
$434.99
|
| Rate for Payer: United Healthcare Medicare |
$277.85
|
| Rate for Payer: WINHealth Partners Commercial |
$432.72
|
| Rate for Payer: Wise Provider Network Commercial |
$432.72
|
|
|
END CAP +10MM 1822-0010S
|
Facility
|
OP
|
$455.49
|
|
| Hospital Charge Code |
3100517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$455.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.38
|
| Rate for Payer: Aetna of WY Medicare |
$300.62
|
| Rate for Payer: Altius Commercial |
$437.27
|
| Rate for Payer: Beech Street Commercial |
$446.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$441.83
|
| Rate for Payer: Cash Price |
$318.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.83
|
| Rate for Payer: Cigna of WY Commercial |
$446.38
|
| Rate for Payer: Entrust Commercial |
$432.72
|
| Rate for Payer: First Choice Health Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.63
|
| Rate for Payer: HealthUtah PPO |
$455.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.83
|
| Rate for Payer: Multiplan Medicare/VA |
$246.65
|
| Rate for Payer: One Health Plan of WY PPO |
$446.38
|
| Rate for Payer: PacificSource Commercial |
$409.94
|
| Rate for Payer: PHCS PPO |
$446.38
|
| Rate for Payer: Three Rivers PPO |
$341.62
|
| Rate for Payer: TriWest Veterans Administration |
$259.63
|
| Rate for Payer: United Healthcare Commercial |
$434.99
|
| Rate for Payer: United Healthcare Medicare |
$259.63
|
| Rate for Payer: WINHealth Partners Commercial |
$446.38
|
| Rate for Payer: Wise Provider Network Commercial |
$432.72
|
|
|
END CAP +15MM 1822-0015S
|
Facility
|
OP
|
$455.49
|
|
| Hospital Charge Code |
3100547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$455.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.38
|
| Rate for Payer: Aetna of WY Medicare |
$300.62
|
| Rate for Payer: Altius Commercial |
$437.27
|
| Rate for Payer: Beech Street Commercial |
$446.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$441.83
|
| Rate for Payer: Cash Price |
$318.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.83
|
| Rate for Payer: Cigna of WY Commercial |
$446.38
|
| Rate for Payer: Entrust Commercial |
$432.72
|
| Rate for Payer: First Choice Health Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$259.63
|
| Rate for Payer: HealthUtah PPO |
$455.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.83
|
| Rate for Payer: Multiplan Medicare/VA |
$246.65
|
| Rate for Payer: One Health Plan of WY PPO |
$446.38
|
| Rate for Payer: PacificSource Commercial |
$409.94
|
| Rate for Payer: PHCS PPO |
$446.38
|
| Rate for Payer: Three Rivers PPO |
$341.62
|
| Rate for Payer: TriWest Veterans Administration |
$259.63
|
| Rate for Payer: United Healthcare Commercial |
$434.99
|
| Rate for Payer: United Healthcare Medicare |
$259.63
|
| Rate for Payer: WINHealth Partners Commercial |
$446.38
|
| Rate for Payer: Wise Provider Network Commercial |
$432.72
|
|
|
END CAP +15MM 1822-0015S
|
Facility
|
IP
|
$455.49
|
|
| Hospital Charge Code |
3100547
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.96 |
| Max. Negotiated Rate |
$455.49 |
| Rate for Payer: United Healthcare Commercial |
$434.99
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$446.38
|
| Rate for Payer: Aetna of WY Medicare |
$291.51
|
| Rate for Payer: Altius Commercial |
$437.27
|
| Rate for Payer: Beech Street Commercial |
$446.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$441.83
|
| Rate for Payer: Cash Price |
$318.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$441.83
|
| Rate for Payer: Cigna of WY Commercial |
$446.38
|
| Rate for Payer: Entrust Commercial |
$432.72
|
| Rate for Payer: First Choice Health Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$432.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$277.85
|
| Rate for Payer: HealthUtah PPO |
$455.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$441.83
|
| Rate for Payer: Multiplan Medicare/VA |
$263.96
|
| Rate for Payer: One Health Plan of WY PPO |
$446.38
|
| Rate for Payer: PacificSource Commercial |
$409.94
|
| Rate for Payer: PHCS PPO |
$446.38
|
| Rate for Payer: Three Rivers PPO |
$341.62
|
| Rate for Payer: TriWest Veterans Administration |
$277.85
|
| Rate for Payer: United Healthcare Medicare |
$277.85
|
| Rate for Payer: WINHealth Partners Commercial |
$432.72
|
| Rate for Payer: Wise Provider Network Commercial |
$432.72
|
|
|
END CAP +5MM 1822-0005
|
Facility
|
IP
|
$456.19
|
|
| Hospital Charge Code |
3100087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.36 |
| Max. Negotiated Rate |
$456.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.07
|
| Rate for Payer: Aetna of WY Medicare |
$291.96
|
| Rate for Payer: Altius Commercial |
$437.94
|
| Rate for Payer: Beech Street Commercial |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.50
|
| Rate for Payer: Cash Price |
$319.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.50
|
| Rate for Payer: Cigna of WY Commercial |
$447.07
|
| Rate for Payer: Entrust Commercial |
$433.38
|
| Rate for Payer: First Choice Health Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.28
|
| Rate for Payer: HealthUtah PPO |
$456.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.50
|
| Rate for Payer: Multiplan Medicare/VA |
$264.36
|
| Rate for Payer: One Health Plan of WY PPO |
$447.07
|
| Rate for Payer: PacificSource Commercial |
$410.57
|
| Rate for Payer: PHCS PPO |
$447.07
|
| Rate for Payer: Three Rivers PPO |
$342.14
|
| Rate for Payer: TriWest Veterans Administration |
$278.28
|
| Rate for Payer: United Healthcare Commercial |
$435.66
|
| Rate for Payer: United Healthcare Medicare |
$278.28
|
| Rate for Payer: WINHealth Partners Commercial |
$433.38
|
| Rate for Payer: Wise Provider Network Commercial |
$433.38
|
|
|
END CAP +5MM 1822-0005
|
Facility
|
OP
|
$456.19
|
|
| Hospital Charge Code |
3100087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.03 |
| Max. Negotiated Rate |
$456.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.07
|
| Rate for Payer: Aetna of WY Medicare |
$301.09
|
| Rate for Payer: Altius Commercial |
$437.94
|
| Rate for Payer: Beech Street Commercial |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.50
|
| Rate for Payer: Cash Price |
$319.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.50
|
| Rate for Payer: Cigna of WY Commercial |
$447.07
|
| Rate for Payer: Entrust Commercial |
$433.38
|
| Rate for Payer: First Choice Health Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.03
|
| Rate for Payer: HealthUtah PPO |
$456.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.50
|
| Rate for Payer: Multiplan Medicare/VA |
$247.03
|
| Rate for Payer: One Health Plan of WY PPO |
$447.07
|
| Rate for Payer: PacificSource Commercial |
$410.57
|
| Rate for Payer: PHCS PPO |
$447.07
|
| Rate for Payer: Three Rivers PPO |
$342.14
|
| Rate for Payer: TriWest Veterans Administration |
$260.03
|
| Rate for Payer: United Healthcare Commercial |
$435.66
|
| Rate for Payer: United Healthcare Medicare |
$260.03
|
| Rate for Payer: WINHealth Partners Commercial |
$447.07
|
| Rate for Payer: Wise Provider Network Commercial |
$433.38
|
|
|
END CAP 5MM HOFFMAN
|
Facility
|
IP
|
$114.24
|
|
| Hospital Charge Code |
3100405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.96
|
| Rate for Payer: Aetna of WY Medicare |
$73.11
|
| Rate for Payer: Altius Commercial |
$109.67
|
| Rate for Payer: Beech Street Commercial |
$111.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.81
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.81
|
| Rate for Payer: Cigna of WY Commercial |
$111.96
|
| Rate for Payer: Entrust Commercial |
$108.53
|
| Rate for Payer: First Choice Health Commercial |
$108.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.69
|
| Rate for Payer: HealthUtah PPO |
$114.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.81
|
| Rate for Payer: Multiplan Medicare/VA |
$66.20
|
| Rate for Payer: One Health Plan of WY PPO |
$111.96
|
| Rate for Payer: PacificSource Commercial |
$102.82
|
| Rate for Payer: PHCS PPO |
$111.96
|
| Rate for Payer: Three Rivers PPO |
$85.68
|
| Rate for Payer: TriWest Veterans Administration |
$69.69
|
| Rate for Payer: United Healthcare Commercial |
$109.10
|
| Rate for Payer: United Healthcare Medicare |
$69.69
|
| Rate for Payer: WINHealth Partners Commercial |
$108.53
|
| Rate for Payer: Wise Provider Network Commercial |
$108.53
|
|
|
END CAP 5MM HOFFMAN
|
Facility
|
OP
|
$114.24
|
|
| Hospital Charge Code |
3100405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$111.96
|
| Rate for Payer: Aetna of WY Medicare |
$75.40
|
| Rate for Payer: Altius Commercial |
$109.67
|
| Rate for Payer: Beech Street Commercial |
$111.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.81
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$110.81
|
| Rate for Payer: Cigna of WY Commercial |
$111.96
|
| Rate for Payer: Entrust Commercial |
$108.53
|
| Rate for Payer: First Choice Health Commercial |
$108.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$108.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.12
|
| Rate for Payer: HealthUtah PPO |
$114.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$110.81
|
| Rate for Payer: Multiplan Medicare/VA |
$61.86
|
| Rate for Payer: One Health Plan of WY PPO |
$111.96
|
| Rate for Payer: PacificSource Commercial |
$102.82
|
| Rate for Payer: PHCS PPO |
$111.96
|
| Rate for Payer: Three Rivers PPO |
$85.68
|
| Rate for Payer: TriWest Veterans Administration |
$65.12
|
| Rate for Payer: United Healthcare Commercial |
$109.10
|
| Rate for Payer: United Healthcare Medicare |
$65.12
|
| Rate for Payer: WINHealth Partners Commercial |
$111.96
|
| Rate for Payer: Wise Provider Network Commercial |
$108.53
|
|
|
END CAP 8MM 1822-0003
|
Facility
|
IP
|
$456.19
|
|
| Hospital Charge Code |
3100024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.36 |
| Max. Negotiated Rate |
$456.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.07
|
| Rate for Payer: Aetna of WY Medicare |
$291.96
|
| Rate for Payer: Altius Commercial |
$437.94
|
| Rate for Payer: Beech Street Commercial |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.50
|
| Rate for Payer: Cash Price |
$319.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.50
|
| Rate for Payer: Cigna of WY Commercial |
$447.07
|
| Rate for Payer: Entrust Commercial |
$433.38
|
| Rate for Payer: First Choice Health Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$278.28
|
| Rate for Payer: HealthUtah PPO |
$456.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.50
|
| Rate for Payer: Multiplan Medicare/VA |
$264.36
|
| Rate for Payer: One Health Plan of WY PPO |
$447.07
|
| Rate for Payer: PacificSource Commercial |
$410.57
|
| Rate for Payer: PHCS PPO |
$447.07
|
| Rate for Payer: Three Rivers PPO |
$342.14
|
| Rate for Payer: TriWest Veterans Administration |
$278.28
|
| Rate for Payer: United Healthcare Commercial |
$435.66
|
| Rate for Payer: United Healthcare Medicare |
$278.28
|
| Rate for Payer: WINHealth Partners Commercial |
$433.38
|
| Rate for Payer: Wise Provider Network Commercial |
$433.38
|
|
|
END CAP 8MM 1822-0003
|
Facility
|
OP
|
$456.19
|
|
| Hospital Charge Code |
3100024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.03 |
| Max. Negotiated Rate |
$456.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$447.07
|
| Rate for Payer: Aetna of WY Medicare |
$301.09
|
| Rate for Payer: Altius Commercial |
$437.94
|
| Rate for Payer: Beech Street Commercial |
$447.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$442.50
|
| Rate for Payer: Cash Price |
$319.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$442.50
|
| Rate for Payer: Cigna of WY Commercial |
$447.07
|
| Rate for Payer: Entrust Commercial |
$433.38
|
| Rate for Payer: First Choice Health Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$433.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$260.03
|
| Rate for Payer: HealthUtah PPO |
$456.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$442.50
|
| Rate for Payer: Multiplan Medicare/VA |
$247.03
|
| Rate for Payer: One Health Plan of WY PPO |
$447.07
|
| Rate for Payer: PacificSource Commercial |
$410.57
|
| Rate for Payer: PHCS PPO |
$447.07
|
| Rate for Payer: Three Rivers PPO |
$342.14
|
| Rate for Payer: TriWest Veterans Administration |
$260.03
|
| Rate for Payer: United Healthcare Commercial |
$435.66
|
| Rate for Payer: United Healthcare Medicare |
$260.03
|
| Rate for Payer: WINHealth Partners Commercial |
$447.07
|
| Rate for Payer: Wise Provider Network Commercial |
$433.38
|
|
|
END CAP G3 10MM 3005-1110S
|
Facility
|
OP
|
$540.96
|
|
| Hospital Charge Code |
3100663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.93 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.14
|
| Rate for Payer: Aetna of WY Medicare |
$357.03
|
| Rate for Payer: Altius Commercial |
$519.32
|
| Rate for Payer: Beech Street Commercial |
$530.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$378.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.73
|
| Rate for Payer: Cigna of WY Commercial |
$530.14
|
| Rate for Payer: Entrust Commercial |
$513.91
|
| Rate for Payer: First Choice Health Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.35
|
| Rate for Payer: HealthUtah PPO |
$540.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.73
|
| Rate for Payer: Multiplan Medicare/VA |
$292.93
|
| Rate for Payer: One Health Plan of WY PPO |
$530.14
|
| Rate for Payer: PacificSource Commercial |
$486.86
|
| Rate for Payer: PHCS PPO |
$530.14
|
| Rate for Payer: Three Rivers PPO |
$405.72
|
| Rate for Payer: TriWest Veterans Administration |
$308.35
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: United Healthcare Medicare |
$308.35
|
| Rate for Payer: WINHealth Partners Commercial |
$530.14
|
| Rate for Payer: Wise Provider Network Commercial |
$513.91
|
|
|
END CAP G3 10MM 3005-1110S
|
Facility
|
IP
|
$540.96
|
|
| Hospital Charge Code |
3100663
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.49 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.14
|
| Rate for Payer: Aetna of WY Medicare |
$346.21
|
| Rate for Payer: Altius Commercial |
$519.32
|
| Rate for Payer: Beech Street Commercial |
$530.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$378.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.73
|
| Rate for Payer: Cigna of WY Commercial |
$530.14
|
| Rate for Payer: Entrust Commercial |
$513.91
|
| Rate for Payer: First Choice Health Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.99
|
| Rate for Payer: HealthUtah PPO |
$540.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.73
|
| Rate for Payer: Multiplan Medicare/VA |
$313.49
|
| Rate for Payer: One Health Plan of WY PPO |
$530.14
|
| Rate for Payer: PacificSource Commercial |
$486.86
|
| Rate for Payer: PHCS PPO |
$530.14
|
| Rate for Payer: Three Rivers PPO |
$405.72
|
| Rate for Payer: TriWest Veterans Administration |
$329.99
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: United Healthcare Medicare |
$329.99
|
| Rate for Payer: WINHealth Partners Commercial |
$513.91
|
| Rate for Payer: Wise Provider Network Commercial |
$513.91
|
|
|
END CAP G3 5MM 3005-1105S
|
Facility
|
OP
|
$540.96
|
|
| Hospital Charge Code |
3100662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.93 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.14
|
| Rate for Payer: Aetna of WY Medicare |
$357.03
|
| Rate for Payer: Altius Commercial |
$519.32
|
| Rate for Payer: Beech Street Commercial |
$530.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$378.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.73
|
| Rate for Payer: Cigna of WY Commercial |
$530.14
|
| Rate for Payer: Entrust Commercial |
$513.91
|
| Rate for Payer: First Choice Health Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.35
|
| Rate for Payer: HealthUtah PPO |
$540.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.73
|
| Rate for Payer: Multiplan Medicare/VA |
$292.93
|
| Rate for Payer: One Health Plan of WY PPO |
$530.14
|
| Rate for Payer: PacificSource Commercial |
$486.86
|
| Rate for Payer: PHCS PPO |
$530.14
|
| Rate for Payer: Three Rivers PPO |
$405.72
|
| Rate for Payer: TriWest Veterans Administration |
$308.35
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: United Healthcare Medicare |
$308.35
|
| Rate for Payer: WINHealth Partners Commercial |
$530.14
|
| Rate for Payer: Wise Provider Network Commercial |
$513.91
|
|
|
END CAP G3 5MM 3005-1105S
|
Facility
|
IP
|
$540.96
|
|
| Hospital Charge Code |
3100662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.49 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.14
|
| Rate for Payer: Aetna of WY Medicare |
$346.21
|
| Rate for Payer: Altius Commercial |
$519.32
|
| Rate for Payer: Beech Street Commercial |
$530.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$378.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.73
|
| Rate for Payer: Cigna of WY Commercial |
$530.14
|
| Rate for Payer: Entrust Commercial |
$513.91
|
| Rate for Payer: First Choice Health Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.99
|
| Rate for Payer: HealthUtah PPO |
$540.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.73
|
| Rate for Payer: Multiplan Medicare/VA |
$313.49
|
| Rate for Payer: One Health Plan of WY PPO |
$530.14
|
| Rate for Payer: PacificSource Commercial |
$486.86
|
| Rate for Payer: PHCS PPO |
$530.14
|
| Rate for Payer: Three Rivers PPO |
$405.72
|
| Rate for Payer: TriWest Veterans Administration |
$329.99
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: United Healthcare Medicare |
$329.99
|
| Rate for Payer: WINHealth Partners Commercial |
$513.91
|
| Rate for Payer: Wise Provider Network Commercial |
$513.91
|
|
|
END CAP G3 STD 3005-1100S
|
Facility
|
IP
|
$540.96
|
|
| Hospital Charge Code |
3100661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$313.49 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.14
|
| Rate for Payer: Aetna of WY Medicare |
$346.21
|
| Rate for Payer: Altius Commercial |
$519.32
|
| Rate for Payer: Beech Street Commercial |
$530.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$378.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.73
|
| Rate for Payer: Cigna of WY Commercial |
$530.14
|
| Rate for Payer: Entrust Commercial |
$513.91
|
| Rate for Payer: First Choice Health Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$329.99
|
| Rate for Payer: HealthUtah PPO |
$540.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.73
|
| Rate for Payer: Multiplan Medicare/VA |
$313.49
|
| Rate for Payer: One Health Plan of WY PPO |
$530.14
|
| Rate for Payer: PacificSource Commercial |
$486.86
|
| Rate for Payer: PHCS PPO |
$530.14
|
| Rate for Payer: Three Rivers PPO |
$405.72
|
| Rate for Payer: TriWest Veterans Administration |
$329.99
|
| Rate for Payer: United Healthcare Medicare |
$329.99
|
| Rate for Payer: WINHealth Partners Commercial |
$513.91
|
| Rate for Payer: Wise Provider Network Commercial |
$513.91
|
|
|
END CAP G3 STD 3005-1100S
|
Facility
|
OP
|
$540.96
|
|
| Hospital Charge Code |
3100661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$292.93 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$530.14
|
| Rate for Payer: Aetna of WY Medicare |
$357.03
|
| Rate for Payer: Altius Commercial |
$519.32
|
| Rate for Payer: Beech Street Commercial |
$530.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$524.73
|
| Rate for Payer: Cash Price |
$378.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$524.73
|
| Rate for Payer: Cigna of WY Commercial |
$530.14
|
| Rate for Payer: Entrust Commercial |
$513.91
|
| Rate for Payer: First Choice Health Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$513.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.35
|
| Rate for Payer: HealthUtah PPO |
$540.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$524.73
|
| Rate for Payer: Multiplan Medicare/VA |
$292.93
|
| Rate for Payer: One Health Plan of WY PPO |
$530.14
|
| Rate for Payer: PacificSource Commercial |
$486.86
|
| Rate for Payer: PHCS PPO |
$530.14
|
| Rate for Payer: Three Rivers PPO |
$405.72
|
| Rate for Payer: TriWest Veterans Administration |
$308.35
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: United Healthcare Medicare |
$308.35
|
| Rate for Payer: WINHealth Partners Commercial |
$530.14
|
| Rate for Payer: Wise Provider Network Commercial |
$513.91
|
|
|
END CAP HUMERAL STANDARD T2
|
Facility
|
IP
|
$462.00
|
|
| Hospital Charge Code |
3100546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.73 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$452.76
|
| Rate for Payer: Aetna of WY Medicare |
$295.68
|
| Rate for Payer: Altius Commercial |
$443.52
|
| Rate for Payer: Beech Street Commercial |
$452.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$448.14
|
| Rate for Payer: Cash Price |
$323.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$448.14
|
| Rate for Payer: Cigna of WY Commercial |
$452.76
|
| Rate for Payer: Entrust Commercial |
$438.90
|
| Rate for Payer: First Choice Health Commercial |
$438.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$438.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$281.82
|
| Rate for Payer: HealthUtah PPO |
$462.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$448.14
|
| Rate for Payer: Multiplan Medicare/VA |
$267.73
|
| Rate for Payer: One Health Plan of WY PPO |
$452.76
|
| Rate for Payer: PacificSource Commercial |
$415.80
|
| Rate for Payer: PHCS PPO |
$452.76
|
| Rate for Payer: Three Rivers PPO |
$346.50
|
| Rate for Payer: TriWest Veterans Administration |
$281.82
|
| Rate for Payer: United Healthcare Commercial |
$441.21
|
| Rate for Payer: United Healthcare Medicare |
$281.82
|
| Rate for Payer: WINHealth Partners Commercial |
$438.90
|
| Rate for Payer: Wise Provider Network Commercial |
$438.90
|
|
|
END CAP HUMERAL STANDARD T2
|
Facility
|
OP
|
$462.00
|
|
| Hospital Charge Code |
3100546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.17 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$452.76
|
| Rate for Payer: Aetna of WY Medicare |
$304.92
|
| Rate for Payer: Altius Commercial |
$443.52
|
| Rate for Payer: Beech Street Commercial |
$452.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$448.14
|
| Rate for Payer: Cash Price |
$323.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$448.14
|
| Rate for Payer: Cigna of WY Commercial |
$452.76
|
| Rate for Payer: Entrust Commercial |
$438.90
|
| Rate for Payer: First Choice Health Commercial |
$438.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$438.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.34
|
| Rate for Payer: HealthUtah PPO |
$462.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$448.14
|
| Rate for Payer: Multiplan Medicare/VA |
$250.17
|
| Rate for Payer: One Health Plan of WY PPO |
$452.76
|
| Rate for Payer: PacificSource Commercial |
$415.80
|
| Rate for Payer: PHCS PPO |
$452.76
|
| Rate for Payer: Three Rivers PPO |
$346.50
|
| Rate for Payer: TriWest Veterans Administration |
$263.34
|
| Rate for Payer: United Healthcare Commercial |
$441.21
|
| Rate for Payer: United Healthcare Medicare |
$263.34
|
| Rate for Payer: WINHealth Partners Commercial |
$452.76
|
| Rate for Payer: Wise Provider Network Commercial |
$438.90
|
|
|
END CAP TIBIA 11.5 + 10MM
|
Facility
|
OP
|
$620.27
|
|
| Hospital Charge Code |
3100710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.88 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$409.38
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.55
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$335.88
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$353.55
|
| Rate for Payer: WINHealth Partners Commercial |
$607.86
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 + 10MM
|
Facility
|
IP
|
$620.27
|
|
| Hospital Charge Code |
3100710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.45 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$396.97
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.36
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$359.45
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$378.36
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$378.36
|
| Rate for Payer: WINHealth Partners Commercial |
$589.26
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +10MM
|
Facility
|
IP
|
$620.27
|
|
| Hospital Charge Code |
3100745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.45 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$396.97
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$378.36
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$359.45
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$378.36
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$378.36
|
| Rate for Payer: WINHealth Partners Commercial |
$589.26
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
|
END CAP TIBIA 11.5 +10MM
|
Facility
|
OP
|
$620.27
|
|
| Hospital Charge Code |
3100745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$335.88 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$607.86
|
| Rate for Payer: Aetna of WY Medicare |
$409.38
|
| Rate for Payer: Altius Commercial |
$595.46
|
| Rate for Payer: Beech Street Commercial |
$607.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$601.66
|
| Rate for Payer: Cash Price |
$434.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$601.66
|
| Rate for Payer: Cigna of WY Commercial |
$607.86
|
| Rate for Payer: Entrust Commercial |
$589.26
|
| Rate for Payer: First Choice Health Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$353.55
|
| Rate for Payer: HealthUtah PPO |
$620.27
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$601.66
|
| Rate for Payer: Multiplan Medicare/VA |
$335.88
|
| Rate for Payer: One Health Plan of WY PPO |
$607.86
|
| Rate for Payer: PacificSource Commercial |
$558.24
|
| Rate for Payer: PHCS PPO |
$607.86
|
| Rate for Payer: Three Rivers PPO |
$465.20
|
| Rate for Payer: TriWest Veterans Administration |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$592.36
|
| Rate for Payer: United Healthcare Medicare |
$353.55
|
| Rate for Payer: WINHealth Partners Commercial |
$607.86
|
| Rate for Payer: Wise Provider Network Commercial |
$589.26
|
|
