|
ASPIRIN 81 MG CHEWABLE TABLET [15387]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 6655300201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.20
|
| Rate for Payer: Aetna of WY Medicare |
$0.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.19
|
| Rate for Payer: Altius Commercial |
$0.19
|
| Rate for Payer: Beech Street Commercial |
$0.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.19
|
| Rate for Payer: Cigna of WY Commercial |
$0.20
|
| Rate for Payer: Entrust Commercial |
$0.19
|
| Rate for Payer: First Choice Health Commercial |
$0.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.20
|
| Rate for Payer: PacificSource Commercial |
$0.18
|
| Rate for Payer: PHCS PPO |
$0.20
|
| Rate for Payer: Three Rivers PPO |
$0.15
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.17
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.20
|
| Rate for Payer: Wise Provider Network Commercial |
$0.19
|
|
|
ASSAY OF PHENYLALANINE BLOOD
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 84030
|
| Hospital Charge Code |
84030
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.44
|
| Rate for Payer: Aetna of WY Medicare |
$5.50
|
| Rate for Payer: Beech Street Commercial |
$121.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.16
|
| Rate for Payer: Cigna of WY Commercial |
$125.44
|
| Rate for Payer: First Choice Health Commercial |
$115.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.50
|
| Rate for Payer: HealthUtah PPO |
$128.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.16
|
| Rate for Payer: Multiplan Medicare/VA |
$4.68
|
| Rate for Payer: One Health Plan of WY PPO |
$125.44
|
| Rate for Payer: PacificSource Commercial |
$115.20
|
| Rate for Payer: PHCS PPO |
$121.60
|
| Rate for Payer: Three Rivers PPO |
$96.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.50
|
| Rate for Payer: United Healthcare Commercial |
$111.36
|
| Rate for Payer: United Healthcare Medicare |
$5.50
|
| Rate for Payer: WINHealth Partners Commercial |
$121.60
|
|
|
ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
84153
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.88
|
| Rate for Payer: Aetna of WY Medicare |
$18.39
|
| Rate for Payer: Beech Street Commercial |
$100.70
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.82
|
| Rate for Payer: Cigna of WY Commercial |
$103.88
|
| Rate for Payer: First Choice Health Commercial |
$95.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.39
|
| Rate for Payer: HealthUtah PPO |
$106.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.82
|
| Rate for Payer: Multiplan Medicare/VA |
$15.63
|
| Rate for Payer: One Health Plan of WY PPO |
$103.88
|
| Rate for Payer: PacificSource Commercial |
$95.40
|
| Rate for Payer: PHCS PPO |
$100.70
|
| Rate for Payer: Three Rivers PPO |
$79.50
|
| Rate for Payer: TriWest Veterans Administration |
$18.39
|
| Rate for Payer: United Healthcare Commercial |
$92.22
|
| Rate for Payer: United Healthcare Medicare |
$18.39
|
| Rate for Payer: WINHealth Partners Commercial |
$100.70
|
|
|
ASSAY OF THYROID STIMULATING HORMONE TSH
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 84443
|
| Hospital Charge Code |
84443
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$107.80
|
| Rate for Payer: Aetna of WY Medicare |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$104.50
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$106.70
|
| Rate for Payer: Cigna of WY Commercial |
$107.80
|
| Rate for Payer: First Choice Health Commercial |
$99.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$104.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.80
|
| Rate for Payer: HealthUtah PPO |
$110.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$106.70
|
| Rate for Payer: Multiplan Medicare/VA |
$14.28
|
| Rate for Payer: One Health Plan of WY PPO |
$107.80
|
| Rate for Payer: PacificSource Commercial |
$99.00
|
| Rate for Payer: PHCS PPO |
$104.50
|
| Rate for Payer: Three Rivers PPO |
$82.50
|
| Rate for Payer: TriWest Veterans Administration |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$95.70
|
| Rate for Payer: United Healthcare Medicare |
$16.80
|
| Rate for Payer: WINHealth Partners Commercial |
$104.50
|
|
|
ASSAY OF TROPONIN QUANTITATIVE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 84484
|
| Hospital Charge Code |
84484
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$99.96
|
| Rate for Payer: Aetna of WY Medicare |
$12.47
|
| Rate for Payer: Beech Street Commercial |
$96.90
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$98.94
|
| Rate for Payer: Cigna of WY Commercial |
$99.96
|
| Rate for Payer: First Choice Health Commercial |
$91.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$96.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.47
|
| Rate for Payer: HealthUtah PPO |
$102.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$98.94
|
| Rate for Payer: Multiplan Medicare/VA |
$10.60
|
| Rate for Payer: One Health Plan of WY PPO |
$99.96
|
| Rate for Payer: PacificSource Commercial |
$91.80
|
| Rate for Payer: PHCS PPO |
$96.90
|
| Rate for Payer: Three Rivers PPO |
$76.50
|
| Rate for Payer: TriWest Veterans Administration |
$12.47
|
| Rate for Payer: United Healthcare Commercial |
$88.74
|
| Rate for Payer: United Healthcare Medicare |
$12.47
|
| Rate for Payer: WINHealth Partners Commercial |
$96.90
|
|
|
ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 99483
|
| Hospital Charge Code |
99483
|
| Min. Negotiated Rate |
$157.87 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$622.30
|
| Rate for Payer: Aetna of WY Medicare |
$185.73
|
| Rate for Payer: Beech Street Commercial |
$603.25
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: Cash Price |
$444.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$615.95
|
| Rate for Payer: Cigna of WY Commercial |
$622.30
|
| Rate for Payer: First Choice Health Commercial |
$571.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$603.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$185.73
|
| Rate for Payer: HealthUtah PPO |
$635.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$615.95
|
| Rate for Payer: Multiplan Medicare/VA |
$157.87
|
| Rate for Payer: One Health Plan of WY PPO |
$622.30
|
| Rate for Payer: PacificSource Commercial |
$571.50
|
| Rate for Payer: PHCS PPO |
$603.25
|
| Rate for Payer: Three Rivers PPO |
$476.25
|
| Rate for Payer: TriWest Veterans Administration |
$185.73
|
| Rate for Payer: United Healthcare Commercial |
$552.45
|
| Rate for Payer: United Healthcare Medicare |
$185.73
|
| Rate for Payer: WINHealth Partners Commercial |
$603.25
|
|
|
ATENOLOL 25 MG TABLET [5852]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 6068760511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$0.99
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
ATENOLOL 25 MG TABLET [5852]
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
NDC 6068760501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$0.99
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
ATENOLOL 25 MG TABLET [5852]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 6068760511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
ATENOLOL 25 MG TABLET [5852]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 6068760501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.00
|
| Rate for Payer: Altius Commercial |
$1.00
|
| Rate for Payer: Beech Street Commercial |
$1.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.01
|
| Rate for Payer: Cigna of WY Commercial |
$1.02
|
| Rate for Payer: Entrust Commercial |
$0.99
|
| Rate for Payer: First Choice Health Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.60
|
| Rate for Payer: HealthUtah PPO |
$1.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.57
|
| Rate for Payer: One Health Plan of WY PPO |
$1.02
|
| Rate for Payer: PacificSource Commercial |
$0.94
|
| Rate for Payer: PHCS PPO |
$1.02
|
| Rate for Payer: Three Rivers PPO |
$0.78
|
| Rate for Payer: TriWest Veterans Administration |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$0.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.99
|
|
|
ATHLETIC SUPP LG ADLT
|
Facility
|
IP
|
$11.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.46
|
| Rate for Payer: Altius Commercial |
$11.46
|
| Rate for Payer: Beech Street Commercial |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.58
|
| Rate for Payer: Cigna of WY Commercial |
$11.70
|
| Rate for Payer: Entrust Commercial |
$11.34
|
| Rate for Payer: First Choice Health Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.88
|
| Rate for Payer: HealthUtah PPO |
$11.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.58
|
| Rate for Payer: Multiplan Medicare/VA |
$7.49
|
| Rate for Payer: One Health Plan of WY PPO |
$11.70
|
| Rate for Payer: PacificSource Commercial |
$10.75
|
| Rate for Payer: PHCS PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$8.96
|
| Rate for Payer: TriWest Veterans Administration |
$7.88
|
| Rate for Payer: United Healthcare Commercial |
$10.39
|
| Rate for Payer: United Healthcare Medicare |
$7.88
|
| Rate for Payer: WINHealth Partners Commercial |
$11.34
|
| Rate for Payer: Wise Provider Network Commercial |
$11.34
|
|
|
ATHLETIC SUPP LG ADLT
|
Facility
|
OP
|
$11.94
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$11.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.70
|
| Rate for Payer: Aetna of WY Medicare |
$7.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.46
|
| Rate for Payer: Altius Commercial |
$11.46
|
| Rate for Payer: Beech Street Commercial |
$11.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.58
|
| Rate for Payer: Cigna of WY Commercial |
$11.70
|
| Rate for Payer: Entrust Commercial |
$11.34
|
| Rate for Payer: First Choice Health Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.93
|
| Rate for Payer: HealthUtah PPO |
$11.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.58
|
| Rate for Payer: Multiplan Medicare/VA |
$6.58
|
| Rate for Payer: One Health Plan of WY PPO |
$11.70
|
| Rate for Payer: PacificSource Commercial |
$10.75
|
| Rate for Payer: PHCS PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$8.96
|
| Rate for Payer: TriWest Veterans Administration |
$6.93
|
| Rate for Payer: United Healthcare Commercial |
$10.39
|
| Rate for Payer: United Healthcare Medicare |
$6.93
|
| Rate for Payer: WINHealth Partners Commercial |
$11.70
|
| Rate for Payer: Wise Provider Network Commercial |
$11.34
|
|
|
ATHLETIC SUPP XLG ADLT
|
Facility
|
IP
|
$11.83
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$11.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.36
|
| Rate for Payer: Altius Commercial |
$11.36
|
| Rate for Payer: Beech Street Commercial |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.48
|
| Rate for Payer: Cigna of WY Commercial |
$11.59
|
| Rate for Payer: Entrust Commercial |
$11.24
|
| Rate for Payer: First Choice Health Commercial |
$11.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.81
|
| Rate for Payer: HealthUtah PPO |
$11.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.48
|
| Rate for Payer: Multiplan Medicare/VA |
$7.42
|
| Rate for Payer: One Health Plan of WY PPO |
$11.59
|
| Rate for Payer: PacificSource Commercial |
$10.65
|
| Rate for Payer: PHCS PPO |
$11.59
|
| Rate for Payer: Three Rivers PPO |
$8.87
|
| Rate for Payer: TriWest Veterans Administration |
$7.81
|
| Rate for Payer: United Healthcare Commercial |
$10.29
|
| Rate for Payer: United Healthcare Medicare |
$7.81
|
| Rate for Payer: WINHealth Partners Commercial |
$11.24
|
| Rate for Payer: Wise Provider Network Commercial |
$11.24
|
|
|
ATHLETIC SUPP XLG ADLT
|
Facility
|
OP
|
$11.83
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$11.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.59
|
| Rate for Payer: Aetna of WY Medicare |
$7.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.36
|
| Rate for Payer: Altius Commercial |
$11.36
|
| Rate for Payer: Beech Street Commercial |
$11.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.48
|
| Rate for Payer: Cigna of WY Commercial |
$11.59
|
| Rate for Payer: Entrust Commercial |
$11.24
|
| Rate for Payer: First Choice Health Commercial |
$11.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.86
|
| Rate for Payer: HealthUtah PPO |
$11.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.48
|
| Rate for Payer: Multiplan Medicare/VA |
$6.52
|
| Rate for Payer: One Health Plan of WY PPO |
$11.59
|
| Rate for Payer: PacificSource Commercial |
$10.65
|
| Rate for Payer: PHCS PPO |
$11.59
|
| Rate for Payer: Three Rivers PPO |
$8.87
|
| Rate for Payer: TriWest Veterans Administration |
$6.86
|
| Rate for Payer: United Healthcare Commercial |
$10.29
|
| Rate for Payer: United Healthcare Medicare |
$6.86
|
| Rate for Payer: WINHealth Partners Commercial |
$11.59
|
| Rate for Payer: Wise Provider Network Commercial |
$11.24
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 6808409711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.42
|
| Rate for Payer: Altius Commercial |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.44
|
| Rate for Payer: Cigna of WY Commercial |
$1.45
|
| Rate for Payer: Entrust Commercial |
$1.41
|
| Rate for Payer: First Choice Health Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.98
|
| Rate for Payer: HealthUtah PPO |
$1.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.44
|
| Rate for Payer: Multiplan Medicare/VA |
$0.93
|
| Rate for Payer: One Health Plan of WY PPO |
$1.45
|
| Rate for Payer: PacificSource Commercial |
$1.33
|
| Rate for Payer: PHCS PPO |
$1.45
|
| Rate for Payer: Three Rivers PPO |
$1.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1.41
|
| Rate for Payer: Wise Provider Network Commercial |
$1.41
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
IP
|
$0.68
|
|
|
Service Code
|
NDC 6050525789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.65
|
| Rate for Payer: Altius Commercial |
$0.65
|
| Rate for Payer: Beech Street Commercial |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.66
|
| Rate for Payer: Cigna of WY Commercial |
$0.67
|
| Rate for Payer: Entrust Commercial |
$0.65
|
| Rate for Payer: First Choice Health Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.66
|
| Rate for Payer: Multiplan Medicare/VA |
$0.43
|
| Rate for Payer: One Health Plan of WY PPO |
$0.67
|
| Rate for Payer: PacificSource Commercial |
$0.61
|
| Rate for Payer: PHCS PPO |
$0.67
|
| Rate for Payer: Three Rivers PPO |
$0.51
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.59
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.65
|
| Rate for Payer: Wise Provider Network Commercial |
$0.65
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
OP
|
$0.68
|
|
|
Service Code
|
NDC 6050525789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.67
|
| Rate for Payer: Aetna of WY Medicare |
$0.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.65
|
| Rate for Payer: Altius Commercial |
$0.65
|
| Rate for Payer: Beech Street Commercial |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.66
|
| Rate for Payer: Cigna of WY Commercial |
$0.67
|
| Rate for Payer: Entrust Commercial |
$0.65
|
| Rate for Payer: First Choice Health Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.39
|
| Rate for Payer: HealthUtah PPO |
$0.68
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.66
|
| Rate for Payer: Multiplan Medicare/VA |
$0.37
|
| Rate for Payer: One Health Plan of WY PPO |
$0.67
|
| Rate for Payer: PacificSource Commercial |
$0.61
|
| Rate for Payer: PHCS PPO |
$0.67
|
| Rate for Payer: Three Rivers PPO |
$0.51
|
| Rate for Payer: TriWest Veterans Administration |
$0.39
|
| Rate for Payer: United Healthcare Commercial |
$0.59
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
| Rate for Payer: WINHealth Partners Commercial |
$0.67
|
| Rate for Payer: Wise Provider Network Commercial |
$0.65
|
|
|
ATORVASTATIN 10 MG TABLET [2882]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 6808409711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.45
|
| Rate for Payer: Aetna of WY Medicare |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.42
|
| Rate for Payer: Altius Commercial |
$1.42
|
| Rate for Payer: Beech Street Commercial |
$1.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.44
|
| Rate for Payer: Cigna of WY Commercial |
$1.45
|
| Rate for Payer: Entrust Commercial |
$1.41
|
| Rate for Payer: First Choice Health Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.86
|
| Rate for Payer: HealthUtah PPO |
$1.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.44
|
| Rate for Payer: Multiplan Medicare/VA |
$0.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1.45
|
| Rate for Payer: PacificSource Commercial |
$1.33
|
| Rate for Payer: PHCS PPO |
$1.45
|
| Rate for Payer: Three Rivers PPO |
$1.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.86
|
| Rate for Payer: WINHealth Partners Commercial |
$1.45
|
| Rate for Payer: Wise Provider Network Commercial |
$1.41
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6808409801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6808409811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Aetna of WY Medicare |
$1.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6808409811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 6050525798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.94
|
| Rate for Payer: Aetna of WY Medicare |
$0.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.92
|
| Rate for Payer: Altius Commercial |
$0.92
|
| Rate for Payer: Beech Street Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.93
|
| Rate for Payer: Cigna of WY Commercial |
$0.94
|
| Rate for Payer: Entrust Commercial |
$0.91
|
| Rate for Payer: First Choice Health Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.56
|
| Rate for Payer: HealthUtah PPO |
$0.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.93
|
| Rate for Payer: Multiplan Medicare/VA |
$0.53
|
| Rate for Payer: One Health Plan of WY PPO |
$0.94
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.94
|
| Rate for Payer: Three Rivers PPO |
$0.72
|
| Rate for Payer: TriWest Veterans Administration |
$0.56
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
| Rate for Payer: WINHealth Partners Commercial |
$0.94
|
| Rate for Payer: Wise Provider Network Commercial |
$0.91
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6808409801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Aetna of WY Medicare |
$1.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 20 MG TABLET [1802]
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 6050525798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.92
|
| Rate for Payer: Altius Commercial |
$0.92
|
| Rate for Payer: Beech Street Commercial |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.93
|
| Rate for Payer: Cigna of WY Commercial |
$0.94
|
| Rate for Payer: Entrust Commercial |
$0.91
|
| Rate for Payer: First Choice Health Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$0.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.93
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$0.94
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.94
|
| Rate for Payer: Three Rivers PPO |
$0.72
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.84
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$0.91
|
| Rate for Payer: Wise Provider Network Commercial |
$0.91
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6808409901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
