|
BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$1,292.00
|
|
|
Service Code
|
HCPCS 41100
|
| Hospital Charge Code |
41100
|
| Min. Negotiated Rate |
$88.80 |
| Max. Negotiated Rate |
$1,292.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,266.16
|
| Rate for Payer: Aetna of WY Medicare |
$104.47
|
| Rate for Payer: Beech Street Commercial |
$1,227.40
|
| Rate for Payer: Cash Price |
$904.40
|
| Rate for Payer: Cash Price |
$904.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,253.24
|
| Rate for Payer: Cigna of WY Commercial |
$1,266.16
|
| Rate for Payer: First Choice Health Commercial |
$1,162.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,227.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$104.47
|
| Rate for Payer: HealthUtah PPO |
$1,292.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,253.24
|
| Rate for Payer: Multiplan Medicare/VA |
$88.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1,266.16
|
| Rate for Payer: PacificSource Commercial |
$1,162.80
|
| Rate for Payer: PHCS PPO |
$1,227.40
|
| Rate for Payer: Three Rivers PPO |
$969.00
|
| Rate for Payer: TriWest Veterans Administration |
$104.47
|
| Rate for Payer: United Healthcare Commercial |
$1,124.04
|
| Rate for Payer: United Healthcare Medicare |
$104.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,098.20
|
|
|
BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 41105
|
| Hospital Charge Code |
41105
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$642.88
|
| Rate for Payer: Aetna of WY Medicare |
$107.41
|
| Rate for Payer: Beech Street Commercial |
$623.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$636.32
|
| Rate for Payer: Cigna of WY Commercial |
$642.88
|
| Rate for Payer: First Choice Health Commercial |
$590.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$623.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.41
|
| Rate for Payer: HealthUtah PPO |
$656.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$636.32
|
| Rate for Payer: Multiplan Medicare/VA |
$91.30
|
| Rate for Payer: One Health Plan of WY PPO |
$642.88
|
| Rate for Payer: PacificSource Commercial |
$590.40
|
| Rate for Payer: PHCS PPO |
$623.20
|
| Rate for Payer: Three Rivers PPO |
$492.00
|
| Rate for Payer: TriWest Veterans Administration |
$107.41
|
| Rate for Payer: United Healthcare Commercial |
$570.72
|
| Rate for Payer: United Healthcare Medicare |
$107.41
|
| Rate for Payer: WINHealth Partners Commercial |
$557.60
|
|
|
BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Professional
|
Both
|
$2,802.00
|
|
|
Service Code
|
HCPCS 57105
|
| Hospital Charge Code |
57105
|
| Min. Negotiated Rate |
$121.75 |
| Max. Negotiated Rate |
$2,802.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,745.96
|
| Rate for Payer: Aetna of WY Medicare |
$143.23
|
| Rate for Payer: Beech Street Commercial |
$2,661.90
|
| Rate for Payer: Cash Price |
$1,961.40
|
| Rate for Payer: Cash Price |
$1,961.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,717.94
|
| Rate for Payer: Cigna of WY Commercial |
$2,745.96
|
| Rate for Payer: First Choice Health Commercial |
$2,521.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,661.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.23
|
| Rate for Payer: HealthUtah PPO |
$2,802.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,717.94
|
| Rate for Payer: Multiplan Medicare/VA |
$121.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,745.96
|
| Rate for Payer: PacificSource Commercial |
$2,521.80
|
| Rate for Payer: PHCS PPO |
$2,661.90
|
| Rate for Payer: Three Rivers PPO |
$2,101.50
|
| Rate for Payer: TriWest Veterans Administration |
$143.23
|
| Rate for Payer: United Healthcare Commercial |
$2,437.74
|
| Rate for Payer: United Healthcare Medicare |
$143.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2,381.70
|
|
|
BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 57100
|
| Hospital Charge Code |
57100
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$1,617.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,584.66
|
| Rate for Payer: Aetna of WY Medicare |
$62.47
|
| Rate for Payer: Beech Street Commercial |
$1,536.15
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,568.49
|
| Rate for Payer: Cigna of WY Commercial |
$1,584.66
|
| Rate for Payer: First Choice Health Commercial |
$1,455.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,536.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.47
|
| Rate for Payer: HealthUtah PPO |
$1,617.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,568.49
|
| Rate for Payer: Multiplan Medicare/VA |
$53.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,584.66
|
| Rate for Payer: PacificSource Commercial |
$1,455.30
|
| Rate for Payer: PHCS PPO |
$1,536.15
|
| Rate for Payer: Three Rivers PPO |
$1,212.75
|
| Rate for Payer: TriWest Veterans Administration |
$62.47
|
| Rate for Payer: United Healthcare Commercial |
$1,406.79
|
| Rate for Payer: United Healthcare Medicare |
$62.47
|
| Rate for Payer: WINHealth Partners Commercial |
$1,374.45
|
|
|
BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
40808
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$445.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$436.10
|
| Rate for Payer: Aetna of WY Medicare |
$86.97
|
| Rate for Payer: Beech Street Commercial |
$422.75
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: Cash Price |
$311.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$431.65
|
| Rate for Payer: Cigna of WY Commercial |
$436.10
|
| Rate for Payer: First Choice Health Commercial |
$400.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$422.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.97
|
| Rate for Payer: HealthUtah PPO |
$445.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$431.65
|
| Rate for Payer: Multiplan Medicare/VA |
$73.92
|
| Rate for Payer: One Health Plan of WY PPO |
$436.10
|
| Rate for Payer: PacificSource Commercial |
$400.50
|
| Rate for Payer: PHCS PPO |
$422.75
|
| Rate for Payer: Three Rivers PPO |
$333.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.97
|
| Rate for Payer: United Healthcare Commercial |
$387.15
|
| Rate for Payer: United Healthcare Medicare |
$86.97
|
| Rate for Payer: WINHealth Partners Commercial |
$378.25
|
|
|
BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 56605
|
| Hospital Charge Code |
56605
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$696.78
|
| Rate for Payer: Aetna of WY Medicare |
$56.42
|
| Rate for Payer: Beech Street Commercial |
$675.45
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$689.67
|
| Rate for Payer: Cigna of WY Commercial |
$696.78
|
| Rate for Payer: First Choice Health Commercial |
$639.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$675.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.42
|
| Rate for Payer: HealthUtah PPO |
$711.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$689.67
|
| Rate for Payer: Multiplan Medicare/VA |
$47.96
|
| Rate for Payer: One Health Plan of WY PPO |
$696.78
|
| Rate for Payer: PacificSource Commercial |
$639.90
|
| Rate for Payer: PHCS PPO |
$675.45
|
| Rate for Payer: Three Rivers PPO |
$533.25
|
| Rate for Payer: TriWest Veterans Administration |
$56.42
|
| Rate for Payer: United Healthcare Commercial |
$618.57
|
| Rate for Payer: United Healthcare Medicare |
$56.42
|
| Rate for Payer: WINHealth Partners Commercial |
$604.35
|
|
|
BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
56606
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Aetna of WY Medicare |
$27.72
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.72
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: TriWest Veterans Administration |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$273.18
|
| Rate for Payer: United Healthcare Medicare |
$27.72
|
| Rate for Payer: WINHealth Partners Commercial |
$266.90
|
|
|
BIOTENODESIS DISP KT AR-1676DS
|
Facility
|
OP
|
$797.16
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.24 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Aetna of WY Medicare |
$526.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$765.27
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$654.47
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.35
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$439.24
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$462.35
|
| Rate for Payer: United Healthcare Commercial |
$693.53
|
| Rate for Payer: United Healthcare Medicare |
$462.35
|
| Rate for Payer: WINHealth Partners Commercial |
$781.22
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
BIOTENODESIS DISP KT AR-1676DS
|
Facility
|
IP
|
$797.16
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$499.82 |
| Max. Negotiated Rate |
$797.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$781.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$765.27
|
| Rate for Payer: Altius Commercial |
$765.27
|
| Rate for Payer: Beech Street Commercial |
$781.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$654.47
|
| Rate for Payer: Cash Price |
$558.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$773.25
|
| Rate for Payer: Cigna of WY Commercial |
$781.22
|
| Rate for Payer: Entrust Commercial |
$757.30
|
| Rate for Payer: First Choice Health Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$757.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.13
|
| Rate for Payer: HealthUtah PPO |
$797.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$773.25
|
| Rate for Payer: Multiplan Medicare/VA |
$499.82
|
| Rate for Payer: One Health Plan of WY PPO |
$781.22
|
| Rate for Payer: PacificSource Commercial |
$717.44
|
| Rate for Payer: PHCS PPO |
$781.22
|
| Rate for Payer: Three Rivers PPO |
$597.87
|
| Rate for Payer: TriWest Veterans Administration |
$526.13
|
| Rate for Payer: United Healthcare Commercial |
$693.53
|
| Rate for Payer: United Healthcare Medicare |
$526.13
|
| Rate for Payer: WINHealth Partners Commercial |
$757.30
|
| Rate for Payer: Wise Provider Network Commercial |
$757.30
|
|
|
BIOTIN 5,000 MCG DISINTEGRATING TABLET [147504]
|
Facility
|
OP
|
$0.35
|
|
|
Service Code
|
NDC 4009310118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Aetna of WY Medicare |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.34
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
BIOTIN 5,000 MCG DISINTEGRATING TABLET [147504]
|
Facility
|
IP
|
$0.35
|
|
|
Service Code
|
NDC 4009310118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.34
|
| Rate for Payer: Altius Commercial |
$0.34
|
| Rate for Payer: Beech Street Commercial |
$0.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$0.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.34
|
| Rate for Payer: Cigna of WY Commercial |
$0.34
|
| Rate for Payer: Entrust Commercial |
$0.33
|
| Rate for Payer: First Choice Health Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.33
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.34
|
| Rate for Payer: Multiplan Medicare/VA |
$0.22
|
| Rate for Payer: One Health Plan of WY PPO |
$0.34
|
| Rate for Payer: PacificSource Commercial |
$0.32
|
| Rate for Payer: PHCS PPO |
$0.34
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.33
|
|
|
BIOTIN 5 MG CAPSULE [3165]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 8770140734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
BIOTIN 5 MG CAPSULE [3165]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 8770140734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 0574705012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.35
|
| Rate for Payer: Altius Commercial |
$1.35
|
| Rate for Payer: Beech Street Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.37
|
| Rate for Payer: Cigna of WY Commercial |
$1.38
|
| Rate for Payer: Entrust Commercial |
$1.34
|
| Rate for Payer: First Choice Health Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.38
|
| Rate for Payer: PacificSource Commercial |
$1.27
|
| Rate for Payer: PHCS PPO |
$1.38
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1.34
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 0574705050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.01
|
| Rate for Payer: Altius Commercial |
$1.01
|
| Rate for Payer: Beech Street Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.02
|
| Rate for Payer: Cigna of WY Commercial |
$1.03
|
| Rate for Payer: Entrust Commercial |
$1.00
|
| Rate for Payer: First Choice Health Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.03
|
| Rate for Payer: PacificSource Commercial |
$0.95
|
| Rate for Payer: PHCS PPO |
$1.03
|
| Rate for Payer: Three Rivers PPO |
$0.79
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$0.91
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1.00
|
| Rate for Payer: Wise Provider Network Commercial |
$1.00
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
NDC 0574705012
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.35
|
| Rate for Payer: Altius Commercial |
$1.35
|
| Rate for Payer: Beech Street Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.37
|
| Rate for Payer: Cigna of WY Commercial |
$1.38
|
| Rate for Payer: Entrust Commercial |
$1.34
|
| Rate for Payer: First Choice Health Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.93
|
| Rate for Payer: HealthUtah PPO |
$1.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.38
|
| Rate for Payer: PacificSource Commercial |
$1.27
|
| Rate for Payer: PHCS PPO |
$1.38
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1.34
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY [12070]
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 0574705050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.01
|
| Rate for Payer: Altius Commercial |
$1.01
|
| Rate for Payer: Beech Street Commercial |
$1.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.02
|
| Rate for Payer: Cigna of WY Commercial |
$1.03
|
| Rate for Payer: Entrust Commercial |
$1.00
|
| Rate for Payer: First Choice Health Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.61
|
| Rate for Payer: HealthUtah PPO |
$1.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.58
|
| Rate for Payer: One Health Plan of WY PPO |
$1.03
|
| Rate for Payer: PacificSource Commercial |
$0.95
|
| Rate for Payer: PHCS PPO |
$1.03
|
| Rate for Payer: Three Rivers PPO |
$0.79
|
| Rate for Payer: TriWest Veterans Administration |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$0.91
|
| Rate for Payer: United Healthcare Medicare |
$0.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.00
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [16233]
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0904640761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.07
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.07
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.07
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.07
|
| Rate for Payer: WINHealth Partners Commercial |
$0.10
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE [16233]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0904640761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.11
|
| Rate for Payer: Altius Commercial |
$0.11
|
| Rate for Payer: Beech Street Commercial |
$0.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.11
|
| Rate for Payer: Cigna of WY Commercial |
$0.11
|
| Rate for Payer: Entrust Commercial |
$0.10
|
| Rate for Payer: First Choice Health Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.06
|
| Rate for Payer: HealthUtah PPO |
$0.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.06
|
| Rate for Payer: One Health Plan of WY PPO |
$0.11
|
| Rate for Payer: PacificSource Commercial |
$0.10
|
| Rate for Payer: PHCS PPO |
$0.11
|
| Rate for Payer: Three Rivers PPO |
$0.08
|
| Rate for Payer: TriWest Veterans Administration |
$0.06
|
| Rate for Payer: United Healthcare Commercial |
$0.10
|
| Rate for Payer: United Healthcare Medicare |
$0.06
|
| Rate for Payer: WINHealth Partners Commercial |
$0.11
|
| Rate for Payer: Wise Provider Network Commercial |
$0.10
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [12632]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 4612270326
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.08
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [12632]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 4612270326
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.08
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET [15105]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
NDC 2438502465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.36
|
| Rate for Payer: Beech Street Commercial |
$0.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.37
|
| Rate for Payer: Cigna of WY Commercial |
$0.37
|
| Rate for Payer: Entrust Commercial |
$0.36
|
| Rate for Payer: First Choice Health Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.37
|
| Rate for Payer: PacificSource Commercial |
$0.34
|
| Rate for Payer: PHCS PPO |
$0.37
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.33
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.37
|
| Rate for Payer: Wise Provider Network Commercial |
$0.36
|
|
|
BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET [15105]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
NDC 2438502465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.36
|
| Rate for Payer: Beech Street Commercial |
$0.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.37
|
| Rate for Payer: Cigna of WY Commercial |
$0.37
|
| Rate for Payer: Entrust Commercial |
$0.36
|
| Rate for Payer: First Choice Health Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.25
|
| Rate for Payer: HealthUtah PPO |
$0.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.37
|
| Rate for Payer: PacificSource Commercial |
$0.34
|
| Rate for Payer: PHCS PPO |
$0.37
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.25
|
| Rate for Payer: United Healthcare Commercial |
$0.33
|
| Rate for Payer: United Healthcare Medicare |
$0.25
|
| Rate for Payer: WINHealth Partners Commercial |
$0.36
|
| Rate for Payer: Wise Provider Network Commercial |
$0.36
|
|
|
BISMUTH SUBSALICYLATE 262 MG TABLET [16154]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 2438501758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.37
|
| Rate for Payer: Altius Commercial |
$0.37
|
| Rate for Payer: Beech Street Commercial |
$0.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.38
|
| Rate for Payer: Cigna of WY Commercial |
$0.38
|
| Rate for Payer: Entrust Commercial |
$0.37
|
| Rate for Payer: First Choice Health Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.38
|
| Rate for Payer: PacificSource Commercial |
$0.35
|
| Rate for Payer: PHCS PPO |
$0.38
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.34
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.38
|
| Rate for Payer: Wise Provider Network Commercial |
$0.37
|
|
|
BISMUTH SUBSALICYLATE 262 MG TABLET [16154]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 8770127262
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.37
|
| Rate for Payer: Altius Commercial |
$0.37
|
| Rate for Payer: Beech Street Commercial |
$0.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.38
|
| Rate for Payer: Cigna of WY Commercial |
$0.38
|
| Rate for Payer: Entrust Commercial |
$0.37
|
| Rate for Payer: First Choice Health Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.23
|
| Rate for Payer: HealthUtah PPO |
$0.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.38
|
| Rate for Payer: PacificSource Commercial |
$0.35
|
| Rate for Payer: PHCS PPO |
$0.38
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.23
|
| Rate for Payer: United Healthcare Commercial |
$0.34
|
| Rate for Payer: United Healthcare Medicare |
$0.23
|
| Rate for Payer: WINHealth Partners Commercial |
$0.38
|
| Rate for Payer: Wise Provider Network Commercial |
$0.37
|
|
