|
IBUPROFEN 200 MG TABLET [14626]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 0904674780
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.05
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.05
|
| Rate for Payer: Beech Street Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.05
|
| Rate for Payer: Cigna of WY Commercial |
$0.05
|
| Rate for Payer: Entrust Commercial |
$0.05
|
| Rate for Payer: First Choice Health Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.05
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.05
|
| Rate for Payer: Three Rivers PPO |
$0.04
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.05
|
| Rate for Payer: Wise Provider Network Commercial |
$0.05
|
|
|
IBUPROFEN 200 MG TABLET [14626]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 5058023006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Aetna of WY Medicare |
$0.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.08
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
IBUPROFEN 200 MG TABLET [14626]
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
NDC 5058023006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.14
|
| Rate for Payer: Altius Commercial |
$0.14
|
| Rate for Payer: Beech Street Commercial |
$0.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.15
|
| Rate for Payer: Cigna of WY Commercial |
$0.15
|
| Rate for Payer: Entrust Commercial |
$0.14
|
| Rate for Payer: First Choice Health Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.15
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.15
|
| Rate for Payer: Three Rivers PPO |
$0.11
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.14
|
| Rate for Payer: Wise Provider Network Commercial |
$0.14
|
|
|
IBUPROFEN 200 MG TABLET [14626]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 0904674780
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.05
|
| Rate for Payer: Beech Street Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.05
|
| Rate for Payer: Cigna of WY Commercial |
$0.05
|
| Rate for Payer: Entrust Commercial |
$0.05
|
| Rate for Payer: First Choice Health Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.05
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.05
|
| Rate for Payer: Three Rivers PPO |
$0.04
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.05
|
| Rate for Payer: Wise Provider Network Commercial |
$0.05
|
|
|
IBUPROFEN 600 MG TABLET [17374]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
NDC 6068745711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Aetna of WY Medicare |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.75
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
IBUPROFEN 600 MG TABLET [17374]
|
Facility
|
OP
|
$0.77
|
|
|
Service Code
|
NDC 6068745701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Aetna of WY Medicare |
$0.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.45
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.42
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.45
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
| Rate for Payer: WINHealth Partners Commercial |
$0.75
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
IBUPROFEN 600 MG TABLET [17374]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
NDC 6068745701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
IBUPROFEN 600 MG TABLET [17374]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 0904585461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Aetna of WY Medicare |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| 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 |
$0.33
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
IBUPROFEN 600 MG TABLET [17374]
|
Facility
|
IP
|
$0.34
|
|
|
Service Code
|
NDC 0904585461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.33
|
| Rate for Payer: Altius Commercial |
$0.33
|
| Rate for Payer: Beech Street Commercial |
$0.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.28
|
| Rate for Payer: Cash Price |
$0.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.33
|
| Rate for Payer: Cigna of WY Commercial |
$0.33
|
| Rate for Payer: Entrust Commercial |
$0.32
|
| Rate for Payer: First Choice Health Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.33
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.33
|
| Rate for Payer: PacificSource Commercial |
$0.31
|
| Rate for Payer: PHCS PPO |
$0.33
|
| Rate for Payer: Three Rivers PPO |
$0.26
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.30
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.32
|
| Rate for Payer: Wise Provider Network Commercial |
$0.32
|
|
|
IBUPROFEN 600 MG TABLET [17374]
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
NDC 6068745711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.74
|
| Rate for Payer: Altius Commercial |
$0.74
|
| Rate for Payer: Beech Street Commercial |
$0.75
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.63
|
| Rate for Payer: Cash Price |
$0.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.75
|
| Rate for Payer: Cigna of WY Commercial |
$0.75
|
| Rate for Payer: Entrust Commercial |
$0.73
|
| Rate for Payer: First Choice Health Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.75
|
| Rate for Payer: PacificSource Commercial |
$0.69
|
| Rate for Payer: PHCS PPO |
$0.75
|
| Rate for Payer: Three Rivers PPO |
$0.58
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.73
|
| Rate for Payer: Wise Provider Network Commercial |
$0.73
|
|
|
IBUPROFEN 800 MG TABLET [3300]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 0904585561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.29
|
| Rate for Payer: Aetna of WY Medicare |
$0.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.29
|
| Rate for Payer: Beech Street Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.29
|
| Rate for Payer: Cigna of WY Commercial |
$0.29
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$0.29
|
| Rate for Payer: PacificSource Commercial |
$0.27
|
| Rate for Payer: PHCS PPO |
$0.29
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
IBUPROFEN 800 MG TABLET [3300]
|
Facility
|
IP
|
$0.30
|
|
|
Service Code
|
NDC 0904585561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.29
|
| Rate for Payer: Beech Street Commercial |
$0.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$0.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.29
|
| Rate for Payer: Cigna of WY Commercial |
$0.29
|
| Rate for Payer: Entrust Commercial |
$0.29
|
| Rate for Payer: First Choice Health Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$0.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.29
|
| Rate for Payer: Multiplan Medicare/VA |
$0.19
|
| Rate for Payer: One Health Plan of WY PPO |
$0.29
|
| Rate for Payer: PacificSource Commercial |
$0.27
|
| Rate for Payer: PHCS PPO |
$0.29
|
| Rate for Payer: Three Rivers PPO |
$0.23
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$0.26
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$0.29
|
| Rate for Payer: Wise Provider Network Commercial |
$0.29
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [18095]
|
Facility
|
OP
|
$74.66
|
|
|
Service Code
|
HCPCS J1742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$74.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.17
|
| Rate for Payer: Aetna of WY Medicare |
$49.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.67
|
| Rate for Payer: Altius Commercial |
$71.67
|
| Rate for Payer: Beech Street Commercial |
$73.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.30
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.42
|
| Rate for Payer: Cigna of WY Commercial |
$73.17
|
| Rate for Payer: Entrust Commercial |
$70.93
|
| Rate for Payer: First Choice Health Commercial |
$70.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.30
|
| Rate for Payer: HealthUtah PPO |
$74.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.42
|
| Rate for Payer: Multiplan Medicare/VA |
$41.14
|
| Rate for Payer: One Health Plan of WY PPO |
$73.17
|
| Rate for Payer: PacificSource Commercial |
$67.19
|
| Rate for Payer: PHCS PPO |
$73.17
|
| Rate for Payer: Three Rivers PPO |
$56.00
|
| Rate for Payer: TriWest Veterans Administration |
$43.30
|
| Rate for Payer: United Healthcare Commercial |
$64.95
|
| Rate for Payer: United Healthcare Medicare |
$43.30
|
| Rate for Payer: WINHealth Partners Commercial |
$73.17
|
| Rate for Payer: Wise Provider Network Commercial |
$70.93
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION [18095]
|
Facility
|
IP
|
$74.66
|
|
|
Service Code
|
HCPCS J1742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$74.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.67
|
| Rate for Payer: Altius Commercial |
$71.67
|
| Rate for Payer: Beech Street Commercial |
$73.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.30
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.42
|
| Rate for Payer: Cigna of WY Commercial |
$73.17
|
| Rate for Payer: Entrust Commercial |
$70.93
|
| Rate for Payer: First Choice Health Commercial |
$70.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.28
|
| Rate for Payer: HealthUtah PPO |
$74.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.42
|
| Rate for Payer: Multiplan Medicare/VA |
$46.81
|
| Rate for Payer: One Health Plan of WY PPO |
$73.17
|
| Rate for Payer: PacificSource Commercial |
$67.19
|
| Rate for Payer: PHCS PPO |
$73.17
|
| Rate for Payer: Three Rivers PPO |
$56.00
|
| Rate for Payer: TriWest Veterans Administration |
$49.28
|
| Rate for Payer: United Healthcare Commercial |
$64.95
|
| Rate for Payer: United Healthcare Medicare |
$49.28
|
| Rate for Payer: WINHealth Partners Commercial |
$70.93
|
| Rate for Payer: Wise Provider Network Commercial |
$70.93
|
|
|
ICU MED THERMOSET ROOM T
|
Facility
|
IP
|
$57.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.95 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.04
|
| Rate for Payer: Altius Commercial |
$55.04
|
| Rate for Payer: Beech Street Commercial |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.07
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.61
|
| Rate for Payer: Cigna of WY Commercial |
$56.18
|
| Rate for Payer: Entrust Commercial |
$54.46
|
| Rate for Payer: First Choice Health Commercial |
$54.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.84
|
| Rate for Payer: HealthUtah PPO |
$57.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.61
|
| Rate for Payer: Multiplan Medicare/VA |
$35.95
|
| Rate for Payer: One Health Plan of WY PPO |
$56.18
|
| Rate for Payer: PacificSource Commercial |
$51.60
|
| Rate for Payer: PHCS PPO |
$56.18
|
| Rate for Payer: Three Rivers PPO |
$43.00
|
| Rate for Payer: TriWest Veterans Administration |
$37.84
|
| Rate for Payer: United Healthcare Commercial |
$49.88
|
| Rate for Payer: United Healthcare Medicare |
$37.84
|
| Rate for Payer: WINHealth Partners Commercial |
$54.46
|
| Rate for Payer: Wise Provider Network Commercial |
$54.46
|
|
|
ICU MED THERMOSET ROOM T
|
Facility
|
OP
|
$57.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.18
|
| Rate for Payer: Aetna of WY Medicare |
$37.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.04
|
| Rate for Payer: Altius Commercial |
$55.04
|
| Rate for Payer: Beech Street Commercial |
$56.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.07
|
| Rate for Payer: Cash Price |
$40.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.61
|
| Rate for Payer: Cigna of WY Commercial |
$56.18
|
| Rate for Payer: Entrust Commercial |
$54.46
|
| Rate for Payer: First Choice Health Commercial |
$54.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.25
|
| Rate for Payer: HealthUtah PPO |
$57.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.61
|
| Rate for Payer: Multiplan Medicare/VA |
$31.59
|
| Rate for Payer: One Health Plan of WY PPO |
$56.18
|
| Rate for Payer: PacificSource Commercial |
$51.60
|
| Rate for Payer: PHCS PPO |
$56.18
|
| Rate for Payer: Three Rivers PPO |
$43.00
|
| Rate for Payer: TriWest Veterans Administration |
$33.25
|
| Rate for Payer: United Healthcare Commercial |
$49.88
|
| Rate for Payer: United Healthcare Medicare |
$33.25
|
| Rate for Payer: WINHealth Partners Commercial |
$56.18
|
| Rate for Payer: Wise Provider Network Commercial |
$54.46
|
|
|
I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$2,899.00
|
|
|
Service Code
|
HCPCS 28003
|
| Hospital Charge Code |
28003
|
| Min. Negotiated Rate |
$210.45 |
| Max. Negotiated Rate |
$2,899.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,841.02
|
| Rate for Payer: Aetna of WY Medicare |
$247.59
|
| Rate for Payer: Beech Street Commercial |
$2,754.05
|
| Rate for Payer: Cash Price |
$2,029.30
|
| Rate for Payer: Cash Price |
$2,029.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,812.03
|
| Rate for Payer: Cigna of WY Commercial |
$2,841.02
|
| Rate for Payer: First Choice Health Commercial |
$2,609.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,754.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.59
|
| Rate for Payer: HealthUtah PPO |
$2,899.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,812.03
|
| Rate for Payer: Multiplan Medicare/VA |
$210.45
|
| Rate for Payer: One Health Plan of WY PPO |
$2,841.02
|
| Rate for Payer: PacificSource Commercial |
$2,609.10
|
| Rate for Payer: PHCS PPO |
$2,754.05
|
| Rate for Payer: Three Rivers PPO |
$2,174.25
|
| Rate for Payer: TriWest Veterans Administration |
$247.59
|
| Rate for Payer: United Healthcare Commercial |
$2,522.13
|
| Rate for Payer: United Healthcare Medicare |
$247.59
|
| Rate for Payer: WINHealth Partners Commercial |
$2,464.15
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
27301
|
| Min. Negotiated Rate |
$420.60 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Aetna of WY Medicare |
$494.82
|
| Rate for Payer: Beech Street Commercial |
$2,470.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: First Choice Health Commercial |
$2,340.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$494.82
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$420.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$494.82
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$494.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,210.00
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 27301 AS
|
| Hospital Charge Code |
27301
|
| Min. Negotiated Rate |
$420.60 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Aetna of WY Medicare |
$494.82
|
| Rate for Payer: Beech Street Commercial |
$2,470.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: First Choice Health Commercial |
$2,340.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$494.82
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$420.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$494.82
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$494.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,210.00
|
|
|
I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 27301 80
|
| Hospital Charge Code |
27301
|
| Min. Negotiated Rate |
$420.60 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,548.00
|
| Rate for Payer: Aetna of WY Medicare |
$494.82
|
| Rate for Payer: Beech Street Commercial |
$2,470.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,522.00
|
| Rate for Payer: Cigna of WY Commercial |
$2,548.00
|
| Rate for Payer: First Choice Health Commercial |
$2,340.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,470.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$494.82
|
| Rate for Payer: HealthUtah PPO |
$2,600.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,522.00
|
| Rate for Payer: Multiplan Medicare/VA |
$420.60
|
| Rate for Payer: One Health Plan of WY PPO |
$2,548.00
|
| Rate for Payer: PacificSource Commercial |
$2,340.00
|
| Rate for Payer: PHCS PPO |
$2,470.00
|
| Rate for Payer: Three Rivers PPO |
$1,950.00
|
| Rate for Payer: TriWest Veterans Administration |
$494.82
|
| Rate for Payer: United Healthcare Commercial |
$2,262.00
|
| Rate for Payer: United Healthcare Medicare |
$494.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,210.00
|
|
|
I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC
|
Professional
|
Both
|
$3,869.00
|
|
|
Service Code
|
HCPCS 22015
|
| Hospital Charge Code |
22015
|
| Min. Negotiated Rate |
$776.41 |
| Max. Negotiated Rate |
$3,869.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,791.62
|
| Rate for Payer: Aetna of WY Medicare |
$913.42
|
| Rate for Payer: Beech Street Commercial |
$3,675.55
|
| Rate for Payer: Cash Price |
$2,708.30
|
| Rate for Payer: Cash Price |
$2,708.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,752.93
|
| Rate for Payer: Cigna of WY Commercial |
$3,791.62
|
| Rate for Payer: First Choice Health Commercial |
$3,482.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,675.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$913.42
|
| Rate for Payer: HealthUtah PPO |
$3,869.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,752.93
|
| Rate for Payer: Multiplan Medicare/VA |
$776.41
|
| Rate for Payer: One Health Plan of WY PPO |
$3,791.62
|
| Rate for Payer: PacificSource Commercial |
$3,482.10
|
| Rate for Payer: PHCS PPO |
$3,675.55
|
| Rate for Payer: Three Rivers PPO |
$2,901.75
|
| Rate for Payer: TriWest Veterans Administration |
$913.42
|
| Rate for Payer: United Healthcare Commercial |
$3,366.03
|
| Rate for Payer: United Healthcare Medicare |
$913.42
|
| Rate for Payer: WINHealth Partners Commercial |
$3,288.65
|
|
|
I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 21501
|
| Hospital Charge Code |
21501
|
| Min. Negotiated Rate |
$279.33 |
| Max. Negotiated Rate |
$1,678.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,644.44
|
| Rate for Payer: Aetna of WY Medicare |
$328.62
|
| Rate for Payer: Beech Street Commercial |
$1,594.10
|
| Rate for Payer: Cash Price |
$1,174.60
|
| Rate for Payer: Cash Price |
$1,174.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,627.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,644.44
|
| Rate for Payer: First Choice Health Commercial |
$1,510.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,594.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$328.62
|
| Rate for Payer: HealthUtah PPO |
$1,678.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,627.66
|
| Rate for Payer: Multiplan Medicare/VA |
$279.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,644.44
|
| Rate for Payer: PacificSource Commercial |
$1,510.20
|
| Rate for Payer: PHCS PPO |
$1,594.10
|
| Rate for Payer: Three Rivers PPO |
$1,258.50
|
| Rate for Payer: TriWest Veterans Administration |
$328.62
|
| Rate for Payer: United Healthcare Commercial |
$1,459.86
|
| Rate for Payer: United Healthcare Medicare |
$328.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,426.30
|
|
|
I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$3,993.00
|
|
|
Service Code
|
HCPCS 25028
|
| Hospital Charge Code |
25028
|
| Min. Negotiated Rate |
$576.56 |
| Max. Negotiated Rate |
$3,993.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,913.14
|
| Rate for Payer: Aetna of WY Medicare |
$678.31
|
| Rate for Payer: Beech Street Commercial |
$3,793.35
|
| Rate for Payer: Cash Price |
$2,795.10
|
| Rate for Payer: Cash Price |
$2,795.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,873.21
|
| Rate for Payer: Cigna of WY Commercial |
$3,913.14
|
| Rate for Payer: First Choice Health Commercial |
$3,593.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,793.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$678.31
|
| Rate for Payer: HealthUtah PPO |
$3,993.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,873.21
|
| Rate for Payer: Multiplan Medicare/VA |
$576.56
|
| Rate for Payer: One Health Plan of WY PPO |
$3,913.14
|
| Rate for Payer: PacificSource Commercial |
$3,593.70
|
| Rate for Payer: PHCS PPO |
$3,793.35
|
| Rate for Payer: Three Rivers PPO |
$2,994.75
|
| Rate for Payer: TriWest Veterans Administration |
$678.31
|
| Rate for Payer: United Healthcare Commercial |
$3,473.91
|
| Rate for Payer: United Healthcare Medicare |
$678.31
|
| Rate for Payer: WINHealth Partners Commercial |
$3,394.05
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 10140
|
| Hospital Charge Code |
10140
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$582.12
|
| Rate for Payer: Aetna of WY Medicare |
$115.10
|
| Rate for Payer: Beech Street Commercial |
$564.30
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$576.18
|
| Rate for Payer: Cigna of WY Commercial |
$582.12
|
| Rate for Payer: First Choice Health Commercial |
$534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.10
|
| Rate for Payer: HealthUtah PPO |
$594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$576.18
|
| Rate for Payer: Multiplan Medicare/VA |
$97.84
|
| Rate for Payer: One Health Plan of WY PPO |
$582.12
|
| Rate for Payer: PacificSource Commercial |
$534.60
|
| Rate for Payer: PHCS PPO |
$564.30
|
| Rate for Payer: Three Rivers PPO |
$445.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.10
|
| Rate for Payer: United Healthcare Commercial |
$516.78
|
| Rate for Payer: United Healthcare Medicare |
$115.10
|
| Rate for Payer: WINHealth Partners Commercial |
$504.90
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 10140 80
|
| Hospital Charge Code |
10140
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$582.12
|
| Rate for Payer: Aetna of WY Medicare |
$115.10
|
| Rate for Payer: Beech Street Commercial |
$564.30
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$576.18
|
| Rate for Payer: Cigna of WY Commercial |
$582.12
|
| Rate for Payer: First Choice Health Commercial |
$534.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$564.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.10
|
| Rate for Payer: HealthUtah PPO |
$594.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$576.18
|
| Rate for Payer: Multiplan Medicare/VA |
$97.84
|
| Rate for Payer: One Health Plan of WY PPO |
$582.12
|
| Rate for Payer: PacificSource Commercial |
$534.60
|
| Rate for Payer: PHCS PPO |
$564.30
|
| Rate for Payer: Three Rivers PPO |
$445.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.10
|
| Rate for Payer: United Healthcare Commercial |
$516.78
|
| Rate for Payer: United Healthcare Medicare |
$115.10
|
| Rate for Payer: WINHealth Partners Commercial |
$504.90
|
|
