|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 6332326970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.17
|
| Rate for Payer: Aetna of WY Medicare |
$10.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.86
|
| Rate for Payer: Altius Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.02
|
| Rate for Payer: Cigna of WY Commercial |
$15.17
|
| Rate for Payer: Entrust Commercial |
$14.71
|
| Rate for Payer: First Choice Health Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.98
|
| Rate for Payer: HealthUtah PPO |
$15.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.02
|
| Rate for Payer: Multiplan Medicare/VA |
$8.53
|
| Rate for Payer: One Health Plan of WY PPO |
$15.17
|
| Rate for Payer: PacificSource Commercial |
$13.93
|
| Rate for Payer: PHCS PPO |
$15.17
|
| Rate for Payer: Three Rivers PPO |
$11.61
|
| Rate for Payer: TriWest Veterans Administration |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare |
$8.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.17
|
| Rate for Payer: Wise Provider Network Commercial |
$14.71
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 6332326965
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Aetna of WY Medicare |
$10.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.55
|
| Rate for Payer: Altius Commercial |
$15.55
|
| Rate for Payer: Beech Street Commercial |
$15.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.71
|
| Rate for Payer: Cigna of WY Commercial |
$15.88
|
| Rate for Payer: Entrust Commercial |
$15.39
|
| Rate for Payer: First Choice Health Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.40
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.88
|
| Rate for Payer: PacificSource Commercial |
$14.58
|
| Rate for Payer: PHCS PPO |
$15.88
|
| Rate for Payer: Three Rivers PPO |
$12.15
|
| Rate for Payer: TriWest Veterans Administration |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$14.09
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
| Rate for Payer: WINHealth Partners Commercial |
$15.88
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
NDC 6332326970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.86
|
| Rate for Payer: Altius Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.02
|
| Rate for Payer: Cigna of WY Commercial |
$15.17
|
| Rate for Payer: Entrust Commercial |
$14.71
|
| Rate for Payer: First Choice Health Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.22
|
| Rate for Payer: HealthUtah PPO |
$15.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.02
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.17
|
| Rate for Payer: PacificSource Commercial |
$13.93
|
| Rate for Payer: PHCS PPO |
$15.17
|
| Rate for Payer: Three Rivers PPO |
$11.61
|
| Rate for Payer: TriWest Veterans Administration |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.71
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 6332326929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.55
|
| Rate for Payer: Altius Commercial |
$15.55
|
| Rate for Payer: Beech Street Commercial |
$15.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.71
|
| Rate for Payer: Cigna of WY Commercial |
$15.88
|
| Rate for Payer: Entrust Commercial |
$15.39
|
| Rate for Payer: First Choice Health Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.69
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$10.16
|
| Rate for Payer: One Health Plan of WY PPO |
$15.88
|
| Rate for Payer: PacificSource Commercial |
$14.58
|
| Rate for Payer: PHCS PPO |
$15.88
|
| Rate for Payer: Three Rivers PPO |
$12.15
|
| Rate for Payer: TriWest Veterans Administration |
$10.69
|
| Rate for Payer: United Healthcare Commercial |
$14.09
|
| Rate for Payer: United Healthcare Medicare |
$10.69
|
| Rate for Payer: WINHealth Partners Commercial |
$15.39
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 6332326922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Aetna of WY Medicare |
$10.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.55
|
| Rate for Payer: Altius Commercial |
$15.55
|
| Rate for Payer: Beech Street Commercial |
$15.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.71
|
| Rate for Payer: Cigna of WY Commercial |
$15.88
|
| Rate for Payer: Entrust Commercial |
$15.39
|
| Rate for Payer: First Choice Health Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.40
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.88
|
| Rate for Payer: PacificSource Commercial |
$14.58
|
| Rate for Payer: PHCS PPO |
$15.88
|
| Rate for Payer: Three Rivers PPO |
$12.15
|
| Rate for Payer: TriWest Veterans Administration |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$14.09
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
| Rate for Payer: WINHealth Partners Commercial |
$15.88
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 6332326978
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.17
|
| Rate for Payer: Aetna of WY Medicare |
$10.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.86
|
| Rate for Payer: Altius Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.02
|
| Rate for Payer: Cigna of WY Commercial |
$15.17
|
| Rate for Payer: Entrust Commercial |
$14.71
|
| Rate for Payer: First Choice Health Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.98
|
| Rate for Payer: HealthUtah PPO |
$15.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.02
|
| Rate for Payer: Multiplan Medicare/VA |
$8.53
|
| Rate for Payer: One Health Plan of WY PPO |
$15.17
|
| Rate for Payer: PacificSource Commercial |
$13.93
|
| Rate for Payer: PHCS PPO |
$15.17
|
| Rate for Payer: Three Rivers PPO |
$11.61
|
| Rate for Payer: TriWest Veterans Administration |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare |
$8.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.17
|
| Rate for Payer: Wise Provider Network Commercial |
$14.71
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
NDC 6332326978
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.86
|
| Rate for Payer: Altius Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.02
|
| Rate for Payer: Cigna of WY Commercial |
$15.17
|
| Rate for Payer: Entrust Commercial |
$14.71
|
| Rate for Payer: First Choice Health Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.22
|
| Rate for Payer: HealthUtah PPO |
$15.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.02
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.17
|
| Rate for Payer: PacificSource Commercial |
$13.93
|
| Rate for Payer: PHCS PPO |
$15.17
|
| Rate for Payer: Three Rivers PPO |
$11.61
|
| Rate for Payer: TriWest Veterans Administration |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.71
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 6332326929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Aetna of WY Medicare |
$10.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.55
|
| Rate for Payer: Altius Commercial |
$15.55
|
| Rate for Payer: Beech Street Commercial |
$15.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.71
|
| Rate for Payer: Cigna of WY Commercial |
$15.88
|
| Rate for Payer: Entrust Commercial |
$15.39
|
| Rate for Payer: First Choice Health Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.40
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$8.93
|
| Rate for Payer: One Health Plan of WY PPO |
$15.88
|
| Rate for Payer: PacificSource Commercial |
$14.58
|
| Rate for Payer: PHCS PPO |
$15.88
|
| Rate for Payer: Three Rivers PPO |
$12.15
|
| Rate for Payer: TriWest Veterans Administration |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$14.09
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
| Rate for Payer: WINHealth Partners Commercial |
$15.88
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION [17487]
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 6332326965
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.55
|
| Rate for Payer: Altius Commercial |
$15.55
|
| Rate for Payer: Beech Street Commercial |
$15.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.71
|
| Rate for Payer: Cigna of WY Commercial |
$15.88
|
| Rate for Payer: Entrust Commercial |
$15.39
|
| Rate for Payer: First Choice Health Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.69
|
| Rate for Payer: HealthUtah PPO |
$16.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.71
|
| Rate for Payer: Multiplan Medicare/VA |
$10.16
|
| Rate for Payer: One Health Plan of WY PPO |
$15.88
|
| Rate for Payer: PacificSource Commercial |
$14.58
|
| Rate for Payer: PHCS PPO |
$15.88
|
| Rate for Payer: Three Rivers PPO |
$12.15
|
| Rate for Payer: TriWest Veterans Administration |
$10.69
|
| Rate for Payer: United Healthcare Commercial |
$14.09
|
| Rate for Payer: United Healthcare Medicare |
$10.69
|
| Rate for Payer: WINHealth Partners Commercial |
$15.39
|
| Rate for Payer: Wise Provider Network Commercial |
$15.39
|
|
|
PROPOFOL INFUSION 10 MG/ML [40840026]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.79
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.79
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
PROPOFOL INFUSION 10 MG/ML [40840026]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J2704
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.15
|
| Rate for Payer: Altius Commercial |
$1.15
|
| Rate for Payer: Beech Street Commercial |
$1.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.99
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.16
|
| Rate for Payer: Cigna of WY Commercial |
$1.18
|
| Rate for Payer: Entrust Commercial |
$1.14
|
| Rate for Payer: First Choice Health Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.70
|
| Rate for Payer: HealthUtah PPO |
$1.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.18
|
| Rate for Payer: PacificSource Commercial |
$1.08
|
| Rate for Payer: PHCS PPO |
$1.18
|
| Rate for Payer: Three Rivers PPO |
$0.90
|
| Rate for Payer: TriWest Veterans Administration |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1.18
|
| Rate for Payer: Wise Provider Network Commercial |
$1.14
|
|
|
PROPRANOLOL 20 MG TABLET [18174]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 6068759801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.81
|
| Rate for Payer: Aetna of WY Medicare |
$1.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.78
|
| Rate for Payer: Altius Commercial |
$1.78
|
| Rate for Payer: Beech Street Commercial |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.52
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.79
|
| Rate for Payer: Cigna of WY Commercial |
$1.81
|
| Rate for Payer: Entrust Commercial |
$1.76
|
| Rate for Payer: First Choice Health Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.07
|
| Rate for Payer: HealthUtah PPO |
$1.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1.81
|
| Rate for Payer: PacificSource Commercial |
$1.66
|
| Rate for Payer: PHCS PPO |
$1.81
|
| Rate for Payer: Three Rivers PPO |
$1.39
|
| Rate for Payer: TriWest Veterans Administration |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Medicare |
$1.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1.81
|
| Rate for Payer: Wise Provider Network Commercial |
$1.76
|
|
|
PROPRANOLOL 20 MG TABLET [18174]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 6068759811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.78
|
| Rate for Payer: Altius Commercial |
$1.78
|
| Rate for Payer: Beech Street Commercial |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.52
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.79
|
| Rate for Payer: Cigna of WY Commercial |
$1.81
|
| Rate for Payer: Entrust Commercial |
$1.76
|
| Rate for Payer: First Choice Health Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.22
|
| Rate for Payer: HealthUtah PPO |
$1.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1.81
|
| Rate for Payer: PacificSource Commercial |
$1.66
|
| Rate for Payer: PHCS PPO |
$1.81
|
| Rate for Payer: Three Rivers PPO |
$1.39
|
| Rate for Payer: TriWest Veterans Administration |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Medicare |
$1.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1.76
|
|
|
PROPRANOLOL 20 MG TABLET [18174]
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
NDC 6068759811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.81
|
| Rate for Payer: Aetna of WY Medicare |
$1.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.78
|
| Rate for Payer: Altius Commercial |
$1.78
|
| Rate for Payer: Beech Street Commercial |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.52
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.79
|
| Rate for Payer: Cigna of WY Commercial |
$1.81
|
| Rate for Payer: Entrust Commercial |
$1.76
|
| Rate for Payer: First Choice Health Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.07
|
| Rate for Payer: HealthUtah PPO |
$1.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1.02
|
| Rate for Payer: One Health Plan of WY PPO |
$1.81
|
| Rate for Payer: PacificSource Commercial |
$1.66
|
| Rate for Payer: PHCS PPO |
$1.81
|
| Rate for Payer: Three Rivers PPO |
$1.39
|
| Rate for Payer: TriWest Veterans Administration |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Medicare |
$1.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1.81
|
| Rate for Payer: Wise Provider Network Commercial |
$1.76
|
|
|
PROPRANOLOL 20 MG TABLET [18174]
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
NDC 6068759801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.78
|
| Rate for Payer: Altius Commercial |
$1.78
|
| Rate for Payer: Beech Street Commercial |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.52
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.79
|
| Rate for Payer: Cigna of WY Commercial |
$1.81
|
| Rate for Payer: Entrust Commercial |
$1.76
|
| Rate for Payer: First Choice Health Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.22
|
| Rate for Payer: HealthUtah PPO |
$1.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.79
|
| Rate for Payer: Multiplan Medicare/VA |
$1.16
|
| Rate for Payer: One Health Plan of WY PPO |
$1.81
|
| Rate for Payer: PacificSource Commercial |
$1.66
|
| Rate for Payer: PHCS PPO |
$1.81
|
| Rate for Payer: Three Rivers PPO |
$1.39
|
| Rate for Payer: TriWest Veterans Administration |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Medicare |
$1.22
|
| Rate for Payer: WINHealth Partners Commercial |
$1.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1.76
|
|
|
PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$6,512.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
23335
|
| Min. Negotiated Rate |
$1,035.05 |
| Max. Negotiated Rate |
$6,512.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,381.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,217.71
|
| Rate for Payer: Beech Street Commercial |
$6,186.40
|
| Rate for Payer: Cash Price |
$4,558.40
|
| Rate for Payer: Cash Price |
$4,558.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,316.64
|
| Rate for Payer: Cigna of WY Commercial |
$6,381.76
|
| Rate for Payer: First Choice Health Commercial |
$5,860.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,186.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,217.71
|
| Rate for Payer: HealthUtah PPO |
$6,512.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,316.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1,035.05
|
| Rate for Payer: One Health Plan of WY PPO |
$6,381.76
|
| Rate for Payer: PacificSource Commercial |
$5,860.80
|
| Rate for Payer: PHCS PPO |
$6,186.40
|
| Rate for Payer: Three Rivers PPO |
$4,884.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,217.71
|
| Rate for Payer: United Healthcare Commercial |
$5,665.44
|
| Rate for Payer: United Healthcare Medicare |
$1,217.71
|
| Rate for Payer: WINHealth Partners Commercial |
$5,535.20
|
|
|
PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$4,309.00
|
|
|
Service Code
|
HCPCS 24160 AS
|
| Hospital Charge Code |
24160
|
| Min. Negotiated Rate |
$1,026.40 |
| Max. Negotiated Rate |
$4,309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,222.82
|
| Rate for Payer: Aetna of WY Medicare |
$1,207.53
|
| Rate for Payer: Beech Street Commercial |
$4,093.55
|
| Rate for Payer: Cash Price |
$3,016.30
|
| Rate for Payer: Cash Price |
$3,016.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,179.73
|
| Rate for Payer: Cigna of WY Commercial |
$4,222.82
|
| Rate for Payer: First Choice Health Commercial |
$3,878.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,093.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,207.53
|
| Rate for Payer: HealthUtah PPO |
$4,309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,179.73
|
| Rate for Payer: Multiplan Medicare/VA |
$1,026.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,222.82
|
| Rate for Payer: PacificSource Commercial |
$3,878.10
|
| Rate for Payer: PHCS PPO |
$4,093.55
|
| Rate for Payer: Three Rivers PPO |
$3,231.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,207.53
|
| Rate for Payer: United Healthcare Commercial |
$3,748.83
|
| Rate for Payer: United Healthcare Medicare |
$1,207.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,662.65
|
|
|
PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$4,309.00
|
|
|
Service Code
|
HCPCS 24160 80
|
| Hospital Charge Code |
24160
|
| Min. Negotiated Rate |
$1,026.40 |
| Max. Negotiated Rate |
$4,309.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,222.82
|
| Rate for Payer: Aetna of WY Medicare |
$1,207.53
|
| Rate for Payer: Beech Street Commercial |
$4,093.55
|
| Rate for Payer: Cash Price |
$3,016.30
|
| Rate for Payer: Cash Price |
$3,016.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,179.73
|
| Rate for Payer: Cigna of WY Commercial |
$4,222.82
|
| Rate for Payer: First Choice Health Commercial |
$3,878.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,093.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,207.53
|
| Rate for Payer: HealthUtah PPO |
$4,309.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,179.73
|
| Rate for Payer: Multiplan Medicare/VA |
$1,026.40
|
| Rate for Payer: One Health Plan of WY PPO |
$4,222.82
|
| Rate for Payer: PacificSource Commercial |
$3,878.10
|
| Rate for Payer: PHCS PPO |
$4,093.55
|
| Rate for Payer: Three Rivers PPO |
$3,231.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,207.53
|
| Rate for Payer: United Healthcare Commercial |
$3,748.83
|
| Rate for Payer: United Healthcare Medicare |
$1,207.53
|
| Rate for Payer: WINHealth Partners Commercial |
$3,662.65
|
|
|
PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$2,513.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
24164
|
| Min. Negotiated Rate |
$598.74 |
| Max. Negotiated Rate |
$2,513.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,462.74
|
| Rate for Payer: Aetna of WY Medicare |
$704.40
|
| Rate for Payer: Beech Street Commercial |
$2,387.35
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: Cash Price |
$1,759.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,437.61
|
| Rate for Payer: Cigna of WY Commercial |
$2,462.74
|
| Rate for Payer: First Choice Health Commercial |
$2,261.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,387.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$704.40
|
| Rate for Payer: HealthUtah PPO |
$2,513.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,437.61
|
| Rate for Payer: Multiplan Medicare/VA |
$598.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2,462.74
|
| Rate for Payer: PacificSource Commercial |
$2,261.70
|
| Rate for Payer: PHCS PPO |
$2,387.35
|
| Rate for Payer: Three Rivers PPO |
$1,884.75
|
| Rate for Payer: TriWest Veterans Administration |
$704.40
|
| Rate for Payer: United Healthcare Commercial |
$2,186.31
|
| Rate for Payer: United Healthcare Medicare |
$704.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,136.05
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [2434]
|
Facility
|
OP
|
$26.61
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$26.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.08
|
| Rate for Payer: Aetna of WY Medicare |
$17.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.55
|
| Rate for Payer: Altius Commercial |
$25.55
|
| Rate for Payer: Beech Street Commercial |
$26.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.81
|
| Rate for Payer: Cigna of WY Commercial |
$26.08
|
| Rate for Payer: Entrust Commercial |
$25.28
|
| Rate for Payer: First Choice Health Commercial |
$25.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.43
|
| Rate for Payer: HealthUtah PPO |
$26.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.81
|
| Rate for Payer: Multiplan Medicare/VA |
$14.66
|
| Rate for Payer: One Health Plan of WY PPO |
$26.08
|
| Rate for Payer: PacificSource Commercial |
$23.95
|
| Rate for Payer: PHCS PPO |
$26.08
|
| Rate for Payer: Three Rivers PPO |
$19.96
|
| Rate for Payer: TriWest Veterans Administration |
$15.43
|
| Rate for Payer: United Healthcare Commercial |
$23.15
|
| Rate for Payer: United Healthcare Medicare |
$15.43
|
| Rate for Payer: WINHealth Partners Commercial |
$26.08
|
| Rate for Payer: Wise Provider Network Commercial |
$25.28
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION [2434]
|
Facility
|
IP
|
$26.61
|
|
|
Service Code
|
HCPCS J2720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.68 |
| Max. Negotiated Rate |
$26.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.55
|
| Rate for Payer: Altius Commercial |
$25.55
|
| Rate for Payer: Beech Street Commercial |
$26.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.81
|
| Rate for Payer: Cigna of WY Commercial |
$26.08
|
| Rate for Payer: Entrust Commercial |
$25.28
|
| Rate for Payer: First Choice Health Commercial |
$25.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.56
|
| Rate for Payer: HealthUtah PPO |
$26.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.81
|
| Rate for Payer: Multiplan Medicare/VA |
$16.68
|
| Rate for Payer: One Health Plan of WY PPO |
$26.08
|
| Rate for Payer: PacificSource Commercial |
$23.95
|
| Rate for Payer: PHCS PPO |
$26.08
|
| Rate for Payer: Three Rivers PPO |
$19.96
|
| Rate for Payer: TriWest Veterans Administration |
$17.56
|
| Rate for Payer: United Healthcare Commercial |
$23.15
|
| Rate for Payer: United Healthcare Medicare |
$17.56
|
| Rate for Payer: WINHealth Partners Commercial |
$25.28
|
| Rate for Payer: Wise Provider Network Commercial |
$25.28
|
|
|
PROTHROMBIN TIME
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 85610
|
| Hospital Charge Code |
85610
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$4.29
|
| Rate for Payer: Beech Street Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: First Choice Health Commercial |
$54.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.29
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$3.65
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$57.00
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$4.29
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$4.29
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
|
|
PR PCV21 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 90684
|
| Hospital Charge Code |
90684
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$511.56
|
| Rate for Payer: Beech Street Commercial |
$495.90
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$506.34
|
| Rate for Payer: Cigna of WY Commercial |
$511.56
|
| Rate for Payer: First Choice Health Commercial |
$469.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$495.90
|
| Rate for Payer: HealthUtah PPO |
$522.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$506.34
|
| Rate for Payer: One Health Plan of WY PPO |
$511.56
|
| Rate for Payer: PacificSource Commercial |
$469.80
|
| Rate for Payer: PHCS PPO |
$495.90
|
| Rate for Payer: Three Rivers PPO |
$391.50
|
| Rate for Payer: United Healthcare Commercial |
$454.14
|
| Rate for Payer: WINHealth Partners Commercial |
$522.00
|
|
|
PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$2,623.00
|
|
|
Service Code
|
HCPCS 64561
|
| Hospital Charge Code |
64561
|
| Min. Negotiated Rate |
$246.79 |
| Max. Negotiated Rate |
$2,623.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,570.54
|
| Rate for Payer: Aetna of WY Medicare |
$290.34
|
| Rate for Payer: Beech Street Commercial |
$2,491.85
|
| Rate for Payer: Cash Price |
$1,836.10
|
| Rate for Payer: Cash Price |
$1,836.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,544.31
|
| Rate for Payer: Cigna of WY Commercial |
$2,570.54
|
| Rate for Payer: First Choice Health Commercial |
$2,360.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,491.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$290.34
|
| Rate for Payer: HealthUtah PPO |
$2,623.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,544.31
|
| Rate for Payer: Multiplan Medicare/VA |
$246.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,570.54
|
| Rate for Payer: PacificSource Commercial |
$2,360.70
|
| Rate for Payer: PHCS PPO |
$2,491.85
|
| Rate for Payer: Three Rivers PPO |
$1,967.25
|
| Rate for Payer: TriWest Veterans Administration |
$290.34
|
| Rate for Payer: United Healthcare Commercial |
$2,282.01
|
| Rate for Payer: United Healthcare Medicare |
$290.34
|
| Rate for Payer: WINHealth Partners Commercial |
$2,229.55
|
|
|
PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$7,955.00
|
|
|
Service Code
|
HCPCS 63650 AS
|
| Hospital Charge Code |
63650
|
| Min. Negotiated Rate |
$339.73 |
| Max. Negotiated Rate |
$7,955.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,795.90
|
| Rate for Payer: Aetna of WY Medicare |
$399.68
|
| Rate for Payer: Beech Street Commercial |
$7,557.25
|
| Rate for Payer: Cash Price |
$5,568.50
|
| Rate for Payer: Cash Price |
$5,568.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,716.35
|
| Rate for Payer: Cigna of WY Commercial |
$7,795.90
|
| Rate for Payer: First Choice Health Commercial |
$7,159.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,557.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$399.68
|
| Rate for Payer: HealthUtah PPO |
$7,955.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,716.35
|
| Rate for Payer: Multiplan Medicare/VA |
$339.73
|
| Rate for Payer: One Health Plan of WY PPO |
$7,795.90
|
| Rate for Payer: PacificSource Commercial |
$7,159.50
|
| Rate for Payer: PHCS PPO |
$7,557.25
|
| Rate for Payer: Three Rivers PPO |
$5,966.25
|
| Rate for Payer: TriWest Veterans Administration |
$399.68
|
| Rate for Payer: United Healthcare Commercial |
$6,920.85
|
| Rate for Payer: United Healthcare Medicare |
$399.68
|
| Rate for Payer: WINHealth Partners Commercial |
$6,761.75
|
|
