|
TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
HCPCS 42825
|
| Hospital Charge Code |
42825
|
| Min. Negotiated Rate |
$223.76 |
| Max. Negotiated Rate |
$1,349.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,322.02
|
| Rate for Payer: Aetna of WY Medicare |
$263.25
|
| Rate for Payer: Beech Street Commercial |
$1,281.55
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,308.53
|
| Rate for Payer: Cigna of WY Commercial |
$1,322.02
|
| Rate for Payer: First Choice Health Commercial |
$1,214.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,281.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$263.25
|
| Rate for Payer: HealthUtah PPO |
$1,349.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,308.53
|
| Rate for Payer: Multiplan Medicare/VA |
$223.76
|
| Rate for Payer: One Health Plan of WY PPO |
$1,322.02
|
| Rate for Payer: PacificSource Commercial |
$1,214.10
|
| Rate for Payer: PHCS PPO |
$1,281.55
|
| Rate for Payer: Three Rivers PPO |
$1,011.75
|
| Rate for Payer: TriWest Veterans Administration |
$263.25
|
| Rate for Payer: United Healthcare Commercial |
$1,173.63
|
| Rate for Payer: United Healthcare Medicare |
$263.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1,146.65
|
|
|
TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$1,291.00
|
|
|
Service Code
|
HCPCS 42826
|
| Hospital Charge Code |
42826
|
| Min. Negotiated Rate |
$212.91 |
| Max. Negotiated Rate |
$1,291.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,265.18
|
| Rate for Payer: Aetna of WY Medicare |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$1,226.45
|
| Rate for Payer: Cash Price |
$903.70
|
| Rate for Payer: Cash Price |
$903.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,252.27
|
| Rate for Payer: Cigna of WY Commercial |
$1,265.18
|
| Rate for Payer: First Choice Health Commercial |
$1,161.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,226.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$250.48
|
| Rate for Payer: HealthUtah PPO |
$1,291.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,252.27
|
| Rate for Payer: Multiplan Medicare/VA |
$212.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,265.18
|
| Rate for Payer: PacificSource Commercial |
$1,161.90
|
| Rate for Payer: PHCS PPO |
$1,226.45
|
| Rate for Payer: Three Rivers PPO |
$968.25
|
| Rate for Payer: TriWest Veterans Administration |
$250.48
|
| Rate for Payer: United Healthcare Commercial |
$1,123.17
|
| Rate for Payer: United Healthcare Medicare |
$250.48
|
| Rate for Payer: WINHealth Partners Commercial |
$1,097.35
|
|
|
TOPICAL APPLICATION OF FLUORIDE VARNISH
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS D1206
|
| Hospital Charge Code |
D1206
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.06
|
| Rate for Payer: Beech Street Commercial |
$44.65
|
| Rate for Payer: Cash Price |
$32.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.59
|
| Rate for Payer: Cigna of WY Commercial |
$46.06
|
| Rate for Payer: First Choice Health Commercial |
$42.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.65
|
| Rate for Payer: HealthUtah PPO |
$47.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.59
|
| Rate for Payer: One Health Plan of WY PPO |
$46.06
|
| Rate for Payer: PacificSource Commercial |
$42.30
|
| Rate for Payer: PHCS PPO |
$44.65
|
| Rate for Payer: Three Rivers PPO |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$40.89
|
| Rate for Payer: WINHealth Partners Commercial |
$44.65
|
|
|
TOPIRAMATE 100 MG TABLET [18699]
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
NDC 6808434401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.25
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
TOPIRAMATE 100 MG TABLET [18699]
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
NDC 6808434401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Aetna of WY Medicare |
$1.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.10
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
TOPIRAMATE 100 MG TABLET [18699]
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
NDC 6808434411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.25
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
| Rate for Payer: WINHealth Partners Commercial |
$1.80
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
TOPIRAMATE 100 MG TABLET [18699]
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
NDC 6808434411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.86
|
| Rate for Payer: Aetna of WY Medicare |
$1.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.82
|
| Rate for Payer: Altius Commercial |
$1.82
|
| Rate for Payer: Beech Street Commercial |
$1.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.84
|
| Rate for Payer: Cigna of WY Commercial |
$1.86
|
| Rate for Payer: Entrust Commercial |
$1.80
|
| Rate for Payer: First Choice Health Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.10
|
| Rate for Payer: HealthUtah PPO |
$1.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.84
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.86
|
| Rate for Payer: PacificSource Commercial |
$1.71
|
| Rate for Payer: PHCS PPO |
$1.86
|
| Rate for Payer: Three Rivers PPO |
$1.42
|
| Rate for Payer: TriWest Veterans Administration |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$1.10
|
| Rate for Payer: WINHealth Partners Commercial |
$1.86
|
| Rate for Payer: Wise Provider Network Commercial |
$1.80
|
|
|
TOPIRAMATE 25 MG TABLET [6588]
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
NDC 6808434201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.14
|
| Rate for Payer: Altius Commercial |
$1.14
|
| Rate for Payer: Beech Street Commercial |
$1.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.15
|
| Rate for Payer: Cigna of WY Commercial |
$1.17
|
| Rate for Payer: Entrust Commercial |
$1.13
|
| Rate for Payer: First Choice Health Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.79
|
| Rate for Payer: HealthUtah PPO |
$1.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1.17
|
| Rate for Payer: PacificSource Commercial |
$1.07
|
| Rate for Payer: PHCS PPO |
$1.17
|
| Rate for Payer: Three Rivers PPO |
$0.89
|
| 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 |
$1.13
|
| Rate for Payer: Wise Provider Network Commercial |
$1.13
|
|
|
TOPIRAMATE 25 MG TABLET [6588]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 6808434201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.14
|
| Rate for Payer: Altius Commercial |
$1.14
|
| Rate for Payer: Beech Street Commercial |
$1.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.15
|
| Rate for Payer: Cigna of WY Commercial |
$1.17
|
| Rate for Payer: Entrust Commercial |
$1.13
|
| Rate for Payer: First Choice Health Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.17
|
| Rate for Payer: PacificSource Commercial |
$1.07
|
| Rate for Payer: PHCS PPO |
$1.17
|
| Rate for Payer: Three Rivers PPO |
$0.89
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1.13
|
|
|
TOPIRAMATE 25 MG TABLET [6588]
|
Facility
|
IP
|
$1.19
|
|
|
Service Code
|
NDC 6808434211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.14
|
| Rate for Payer: Altius Commercial |
$1.14
|
| Rate for Payer: Beech Street Commercial |
$1.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.15
|
| Rate for Payer: Cigna of WY Commercial |
$1.17
|
| Rate for Payer: Entrust Commercial |
$1.13
|
| Rate for Payer: First Choice Health Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.79
|
| Rate for Payer: HealthUtah PPO |
$1.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.75
|
| Rate for Payer: One Health Plan of WY PPO |
$1.17
|
| Rate for Payer: PacificSource Commercial |
$1.07
|
| Rate for Payer: PHCS PPO |
$1.17
|
| Rate for Payer: Three Rivers PPO |
$0.89
|
| 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 |
$1.13
|
| Rate for Payer: Wise Provider Network Commercial |
$1.13
|
|
|
TOPIRAMATE 25 MG TABLET [6588]
|
Facility
|
OP
|
$1.19
|
|
|
Service Code
|
NDC 6808434211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.14
|
| Rate for Payer: Altius Commercial |
$1.14
|
| Rate for Payer: Beech Street Commercial |
$1.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.15
|
| Rate for Payer: Cigna of WY Commercial |
$1.17
|
| Rate for Payer: Entrust Commercial |
$1.13
|
| Rate for Payer: First Choice Health Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.15
|
| Rate for Payer: Multiplan Medicare/VA |
$0.66
|
| Rate for Payer: One Health Plan of WY PPO |
$1.17
|
| Rate for Payer: PacificSource Commercial |
$1.07
|
| Rate for Payer: PHCS PPO |
$1.17
|
| Rate for Payer: Three Rivers PPO |
$0.89
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1.13
|
|
|
TORSEMIDE 20 MG TABLET [2170]
|
Facility
|
IP
|
$1.42
|
|
|
Service Code
|
NDC 6808453901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.94
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 20 MG TABLET [2170]
|
Facility
|
OP
|
$1.42
|
|
|
Service Code
|
NDC 6808453901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.39
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 20 MG TABLET [2170]
|
Facility
|
IP
|
$1.42
|
|
|
Service Code
|
NDC 6808453911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.94
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 20 MG TABLET [2170]
|
Facility
|
OP
|
$1.42
|
|
|
Service Code
|
NDC 6808453911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.39
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 5 MG TABLET [11846]
|
Facility
|
IP
|
$0.56
|
|
|
Service Code
|
NDC 2315587101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.37
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.35
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.37
|
| Rate for Payer: United Healthcare Commercial |
$0.49
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
| Rate for Payer: WINHealth Partners Commercial |
$0.53
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
TORSEMIDE 5 MG TABLET [11846]
|
Facility
|
OP
|
$0.56
|
|
|
Service Code
|
NDC 2315587101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.54
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.46
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.31
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.49
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
TORSEMIDE 5 MG TABLET [11846]
|
Facility
|
IP
|
$1.42
|
|
|
Service Code
|
NDC 5026875411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.94
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 5 MG TABLET [11846]
|
Facility
|
OP
|
$1.42
|
|
|
Service Code
|
NDC 5026875411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.39
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 5 MG TABLET [11846]
|
Facility
|
IP
|
$1.42
|
|
|
Service Code
|
NDC 5026875415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.94
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.89
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.94
|
| Rate for Payer: WINHealth Partners Commercial |
$1.35
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TORSEMIDE 5 MG TABLET [11846]
|
Facility
|
OP
|
$1.42
|
|
|
Service Code
|
NDC 5026875415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.39
|
| Rate for Payer: Aetna of WY Medicare |
$0.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.36
|
| Rate for Payer: Altius Commercial |
$1.36
|
| Rate for Payer: Beech Street Commercial |
$1.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.38
|
| Rate for Payer: Cigna of WY Commercial |
$1.39
|
| Rate for Payer: Entrust Commercial |
$1.35
|
| Rate for Payer: First Choice Health Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.39
|
| Rate for Payer: PacificSource Commercial |
$1.28
|
| Rate for Payer: PHCS PPO |
$1.39
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.39
|
| Rate for Payer: Wise Provider Network Commercial |
$1.35
|
|
|
TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$5,229.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
58150
|
| Min. Negotiated Rate |
$831.10 |
| Max. Negotiated Rate |
$5,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,124.42
|
| Rate for Payer: Aetna of WY Medicare |
$977.76
|
| Rate for Payer: Beech Street Commercial |
$4,967.55
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,072.13
|
| Rate for Payer: Cigna of WY Commercial |
$5,124.42
|
| Rate for Payer: First Choice Health Commercial |
$4,706.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,967.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.76
|
| Rate for Payer: HealthUtah PPO |
$5,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,072.13
|
| Rate for Payer: Multiplan Medicare/VA |
$831.10
|
| Rate for Payer: One Health Plan of WY PPO |
$5,124.42
|
| Rate for Payer: PacificSource Commercial |
$4,706.10
|
| Rate for Payer: PHCS PPO |
$4,967.55
|
| Rate for Payer: Three Rivers PPO |
$3,921.75
|
| Rate for Payer: TriWest Veterans Administration |
$977.76
|
| Rate for Payer: United Healthcare Commercial |
$4,549.23
|
| Rate for Payer: United Healthcare Medicare |
$977.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4,444.65
|
|
|
TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$5,229.00
|
|
|
Service Code
|
HCPCS 58150 AS
|
| Hospital Charge Code |
58150
|
| Min. Negotiated Rate |
$831.10 |
| Max. Negotiated Rate |
$5,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,124.42
|
| Rate for Payer: Aetna of WY Medicare |
$977.76
|
| Rate for Payer: Beech Street Commercial |
$4,967.55
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,072.13
|
| Rate for Payer: Cigna of WY Commercial |
$5,124.42
|
| Rate for Payer: First Choice Health Commercial |
$4,706.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,967.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.76
|
| Rate for Payer: HealthUtah PPO |
$5,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,072.13
|
| Rate for Payer: Multiplan Medicare/VA |
$831.10
|
| Rate for Payer: One Health Plan of WY PPO |
$5,124.42
|
| Rate for Payer: PacificSource Commercial |
$4,706.10
|
| Rate for Payer: PHCS PPO |
$4,967.55
|
| Rate for Payer: Three Rivers PPO |
$3,921.75
|
| Rate for Payer: TriWest Veterans Administration |
$977.76
|
| Rate for Payer: United Healthcare Commercial |
$4,549.23
|
| Rate for Payer: United Healthcare Medicare |
$977.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4,444.65
|
|
|
TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$5,229.00
|
|
|
Service Code
|
HCPCS 58150 80
|
| Hospital Charge Code |
58150
|
| Min. Negotiated Rate |
$831.10 |
| Max. Negotiated Rate |
$5,229.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,124.42
|
| Rate for Payer: Aetna of WY Medicare |
$977.76
|
| Rate for Payer: Beech Street Commercial |
$4,967.55
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: Cash Price |
$3,660.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,072.13
|
| Rate for Payer: Cigna of WY Commercial |
$5,124.42
|
| Rate for Payer: First Choice Health Commercial |
$4,706.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,967.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$977.76
|
| Rate for Payer: HealthUtah PPO |
$5,229.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,072.13
|
| Rate for Payer: Multiplan Medicare/VA |
$831.10
|
| Rate for Payer: One Health Plan of WY PPO |
$5,124.42
|
| Rate for Payer: PacificSource Commercial |
$4,706.10
|
| Rate for Payer: PHCS PPO |
$4,967.55
|
| Rate for Payer: Three Rivers PPO |
$3,921.75
|
| Rate for Payer: TriWest Veterans Administration |
$977.76
|
| Rate for Payer: United Healthcare Commercial |
$4,549.23
|
| Rate for Payer: United Healthcare Medicare |
$977.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4,444.65
|
|
|
TOTAL DISC ARTHRP ANT 2ND LEVEL CERVICAL
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 22858 AS
|
| Hospital Charge Code |
22858
|
| Min. Negotiated Rate |
$402.10 |
| Max. Negotiated Rate |
$2,032.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,991.36
|
| Rate for Payer: Aetna of WY Medicare |
$473.06
|
| Rate for Payer: Beech Street Commercial |
$1,930.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: Cash Price |
$1,422.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,971.04
|
| Rate for Payer: Cigna of WY Commercial |
$1,991.36
|
| Rate for Payer: First Choice Health Commercial |
$1,828.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,930.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$473.06
|
| Rate for Payer: HealthUtah PPO |
$2,032.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,971.04
|
| Rate for Payer: Multiplan Medicare/VA |
$402.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1,991.36
|
| Rate for Payer: PacificSource Commercial |
$1,828.80
|
| Rate for Payer: PHCS PPO |
$1,930.40
|
| Rate for Payer: Three Rivers PPO |
$1,524.00
|
| Rate for Payer: TriWest Veterans Administration |
$473.06
|
| Rate for Payer: United Healthcare Commercial |
$1,767.84
|
| Rate for Payer: United Healthcare Medicare |
$473.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,727.20
|
|
