|
US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 76937
|
| Hospital Charge Code |
76937
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$197.96
|
| Rate for Payer: Aetna of WY Medicare |
$37.31
|
| Rate for Payer: Beech Street Commercial |
$191.90
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: Cash Price |
$141.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$195.94
|
| Rate for Payer: Cigna of WY Commercial |
$197.96
|
| Rate for Payer: First Choice Health Commercial |
$181.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$191.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.31
|
| Rate for Payer: HealthUtah PPO |
$202.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$195.94
|
| Rate for Payer: Multiplan Medicare/VA |
$31.71
|
| Rate for Payer: One Health Plan of WY PPO |
$197.96
|
| Rate for Payer: PacificSource Commercial |
$181.80
|
| Rate for Payer: PHCS PPO |
$191.90
|
| Rate for Payer: Three Rivers PPO |
$151.50
|
| Rate for Payer: TriWest Veterans Administration |
$37.31
|
| Rate for Payer: United Healthcare Commercial |
$175.74
|
| Rate for Payer: United Healthcare Medicare |
$37.31
|
| Rate for Payer: WINHealth Partners Commercial |
$191.90
|
|
|
UTERINE MANIPULATOR VCARE MED
|
Facility
|
IP
|
$175.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.75 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.04
|
| Rate for Payer: Altius Commercial |
$168.04
|
| Rate for Payer: Beech Street Commercial |
$171.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.71
|
| Rate for Payer: Cash Price |
$122.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.79
|
| Rate for Payer: Cigna of WY Commercial |
$171.54
|
| Rate for Payer: Entrust Commercial |
$166.29
|
| Rate for Payer: First Choice Health Commercial |
$166.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.53
|
| Rate for Payer: HealthUtah PPO |
$175.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.79
|
| Rate for Payer: Multiplan Medicare/VA |
$109.75
|
| Rate for Payer: One Health Plan of WY PPO |
$171.54
|
| Rate for Payer: PacificSource Commercial |
$157.54
|
| Rate for Payer: PHCS PPO |
$171.54
|
| Rate for Payer: Three Rivers PPO |
$131.28
|
| Rate for Payer: TriWest Veterans Administration |
$115.53
|
| Rate for Payer: United Healthcare Commercial |
$152.28
|
| Rate for Payer: United Healthcare Medicare |
$115.53
|
| Rate for Payer: WINHealth Partners Commercial |
$166.29
|
| Rate for Payer: Wise Provider Network Commercial |
$166.29
|
|
|
UTERINE MANIPULATOR VCARE MED
|
Facility
|
OP
|
$175.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.45 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$171.54
|
| Rate for Payer: Aetna of WY Medicare |
$115.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$168.04
|
| Rate for Payer: Altius Commercial |
$168.04
|
| Rate for Payer: Beech Street Commercial |
$171.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.71
|
| Rate for Payer: Cash Price |
$122.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.79
|
| Rate for Payer: Cigna of WY Commercial |
$171.54
|
| Rate for Payer: Entrust Commercial |
$166.29
|
| Rate for Payer: First Choice Health Commercial |
$166.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$166.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.52
|
| Rate for Payer: HealthUtah PPO |
$175.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.79
|
| Rate for Payer: Multiplan Medicare/VA |
$96.45
|
| Rate for Payer: One Health Plan of WY PPO |
$171.54
|
| Rate for Payer: PacificSource Commercial |
$157.54
|
| Rate for Payer: PHCS PPO |
$171.54
|
| Rate for Payer: Three Rivers PPO |
$131.28
|
| Rate for Payer: TriWest Veterans Administration |
$101.52
|
| Rate for Payer: United Healthcare Commercial |
$152.28
|
| Rate for Payer: United Healthcare Medicare |
$101.52
|
| Rate for Payer: WINHealth Partners Commercial |
$171.54
|
| Rate for Payer: Wise Provider Network Commercial |
$166.29
|
|
|
UTERINE SOUND MDS6306000
|
Facility
|
IP
|
$8.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.90
|
| Rate for Payer: Altius Commercial |
$7.90
|
| Rate for Payer: Beech Street Commercial |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.98
|
| Rate for Payer: Cigna of WY Commercial |
$8.07
|
| Rate for Payer: Entrust Commercial |
$7.82
|
| Rate for Payer: First Choice Health Commercial |
$7.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.43
|
| Rate for Payer: HealthUtah PPO |
$8.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.98
|
| Rate for Payer: Multiplan Medicare/VA |
$5.16
|
| Rate for Payer: One Health Plan of WY PPO |
$8.07
|
| Rate for Payer: PacificSource Commercial |
$7.41
|
| Rate for Payer: PHCS PPO |
$8.07
|
| Rate for Payer: Three Rivers PPO |
$6.17
|
| Rate for Payer: TriWest Veterans Administration |
$5.43
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
| Rate for Payer: United Healthcare Medicare |
$5.43
|
| Rate for Payer: WINHealth Partners Commercial |
$7.82
|
| Rate for Payer: Wise Provider Network Commercial |
$7.82
|
|
|
UTERINE SOUND MDS6306000
|
Facility
|
OP
|
$8.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.07
|
| Rate for Payer: Aetna of WY Medicare |
$5.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.90
|
| Rate for Payer: Altius Commercial |
$7.90
|
| Rate for Payer: Beech Street Commercial |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.76
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.98
|
| Rate for Payer: Cigna of WY Commercial |
$8.07
|
| Rate for Payer: Entrust Commercial |
$7.82
|
| Rate for Payer: First Choice Health Commercial |
$7.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.77
|
| Rate for Payer: HealthUtah PPO |
$8.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.98
|
| Rate for Payer: Multiplan Medicare/VA |
$4.53
|
| Rate for Payer: One Health Plan of WY PPO |
$8.07
|
| Rate for Payer: PacificSource Commercial |
$7.41
|
| Rate for Payer: PHCS PPO |
$8.07
|
| Rate for Payer: Three Rivers PPO |
$6.17
|
| Rate for Payer: TriWest Veterans Administration |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
| Rate for Payer: United Healthcare Medicare |
$4.77
|
| Rate for Payer: WINHealth Partners Commercial |
$8.07
|
| Rate for Payer: Wise Provider Network Commercial |
$7.82
|
|
|
UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX
|
Professional
|
Both
|
$1,631.00
|
|
|
Service Code
|
HCPCS 58400
|
| Hospital Charge Code |
58400
|
| Min. Negotiated Rate |
$382.36 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,598.38
|
| Rate for Payer: Aetna of WY Medicare |
$449.83
|
| Rate for Payer: Beech Street Commercial |
$1,549.45
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,582.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,598.38
|
| Rate for Payer: First Choice Health Commercial |
$1,467.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,549.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$449.83
|
| Rate for Payer: HealthUtah PPO |
$1,631.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,582.07
|
| Rate for Payer: Multiplan Medicare/VA |
$382.36
|
| Rate for Payer: One Health Plan of WY PPO |
$1,598.38
|
| Rate for Payer: PacificSource Commercial |
$1,467.90
|
| Rate for Payer: PHCS PPO |
$1,549.45
|
| Rate for Payer: Three Rivers PPO |
$1,223.25
|
| Rate for Payer: TriWest Veterans Administration |
$449.83
|
| Rate for Payer: United Healthcare Commercial |
$1,418.97
|
| Rate for Payer: United Healthcare Medicare |
$449.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,386.35
|
|
|
UVULECTOMY EXCISION UVULA
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
42140
|
| Min. Negotiated Rate |
$136.03 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,066.24
|
| Rate for Payer: Aetna of WY Medicare |
$160.03
|
| Rate for Payer: Beech Street Commercial |
$1,033.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,055.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,066.24
|
| Rate for Payer: First Choice Health Commercial |
$979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,033.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.03
|
| Rate for Payer: HealthUtah PPO |
$1,088.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,055.36
|
| Rate for Payer: Multiplan Medicare/VA |
$136.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,066.24
|
| Rate for Payer: PacificSource Commercial |
$979.20
|
| Rate for Payer: PHCS PPO |
$1,033.60
|
| Rate for Payer: Three Rivers PPO |
$816.00
|
| Rate for Payer: TriWest Veterans Administration |
$160.03
|
| Rate for Payer: United Healthcare Commercial |
$946.56
|
| Rate for Payer: United Healthcare Medicare |
$160.03
|
| Rate for Payer: WINHealth Partners Commercial |
$924.80
|
|
|
VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$4,407.00
|
|
|
Service Code
|
HCPCS 58262
|
| Hospital Charge Code |
58262
|
| Min. Negotiated Rate |
$758.95 |
| Max. Negotiated Rate |
$4,407.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,318.86
|
| Rate for Payer: Aetna of WY Medicare |
$892.88
|
| Rate for Payer: Beech Street Commercial |
$4,186.65
|
| Rate for Payer: Cash Price |
$3,084.90
|
| Rate for Payer: Cash Price |
$3,084.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,274.79
|
| Rate for Payer: Cigna of WY Commercial |
$4,318.86
|
| Rate for Payer: First Choice Health Commercial |
$3,966.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,186.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$892.88
|
| Rate for Payer: HealthUtah PPO |
$4,407.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,274.79
|
| Rate for Payer: Multiplan Medicare/VA |
$758.95
|
| Rate for Payer: One Health Plan of WY PPO |
$4,318.86
|
| Rate for Payer: PacificSource Commercial |
$3,966.30
|
| Rate for Payer: PHCS PPO |
$4,186.65
|
| Rate for Payer: Three Rivers PPO |
$3,305.25
|
| Rate for Payer: TriWest Veterans Administration |
$892.88
|
| Rate for Payer: United Healthcare Commercial |
$3,834.09
|
| Rate for Payer: United Healthcare Medicare |
$892.88
|
| Rate for Payer: WINHealth Partners Commercial |
$3,745.95
|
|
|
VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,744.00
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
59612
|
| Min. Negotiated Rate |
$721.58 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,689.12
|
| Rate for Payer: Aetna of WY Medicare |
$848.92
|
| Rate for Payer: Beech Street Commercial |
$2,606.80
|
| Rate for Payer: Cash Price |
$1,920.80
|
| Rate for Payer: Cash Price |
$1,920.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,661.68
|
| Rate for Payer: Cigna of WY Commercial |
$2,689.12
|
| Rate for Payer: First Choice Health Commercial |
$2,469.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,606.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$848.92
|
| Rate for Payer: HealthUtah PPO |
$2,744.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,661.68
|
| Rate for Payer: Multiplan Medicare/VA |
$721.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2,689.12
|
| Rate for Payer: PacificSource Commercial |
$2,469.60
|
| Rate for Payer: PHCS PPO |
$2,606.80
|
| Rate for Payer: Three Rivers PPO |
$2,058.00
|
| Rate for Payer: TriWest Veterans Administration |
$848.92
|
| Rate for Payer: United Healthcare Commercial |
$2,387.28
|
| Rate for Payer: United Healthcare Medicare |
$848.92
|
| Rate for Payer: WINHealth Partners Commercial |
$2,332.40
|
|
|
VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$2,432.00
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
59409
|
| Min. Negotiated Rate |
$639.85 |
| Max. Negotiated Rate |
$2,383.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,383.36
|
| Rate for Payer: Aetna of WY Medicare |
$752.77
|
| Rate for Payer: Beech Street Commercial |
$2,310.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: Cash Price |
$1,702.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,359.04
|
| Rate for Payer: Cigna of WY Commercial |
$2,383.36
|
| Rate for Payer: First Choice Health Commercial |
$2,188.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,310.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$752.77
|
| Rate for Payer: HealthUtah PPO |
$1,406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,359.04
|
| Rate for Payer: Multiplan Medicare/VA |
$639.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,383.36
|
| Rate for Payer: PacificSource Commercial |
$2,188.80
|
| Rate for Payer: PHCS PPO |
$2,310.40
|
| Rate for Payer: Three Rivers PPO |
$1,824.00
|
| Rate for Payer: TriWest Veterans Administration |
$752.77
|
| Rate for Payer: United Healthcare Commercial |
$2,115.84
|
| Rate for Payer: United Healthcare Medicare |
$752.77
|
| Rate for Payer: WINHealth Partners Commercial |
$2,067.20
|
|
|
VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$3,133.00
|
|
|
Service Code
|
HCPCS 59410
|
| Hospital Charge Code |
59410
|
| Min. Negotiated Rate |
$867.42 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,070.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,020.50
|
| Rate for Payer: Beech Street Commercial |
$2,976.35
|
| Rate for Payer: Cash Price |
$2,193.10
|
| Rate for Payer: Cash Price |
$2,193.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,039.01
|
| Rate for Payer: Cigna of WY Commercial |
$3,070.34
|
| Rate for Payer: First Choice Health Commercial |
$2,819.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,976.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,020.50
|
| Rate for Payer: HealthUtah PPO |
$3,133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,039.01
|
| Rate for Payer: Multiplan Medicare/VA |
$867.42
|
| Rate for Payer: One Health Plan of WY PPO |
$3,070.34
|
| Rate for Payer: PacificSource Commercial |
$2,819.70
|
| Rate for Payer: PHCS PPO |
$2,976.35
|
| Rate for Payer: Three Rivers PPO |
$2,349.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,020.50
|
| Rate for Payer: United Healthcare Commercial |
$2,725.71
|
| Rate for Payer: United Healthcare Medicare |
$1,020.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2,663.05
|
|
|
VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$3,412.00
|
|
|
Service Code
|
HCPCS 59614
|
| Hospital Charge Code |
59614
|
| Min. Negotiated Rate |
$932.76 |
| Max. Negotiated Rate |
$3,412.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,343.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,097.37
|
| Rate for Payer: Beech Street Commercial |
$3,241.40
|
| Rate for Payer: Cash Price |
$2,388.40
|
| Rate for Payer: Cash Price |
$2,388.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,309.64
|
| Rate for Payer: Cigna of WY Commercial |
$3,343.76
|
| Rate for Payer: First Choice Health Commercial |
$3,070.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,241.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,097.37
|
| Rate for Payer: HealthUtah PPO |
$3,412.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,309.64
|
| Rate for Payer: Multiplan Medicare/VA |
$932.76
|
| Rate for Payer: One Health Plan of WY PPO |
$3,343.76
|
| Rate for Payer: PacificSource Commercial |
$3,070.80
|
| Rate for Payer: PHCS PPO |
$3,241.40
|
| Rate for Payer: Three Rivers PPO |
$2,559.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,097.37
|
| Rate for Payer: United Healthcare Commercial |
$2,968.44
|
| Rate for Payer: United Healthcare Medicare |
$1,097.37
|
| Rate for Payer: WINHealth Partners Commercial |
$2,900.20
|
|
|
VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$4,035.00
|
|
|
Service Code
|
HCPCS 58260
|
| Hospital Charge Code |
58260
|
| Min. Negotiated Rate |
$687.22 |
| Max. Negotiated Rate |
$4,035.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,954.30
|
| Rate for Payer: Aetna of WY Medicare |
$808.50
|
| Rate for Payer: Beech Street Commercial |
$3,833.25
|
| Rate for Payer: Cash Price |
$2,824.50
|
| Rate for Payer: Cash Price |
$2,824.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,913.95
|
| Rate for Payer: Cigna of WY Commercial |
$3,954.30
|
| Rate for Payer: First Choice Health Commercial |
$3,631.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,833.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$808.50
|
| Rate for Payer: HealthUtah PPO |
$4,035.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,913.95
|
| Rate for Payer: Multiplan Medicare/VA |
$687.22
|
| Rate for Payer: One Health Plan of WY PPO |
$3,954.30
|
| Rate for Payer: PacificSource Commercial |
$3,631.50
|
| Rate for Payer: PHCS PPO |
$3,833.25
|
| Rate for Payer: Three Rivers PPO |
$3,026.25
|
| Rate for Payer: TriWest Veterans Administration |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$3,510.45
|
| Rate for Payer: United Healthcare Medicare |
$808.50
|
| Rate for Payer: WINHealth Partners Commercial |
$3,429.75
|
|
|
VALACYCLOVIR 1 GRAM TABLET [3739]
|
Facility
|
OP
|
$13.12
|
|
|
Service Code
|
NDC 6808430911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.86
|
| Rate for Payer: Aetna of WY Medicare |
$8.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.60
|
| Rate for Payer: Altius Commercial |
$12.60
|
| Rate for Payer: Beech Street Commercial |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.73
|
| Rate for Payer: Cigna of WY Commercial |
$12.86
|
| Rate for Payer: Entrust Commercial |
$12.46
|
| Rate for Payer: First Choice Health Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.61
|
| Rate for Payer: HealthUtah PPO |
$13.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.73
|
| Rate for Payer: Multiplan Medicare/VA |
$7.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12.86
|
| Rate for Payer: PacificSource Commercial |
$11.81
|
| Rate for Payer: PHCS PPO |
$12.86
|
| Rate for Payer: Three Rivers PPO |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$7.61
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$7.61
|
| Rate for Payer: WINHealth Partners Commercial |
$12.86
|
| Rate for Payer: Wise Provider Network Commercial |
$12.46
|
|
|
VALACYCLOVIR 1 GRAM TABLET [3739]
|
Facility
|
IP
|
$13.12
|
|
|
Service Code
|
NDC 6808430911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.60
|
| Rate for Payer: Altius Commercial |
$12.60
|
| Rate for Payer: Beech Street Commercial |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.73
|
| Rate for Payer: Cigna of WY Commercial |
$12.86
|
| Rate for Payer: Entrust Commercial |
$12.46
|
| Rate for Payer: First Choice Health Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$13.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12.86
|
| Rate for Payer: PacificSource Commercial |
$11.81
|
| Rate for Payer: PHCS PPO |
$12.86
|
| Rate for Payer: Three Rivers PPO |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$12.46
|
| Rate for Payer: Wise Provider Network Commercial |
$12.46
|
|
|
VALACYCLOVIR 1 GRAM TABLET [3739]
|
Facility
|
IP
|
$13.12
|
|
|
Service Code
|
NDC 6808430921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.60
|
| Rate for Payer: Altius Commercial |
$12.60
|
| Rate for Payer: Beech Street Commercial |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.73
|
| Rate for Payer: Cigna of WY Commercial |
$12.86
|
| Rate for Payer: Entrust Commercial |
$12.46
|
| Rate for Payer: First Choice Health Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.66
|
| Rate for Payer: HealthUtah PPO |
$13.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.73
|
| Rate for Payer: Multiplan Medicare/VA |
$8.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12.86
|
| Rate for Payer: PacificSource Commercial |
$11.81
|
| Rate for Payer: PHCS PPO |
$12.86
|
| Rate for Payer: Three Rivers PPO |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$8.66
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$8.66
|
| Rate for Payer: WINHealth Partners Commercial |
$12.46
|
| Rate for Payer: Wise Provider Network Commercial |
$12.46
|
|
|
VALACYCLOVIR 1 GRAM TABLET [3739]
|
Facility
|
OP
|
$13.12
|
|
|
Service Code
|
NDC 6808430921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.86
|
| Rate for Payer: Aetna of WY Medicare |
$8.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.60
|
| Rate for Payer: Altius Commercial |
$12.60
|
| Rate for Payer: Beech Street Commercial |
$12.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.77
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.73
|
| Rate for Payer: Cigna of WY Commercial |
$12.86
|
| Rate for Payer: Entrust Commercial |
$12.46
|
| Rate for Payer: First Choice Health Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.61
|
| Rate for Payer: HealthUtah PPO |
$13.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.73
|
| Rate for Payer: Multiplan Medicare/VA |
$7.23
|
| Rate for Payer: One Health Plan of WY PPO |
$12.86
|
| Rate for Payer: PacificSource Commercial |
$11.81
|
| Rate for Payer: PHCS PPO |
$12.86
|
| Rate for Payer: Three Rivers PPO |
$9.84
|
| Rate for Payer: TriWest Veterans Administration |
$7.61
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$7.61
|
| Rate for Payer: WINHealth Partners Commercial |
$12.86
|
| Rate for Payer: Wise Provider Network Commercial |
$12.46
|
|
|
VALACYCLOVIR 500 MG TABLET [7517]
|
Facility
|
IP
|
$3.26
|
|
|
Service Code
|
NDC 3172270430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.13
|
| Rate for Payer: Altius Commercial |
$3.13
|
| Rate for Payer: Beech Street Commercial |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.16
|
| Rate for Payer: Cigna of WY Commercial |
$3.19
|
| Rate for Payer: Entrust Commercial |
$3.10
|
| Rate for Payer: First Choice Health Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.15
|
| Rate for Payer: HealthUtah PPO |
$3.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.16
|
| Rate for Payer: Multiplan Medicare/VA |
$2.04
|
| Rate for Payer: One Health Plan of WY PPO |
$3.19
|
| Rate for Payer: PacificSource Commercial |
$2.93
|
| Rate for Payer: PHCS PPO |
$3.19
|
| Rate for Payer: Three Rivers PPO |
$2.44
|
| Rate for Payer: TriWest Veterans Administration |
$2.15
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare |
$2.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3.10
|
|
|
VALACYCLOVIR 500 MG TABLET [7517]
|
Facility
|
OP
|
$3.26
|
|
|
Service Code
|
NDC 3172270430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.19
|
| Rate for Payer: Aetna of WY Medicare |
$2.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.13
|
| Rate for Payer: Altius Commercial |
$3.13
|
| Rate for Payer: Beech Street Commercial |
$3.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.16
|
| Rate for Payer: Cigna of WY Commercial |
$3.19
|
| Rate for Payer: Entrust Commercial |
$3.10
|
| Rate for Payer: First Choice Health Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.89
|
| Rate for Payer: HealthUtah PPO |
$3.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.16
|
| Rate for Payer: Multiplan Medicare/VA |
$1.80
|
| Rate for Payer: One Health Plan of WY PPO |
$3.19
|
| Rate for Payer: PacificSource Commercial |
$2.93
|
| Rate for Payer: PHCS PPO |
$3.19
|
| Rate for Payer: Three Rivers PPO |
$2.44
|
| Rate for Payer: TriWest Veterans Administration |
$1.89
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Medicare |
$1.89
|
| Rate for Payer: WINHealth Partners Commercial |
$3.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3.10
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [13818]
|
Facility
|
IP
|
$20.36
|
|
|
Service Code
|
NDC 6332349401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.55
|
| Rate for Payer: Altius Commercial |
$19.55
|
| Rate for Payer: Beech Street Commercial |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.75
|
| Rate for Payer: Cigna of WY Commercial |
$19.95
|
| Rate for Payer: Entrust Commercial |
$19.34
|
| Rate for Payer: First Choice Health Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.44
|
| Rate for Payer: HealthUtah PPO |
$20.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.75
|
| Rate for Payer: Multiplan Medicare/VA |
$12.77
|
| Rate for Payer: One Health Plan of WY PPO |
$19.95
|
| Rate for Payer: PacificSource Commercial |
$18.32
|
| Rate for Payer: PHCS PPO |
$19.95
|
| Rate for Payer: Three Rivers PPO |
$15.27
|
| Rate for Payer: TriWest Veterans Administration |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$17.71
|
| Rate for Payer: United Healthcare Medicare |
$13.44
|
| Rate for Payer: WINHealth Partners Commercial |
$19.34
|
| Rate for Payer: Wise Provider Network Commercial |
$19.34
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [13818]
|
Facility
|
OP
|
$20.36
|
|
|
Service Code
|
NDC 6332349401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.95
|
| Rate for Payer: Aetna of WY Medicare |
$13.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.55
|
| Rate for Payer: Altius Commercial |
$19.55
|
| Rate for Payer: Beech Street Commercial |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.75
|
| Rate for Payer: Cigna of WY Commercial |
$19.95
|
| Rate for Payer: Entrust Commercial |
$19.34
|
| Rate for Payer: First Choice Health Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.81
|
| Rate for Payer: HealthUtah PPO |
$20.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.75
|
| Rate for Payer: Multiplan Medicare/VA |
$11.22
|
| Rate for Payer: One Health Plan of WY PPO |
$19.95
|
| Rate for Payer: PacificSource Commercial |
$18.32
|
| Rate for Payer: PHCS PPO |
$19.95
|
| Rate for Payer: Three Rivers PPO |
$15.27
|
| Rate for Payer: TriWest Veterans Administration |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$17.71
|
| Rate for Payer: United Healthcare Medicare |
$11.81
|
| Rate for Payer: WINHealth Partners Commercial |
$19.95
|
| Rate for Payer: Wise Provider Network Commercial |
$19.34
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [13818]
|
Facility
|
IP
|
$20.36
|
|
|
Service Code
|
NDC 6332349405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.55
|
| Rate for Payer: Altius Commercial |
$19.55
|
| Rate for Payer: Beech Street Commercial |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.75
|
| Rate for Payer: Cigna of WY Commercial |
$19.95
|
| Rate for Payer: Entrust Commercial |
$19.34
|
| Rate for Payer: First Choice Health Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.44
|
| Rate for Payer: HealthUtah PPO |
$20.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.75
|
| Rate for Payer: Multiplan Medicare/VA |
$12.77
|
| Rate for Payer: One Health Plan of WY PPO |
$19.95
|
| Rate for Payer: PacificSource Commercial |
$18.32
|
| Rate for Payer: PHCS PPO |
$19.95
|
| Rate for Payer: Three Rivers PPO |
$15.27
|
| Rate for Payer: TriWest Veterans Administration |
$13.44
|
| Rate for Payer: United Healthcare Commercial |
$17.71
|
| Rate for Payer: United Healthcare Medicare |
$13.44
|
| Rate for Payer: WINHealth Partners Commercial |
$19.34
|
| Rate for Payer: Wise Provider Network Commercial |
$19.34
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [13818]
|
Facility
|
OP
|
$20.36
|
|
|
Service Code
|
NDC 6332349405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.95
|
| Rate for Payer: Aetna of WY Medicare |
$13.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.55
|
| Rate for Payer: Altius Commercial |
$19.55
|
| Rate for Payer: Beech Street Commercial |
$19.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.75
|
| Rate for Payer: Cigna of WY Commercial |
$19.95
|
| Rate for Payer: Entrust Commercial |
$19.34
|
| Rate for Payer: First Choice Health Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.81
|
| Rate for Payer: HealthUtah PPO |
$20.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.75
|
| Rate for Payer: Multiplan Medicare/VA |
$11.22
|
| Rate for Payer: One Health Plan of WY PPO |
$19.95
|
| Rate for Payer: PacificSource Commercial |
$18.32
|
| Rate for Payer: PHCS PPO |
$19.95
|
| Rate for Payer: Three Rivers PPO |
$15.27
|
| Rate for Payer: TriWest Veterans Administration |
$11.81
|
| Rate for Payer: United Healthcare Commercial |
$17.71
|
| Rate for Payer: United Healthcare Medicare |
$11.81
|
| Rate for Payer: WINHealth Partners Commercial |
$19.95
|
| Rate for Payer: Wise Provider Network Commercial |
$19.34
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [13818]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 7086078441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$11.91
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.54
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION [13818]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 7086078441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
