|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [6033]
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 6808471301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.43
|
| Rate for Payer: Aetna of WY Medicare |
$1.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.38
|
| Rate for Payer: Altius Commercial |
$2.38
|
| Rate for Payer: Beech Street Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.41
|
| Rate for Payer: Cigna of WY Commercial |
$2.43
|
| Rate for Payer: Entrust Commercial |
$2.36
|
| Rate for Payer: First Choice Health Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.44
|
| Rate for Payer: HealthUtah PPO |
$2.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.41
|
| Rate for Payer: Multiplan Medicare/VA |
$1.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2.43
|
| Rate for Payer: PacificSource Commercial |
$2.23
|
| Rate for Payer: PHCS PPO |
$2.43
|
| Rate for Payer: Three Rivers PPO |
$1.86
|
| Rate for Payer: TriWest Veterans Administration |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$1.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2.43
|
| Rate for Payer: Wise Provider Network Commercial |
$2.36
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [6033]
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
NDC 6808471311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.38
|
| Rate for Payer: Altius Commercial |
$2.38
|
| Rate for Payer: Beech Street Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.41
|
| Rate for Payer: Cigna of WY Commercial |
$2.43
|
| Rate for Payer: Entrust Commercial |
$2.36
|
| Rate for Payer: First Choice Health Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.64
|
| Rate for Payer: HealthUtah PPO |
$2.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.41
|
| Rate for Payer: Multiplan Medicare/VA |
$1.55
|
| Rate for Payer: One Health Plan of WY PPO |
$2.43
|
| Rate for Payer: PacificSource Commercial |
$2.23
|
| Rate for Payer: PHCS PPO |
$2.43
|
| Rate for Payer: Three Rivers PPO |
$1.86
|
| Rate for Payer: TriWest Veterans Administration |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$1.64
|
| Rate for Payer: WINHealth Partners Commercial |
$2.36
|
| Rate for Payer: Wise Provider Network Commercial |
$2.36
|
|
|
VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [6033]
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 6808471311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.43
|
| Rate for Payer: Aetna of WY Medicare |
$1.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.38
|
| Rate for Payer: Altius Commercial |
$2.38
|
| Rate for Payer: Beech Street Commercial |
$2.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.04
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.41
|
| Rate for Payer: Cigna of WY Commercial |
$2.43
|
| Rate for Payer: Entrust Commercial |
$2.36
|
| Rate for Payer: First Choice Health Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.44
|
| Rate for Payer: HealthUtah PPO |
$2.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.41
|
| Rate for Payer: Multiplan Medicare/VA |
$1.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2.43
|
| Rate for Payer: PacificSource Commercial |
$2.23
|
| Rate for Payer: PHCS PPO |
$2.43
|
| Rate for Payer: Three Rivers PPO |
$1.86
|
| Rate for Payer: TriWest Veterans Administration |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$1.44
|
| Rate for Payer: WINHealth Partners Commercial |
$2.43
|
| Rate for Payer: Wise Provider Network Commercial |
$2.36
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [1470]
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
NDC 6808470901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.10
|
| Rate for Payer: Altius Commercial |
$2.10
|
| Rate for Payer: Beech Street Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.12
|
| Rate for Payer: Cigna of WY Commercial |
$2.15
|
| Rate for Payer: Entrust Commercial |
$2.08
|
| Rate for Payer: First Choice Health Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.45
|
| Rate for Payer: HealthUtah PPO |
$2.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2.15
|
| Rate for Payer: PacificSource Commercial |
$1.97
|
| Rate for Payer: PHCS PPO |
$2.15
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$1.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2.08
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [1470]
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 6808470901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.15
|
| Rate for Payer: Aetna of WY Medicare |
$1.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.10
|
| Rate for Payer: Altius Commercial |
$2.10
|
| Rate for Payer: Beech Street Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.12
|
| Rate for Payer: Cigna of WY Commercial |
$2.15
|
| Rate for Payer: Entrust Commercial |
$2.08
|
| Rate for Payer: First Choice Health Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.27
|
| Rate for Payer: HealthUtah PPO |
$2.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2.15
|
| Rate for Payer: PacificSource Commercial |
$1.97
|
| Rate for Payer: PHCS PPO |
$2.15
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.27
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$1.27
|
| Rate for Payer: WINHealth Partners Commercial |
$2.15
|
| Rate for Payer: Wise Provider Network Commercial |
$2.08
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [1470]
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
NDC 6808470911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.10
|
| Rate for Payer: Altius Commercial |
$2.10
|
| Rate for Payer: Beech Street Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.12
|
| Rate for Payer: Cigna of WY Commercial |
$2.15
|
| Rate for Payer: Entrust Commercial |
$2.08
|
| Rate for Payer: First Choice Health Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.45
|
| Rate for Payer: HealthUtah PPO |
$2.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1.37
|
| Rate for Payer: One Health Plan of WY PPO |
$2.15
|
| Rate for Payer: PacificSource Commercial |
$1.97
|
| Rate for Payer: PHCS PPO |
$2.15
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$1.45
|
| Rate for Payer: WINHealth Partners Commercial |
$2.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2.08
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [1470]
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 6808470911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.15
|
| Rate for Payer: Aetna of WY Medicare |
$1.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.10
|
| Rate for Payer: Altius Commercial |
$2.10
|
| Rate for Payer: Beech Street Commercial |
$2.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.80
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.12
|
| Rate for Payer: Cigna of WY Commercial |
$2.15
|
| Rate for Payer: Entrust Commercial |
$2.08
|
| Rate for Payer: First Choice Health Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.27
|
| Rate for Payer: HealthUtah PPO |
$2.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1.21
|
| Rate for Payer: One Health Plan of WY PPO |
$2.15
|
| Rate for Payer: PacificSource Commercial |
$1.97
|
| Rate for Payer: PHCS PPO |
$2.15
|
| Rate for Payer: Three Rivers PPO |
$1.64
|
| Rate for Payer: TriWest Veterans Administration |
$1.27
|
| Rate for Payer: United Healthcare Commercial |
$1.91
|
| Rate for Payer: United Healthcare Medicare |
$1.27
|
| Rate for Payer: WINHealth Partners Commercial |
$2.15
|
| Rate for Payer: Wise Provider Network Commercial |
$2.08
|
|
|
VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
69424
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$446.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$437.08
|
| Rate for Payer: Aetna of WY Medicare |
$58.74
|
| Rate for Payer: Beech Street Commercial |
$423.70
|
| Rate for Payer: Cash Price |
$312.20
|
| Rate for Payer: Cash Price |
$312.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$432.62
|
| Rate for Payer: Cigna of WY Commercial |
$437.08
|
| Rate for Payer: First Choice Health Commercial |
$401.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$423.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.74
|
| Rate for Payer: HealthUtah PPO |
$446.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$432.62
|
| Rate for Payer: Multiplan Medicare/VA |
$49.93
|
| Rate for Payer: One Health Plan of WY PPO |
$437.08
|
| Rate for Payer: PacificSource Commercial |
$401.40
|
| Rate for Payer: PHCS PPO |
$423.70
|
| Rate for Payer: Three Rivers PPO |
$334.50
|
| Rate for Payer: TriWest Veterans Administration |
$58.74
|
| Rate for Payer: United Healthcare Commercial |
$388.02
|
| Rate for Payer: United Healthcare Medicare |
$58.74
|
| Rate for Payer: WINHealth Partners Commercial |
$379.10
|
|
|
VENTILATING TUBE RMVL REQUIRING GENERAL ANES
|
Professional
|
Both
|
$892.00
|
|
|
Service Code
|
HCPCS 69424 50
|
| Hospital Charge Code |
69424
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$874.16
|
| Rate for Payer: Aetna of WY Medicare |
$58.74
|
| Rate for Payer: Beech Street Commercial |
$847.40
|
| Rate for Payer: Cash Price |
$624.40
|
| Rate for Payer: Cash Price |
$624.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$865.24
|
| Rate for Payer: Cigna of WY Commercial |
$874.16
|
| Rate for Payer: First Choice Health Commercial |
$802.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$847.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.74
|
| Rate for Payer: HealthUtah PPO |
$892.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$865.24
|
| Rate for Payer: Multiplan Medicare/VA |
$49.93
|
| Rate for Payer: One Health Plan of WY PPO |
$874.16
|
| Rate for Payer: PacificSource Commercial |
$802.80
|
| Rate for Payer: PHCS PPO |
$847.40
|
| Rate for Payer: Three Rivers PPO |
$669.00
|
| Rate for Payer: TriWest Veterans Administration |
$58.74
|
| Rate for Payer: United Healthcare Commercial |
$776.04
|
| Rate for Payer: United Healthcare Medicare |
$58.74
|
| Rate for Payer: WINHealth Partners Commercial |
$758.20
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [15621]
|
Facility
|
IP
|
$33.75
|
|
|
Service Code
|
NDC 7071016431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.28
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Multiplan Medicare/VA |
$21.16
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: TriWest Veterans Administration |
$22.28
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Medicare |
$22.28
|
| Rate for Payer: WINHealth Partners Commercial |
$32.06
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
|
|
VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [15621]
|
Facility
|
OP
|
$33.75
|
|
|
Service Code
|
NDC 7071016431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$33.08
|
| Rate for Payer: Aetna of WY Medicare |
$22.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.40
|
| Rate for Payer: Altius Commercial |
$32.40
|
| Rate for Payer: Beech Street Commercial |
$33.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.74
|
| Rate for Payer: Cigna of WY Commercial |
$33.08
|
| Rate for Payer: Entrust Commercial |
$32.06
|
| Rate for Payer: First Choice Health Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.58
|
| Rate for Payer: HealthUtah PPO |
$33.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.74
|
| Rate for Payer: Multiplan Medicare/VA |
$18.60
|
| Rate for Payer: One Health Plan of WY PPO |
$33.08
|
| Rate for Payer: PacificSource Commercial |
$30.38
|
| Rate for Payer: PHCS PPO |
$33.08
|
| Rate for Payer: Three Rivers PPO |
$25.31
|
| Rate for Payer: TriWest Veterans Administration |
$19.58
|
| Rate for Payer: United Healthcare Commercial |
$29.36
|
| Rate for Payer: United Healthcare Medicare |
$19.58
|
| Rate for Payer: WINHealth Partners Commercial |
$33.08
|
| Rate for Payer: Wise Provider Network Commercial |
$32.06
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [59]
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 6846229201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.31
|
| Rate for Payer: Altius Commercial |
$2.31
|
| Rate for Payer: Beech Street Commercial |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.34
|
| Rate for Payer: Cigna of WY Commercial |
$2.36
|
| Rate for Payer: Entrust Commercial |
$2.29
|
| Rate for Payer: First Choice Health Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.59
|
| Rate for Payer: HealthUtah PPO |
$2.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1.51
|
| Rate for Payer: One Health Plan of WY PPO |
$2.36
|
| Rate for Payer: PacificSource Commercial |
$2.17
|
| Rate for Payer: PHCS PPO |
$2.36
|
| Rate for Payer: Three Rivers PPO |
$1.81
|
| Rate for Payer: TriWest Veterans Administration |
$1.59
|
| Rate for Payer: United Healthcare Commercial |
$2.10
|
| Rate for Payer: United Healthcare Medicare |
$1.59
|
| Rate for Payer: WINHealth Partners Commercial |
$2.29
|
| Rate for Payer: Wise Provider Network Commercial |
$2.29
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [59]
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 6846229201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.36
|
| Rate for Payer: Aetna of WY Medicare |
$1.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.31
|
| Rate for Payer: Altius Commercial |
$2.31
|
| Rate for Payer: Beech Street Commercial |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.34
|
| Rate for Payer: Cigna of WY Commercial |
$2.36
|
| Rate for Payer: Entrust Commercial |
$2.29
|
| Rate for Payer: First Choice Health Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.40
|
| Rate for Payer: HealthUtah PPO |
$2.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2.36
|
| Rate for Payer: PacificSource Commercial |
$2.17
|
| Rate for Payer: PHCS PPO |
$2.36
|
| Rate for Payer: Three Rivers PPO |
$1.81
|
| Rate for Payer: TriWest Veterans Administration |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$2.10
|
| Rate for Payer: United Healthcare Medicare |
$1.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2.36
|
| Rate for Payer: Wise Provider Network Commercial |
$2.29
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [59]
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 7583432001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.31
|
| Rate for Payer: Altius Commercial |
$2.31
|
| Rate for Payer: Beech Street Commercial |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.34
|
| Rate for Payer: Cigna of WY Commercial |
$2.36
|
| Rate for Payer: Entrust Commercial |
$2.29
|
| Rate for Payer: First Choice Health Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.59
|
| Rate for Payer: HealthUtah PPO |
$2.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1.51
|
| Rate for Payer: One Health Plan of WY PPO |
$2.36
|
| Rate for Payer: PacificSource Commercial |
$2.17
|
| Rate for Payer: PHCS PPO |
$2.36
|
| Rate for Payer: Three Rivers PPO |
$1.81
|
| Rate for Payer: TriWest Veterans Administration |
$1.59
|
| Rate for Payer: United Healthcare Commercial |
$2.10
|
| Rate for Payer: United Healthcare Medicare |
$1.59
|
| Rate for Payer: WINHealth Partners Commercial |
$2.29
|
| Rate for Payer: Wise Provider Network Commercial |
$2.29
|
|
|
VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE [59]
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 7583432001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.36
|
| Rate for Payer: Aetna of WY Medicare |
$1.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.31
|
| Rate for Payer: Altius Commercial |
$2.31
|
| Rate for Payer: Beech Street Commercial |
$2.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.34
|
| Rate for Payer: Cigna of WY Commercial |
$2.36
|
| Rate for Payer: Entrust Commercial |
$2.29
|
| Rate for Payer: First Choice Health Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.40
|
| Rate for Payer: HealthUtah PPO |
$2.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.34
|
| Rate for Payer: Multiplan Medicare/VA |
$1.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2.36
|
| Rate for Payer: PacificSource Commercial |
$2.17
|
| Rate for Payer: PHCS PPO |
$2.36
|
| Rate for Payer: Three Rivers PPO |
$1.81
|
| Rate for Payer: TriWest Veterans Administration |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$2.10
|
| Rate for Payer: United Healthcare Medicare |
$1.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2.36
|
| Rate for Payer: Wise Provider Network Commercial |
$2.29
|
|
|
VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG
|
Professional
|
Both
|
$5,974.00
|
|
|
Service Code
|
HCPCS 63081
|
| Hospital Charge Code |
63081
|
| Min. Negotiated Rate |
$1,422.98 |
| Max. Negotiated Rate |
$5,974.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,854.52
|
| Rate for Payer: Aetna of WY Medicare |
$1,674.09
|
| Rate for Payer: Beech Street Commercial |
$5,675.30
|
| Rate for Payer: Cash Price |
$4,181.80
|
| Rate for Payer: Cash Price |
$4,181.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,794.78
|
| Rate for Payer: Cigna of WY Commercial |
$5,854.52
|
| Rate for Payer: First Choice Health Commercial |
$5,376.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,675.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,674.09
|
| Rate for Payer: HealthUtah PPO |
$5,974.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,794.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1,422.98
|
| Rate for Payer: One Health Plan of WY PPO |
$5,854.52
|
| Rate for Payer: PacificSource Commercial |
$5,376.60
|
| Rate for Payer: PHCS PPO |
$5,675.30
|
| Rate for Payer: Three Rivers PPO |
$4,480.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,674.09
|
| Rate for Payer: United Healthcare Commercial |
$5,197.38
|
| Rate for Payer: United Healthcare Medicare |
$1,674.09
|
| Rate for Payer: WINHealth Partners Commercial |
$5,077.90
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000710]
|
Facility
|
IP
|
$54.94
|
|
|
Service Code
|
HCPCS J9370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$54.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.74
|
| Rate for Payer: Altius Commercial |
$52.74
|
| Rate for Payer: Beech Street Commercial |
$53.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.11
|
| Rate for Payer: Cash Price |
$38.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.29
|
| Rate for Payer: Cigna of WY Commercial |
$53.84
|
| Rate for Payer: Entrust Commercial |
$52.19
|
| Rate for Payer: First Choice Health Commercial |
$52.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.26
|
| Rate for Payer: HealthUtah PPO |
$54.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.29
|
| Rate for Payer: Multiplan Medicare/VA |
$34.45
|
| Rate for Payer: One Health Plan of WY PPO |
$53.84
|
| Rate for Payer: PacificSource Commercial |
$49.45
|
| Rate for Payer: PHCS PPO |
$53.84
|
| Rate for Payer: Three Rivers PPO |
$41.20
|
| Rate for Payer: TriWest Veterans Administration |
$36.26
|
| Rate for Payer: United Healthcare Commercial |
$47.80
|
| Rate for Payer: United Healthcare Medicare |
$36.26
|
| Rate for Payer: WINHealth Partners Commercial |
$52.19
|
| Rate for Payer: Wise Provider Network Commercial |
$52.19
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION (WRAPPED) [4000710]
|
Facility
|
OP
|
$54.94
|
|
|
Service Code
|
HCPCS J9370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$54.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.84
|
| Rate for Payer: Aetna of WY Medicare |
$36.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.74
|
| Rate for Payer: Altius Commercial |
$52.74
|
| Rate for Payer: Beech Street Commercial |
$53.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.11
|
| Rate for Payer: Cash Price |
$38.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$53.29
|
| Rate for Payer: Cigna of WY Commercial |
$53.84
|
| Rate for Payer: Entrust Commercial |
$52.19
|
| Rate for Payer: First Choice Health Commercial |
$52.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$52.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.87
|
| Rate for Payer: HealthUtah PPO |
$54.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$53.29
|
| Rate for Payer: Multiplan Medicare/VA |
$30.27
|
| Rate for Payer: One Health Plan of WY PPO |
$53.84
|
| Rate for Payer: PacificSource Commercial |
$49.45
|
| Rate for Payer: PHCS PPO |
$53.84
|
| Rate for Payer: Three Rivers PPO |
$41.20
|
| Rate for Payer: TriWest Veterans Administration |
$31.87
|
| Rate for Payer: United Healthcare Commercial |
$47.80
|
| Rate for Payer: United Healthcare Medicare |
$31.87
|
| Rate for Payer: WINHealth Partners Commercial |
$53.84
|
| Rate for Payer: Wise Provider Network Commercial |
$52.19
|
|
|
VISCERA RETAINER LARGE GREEN
|
Facility
|
OP
|
$85.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$85.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.23
|
| Rate for Payer: Aetna of WY Medicare |
$56.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.51
|
| Rate for Payer: Altius Commercial |
$82.51
|
| Rate for Payer: Beech Street Commercial |
$84.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.56
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.37
|
| Rate for Payer: Cigna of WY Commercial |
$84.23
|
| Rate for Payer: Entrust Commercial |
$81.65
|
| Rate for Payer: First Choice Health Commercial |
$81.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.85
|
| Rate for Payer: HealthUtah PPO |
$85.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.37
|
| Rate for Payer: Multiplan Medicare/VA |
$47.36
|
| Rate for Payer: One Health Plan of WY PPO |
$84.23
|
| Rate for Payer: PacificSource Commercial |
$77.36
|
| Rate for Payer: PHCS PPO |
$84.23
|
| Rate for Payer: Three Rivers PPO |
$64.46
|
| Rate for Payer: TriWest Veterans Administration |
$49.85
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
| Rate for Payer: United Healthcare Medicare |
$49.85
|
| Rate for Payer: WINHealth Partners Commercial |
$84.23
|
| Rate for Payer: Wise Provider Network Commercial |
$81.65
|
|
|
VISCERA RETAINER LARGE GREEN
|
Facility
|
IP
|
$85.95
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$85.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$82.51
|
| Rate for Payer: Altius Commercial |
$82.51
|
| Rate for Payer: Beech Street Commercial |
$84.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.56
|
| Rate for Payer: Cash Price |
$60.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.37
|
| Rate for Payer: Cigna of WY Commercial |
$84.23
|
| Rate for Payer: Entrust Commercial |
$81.65
|
| Rate for Payer: First Choice Health Commercial |
$81.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.73
|
| Rate for Payer: HealthUtah PPO |
$85.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.37
|
| Rate for Payer: Multiplan Medicare/VA |
$53.89
|
| Rate for Payer: One Health Plan of WY PPO |
$84.23
|
| Rate for Payer: PacificSource Commercial |
$77.36
|
| Rate for Payer: PHCS PPO |
$84.23
|
| Rate for Payer: Three Rivers PPO |
$64.46
|
| Rate for Payer: TriWest Veterans Administration |
$56.73
|
| Rate for Payer: United Healthcare Commercial |
$74.78
|
| Rate for Payer: United Healthcare Medicare |
$56.73
|
| Rate for Payer: WINHealth Partners Commercial |
$81.65
|
| Rate for Payer: Wise Provider Network Commercial |
$81.65
|
|
|
VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 94150 26
|
| Hospital Charge Code |
94150
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Beech Street Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: First Choice Health Commercial |
$35.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$37.05
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
|
|
VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
94150
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Beech Street Commercial |
$86.45
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
| Rate for Payer: Cigna of WY Commercial |
$89.18
|
| Rate for Payer: First Choice Health Commercial |
$81.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$86.45
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$79.17
|
| Rate for Payer: WINHealth Partners Commercial |
$86.45
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [10270]
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
NDC 0904208560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE [10270]
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
NDC 0904208560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.17
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.16
|
| Rate for Payer: Altius Commercial |
$0.16
|
| Rate for Payer: Beech Street Commercial |
$0.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.17
|
| Rate for Payer: Entrust Commercial |
$0.16
|
| Rate for Payer: First Choice Health Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.16
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.17
|
| Rate for Payer: PacificSource Commercial |
$0.15
|
| Rate for Payer: PHCS PPO |
$0.17
|
| Rate for Payer: Three Rivers PPO |
$0.13
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.15
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.16
|
|
|
VITAMIN A PALMITATE 50,000 UNIT/ML INTRAMUSCULAR SOLUTION [38075]
|
Facility
|
IP
|
$374.38
|
|
|
Service Code
|
NDC 7019902611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$234.74 |
| Max. Negotiated Rate |
$374.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$366.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$359.40
|
| Rate for Payer: Altius Commercial |
$359.40
|
| Rate for Payer: Beech Street Commercial |
$366.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$307.37
|
| Rate for Payer: Cash Price |
$262.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$363.15
|
| Rate for Payer: Cigna of WY Commercial |
$366.89
|
| Rate for Payer: Entrust Commercial |
$355.66
|
| Rate for Payer: First Choice Health Commercial |
$355.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$355.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$247.09
|
| Rate for Payer: HealthUtah PPO |
$374.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$363.15
|
| Rate for Payer: Multiplan Medicare/VA |
$234.74
|
| Rate for Payer: One Health Plan of WY PPO |
$366.89
|
| Rate for Payer: PacificSource Commercial |
$336.94
|
| Rate for Payer: PHCS PPO |
$366.89
|
| Rate for Payer: Three Rivers PPO |
$280.78
|
| Rate for Payer: TriWest Veterans Administration |
$247.09
|
| Rate for Payer: United Healthcare Commercial |
$325.71
|
| Rate for Payer: United Healthcare Medicare |
$247.09
|
| Rate for Payer: WINHealth Partners Commercial |
$355.66
|
| Rate for Payer: Wise Provider Network Commercial |
$355.66
|
|
