|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 4098527139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.05
|
| Rate for Payer: Aetna of WY Medicare |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.05
|
| Rate for Payer: Beech Street Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.05
|
| Rate for Payer: Cigna of WY Commercial |
$0.05
|
| Rate for Payer: Entrust Commercial |
$0.05
|
| Rate for Payer: First Choice Health Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.05
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.05
|
| Rate for Payer: Three Rivers PPO |
$0.04
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.05
|
| Rate for Payer: Wise Provider Network Commercial |
$0.05
|
|
|
CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [42151]
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 4098527139
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.05
|
| Rate for Payer: Altius Commercial |
$0.05
|
| Rate for Payer: Beech Street Commercial |
$0.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.05
|
| Rate for Payer: Cigna of WY Commercial |
$0.05
|
| Rate for Payer: Entrust Commercial |
$0.05
|
| Rate for Payer: First Choice Health Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.05
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.05
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.05
|
| Rate for Payer: Three Rivers PPO |
$0.04
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.05
|
| Rate for Payer: Wise Provider Network Commercial |
$0.05
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$5,541.00
|
|
|
Service Code
|
HCPCS 47600
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$863.85 |
| Max. Negotiated Rate |
$5,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,430.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,016.29
|
| Rate for Payer: Beech Street Commercial |
$5,263.95
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,374.77
|
| Rate for Payer: Cigna of WY Commercial |
$5,430.18
|
| Rate for Payer: First Choice Health Commercial |
$4,986.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,016.29
|
| Rate for Payer: HealthUtah PPO |
$5,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,374.77
|
| Rate for Payer: Multiplan Medicare/VA |
$863.85
|
| Rate for Payer: One Health Plan of WY PPO |
$5,430.18
|
| Rate for Payer: PacificSource Commercial |
$4,986.90
|
| Rate for Payer: PHCS PPO |
$5,263.95
|
| Rate for Payer: Three Rivers PPO |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,016.29
|
| Rate for Payer: United Healthcare Commercial |
$4,820.67
|
| Rate for Payer: United Healthcare Medicare |
$1,016.29
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.85
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$5,541.00
|
|
|
Service Code
|
HCPCS 47600 80
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$863.85 |
| Max. Negotiated Rate |
$5,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,430.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,016.29
|
| Rate for Payer: Beech Street Commercial |
$5,263.95
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,374.77
|
| Rate for Payer: Cigna of WY Commercial |
$5,430.18
|
| Rate for Payer: First Choice Health Commercial |
$4,986.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,016.29
|
| Rate for Payer: HealthUtah PPO |
$5,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,374.77
|
| Rate for Payer: Multiplan Medicare/VA |
$863.85
|
| Rate for Payer: One Health Plan of WY PPO |
$5,430.18
|
| Rate for Payer: PacificSource Commercial |
$4,986.90
|
| Rate for Payer: PHCS PPO |
$5,263.95
|
| Rate for Payer: Three Rivers PPO |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,016.29
|
| Rate for Payer: United Healthcare Commercial |
$4,820.67
|
| Rate for Payer: United Healthcare Medicare |
$1,016.29
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.85
|
|
|
CHOLECYSTECTOMY
|
Professional
|
Both
|
$5,541.00
|
|
|
Service Code
|
HCPCS 47600 AS
|
| Hospital Charge Code |
47600
|
| Min. Negotiated Rate |
$863.85 |
| Max. Negotiated Rate |
$5,541.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,430.18
|
| Rate for Payer: Aetna of WY Medicare |
$1,016.29
|
| Rate for Payer: Beech Street Commercial |
$5,263.95
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,374.77
|
| Rate for Payer: Cigna of WY Commercial |
$5,430.18
|
| Rate for Payer: First Choice Health Commercial |
$4,986.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,263.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,016.29
|
| Rate for Payer: HealthUtah PPO |
$5,541.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,374.77
|
| Rate for Payer: Multiplan Medicare/VA |
$863.85
|
| Rate for Payer: One Health Plan of WY PPO |
$5,430.18
|
| Rate for Payer: PacificSource Commercial |
$4,986.90
|
| Rate for Payer: PHCS PPO |
$5,263.95
|
| Rate for Payer: Three Rivers PPO |
$4,155.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,016.29
|
| Rate for Payer: United Healthcare Commercial |
$4,820.67
|
| Rate for Payer: United Healthcare Medicare |
$1,016.29
|
| Rate for Payer: WINHealth Partners Commercial |
$4,709.85
|
|
|
CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$3,815.00
|
|
|
Service Code
|
HCPCS 47605 80
|
| Hospital Charge Code |
47605
|
| Min. Negotiated Rate |
$908.98 |
| Max. Negotiated Rate |
$3,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,738.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.39
|
| Rate for Payer: Beech Street Commercial |
$3,624.25
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,700.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,738.70
|
| Rate for Payer: First Choice Health Commercial |
$3,433.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,624.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.39
|
| Rate for Payer: HealthUtah PPO |
$3,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,700.55
|
| Rate for Payer: Multiplan Medicare/VA |
$908.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,738.70
|
| Rate for Payer: PacificSource Commercial |
$3,433.50
|
| Rate for Payer: PHCS PPO |
$3,624.25
|
| Rate for Payer: Three Rivers PPO |
$2,861.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.39
|
| Rate for Payer: United Healthcare Commercial |
$3,319.05
|
| Rate for Payer: United Healthcare Medicare |
$1,069.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,242.75
|
|
|
CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$3,815.00
|
|
|
Service Code
|
HCPCS 47605 AS
|
| Hospital Charge Code |
47605
|
| Min. Negotiated Rate |
$908.98 |
| Max. Negotiated Rate |
$3,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,738.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.39
|
| Rate for Payer: Beech Street Commercial |
$3,624.25
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,700.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,738.70
|
| Rate for Payer: First Choice Health Commercial |
$3,433.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,624.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.39
|
| Rate for Payer: HealthUtah PPO |
$3,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,700.55
|
| Rate for Payer: Multiplan Medicare/VA |
$908.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,738.70
|
| Rate for Payer: PacificSource Commercial |
$3,433.50
|
| Rate for Payer: PHCS PPO |
$3,624.25
|
| Rate for Payer: Three Rivers PPO |
$2,861.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.39
|
| Rate for Payer: United Healthcare Commercial |
$3,319.05
|
| Rate for Payer: United Healthcare Medicare |
$1,069.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,242.75
|
|
|
CHOLECYSTECTOMY W/CHOLANGIOGRAPHY
|
Professional
|
Both
|
$3,815.00
|
|
|
Service Code
|
HCPCS 47605
|
| Hospital Charge Code |
47605
|
| Min. Negotiated Rate |
$908.98 |
| Max. Negotiated Rate |
$3,815.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,738.70
|
| Rate for Payer: Aetna of WY Medicare |
$1,069.39
|
| Rate for Payer: Beech Street Commercial |
$3,624.25
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,700.55
|
| Rate for Payer: Cigna of WY Commercial |
$3,738.70
|
| Rate for Payer: First Choice Health Commercial |
$3,433.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,624.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,069.39
|
| Rate for Payer: HealthUtah PPO |
$3,815.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,700.55
|
| Rate for Payer: Multiplan Medicare/VA |
$908.98
|
| Rate for Payer: One Health Plan of WY PPO |
$3,738.70
|
| Rate for Payer: PacificSource Commercial |
$3,433.50
|
| Rate for Payer: PHCS PPO |
$3,624.25
|
| Rate for Payer: Three Rivers PPO |
$2,861.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,069.39
|
| Rate for Payer: United Healthcare Commercial |
$3,319.05
|
| Rate for Payer: United Healthcare Medicare |
$1,069.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,242.75
|
|
|
CHORIONIC GONADOTROPIN/1000U
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS J0725
|
| Hospital Charge Code |
J0725
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$23.29
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.29
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$19.80
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.29
|
| Rate for Payer: United Healthcare Commercial |
$32.19
|
| Rate for Payer: United Healthcare Medicare |
$23.29
|
| Rate for Payer: WINHealth Partners Commercial |
$35.15
|
|
|
CHROMOTUBATION OVIDUCT W/MATERIALS
|
Professional
|
Both
|
$2,209.00
|
|
|
Service Code
|
HCPCS 58350
|
| Hospital Charge Code |
58350
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$2,209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,164.82
|
| Rate for Payer: Aetna of WY Medicare |
$92.76
|
| Rate for Payer: Beech Street Commercial |
$2,098.55
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: Cash Price |
$1,546.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,142.73
|
| Rate for Payer: Cigna of WY Commercial |
$2,164.82
|
| Rate for Payer: First Choice Health Commercial |
$1,988.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,098.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.76
|
| Rate for Payer: HealthUtah PPO |
$2,209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,142.73
|
| Rate for Payer: Multiplan Medicare/VA |
$78.85
|
| Rate for Payer: One Health Plan of WY PPO |
$2,164.82
|
| Rate for Payer: PacificSource Commercial |
$1,988.10
|
| Rate for Payer: PHCS PPO |
$2,098.55
|
| Rate for Payer: Three Rivers PPO |
$1,656.75
|
| Rate for Payer: TriWest Veterans Administration |
$92.76
|
| Rate for Payer: United Healthcare Commercial |
$1,921.83
|
| Rate for Payer: United Healthcare Medicare |
$92.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,877.65
|
|
|
CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MONTH
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 99491
|
| Hospital Charge Code |
99491
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$397.88
|
| Rate for Payer: Aetna of WY Medicare |
$72.49
|
| Rate for Payer: Beech Street Commercial |
$385.70
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: Cash Price |
$284.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$393.82
|
| Rate for Payer: Cigna of WY Commercial |
$397.88
|
| Rate for Payer: First Choice Health Commercial |
$365.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$385.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.49
|
| Rate for Payer: HealthUtah PPO |
$406.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$393.82
|
| Rate for Payer: Multiplan Medicare/VA |
$61.62
|
| Rate for Payer: One Health Plan of WY PPO |
$397.88
|
| Rate for Payer: PacificSource Commercial |
$365.40
|
| Rate for Payer: PHCS PPO |
$385.70
|
| Rate for Payer: Three Rivers PPO |
$304.50
|
| Rate for Payer: TriWest Veterans Administration |
$72.49
|
| Rate for Payer: United Healthcare Commercial |
$353.22
|
| Rate for Payer: United Healthcare Medicare |
$72.49
|
| Rate for Payer: WINHealth Partners Commercial |
$385.70
|
|
|
CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99490
|
| Hospital Charge Code |
99490
|
| Min. Negotiated Rate |
$40.96 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.54
|
| Rate for Payer: Aetna of WY Medicare |
$48.19
|
| Rate for Payer: Beech Street Commercial |
$116.85
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$119.31
|
| Rate for Payer: Cigna of WY Commercial |
$120.54
|
| Rate for Payer: First Choice Health Commercial |
$110.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.19
|
| Rate for Payer: HealthUtah PPO |
$123.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$119.31
|
| Rate for Payer: Multiplan Medicare/VA |
$40.96
|
| Rate for Payer: One Health Plan of WY PPO |
$120.54
|
| Rate for Payer: PacificSource Commercial |
$110.70
|
| Rate for Payer: PHCS PPO |
$116.85
|
| Rate for Payer: Three Rivers PPO |
$92.25
|
| Rate for Payer: TriWest Veterans Administration |
$48.19
|
| Rate for Payer: United Healthcare Commercial |
$107.01
|
| Rate for Payer: United Healthcare Medicare |
$48.19
|
| Rate for Payer: WINHealth Partners Commercial |
$116.85
|
|
|
CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99439
|
| Hospital Charge Code |
99439
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.44
|
| Rate for Payer: Aetna of WY Medicare |
$33.63
|
| Rate for Payer: Beech Street Commercial |
$169.10
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: Cash Price |
$124.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.66
|
| Rate for Payer: Cigna of WY Commercial |
$174.44
|
| Rate for Payer: First Choice Health Commercial |
$160.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.63
|
| Rate for Payer: HealthUtah PPO |
$178.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.66
|
| Rate for Payer: Multiplan Medicare/VA |
$28.59
|
| Rate for Payer: One Health Plan of WY PPO |
$174.44
|
| Rate for Payer: PacificSource Commercial |
$160.20
|
| Rate for Payer: PHCS PPO |
$169.10
|
| Rate for Payer: Three Rivers PPO |
$133.50
|
| Rate for Payer: TriWest Veterans Administration |
$33.63
|
| Rate for Payer: United Healthcare Commercial |
$154.86
|
| Rate for Payer: United Healthcare Medicare |
$33.63
|
| Rate for Payer: WINHealth Partners Commercial |
$169.10
|
|
|
CICA CARE SILICONE PAD 5"X6"
|
Facility
|
OP
|
$59.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.31
|
| Rate for Payer: Aetna of WY Medicare |
$39.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.12
|
| Rate for Payer: Altius Commercial |
$57.12
|
| Rate for Payer: Beech Street Commercial |
$58.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.85
|
| Rate for Payer: Cash Price |
$41.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.72
|
| Rate for Payer: Cigna of WY Commercial |
$58.31
|
| Rate for Payer: Entrust Commercial |
$56.52
|
| Rate for Payer: First Choice Health Commercial |
$56.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.51
|
| Rate for Payer: HealthUtah PPO |
$59.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.72
|
| Rate for Payer: Multiplan Medicare/VA |
$32.78
|
| Rate for Payer: One Health Plan of WY PPO |
$58.31
|
| Rate for Payer: PacificSource Commercial |
$53.55
|
| Rate for Payer: PHCS PPO |
$58.31
|
| Rate for Payer: Three Rivers PPO |
$44.62
|
| Rate for Payer: TriWest Veterans Administration |
$34.51
|
| Rate for Payer: United Healthcare Commercial |
$51.76
|
| Rate for Payer: United Healthcare Medicare |
$34.51
|
| Rate for Payer: WINHealth Partners Commercial |
$58.31
|
| Rate for Payer: Wise Provider Network Commercial |
$56.52
|
|
|
CICA CARE SILICONE PAD 5"X6"
|
Facility
|
IP
|
$59.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.12
|
| Rate for Payer: Altius Commercial |
$57.12
|
| Rate for Payer: Beech Street Commercial |
$58.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$48.85
|
| Rate for Payer: Cash Price |
$41.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.72
|
| Rate for Payer: Cigna of WY Commercial |
$58.31
|
| Rate for Payer: Entrust Commercial |
$56.52
|
| Rate for Payer: First Choice Health Commercial |
$56.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.27
|
| Rate for Payer: HealthUtah PPO |
$59.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.72
|
| Rate for Payer: Multiplan Medicare/VA |
$37.31
|
| Rate for Payer: One Health Plan of WY PPO |
$58.31
|
| Rate for Payer: PacificSource Commercial |
$53.55
|
| Rate for Payer: PHCS PPO |
$58.31
|
| Rate for Payer: Three Rivers PPO |
$44.62
|
| Rate for Payer: TriWest Veterans Administration |
$39.27
|
| Rate for Payer: United Healthcare Commercial |
$51.76
|
| Rate for Payer: United Healthcare Medicare |
$39.27
|
| Rate for Payer: WINHealth Partners Commercial |
$56.52
|
| Rate for Payer: Wise Provider Network Commercial |
$56.52
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [15924]
|
Facility
|
IP
|
$311.62
|
|
|
Service Code
|
HCPCS J0740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$311.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$305.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$299.16
|
| Rate for Payer: Altius Commercial |
$299.16
|
| Rate for Payer: Beech Street Commercial |
$305.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$255.84
|
| Rate for Payer: Cash Price |
$218.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$302.27
|
| Rate for Payer: Cigna of WY Commercial |
$305.39
|
| Rate for Payer: Entrust Commercial |
$296.04
|
| Rate for Payer: First Choice Health Commercial |
$296.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$205.67
|
| Rate for Payer: HealthUtah PPO |
$311.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$302.27
|
| Rate for Payer: Multiplan Medicare/VA |
$195.39
|
| Rate for Payer: One Health Plan of WY PPO |
$305.39
|
| Rate for Payer: PacificSource Commercial |
$280.46
|
| Rate for Payer: PHCS PPO |
$305.39
|
| Rate for Payer: Three Rivers PPO |
$233.72
|
| Rate for Payer: TriWest Veterans Administration |
$205.67
|
| Rate for Payer: United Healthcare Commercial |
$271.11
|
| Rate for Payer: United Healthcare Medicare |
$205.67
|
| Rate for Payer: WINHealth Partners Commercial |
$296.04
|
| Rate for Payer: Wise Provider Network Commercial |
$296.04
|
|
|
CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [15924]
|
Facility
|
OP
|
$311.62
|
|
|
Service Code
|
HCPCS J0740
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$311.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$305.39
|
| Rate for Payer: Aetna of WY Medicare |
$205.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$299.16
|
| Rate for Payer: Altius Commercial |
$299.16
|
| Rate for Payer: Beech Street Commercial |
$305.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$255.84
|
| Rate for Payer: Cash Price |
$218.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$302.27
|
| Rate for Payer: Cigna of WY Commercial |
$305.39
|
| Rate for Payer: Entrust Commercial |
$296.04
|
| Rate for Payer: First Choice Health Commercial |
$296.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$180.74
|
| Rate for Payer: HealthUtah PPO |
$311.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$302.27
|
| Rate for Payer: Multiplan Medicare/VA |
$171.70
|
| Rate for Payer: One Health Plan of WY PPO |
$305.39
|
| Rate for Payer: PacificSource Commercial |
$280.46
|
| Rate for Payer: PHCS PPO |
$305.39
|
| Rate for Payer: Three Rivers PPO |
$233.72
|
| Rate for Payer: TriWest Veterans Administration |
$180.74
|
| Rate for Payer: United Healthcare Commercial |
$271.11
|
| Rate for Payer: United Healthcare Medicare |
$180.74
|
| Rate for Payer: WINHealth Partners Commercial |
$305.39
|
| Rate for Payer: Wise Provider Network Commercial |
$296.04
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
NDC 7248562513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$38.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.69
|
| Rate for Payer: Aetna of WY Medicare |
$25.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.92
|
| Rate for Payer: Altius Commercial |
$36.92
|
| Rate for Payer: Beech Street Commercial |
$37.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.58
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.31
|
| Rate for Payer: Cigna of WY Commercial |
$37.69
|
| Rate for Payer: Entrust Commercial |
$36.54
|
| Rate for Payer: First Choice Health Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.31
|
| Rate for Payer: HealthUtah PPO |
$38.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.31
|
| Rate for Payer: Multiplan Medicare/VA |
$21.19
|
| Rate for Payer: One Health Plan of WY PPO |
$37.69
|
| Rate for Payer: PacificSource Commercial |
$34.61
|
| Rate for Payer: PHCS PPO |
$37.69
|
| Rate for Payer: Three Rivers PPO |
$28.84
|
| Rate for Payer: TriWest Veterans Administration |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$33.46
|
| Rate for Payer: United Healthcare Medicare |
$22.31
|
| Rate for Payer: WINHealth Partners Commercial |
$37.69
|
| Rate for Payer: Wise Provider Network Commercial |
$36.54
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
IP
|
$59.78
|
|
|
Service Code
|
NDC 0781618667
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.39
|
| Rate for Payer: Altius Commercial |
$57.39
|
| Rate for Payer: Beech Street Commercial |
$58.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.08
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.99
|
| Rate for Payer: Cigna of WY Commercial |
$58.58
|
| Rate for Payer: Entrust Commercial |
$56.79
|
| Rate for Payer: First Choice Health Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.45
|
| Rate for Payer: HealthUtah PPO |
$59.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.99
|
| Rate for Payer: Multiplan Medicare/VA |
$37.48
|
| Rate for Payer: One Health Plan of WY PPO |
$58.58
|
| Rate for Payer: PacificSource Commercial |
$53.80
|
| Rate for Payer: PHCS PPO |
$58.58
|
| Rate for Payer: Three Rivers PPO |
$44.84
|
| Rate for Payer: TriWest Veterans Administration |
$39.45
|
| Rate for Payer: United Healthcare Commercial |
$52.01
|
| Rate for Payer: United Healthcare Medicare |
$39.45
|
| Rate for Payer: WINHealth Partners Commercial |
$56.79
|
| Rate for Payer: Wise Provider Network Commercial |
$56.79
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
OP
|
$38.46
|
|
|
Service Code
|
NDC 4359832675
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$38.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.69
|
| Rate for Payer: Aetna of WY Medicare |
$25.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.92
|
| Rate for Payer: Altius Commercial |
$36.92
|
| Rate for Payer: Beech Street Commercial |
$37.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.58
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.31
|
| Rate for Payer: Cigna of WY Commercial |
$37.69
|
| Rate for Payer: Entrust Commercial |
$36.54
|
| Rate for Payer: First Choice Health Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.31
|
| Rate for Payer: HealthUtah PPO |
$38.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.31
|
| Rate for Payer: Multiplan Medicare/VA |
$21.19
|
| Rate for Payer: One Health Plan of WY PPO |
$37.69
|
| Rate for Payer: PacificSource Commercial |
$34.61
|
| Rate for Payer: PHCS PPO |
$37.69
|
| Rate for Payer: Three Rivers PPO |
$28.84
|
| Rate for Payer: TriWest Veterans Administration |
$22.31
|
| Rate for Payer: United Healthcare Commercial |
$33.46
|
| Rate for Payer: United Healthcare Medicare |
$22.31
|
| Rate for Payer: WINHealth Partners Commercial |
$37.69
|
| Rate for Payer: Wise Provider Network Commercial |
$36.54
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
IP
|
$59.78
|
|
|
Service Code
|
NDC 6275642790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.39
|
| Rate for Payer: Altius Commercial |
$57.39
|
| Rate for Payer: Beech Street Commercial |
$58.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.08
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.99
|
| Rate for Payer: Cigna of WY Commercial |
$58.58
|
| Rate for Payer: Entrust Commercial |
$56.79
|
| Rate for Payer: First Choice Health Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.45
|
| Rate for Payer: HealthUtah PPO |
$59.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.99
|
| Rate for Payer: Multiplan Medicare/VA |
$37.48
|
| Rate for Payer: One Health Plan of WY PPO |
$58.58
|
| Rate for Payer: PacificSource Commercial |
$53.80
|
| Rate for Payer: PHCS PPO |
$58.58
|
| Rate for Payer: Three Rivers PPO |
$44.84
|
| Rate for Payer: TriWest Veterans Administration |
$39.45
|
| Rate for Payer: United Healthcare Commercial |
$52.01
|
| Rate for Payer: United Healthcare Medicare |
$39.45
|
| Rate for Payer: WINHealth Partners Commercial |
$56.79
|
| Rate for Payer: Wise Provider Network Commercial |
$56.79
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
IP
|
$38.46
|
|
|
Service Code
|
NDC 7248562513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$38.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.92
|
| Rate for Payer: Altius Commercial |
$36.92
|
| Rate for Payer: Beech Street Commercial |
$37.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.58
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.31
|
| Rate for Payer: Cigna of WY Commercial |
$37.69
|
| Rate for Payer: Entrust Commercial |
$36.54
|
| Rate for Payer: First Choice Health Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.38
|
| Rate for Payer: HealthUtah PPO |
$38.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.31
|
| Rate for Payer: Multiplan Medicare/VA |
$24.11
|
| Rate for Payer: One Health Plan of WY PPO |
$37.69
|
| Rate for Payer: PacificSource Commercial |
$34.61
|
| Rate for Payer: PHCS PPO |
$37.69
|
| Rate for Payer: Three Rivers PPO |
$28.84
|
| Rate for Payer: TriWest Veterans Administration |
$25.38
|
| Rate for Payer: United Healthcare Commercial |
$33.46
|
| Rate for Payer: United Healthcare Medicare |
$25.38
|
| Rate for Payer: WINHealth Partners Commercial |
$36.54
|
| Rate for Payer: Wise Provider Network Commercial |
$36.54
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
OP
|
$59.78
|
|
|
Service Code
|
NDC 0781618667
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.58
|
| Rate for Payer: Aetna of WY Medicare |
$39.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.39
|
| Rate for Payer: Altius Commercial |
$57.39
|
| Rate for Payer: Beech Street Commercial |
$58.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.08
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.99
|
| Rate for Payer: Cigna of WY Commercial |
$58.58
|
| Rate for Payer: Entrust Commercial |
$56.79
|
| Rate for Payer: First Choice Health Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.67
|
| Rate for Payer: HealthUtah PPO |
$59.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.99
|
| Rate for Payer: Multiplan Medicare/VA |
$32.94
|
| Rate for Payer: One Health Plan of WY PPO |
$58.58
|
| Rate for Payer: PacificSource Commercial |
$53.80
|
| Rate for Payer: PHCS PPO |
$58.58
|
| Rate for Payer: Three Rivers PPO |
$44.84
|
| Rate for Payer: TriWest Veterans Administration |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$52.01
|
| Rate for Payer: United Healthcare Medicare |
$34.67
|
| Rate for Payer: WINHealth Partners Commercial |
$58.58
|
| Rate for Payer: Wise Provider Network Commercial |
$56.79
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
IP
|
$38.46
|
|
|
Service Code
|
NDC 4359832675
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$38.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.92
|
| Rate for Payer: Altius Commercial |
$36.92
|
| Rate for Payer: Beech Street Commercial |
$37.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.58
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.31
|
| Rate for Payer: Cigna of WY Commercial |
$37.69
|
| Rate for Payer: Entrust Commercial |
$36.54
|
| Rate for Payer: First Choice Health Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.38
|
| Rate for Payer: HealthUtah PPO |
$38.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.31
|
| Rate for Payer: Multiplan Medicare/VA |
$24.11
|
| Rate for Payer: One Health Plan of WY PPO |
$37.69
|
| Rate for Payer: PacificSource Commercial |
$34.61
|
| Rate for Payer: PHCS PPO |
$37.69
|
| Rate for Payer: Three Rivers PPO |
$28.84
|
| Rate for Payer: TriWest Veterans Administration |
$25.38
|
| Rate for Payer: United Healthcare Commercial |
$33.46
|
| Rate for Payer: United Healthcare Medicare |
$25.38
|
| Rate for Payer: WINHealth Partners Commercial |
$36.54
|
| Rate for Payer: Wise Provider Network Commercial |
$36.54
|
|
|
CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [29359]
|
Facility
|
OP
|
$59.78
|
|
|
Service Code
|
NDC 6275642790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$59.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.58
|
| Rate for Payer: Aetna of WY Medicare |
$39.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.39
|
| Rate for Payer: Altius Commercial |
$57.39
|
| Rate for Payer: Beech Street Commercial |
$58.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.08
|
| Rate for Payer: Cash Price |
$41.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$57.99
|
| Rate for Payer: Cigna of WY Commercial |
$58.58
|
| Rate for Payer: Entrust Commercial |
$56.79
|
| Rate for Payer: First Choice Health Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$56.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.67
|
| Rate for Payer: HealthUtah PPO |
$59.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$57.99
|
| Rate for Payer: Multiplan Medicare/VA |
$32.94
|
| Rate for Payer: One Health Plan of WY PPO |
$58.58
|
| Rate for Payer: PacificSource Commercial |
$53.80
|
| Rate for Payer: PHCS PPO |
$58.58
|
| Rate for Payer: Three Rivers PPO |
$44.84
|
| Rate for Payer: TriWest Veterans Administration |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$52.01
|
| Rate for Payer: United Healthcare Medicare |
$34.67
|
| Rate for Payer: WINHealth Partners Commercial |
$58.58
|
| Rate for Payer: Wise Provider Network Commercial |
$56.79
|
|
