ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$0.80
|
|
Service Code
|
NDC 2315569405
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.50 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$0.77
|
Rate for Payer: Altius Commercial |
$0.77
|
Rate for Payer: Beech Street Commercial |
$0.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.66
|
Rate for Payer: Cash Price |
$0.56
|
Rate for Payer: ChoiceCare Network Commercial |
$0.78
|
Rate for Payer: Cigna of WY Commercial |
$0.78
|
Rate for Payer: Entrust Commercial |
$0.76
|
Rate for Payer: First Choice Health Commercial |
$0.76
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.76
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.53
|
Rate for Payer: HealthUtah PPO |
$0.80
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.78
|
Rate for Payer: Multiplan Medicare/VA |
$0.50
|
Rate for Payer: One Health Plan of WY PPO |
$0.78
|
Rate for Payer: PacificSource Commercial |
$0.72
|
Rate for Payer: PHCS PPO |
$0.78
|
Rate for Payer: Three Rivers PPO |
$0.60
|
Rate for Payer: TriWest Veterans Administration |
$0.53
|
Rate for Payer: United Healthcare Commercial |
$0.70
|
Rate for Payer: United Healthcare Medicare |
$0.53
|
Rate for Payer: WINHealth Partners Commercial |
$0.76
|
Rate for Payer: Wise Provider Network Commercial |
$0.76
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$2.28
|
|
Service Code
|
NDC 0378018101
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.43 |
Max. Negotiated Rate |
$2.28 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.19
|
Rate for Payer: Altius Commercial |
$2.19
|
Rate for Payer: Beech Street Commercial |
$2.23
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.87
|
Rate for Payer: Cash Price |
$1.60
|
Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
Rate for Payer: Cigna of WY Commercial |
$2.23
|
Rate for Payer: Entrust Commercial |
$2.17
|
Rate for Payer: First Choice Health Commercial |
$2.17
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.50
|
Rate for Payer: HealthUtah PPO |
$2.28
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
Rate for Payer: Multiplan Medicare/VA |
$1.43
|
Rate for Payer: One Health Plan of WY PPO |
$2.23
|
Rate for Payer: PacificSource Commercial |
$2.05
|
Rate for Payer: PHCS PPO |
$2.23
|
Rate for Payer: Three Rivers PPO |
$1.71
|
Rate for Payer: TriWest Veterans Administration |
$1.50
|
Rate for Payer: United Healthcare Commercial |
$1.98
|
Rate for Payer: United Healthcare Medicare |
$1.50
|
Rate for Payer: WINHealth Partners Commercial |
$2.17
|
Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$2.94
|
|
Service Code
|
NDC 6068768811
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.84 |
Max. Negotiated Rate |
$2.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.82
|
Rate for Payer: Altius Commercial |
$2.82
|
Rate for Payer: Beech Street Commercial |
$2.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.41
|
Rate for Payer: Cash Price |
$2.06
|
Rate for Payer: ChoiceCare Network Commercial |
$2.85
|
Rate for Payer: Cigna of WY Commercial |
$2.88
|
Rate for Payer: Entrust Commercial |
$2.79
|
Rate for Payer: First Choice Health Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.94
|
Rate for Payer: HealthUtah PPO |
$2.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.85
|
Rate for Payer: Multiplan Medicare/VA |
$1.84
|
Rate for Payer: One Health Plan of WY PPO |
$2.88
|
Rate for Payer: PacificSource Commercial |
$2.65
|
Rate for Payer: PHCS PPO |
$2.88
|
Rate for Payer: Three Rivers PPO |
$2.20
|
Rate for Payer: TriWest Veterans Administration |
$1.94
|
Rate for Payer: United Healthcare Commercial |
$2.56
|
Rate for Payer: United Healthcare Medicare |
$1.94
|
Rate for Payer: WINHealth Partners Commercial |
$2.79
|
Rate for Payer: Wise Provider Network Commercial |
$2.79
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
IP
|
$2.94
|
|
Service Code
|
NDC 6068768801
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.84 |
Max. Negotiated Rate |
$2.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.88
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.82
|
Rate for Payer: Altius Commercial |
$2.82
|
Rate for Payer: Beech Street Commercial |
$2.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.41
|
Rate for Payer: Cash Price |
$2.06
|
Rate for Payer: ChoiceCare Network Commercial |
$2.85
|
Rate for Payer: Cigna of WY Commercial |
$2.88
|
Rate for Payer: Entrust Commercial |
$2.79
|
Rate for Payer: First Choice Health Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.94
|
Rate for Payer: HealthUtah PPO |
$2.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.85
|
Rate for Payer: Multiplan Medicare/VA |
$1.84
|
Rate for Payer: One Health Plan of WY PPO |
$2.88
|
Rate for Payer: PacificSource Commercial |
$2.65
|
Rate for Payer: PHCS PPO |
$2.88
|
Rate for Payer: Three Rivers PPO |
$2.20
|
Rate for Payer: TriWest Veterans Administration |
$1.94
|
Rate for Payer: United Healthcare Commercial |
$2.56
|
Rate for Payer: United Healthcare Medicare |
$1.94
|
Rate for Payer: WINHealth Partners Commercial |
$2.79
|
Rate for Payer: Wise Provider Network Commercial |
$2.79
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$2.94
|
|
Service Code
|
NDC 6068768801
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.62 |
Max. Negotiated Rate |
$2.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.88
|
Rate for Payer: Aetna of WY Medicare |
$1.94
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.82
|
Rate for Payer: Altius Commercial |
$2.82
|
Rate for Payer: Beech Street Commercial |
$2.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.41
|
Rate for Payer: Cash Price |
$2.06
|
Rate for Payer: ChoiceCare Network Commercial |
$2.85
|
Rate for Payer: Cigna of WY Commercial |
$2.88
|
Rate for Payer: Entrust Commercial |
$2.79
|
Rate for Payer: First Choice Health Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.71
|
Rate for Payer: HealthUtah PPO |
$2.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.85
|
Rate for Payer: Multiplan Medicare/VA |
$1.62
|
Rate for Payer: One Health Plan of WY PPO |
$2.88
|
Rate for Payer: PacificSource Commercial |
$2.65
|
Rate for Payer: PHCS PPO |
$2.88
|
Rate for Payer: Three Rivers PPO |
$2.20
|
Rate for Payer: TriWest Veterans Administration |
$1.71
|
Rate for Payer: United Healthcare Commercial |
$2.56
|
Rate for Payer: United Healthcare Medicare |
$1.71
|
Rate for Payer: WINHealth Partners Commercial |
$2.88
|
Rate for Payer: Wise Provider Network Commercial |
$2.79
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$2.94
|
|
Service Code
|
NDC 6068768811
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.62 |
Max. Negotiated Rate |
$2.94 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.88
|
Rate for Payer: Aetna of WY Medicare |
$1.94
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.82
|
Rate for Payer: Altius Commercial |
$2.82
|
Rate for Payer: Beech Street Commercial |
$2.88
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.41
|
Rate for Payer: Cash Price |
$2.06
|
Rate for Payer: ChoiceCare Network Commercial |
$2.85
|
Rate for Payer: Cigna of WY Commercial |
$2.88
|
Rate for Payer: Entrust Commercial |
$2.79
|
Rate for Payer: First Choice Health Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.79
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.71
|
Rate for Payer: HealthUtah PPO |
$2.94
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.85
|
Rate for Payer: Multiplan Medicare/VA |
$1.62
|
Rate for Payer: One Health Plan of WY PPO |
$2.88
|
Rate for Payer: PacificSource Commercial |
$2.65
|
Rate for Payer: PHCS PPO |
$2.88
|
Rate for Payer: Three Rivers PPO |
$2.20
|
Rate for Payer: TriWest Veterans Administration |
$1.71
|
Rate for Payer: United Healthcare Commercial |
$2.56
|
Rate for Payer: United Healthcare Medicare |
$1.71
|
Rate for Payer: WINHealth Partners Commercial |
$2.88
|
Rate for Payer: Wise Provider Network Commercial |
$2.79
|
|
ALLOPURINOL 300 MG TABLET [16060]
|
Facility
|
OP
|
$2.28
|
|
Service Code
|
NDC 0378018101
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.26 |
Max. Negotiated Rate |
$2.28 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
Rate for Payer: Aetna of WY Medicare |
$1.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$2.19
|
Rate for Payer: Altius Commercial |
$2.19
|
Rate for Payer: Beech Street Commercial |
$2.23
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.87
|
Rate for Payer: Cash Price |
$1.60
|
Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
Rate for Payer: Cigna of WY Commercial |
$2.23
|
Rate for Payer: Entrust Commercial |
$2.17
|
Rate for Payer: First Choice Health Commercial |
$2.17
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
Rate for Payer: HealthUtah PPO |
$2.28
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
Rate for Payer: Multiplan Medicare/VA |
$1.26
|
Rate for Payer: One Health Plan of WY PPO |
$2.23
|
Rate for Payer: PacificSource Commercial |
$2.05
|
Rate for Payer: PHCS PPO |
$2.23
|
Rate for Payer: Three Rivers PPO |
$1.71
|
Rate for Payer: TriWest Veterans Administration |
$1.32
|
Rate for Payer: United Healthcare Commercial |
$1.98
|
Rate for Payer: United Healthcare Medicare |
$1.32
|
Rate for Payer: WINHealth Partners Commercial |
$2.23
|
Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
ALLOSYNC EXPAND FIBERS 10CC
|
Facility
|
IP
|
$5,314.40
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,332.13 |
Max. Negotiated Rate |
$5,314.40 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,208.11
|
Rate for Payer: Altius Auto/Workers Compensation |
$5,101.82
|
Rate for Payer: Altius Commercial |
$5,101.82
|
Rate for Payer: Beech Street Commercial |
$5,208.11
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,363.12
|
Rate for Payer: Cash Price |
$3,720.08
|
Rate for Payer: ChoiceCare Network Commercial |
$5,154.97
|
Rate for Payer: Cigna of WY Commercial |
$5,208.11
|
Rate for Payer: Entrust Commercial |
$5,048.68
|
Rate for Payer: First Choice Health Commercial |
$5,048.68
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,048.68
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,507.50
|
Rate for Payer: HealthUtah PPO |
$5,314.40
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,154.97
|
Rate for Payer: Multiplan Medicare/VA |
$3,332.13
|
Rate for Payer: One Health Plan of WY PPO |
$5,208.11
|
Rate for Payer: PacificSource Commercial |
$4,782.96
|
Rate for Payer: PHCS PPO |
$5,208.11
|
Rate for Payer: Three Rivers PPO |
$3,985.80
|
Rate for Payer: TriWest Veterans Administration |
$3,507.50
|
Rate for Payer: United Healthcare Commercial |
$4,623.53
|
Rate for Payer: United Healthcare Medicare |
$3,507.50
|
Rate for Payer: WINHealth Partners Commercial |
$5,048.68
|
Rate for Payer: Wise Provider Network Commercial |
$5,048.68
|
|
ALLOSYNC EXPAND FIBERS 10CC
|
Facility
|
OP
|
$5,314.40
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,928.23 |
Max. Negotiated Rate |
$5,314.40 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,208.11
|
Rate for Payer: Aetna of WY Medicare |
$3,507.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$5,101.82
|
Rate for Payer: Altius Commercial |
$5,101.82
|
Rate for Payer: Beech Street Commercial |
$5,208.11
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4,363.12
|
Rate for Payer: Cash Price |
$3,720.08
|
Rate for Payer: ChoiceCare Network Commercial |
$5,154.97
|
Rate for Payer: Cigna of WY Commercial |
$5,208.11
|
Rate for Payer: Entrust Commercial |
$5,048.68
|
Rate for Payer: First Choice Health Commercial |
$5,048.68
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,048.68
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,082.35
|
Rate for Payer: HealthUtah PPO |
$5,314.40
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,154.97
|
Rate for Payer: Multiplan Medicare/VA |
$2,928.23
|
Rate for Payer: One Health Plan of WY PPO |
$5,208.11
|
Rate for Payer: PacificSource Commercial |
$4,782.96
|
Rate for Payer: PHCS PPO |
$5,208.11
|
Rate for Payer: Three Rivers PPO |
$3,985.80
|
Rate for Payer: TriWest Veterans Administration |
$3,082.35
|
Rate for Payer: United Healthcare Commercial |
$4,623.53
|
Rate for Payer: United Healthcare Medicare |
$3,082.35
|
Rate for Payer: WINHealth Partners Commercial |
$5,208.11
|
Rate for Payer: Wise Provider Network Commercial |
$5,048.68
|
|
ALLOSYNC EXPAND FIBERS 5CC
|
Facility
|
OP
|
$3,066.00
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,689.37 |
Max. Negotiated Rate |
$3,066.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,004.68
|
Rate for Payer: Aetna of WY Medicare |
$2,023.56
|
Rate for Payer: Altius Auto/Workers Compensation |
$2,943.36
|
Rate for Payer: Altius Commercial |
$2,943.36
|
Rate for Payer: Beech Street Commercial |
$3,004.68
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,517.19
|
Rate for Payer: Cash Price |
$2,146.20
|
Rate for Payer: ChoiceCare Network Commercial |
$2,974.02
|
Rate for Payer: Cigna of WY Commercial |
$3,004.68
|
Rate for Payer: Entrust Commercial |
$2,912.70
|
Rate for Payer: First Choice Health Commercial |
$2,912.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,912.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,778.28
|
Rate for Payer: HealthUtah PPO |
$3,066.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,974.02
|
Rate for Payer: Multiplan Medicare/VA |
$1,689.37
|
Rate for Payer: One Health Plan of WY PPO |
$3,004.68
|
Rate for Payer: PacificSource Commercial |
$2,759.40
|
Rate for Payer: PHCS PPO |
$3,004.68
|
Rate for Payer: Three Rivers PPO |
$2,299.50
|
Rate for Payer: TriWest Veterans Administration |
$1,778.28
|
Rate for Payer: United Healthcare Commercial |
$2,667.42
|
Rate for Payer: United Healthcare Medicare |
$1,778.28
|
Rate for Payer: WINHealth Partners Commercial |
$3,004.68
|
Rate for Payer: Wise Provider Network Commercial |
$2,912.70
|
|
ALLOSYNC EXPAND FIBERS 5CC
|
Facility
|
IP
|
$3,066.00
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,922.38 |
Max. Negotiated Rate |
$3,066.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,004.68
|
Rate for Payer: Altius Auto/Workers Compensation |
$2,943.36
|
Rate for Payer: Altius Commercial |
$2,943.36
|
Rate for Payer: Beech Street Commercial |
$3,004.68
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,517.19
|
Rate for Payer: Cash Price |
$2,146.20
|
Rate for Payer: ChoiceCare Network Commercial |
$2,974.02
|
Rate for Payer: Cigna of WY Commercial |
$3,004.68
|
Rate for Payer: Entrust Commercial |
$2,912.70
|
Rate for Payer: First Choice Health Commercial |
$2,912.70
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,912.70
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,023.56
|
Rate for Payer: HealthUtah PPO |
$3,066.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,974.02
|
Rate for Payer: Multiplan Medicare/VA |
$1,922.38
|
Rate for Payer: One Health Plan of WY PPO |
$3,004.68
|
Rate for Payer: PacificSource Commercial |
$2,759.40
|
Rate for Payer: PHCS PPO |
$3,004.68
|
Rate for Payer: Three Rivers PPO |
$2,299.50
|
Rate for Payer: TriWest Veterans Administration |
$2,023.56
|
Rate for Payer: United Healthcare Commercial |
$2,667.42
|
Rate for Payer: United Healthcare Medicare |
$2,023.56
|
Rate for Payer: WINHealth Partners Commercial |
$2,912.70
|
Rate for Payer: Wise Provider Network Commercial |
$2,912.70
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION [151394]
|
Facility
|
IP
|
$600.00
|
|
Service Code
|
HCPCS J0256
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$376.20 |
Max. Negotiated Rate |
$600.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
Rate for Payer: Altius Commercial |
$576.00
|
Rate for Payer: Beech Street Commercial |
$588.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
Rate for Payer: Cash Price |
$420.00
|
Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
Rate for Payer: Cigna of WY Commercial |
$588.00
|
Rate for Payer: Entrust Commercial |
$570.00
|
Rate for Payer: First Choice Health Commercial |
$570.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$396.00
|
Rate for Payer: HealthUtah PPO |
$600.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
Rate for Payer: Multiplan Medicare/VA |
$376.20
|
Rate for Payer: One Health Plan of WY PPO |
$588.00
|
Rate for Payer: PacificSource Commercial |
$540.00
|
Rate for Payer: PHCS PPO |
$588.00
|
Rate for Payer: Three Rivers PPO |
$450.00
|
Rate for Payer: TriWest Veterans Administration |
$396.00
|
Rate for Payer: United Healthcare Commercial |
$522.00
|
Rate for Payer: United Healthcare Medicare |
$396.00
|
Rate for Payer: WINHealth Partners Commercial |
$570.00
|
Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
ALPHA-1-PROTEINASE INHIBITOR (HUMAN) 1,000 MG (+/-)/20 ML IV SOLUTION [151394]
|
Facility
|
OP
|
$600.00
|
|
Service Code
|
HCPCS J0256
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$330.60 |
Max. Negotiated Rate |
$600.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$588.00
|
Rate for Payer: Aetna of WY Medicare |
$396.00
|
Rate for Payer: Altius Auto/Workers Compensation |
$576.00
|
Rate for Payer: Altius Commercial |
$576.00
|
Rate for Payer: Beech Street Commercial |
$588.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$492.60
|
Rate for Payer: Cash Price |
$420.00
|
Rate for Payer: ChoiceCare Network Commercial |
$582.00
|
Rate for Payer: Cigna of WY Commercial |
$588.00
|
Rate for Payer: Entrust Commercial |
$570.00
|
Rate for Payer: First Choice Health Commercial |
$570.00
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$570.00
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$348.00
|
Rate for Payer: HealthUtah PPO |
$600.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$582.00
|
Rate for Payer: Multiplan Medicare/VA |
$330.60
|
Rate for Payer: One Health Plan of WY PPO |
$588.00
|
Rate for Payer: PacificSource Commercial |
$540.00
|
Rate for Payer: PHCS PPO |
$588.00
|
Rate for Payer: Three Rivers PPO |
$450.00
|
Rate for Payer: TriWest Veterans Administration |
$348.00
|
Rate for Payer: United Healthcare Commercial |
$522.00
|
Rate for Payer: United Healthcare Medicare |
$348.00
|
Rate for Payer: WINHealth Partners Commercial |
$588.00
|
Rate for Payer: Wise Provider Network Commercial |
$570.00
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
IP
|
$0.20
|
|
Service Code
|
NDC 0228202910
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.13 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$0.19
|
Rate for Payer: Altius Commercial |
$0.19
|
Rate for Payer: Beech Street Commercial |
$0.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: ChoiceCare Network Commercial |
$0.19
|
Rate for Payer: Cigna of WY Commercial |
$0.20
|
Rate for Payer: Entrust Commercial |
$0.19
|
Rate for Payer: First Choice Health Commercial |
$0.19
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.19
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
Rate for Payer: HealthUtah PPO |
$0.20
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.19
|
Rate for Payer: Multiplan Medicare/VA |
$0.13
|
Rate for Payer: One Health Plan of WY PPO |
$0.20
|
Rate for Payer: PacificSource Commercial |
$0.18
|
Rate for Payer: PHCS PPO |
$0.20
|
Rate for Payer: Three Rivers PPO |
$0.15
|
Rate for Payer: TriWest Veterans Administration |
$0.13
|
Rate for Payer: United Healthcare Commercial |
$0.17
|
Rate for Payer: United Healthcare Medicare |
$0.13
|
Rate for Payer: WINHealth Partners Commercial |
$0.19
|
Rate for Payer: Wise Provider Network Commercial |
$0.19
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
OP
|
$0.20
|
|
Service Code
|
NDC 0228202910
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.20 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.20
|
Rate for Payer: Aetna of WY Medicare |
$0.13
|
Rate for Payer: Altius Auto/Workers Compensation |
$0.19
|
Rate for Payer: Altius Commercial |
$0.19
|
Rate for Payer: Beech Street Commercial |
$0.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.16
|
Rate for Payer: Cash Price |
$0.14
|
Rate for Payer: ChoiceCare Network Commercial |
$0.19
|
Rate for Payer: Cigna of WY Commercial |
$0.20
|
Rate for Payer: Entrust Commercial |
$0.19
|
Rate for Payer: First Choice Health Commercial |
$0.19
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.19
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
Rate for Payer: HealthUtah PPO |
$0.20
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.19
|
Rate for Payer: Multiplan Medicare/VA |
$0.11
|
Rate for Payer: One Health Plan of WY PPO |
$0.20
|
Rate for Payer: PacificSource Commercial |
$0.18
|
Rate for Payer: PHCS PPO |
$0.20
|
Rate for Payer: Three Rivers PPO |
$0.15
|
Rate for Payer: TriWest Veterans Administration |
$0.12
|
Rate for Payer: United Healthcare Commercial |
$0.17
|
Rate for Payer: United Healthcare Medicare |
$0.12
|
Rate for Payer: WINHealth Partners Commercial |
$0.20
|
Rate for Payer: Wise Provider Network Commercial |
$0.19
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
IP
|
$1.47
|
|
Service Code
|
NDC 6068738811
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.92 |
Max. Negotiated Rate |
$1.47 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.41
|
Rate for Payer: Altius Commercial |
$1.41
|
Rate for Payer: Beech Street Commercial |
$1.44
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.21
|
Rate for Payer: Cash Price |
$1.03
|
Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
Rate for Payer: Cigna of WY Commercial |
$1.44
|
Rate for Payer: Entrust Commercial |
$1.40
|
Rate for Payer: First Choice Health Commercial |
$1.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.97
|
Rate for Payer: HealthUtah PPO |
$1.47
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
Rate for Payer: Multiplan Medicare/VA |
$0.92
|
Rate for Payer: One Health Plan of WY PPO |
$1.44
|
Rate for Payer: PacificSource Commercial |
$1.32
|
Rate for Payer: PHCS PPO |
$1.44
|
Rate for Payer: Three Rivers PPO |
$1.10
|
Rate for Payer: TriWest Veterans Administration |
$0.97
|
Rate for Payer: United Healthcare Commercial |
$1.28
|
Rate for Payer: United Healthcare Medicare |
$0.97
|
Rate for Payer: WINHealth Partners Commercial |
$1.40
|
Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
ALPRAZOLAM 0.5 MG TABLET [9710]
|
Facility
|
OP
|
$1.47
|
|
Service Code
|
NDC 6068738811
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.81 |
Max. Negotiated Rate |
$1.47 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
Rate for Payer: Aetna of WY Medicare |
$0.97
|
Rate for Payer: Altius Auto/Workers Compensation |
$1.41
|
Rate for Payer: Altius Commercial |
$1.41
|
Rate for Payer: Beech Street Commercial |
$1.44
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.21
|
Rate for Payer: Cash Price |
$1.03
|
Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
Rate for Payer: Cigna of WY Commercial |
$1.44
|
Rate for Payer: Entrust Commercial |
$1.40
|
Rate for Payer: First Choice Health Commercial |
$1.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.85
|
Rate for Payer: HealthUtah PPO |
$1.47
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
Rate for Payer: Multiplan Medicare/VA |
$0.81
|
Rate for Payer: One Health Plan of WY PPO |
$1.44
|
Rate for Payer: PacificSource Commercial |
$1.32
|
Rate for Payer: PHCS PPO |
$1.44
|
Rate for Payer: Three Rivers PPO |
$1.10
|
Rate for Payer: TriWest Veterans Administration |
$0.85
|
Rate for Payer: United Healthcare Commercial |
$1.28
|
Rate for Payer: United Healthcare Medicare |
$0.85
|
Rate for Payer: WINHealth Partners Commercial |
$1.44
|
Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
OP
|
$256.92
|
|
Service Code
|
NDC 0009316901
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$141.56 |
Max. Negotiated Rate |
$256.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.78
|
Rate for Payer: Aetna of WY Medicare |
$169.57
|
Rate for Payer: Altius Auto/Workers Compensation |
$246.64
|
Rate for Payer: Altius Commercial |
$246.64
|
Rate for Payer: Beech Street Commercial |
$251.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.93
|
Rate for Payer: Cash Price |
$179.84
|
Rate for Payer: ChoiceCare Network Commercial |
$249.21
|
Rate for Payer: Cigna of WY Commercial |
$251.78
|
Rate for Payer: Entrust Commercial |
$244.07
|
Rate for Payer: First Choice Health Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.01
|
Rate for Payer: HealthUtah PPO |
$256.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.21
|
Rate for Payer: Multiplan Medicare/VA |
$141.56
|
Rate for Payer: One Health Plan of WY PPO |
$251.78
|
Rate for Payer: PacificSource Commercial |
$231.23
|
Rate for Payer: PHCS PPO |
$251.78
|
Rate for Payer: Three Rivers PPO |
$192.69
|
Rate for Payer: TriWest Veterans Administration |
$149.01
|
Rate for Payer: United Healthcare Commercial |
$223.52
|
Rate for Payer: United Healthcare Medicare |
$149.01
|
Rate for Payer: WINHealth Partners Commercial |
$251.78
|
Rate for Payer: Wise Provider Network Commercial |
$244.07
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
OP
|
$256.92
|
|
Service Code
|
NDC 0009316906
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$141.56 |
Max. Negotiated Rate |
$256.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.78
|
Rate for Payer: Aetna of WY Medicare |
$169.57
|
Rate for Payer: Altius Auto/Workers Compensation |
$246.64
|
Rate for Payer: Altius Commercial |
$246.64
|
Rate for Payer: Beech Street Commercial |
$251.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.93
|
Rate for Payer: Cash Price |
$179.84
|
Rate for Payer: ChoiceCare Network Commercial |
$249.21
|
Rate for Payer: Cigna of WY Commercial |
$251.78
|
Rate for Payer: Entrust Commercial |
$244.07
|
Rate for Payer: First Choice Health Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.01
|
Rate for Payer: HealthUtah PPO |
$256.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.21
|
Rate for Payer: Multiplan Medicare/VA |
$141.56
|
Rate for Payer: One Health Plan of WY PPO |
$251.78
|
Rate for Payer: PacificSource Commercial |
$231.23
|
Rate for Payer: PHCS PPO |
$251.78
|
Rate for Payer: Three Rivers PPO |
$192.69
|
Rate for Payer: TriWest Veterans Administration |
$149.01
|
Rate for Payer: United Healthcare Commercial |
$223.52
|
Rate for Payer: United Healthcare Medicare |
$149.01
|
Rate for Payer: WINHealth Partners Commercial |
$251.78
|
Rate for Payer: Wise Provider Network Commercial |
$244.07
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
IP
|
$256.92
|
|
Service Code
|
NDC 0009316901
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$161.09 |
Max. Negotiated Rate |
$256.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$246.64
|
Rate for Payer: Altius Commercial |
$246.64
|
Rate for Payer: Beech Street Commercial |
$251.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.93
|
Rate for Payer: Cash Price |
$179.84
|
Rate for Payer: ChoiceCare Network Commercial |
$249.21
|
Rate for Payer: Cigna of WY Commercial |
$251.78
|
Rate for Payer: Entrust Commercial |
$244.07
|
Rate for Payer: First Choice Health Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.57
|
Rate for Payer: HealthUtah PPO |
$256.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.21
|
Rate for Payer: Multiplan Medicare/VA |
$161.09
|
Rate for Payer: One Health Plan of WY PPO |
$251.78
|
Rate for Payer: PacificSource Commercial |
$231.23
|
Rate for Payer: PHCS PPO |
$251.78
|
Rate for Payer: Three Rivers PPO |
$192.69
|
Rate for Payer: TriWest Veterans Administration |
$169.57
|
Rate for Payer: United Healthcare Commercial |
$223.52
|
Rate for Payer: United Healthcare Medicare |
$169.57
|
Rate for Payer: WINHealth Partners Commercial |
$244.07
|
Rate for Payer: Wise Provider Network Commercial |
$244.07
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION [1746]
|
Facility
|
IP
|
$256.92
|
|
Service Code
|
NDC 0009316906
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$161.09 |
Max. Negotiated Rate |
$256.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$251.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$246.64
|
Rate for Payer: Altius Commercial |
$246.64
|
Rate for Payer: Beech Street Commercial |
$251.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.93
|
Rate for Payer: Cash Price |
$179.84
|
Rate for Payer: ChoiceCare Network Commercial |
$249.21
|
Rate for Payer: Cigna of WY Commercial |
$251.78
|
Rate for Payer: Entrust Commercial |
$244.07
|
Rate for Payer: First Choice Health Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$244.07
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$169.57
|
Rate for Payer: HealthUtah PPO |
$256.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$249.21
|
Rate for Payer: Multiplan Medicare/VA |
$161.09
|
Rate for Payer: One Health Plan of WY PPO |
$251.78
|
Rate for Payer: PacificSource Commercial |
$231.23
|
Rate for Payer: PHCS PPO |
$251.78
|
Rate for Payer: Three Rivers PPO |
$192.69
|
Rate for Payer: TriWest Veterans Administration |
$169.57
|
Rate for Payer: United Healthcare Commercial |
$223.52
|
Rate for Payer: United Healthcare Medicare |
$169.57
|
Rate for Payer: WINHealth Partners Commercial |
$244.07
|
Rate for Payer: Wise Provider Network Commercial |
$244.07
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [19101]
|
Facility
|
IP
|
$277.76
|
|
Service Code
|
HCPCS J2997
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$174.16 |
Max. Negotiated Rate |
$277.76 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.20
|
Rate for Payer: Altius Auto/Workers Compensation |
$266.65
|
Rate for Payer: Altius Commercial |
$266.65
|
Rate for Payer: Beech Street Commercial |
$272.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.04
|
Rate for Payer: Cash Price |
$194.43
|
Rate for Payer: ChoiceCare Network Commercial |
$269.43
|
Rate for Payer: Cigna of WY Commercial |
$272.20
|
Rate for Payer: Entrust Commercial |
$263.87
|
Rate for Payer: First Choice Health Commercial |
$263.87
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.87
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$183.32
|
Rate for Payer: HealthUtah PPO |
$277.76
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.43
|
Rate for Payer: Multiplan Medicare/VA |
$174.16
|
Rate for Payer: One Health Plan of WY PPO |
$272.20
|
Rate for Payer: PacificSource Commercial |
$249.98
|
Rate for Payer: PHCS PPO |
$272.20
|
Rate for Payer: Three Rivers PPO |
$208.32
|
Rate for Payer: TriWest Veterans Administration |
$183.32
|
Rate for Payer: United Healthcare Commercial |
$241.65
|
Rate for Payer: United Healthcare Medicare |
$183.32
|
Rate for Payer: WINHealth Partners Commercial |
$263.87
|
Rate for Payer: Wise Provider Network Commercial |
$263.87
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION [19101]
|
Facility
|
OP
|
$277.76
|
|
Service Code
|
HCPCS J2997
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$153.05 |
Max. Negotiated Rate |
$277.76 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$272.20
|
Rate for Payer: Aetna of WY Medicare |
$183.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$266.65
|
Rate for Payer: Altius Commercial |
$266.65
|
Rate for Payer: Beech Street Commercial |
$272.20
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$228.04
|
Rate for Payer: Cash Price |
$194.43
|
Rate for Payer: ChoiceCare Network Commercial |
$269.43
|
Rate for Payer: Cigna of WY Commercial |
$272.20
|
Rate for Payer: Entrust Commercial |
$263.87
|
Rate for Payer: First Choice Health Commercial |
$263.87
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.87
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.10
|
Rate for Payer: HealthUtah PPO |
$277.76
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$269.43
|
Rate for Payer: Multiplan Medicare/VA |
$153.05
|
Rate for Payer: One Health Plan of WY PPO |
$272.20
|
Rate for Payer: PacificSource Commercial |
$249.98
|
Rate for Payer: PHCS PPO |
$272.20
|
Rate for Payer: Three Rivers PPO |
$208.32
|
Rate for Payer: TriWest Veterans Administration |
$161.10
|
Rate for Payer: United Healthcare Commercial |
$241.65
|
Rate for Payer: United Healthcare Medicare |
$161.10
|
Rate for Payer: WINHealth Partners Commercial |
$272.20
|
Rate for Payer: Wise Provider Network Commercial |
$263.87
|
|
ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$376.00
|
|
Service Code
|
HCPCS J2997
|
Hospital Charge Code |
J2997
|
Min. Negotiated Rate |
$75.50 |
Max. Negotiated Rate |
$376.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$368.48
|
Rate for Payer: Aetna of WY Medicare |
$88.82
|
Rate for Payer: Beech Street Commercial |
$357.20
|
Rate for Payer: Cash Price |
$263.20
|
Rate for Payer: Cash Price |
$263.20
|
Rate for Payer: ChoiceCare Network Commercial |
$364.72
|
Rate for Payer: Cigna of WY Commercial |
$368.48
|
Rate for Payer: First Choice Health Commercial |
$338.40
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$357.20
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.82
|
Rate for Payer: HealthUtah PPO |
$376.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$364.72
|
Rate for Payer: Multiplan Medicare/VA |
$75.50
|
Rate for Payer: One Health Plan of WY PPO |
$368.48
|
Rate for Payer: PacificSource Commercial |
$338.40
|
Rate for Payer: PHCS PPO |
$357.20
|
Rate for Payer: Three Rivers PPO |
$282.00
|
Rate for Payer: TriWest Veterans Administration |
$88.82
|
Rate for Payer: United Healthcare Commercial |
$327.12
|
Rate for Payer: United Healthcare Medicare |
$88.82
|
Rate for Payer: WINHealth Partners Commercial |
$357.20
|
|
ALUMI-HAND XL STUCKI
|
Facility
|
IP
|
$154.00
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$96.56 |
Max. Negotiated Rate |
$154.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$150.92
|
Rate for Payer: Altius Auto/Workers Compensation |
$147.84
|
Rate for Payer: Altius Commercial |
$147.84
|
Rate for Payer: Beech Street Commercial |
$150.92
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.43
|
Rate for Payer: Cash Price |
$107.80
|
Rate for Payer: ChoiceCare Network Commercial |
$149.38
|
Rate for Payer: Cigna of WY Commercial |
$150.92
|
Rate for Payer: Entrust Commercial |
$146.30
|
Rate for Payer: First Choice Health Commercial |
$146.30
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.30
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.64
|
Rate for Payer: HealthUtah PPO |
$154.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.38
|
Rate for Payer: Multiplan Medicare/VA |
$96.56
|
Rate for Payer: One Health Plan of WY PPO |
$150.92
|
Rate for Payer: PacificSource Commercial |
$138.60
|
Rate for Payer: PHCS PPO |
$150.92
|
Rate for Payer: Three Rivers PPO |
$115.50
|
Rate for Payer: TriWest Veterans Administration |
$101.64
|
Rate for Payer: United Healthcare Commercial |
$133.98
|
Rate for Payer: United Healthcare Medicare |
$101.64
|
Rate for Payer: WINHealth Partners Commercial |
$146.30
|
Rate for Payer: Wise Provider Network Commercial |
$146.30
|
|