DURAMATRIX ONLAY 1" X 3"
|
Facility
|
IP
|
$1,245.23
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$780.76 |
Max. Negotiated Rate |
$1,245.23 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,220.33
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,195.42
|
Rate for Payer: Altius Commercial |
$1,195.42
|
Rate for Payer: Beech Street Commercial |
$1,220.33
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,022.33
|
Rate for Payer: Cash Price |
$871.66
|
Rate for Payer: ChoiceCare Network Commercial |
$1,207.87
|
Rate for Payer: Cigna of WY Commercial |
$1,220.33
|
Rate for Payer: Entrust Commercial |
$1,182.97
|
Rate for Payer: First Choice Health Commercial |
$1,182.97
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,182.97
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$821.85
|
Rate for Payer: HealthUtah PPO |
$1,245.23
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,207.87
|
Rate for Payer: Multiplan Medicare/VA |
$780.76
|
Rate for Payer: One Health Plan of WY PPO |
$1,220.33
|
Rate for Payer: PacificSource Commercial |
$1,120.71
|
Rate for Payer: PHCS PPO |
$1,220.33
|
Rate for Payer: Three Rivers PPO |
$933.92
|
Rate for Payer: TriWest Veterans Administration |
$821.85
|
Rate for Payer: United Healthcare Commercial |
$1,083.35
|
Rate for Payer: United Healthcare Medicare |
$821.85
|
Rate for Payer: WINHealth Partners Commercial |
$1,182.97
|
Rate for Payer: Wise Provider Network Commercial |
$1,182.97
|
|
DURAMATRIX ONLAY 1" X 3"
|
Facility
|
OP
|
$1,245.23
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$686.12 |
Max. Negotiated Rate |
$1,245.23 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,220.33
|
Rate for Payer: Aetna of WY Medicare |
$821.85
|
Rate for Payer: Altius Auto/Workers Compensation |
$1,195.42
|
Rate for Payer: Altius Commercial |
$1,195.42
|
Rate for Payer: Beech Street Commercial |
$1,220.33
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,022.33
|
Rate for Payer: Cash Price |
$871.66
|
Rate for Payer: ChoiceCare Network Commercial |
$1,207.87
|
Rate for Payer: Cigna of WY Commercial |
$1,220.33
|
Rate for Payer: Entrust Commercial |
$1,182.97
|
Rate for Payer: First Choice Health Commercial |
$1,182.97
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,182.97
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$722.23
|
Rate for Payer: HealthUtah PPO |
$1,245.23
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,207.87
|
Rate for Payer: Multiplan Medicare/VA |
$686.12
|
Rate for Payer: One Health Plan of WY PPO |
$1,220.33
|
Rate for Payer: PacificSource Commercial |
$1,120.71
|
Rate for Payer: PHCS PPO |
$1,220.33
|
Rate for Payer: Three Rivers PPO |
$933.92
|
Rate for Payer: TriWest Veterans Administration |
$722.23
|
Rate for Payer: United Healthcare Commercial |
$1,083.35
|
Rate for Payer: United Healthcare Medicare |
$722.23
|
Rate for Payer: WINHealth Partners Commercial |
$1,220.33
|
Rate for Payer: Wise Provider Network Commercial |
$1,182.97
|
|
DURAPREP 26ML W/APPLICATOR
|
Facility
|
IP
|
$12.75
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.99 |
Max. Negotiated Rate |
$12.75 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$12.24
|
Rate for Payer: Altius Commercial |
$12.24
|
Rate for Payer: Beech Street Commercial |
$12.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.47
|
Rate for Payer: Cash Price |
$8.93
|
Rate for Payer: ChoiceCare Network Commercial |
$12.37
|
Rate for Payer: Cigna of WY Commercial |
$12.50
|
Rate for Payer: Entrust Commercial |
$12.11
|
Rate for Payer: First Choice Health Commercial |
$12.11
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.11
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.42
|
Rate for Payer: HealthUtah PPO |
$12.75
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.37
|
Rate for Payer: Multiplan Medicare/VA |
$7.99
|
Rate for Payer: One Health Plan of WY PPO |
$12.50
|
Rate for Payer: PacificSource Commercial |
$11.48
|
Rate for Payer: PHCS PPO |
$12.50
|
Rate for Payer: Three Rivers PPO |
$9.56
|
Rate for Payer: TriWest Veterans Administration |
$8.42
|
Rate for Payer: United Healthcare Commercial |
$11.09
|
Rate for Payer: United Healthcare Medicare |
$8.42
|
Rate for Payer: WINHealth Partners Commercial |
$12.11
|
Rate for Payer: Wise Provider Network Commercial |
$12.11
|
|
DURAPREP 26ML W/APPLICATOR
|
Facility
|
OP
|
$12.75
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$7.03 |
Max. Negotiated Rate |
$12.75 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.50
|
Rate for Payer: Aetna of WY Medicare |
$8.42
|
Rate for Payer: Altius Auto/Workers Compensation |
$12.24
|
Rate for Payer: Altius Commercial |
$12.24
|
Rate for Payer: Beech Street Commercial |
$12.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.47
|
Rate for Payer: Cash Price |
$8.93
|
Rate for Payer: ChoiceCare Network Commercial |
$12.37
|
Rate for Payer: Cigna of WY Commercial |
$12.50
|
Rate for Payer: Entrust Commercial |
$12.11
|
Rate for Payer: First Choice Health Commercial |
$12.11
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.11
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.40
|
Rate for Payer: HealthUtah PPO |
$12.75
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.37
|
Rate for Payer: Multiplan Medicare/VA |
$7.03
|
Rate for Payer: One Health Plan of WY PPO |
$12.50
|
Rate for Payer: PacificSource Commercial |
$11.48
|
Rate for Payer: PHCS PPO |
$12.50
|
Rate for Payer: Three Rivers PPO |
$9.56
|
Rate for Payer: TriWest Veterans Administration |
$7.40
|
Rate for Payer: United Healthcare Commercial |
$11.09
|
Rate for Payer: United Healthcare Medicare |
$7.40
|
Rate for Payer: WINHealth Partners Commercial |
$12.50
|
Rate for Payer: Wise Provider Network Commercial |
$12.11
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [148972]
|
Facility
|
OP
|
$436.05
|
|
Service Code
|
HCPCS J9173
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$240.26 |
Max. Negotiated Rate |
$436.05 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.33
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.32
|
Rate for Payer: Aetna of WY Medicare |
$287.79
|
Rate for Payer: Aetna of WY Medicare |
$287.79
|
Rate for Payer: Altius Auto/Workers Compensation |
$418.60
|
Rate for Payer: Altius Auto/Workers Compensation |
$418.61
|
Rate for Payer: Altius Commercial |
$418.61
|
Rate for Payer: Altius Commercial |
$418.60
|
Rate for Payer: Beech Street Commercial |
$427.32
|
Rate for Payer: Beech Street Commercial |
$427.33
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$358.00
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.99
|
Rate for Payer: Cash Price |
$305.23
|
Rate for Payer: Cash Price |
$305.23
|
Rate for Payer: ChoiceCare Network Commercial |
$422.97
|
Rate for Payer: ChoiceCare Network Commercial |
$422.96
|
Rate for Payer: Cigna of WY Commercial |
$427.32
|
Rate for Payer: Cigna of WY Commercial |
$427.33
|
Rate for Payer: Entrust Commercial |
$414.25
|
Rate for Payer: Entrust Commercial |
$414.24
|
Rate for Payer: First Choice Health Commercial |
$414.24
|
Rate for Payer: First Choice Health Commercial |
$414.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.24
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.91
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$252.90
|
Rate for Payer: HealthUtah PPO |
$436.04
|
Rate for Payer: HealthUtah PPO |
$436.05
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.96
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.97
|
Rate for Payer: Multiplan Medicare/VA |
$240.26
|
Rate for Payer: Multiplan Medicare/VA |
$240.26
|
Rate for Payer: One Health Plan of WY PPO |
$427.32
|
Rate for Payer: One Health Plan of WY PPO |
$427.33
|
Rate for Payer: PacificSource Commercial |
$392.44
|
Rate for Payer: PacificSource Commercial |
$392.44
|
Rate for Payer: PHCS PPO |
$427.32
|
Rate for Payer: PHCS PPO |
$427.33
|
Rate for Payer: Three Rivers PPO |
$327.03
|
Rate for Payer: Three Rivers PPO |
$327.04
|
Rate for Payer: TriWest Veterans Administration |
$252.91
|
Rate for Payer: TriWest Veterans Administration |
$252.90
|
Rate for Payer: United Healthcare Commercial |
$379.35
|
Rate for Payer: United Healthcare Commercial |
$379.36
|
Rate for Payer: United Healthcare Medicare |
$252.91
|
Rate for Payer: United Healthcare Medicare |
$252.90
|
Rate for Payer: WINHealth Partners Commercial |
$427.32
|
Rate for Payer: WINHealth Partners Commercial |
$427.33
|
Rate for Payer: Wise Provider Network Commercial |
$414.24
|
Rate for Payer: Wise Provider Network Commercial |
$414.25
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION [148972]
|
Facility
|
IP
|
$436.05
|
|
Service Code
|
HCPCS J9173
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$273.40 |
Max. Negotiated Rate |
$436.05 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.33
|
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$427.32
|
Rate for Payer: Altius Auto/Workers Compensation |
$418.61
|
Rate for Payer: Altius Auto/Workers Compensation |
$418.60
|
Rate for Payer: Altius Commercial |
$418.60
|
Rate for Payer: Altius Commercial |
$418.61
|
Rate for Payer: Beech Street Commercial |
$427.33
|
Rate for Payer: Beech Street Commercial |
$427.32
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$357.99
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$358.00
|
Rate for Payer: Cash Price |
$305.23
|
Rate for Payer: Cash Price |
$305.23
|
Rate for Payer: ChoiceCare Network Commercial |
$422.96
|
Rate for Payer: ChoiceCare Network Commercial |
$422.97
|
Rate for Payer: Cigna of WY Commercial |
$427.33
|
Rate for Payer: Cigna of WY Commercial |
$427.32
|
Rate for Payer: Entrust Commercial |
$414.24
|
Rate for Payer: Entrust Commercial |
$414.25
|
Rate for Payer: First Choice Health Commercial |
$414.24
|
Rate for Payer: First Choice Health Commercial |
$414.25
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.24
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$414.25
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.79
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$287.79
|
Rate for Payer: HealthUtah PPO |
$436.05
|
Rate for Payer: HealthUtah PPO |
$436.04
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.96
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$422.97
|
Rate for Payer: Multiplan Medicare/VA |
$273.40
|
Rate for Payer: Multiplan Medicare/VA |
$273.40
|
Rate for Payer: One Health Plan of WY PPO |
$427.33
|
Rate for Payer: One Health Plan of WY PPO |
$427.32
|
Rate for Payer: PacificSource Commercial |
$392.44
|
Rate for Payer: PacificSource Commercial |
$392.44
|
Rate for Payer: PHCS PPO |
$427.32
|
Rate for Payer: PHCS PPO |
$427.33
|
Rate for Payer: Three Rivers PPO |
$327.03
|
Rate for Payer: Three Rivers PPO |
$327.04
|
Rate for Payer: TriWest Veterans Administration |
$287.79
|
Rate for Payer: TriWest Veterans Administration |
$287.79
|
Rate for Payer: United Healthcare Commercial |
$379.35
|
Rate for Payer: United Healthcare Commercial |
$379.36
|
Rate for Payer: United Healthcare Medicare |
$287.79
|
Rate for Payer: United Healthcare Medicare |
$287.79
|
Rate for Payer: WINHealth Partners Commercial |
$414.24
|
Rate for Payer: WINHealth Partners Commercial |
$414.25
|
Rate for Payer: Wise Provider Network Commercial |
$414.24
|
Rate for Payer: Wise Provider Network Commercial |
$414.25
|
|
DVT CTC 18" MEDIUM CALF SLEEVE
|
Facility
|
IP
|
$32.49
|
|
Hospital Charge Code |
27000000S1
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$20.37 |
Max. Negotiated Rate |
$32.49 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.84
|
Rate for Payer: Altius Auto/Workers Compensation |
$31.19
|
Rate for Payer: Altius Commercial |
$31.19
|
Rate for Payer: Beech Street Commercial |
$31.84
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.67
|
Rate for Payer: Cash Price |
$22.75
|
Rate for Payer: ChoiceCare Network Commercial |
$31.52
|
Rate for Payer: Cigna of WY Commercial |
$31.84
|
Rate for Payer: Entrust Commercial |
$30.87
|
Rate for Payer: First Choice Health Commercial |
$30.87
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.87
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.44
|
Rate for Payer: HealthUtah PPO |
$32.49
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.52
|
Rate for Payer: Multiplan Medicare/VA |
$20.37
|
Rate for Payer: One Health Plan of WY PPO |
$31.84
|
Rate for Payer: PacificSource Commercial |
$29.24
|
Rate for Payer: PHCS PPO |
$31.84
|
Rate for Payer: Three Rivers PPO |
$24.37
|
Rate for Payer: TriWest Veterans Administration |
$21.44
|
Rate for Payer: United Healthcare Commercial |
$28.27
|
Rate for Payer: United Healthcare Medicare |
$21.44
|
Rate for Payer: WINHealth Partners Commercial |
$30.87
|
Rate for Payer: Wise Provider Network Commercial |
$30.87
|
|
DVT CTC 18" MEDIUM CALF SLEEVE
|
Facility
|
OP
|
$32.49
|
|
Hospital Charge Code |
27000000S1
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$17.90 |
Max. Negotiated Rate |
$32.49 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.84
|
Rate for Payer: Aetna of WY Medicare |
$21.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$31.19
|
Rate for Payer: Altius Commercial |
$31.19
|
Rate for Payer: Beech Street Commercial |
$31.84
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$26.67
|
Rate for Payer: Cash Price |
$22.75
|
Rate for Payer: ChoiceCare Network Commercial |
$31.52
|
Rate for Payer: Cigna of WY Commercial |
$31.84
|
Rate for Payer: Entrust Commercial |
$30.87
|
Rate for Payer: First Choice Health Commercial |
$30.87
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.87
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.84
|
Rate for Payer: HealthUtah PPO |
$32.49
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$31.52
|
Rate for Payer: Multiplan Medicare/VA |
$17.90
|
Rate for Payer: One Health Plan of WY PPO |
$31.84
|
Rate for Payer: PacificSource Commercial |
$29.24
|
Rate for Payer: PHCS PPO |
$31.84
|
Rate for Payer: Three Rivers PPO |
$24.37
|
Rate for Payer: TriWest Veterans Administration |
$18.84
|
Rate for Payer: United Healthcare Commercial |
$28.27
|
Rate for Payer: United Healthcare Medicare |
$18.84
|
Rate for Payer: WINHealth Partners Commercial |
$31.84
|
Rate for Payer: Wise Provider Network Commercial |
$30.87
|
|
DVT CTC 24" LARGE CALF SLEEVE
|
Facility
|
OP
|
$40.24
|
|
Hospital Charge Code |
27000000S1
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$22.17 |
Max. Negotiated Rate |
$40.24 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.44
|
Rate for Payer: Aetna of WY Medicare |
$26.56
|
Rate for Payer: Altius Auto/Workers Compensation |
$38.63
|
Rate for Payer: Altius Commercial |
$38.63
|
Rate for Payer: Beech Street Commercial |
$39.44
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.04
|
Rate for Payer: Cash Price |
$28.17
|
Rate for Payer: ChoiceCare Network Commercial |
$39.03
|
Rate for Payer: Cigna of WY Commercial |
$39.44
|
Rate for Payer: Entrust Commercial |
$38.23
|
Rate for Payer: First Choice Health Commercial |
$38.23
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.23
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.34
|
Rate for Payer: HealthUtah PPO |
$40.24
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.03
|
Rate for Payer: Multiplan Medicare/VA |
$22.17
|
Rate for Payer: One Health Plan of WY PPO |
$39.44
|
Rate for Payer: PacificSource Commercial |
$36.22
|
Rate for Payer: PHCS PPO |
$39.44
|
Rate for Payer: Three Rivers PPO |
$30.18
|
Rate for Payer: TriWest Veterans Administration |
$23.34
|
Rate for Payer: United Healthcare Commercial |
$35.01
|
Rate for Payer: United Healthcare Medicare |
$23.34
|
Rate for Payer: WINHealth Partners Commercial |
$39.44
|
Rate for Payer: Wise Provider Network Commercial |
$38.23
|
|
DVT CTC 24" LARGE CALF SLEEVE
|
Facility
|
IP
|
$40.24
|
|
Hospital Charge Code |
27000000S1
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$25.23 |
Max. Negotiated Rate |
$40.24 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$39.44
|
Rate for Payer: Altius Auto/Workers Compensation |
$38.63
|
Rate for Payer: Altius Commercial |
$38.63
|
Rate for Payer: Beech Street Commercial |
$39.44
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.04
|
Rate for Payer: Cash Price |
$28.17
|
Rate for Payer: ChoiceCare Network Commercial |
$39.03
|
Rate for Payer: Cigna of WY Commercial |
$39.44
|
Rate for Payer: Entrust Commercial |
$38.23
|
Rate for Payer: First Choice Health Commercial |
$38.23
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.23
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.56
|
Rate for Payer: HealthUtah PPO |
$40.24
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.03
|
Rate for Payer: Multiplan Medicare/VA |
$25.23
|
Rate for Payer: One Health Plan of WY PPO |
$39.44
|
Rate for Payer: PacificSource Commercial |
$36.22
|
Rate for Payer: PHCS PPO |
$39.44
|
Rate for Payer: Three Rivers PPO |
$30.18
|
Rate for Payer: TriWest Veterans Administration |
$26.56
|
Rate for Payer: United Healthcare Commercial |
$35.01
|
Rate for Payer: United Healthcare Medicare |
$26.56
|
Rate for Payer: WINHealth Partners Commercial |
$38.23
|
Rate for Payer: Wise Provider Network Commercial |
$38.23
|
|
DVT CTC SZ 13 FOOT SLEEVE
|
Facility
|
IP
|
$57.65
|
|
Hospital Charge Code |
27000000S1
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$36.15 |
Max. Negotiated Rate |
$57.65 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$55.34
|
Rate for Payer: Altius Commercial |
$55.34
|
Rate for Payer: Beech Street Commercial |
$56.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.33
|
Rate for Payer: Cash Price |
$40.35
|
Rate for Payer: ChoiceCare Network Commercial |
$55.92
|
Rate for Payer: Cigna of WY Commercial |
$56.50
|
Rate for Payer: Entrust Commercial |
$54.77
|
Rate for Payer: First Choice Health Commercial |
$54.77
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.77
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.05
|
Rate for Payer: HealthUtah PPO |
$57.65
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.92
|
Rate for Payer: Multiplan Medicare/VA |
$36.15
|
Rate for Payer: One Health Plan of WY PPO |
$56.50
|
Rate for Payer: PacificSource Commercial |
$51.88
|
Rate for Payer: PHCS PPO |
$56.50
|
Rate for Payer: Three Rivers PPO |
$43.24
|
Rate for Payer: TriWest Veterans Administration |
$38.05
|
Rate for Payer: United Healthcare Commercial |
$50.16
|
Rate for Payer: United Healthcare Medicare |
$38.05
|
Rate for Payer: WINHealth Partners Commercial |
$54.77
|
Rate for Payer: Wise Provider Network Commercial |
$54.77
|
|
DVT CTC SZ 13 FOOT SLEEVE
|
Facility
|
OP
|
$57.65
|
|
Hospital Charge Code |
27000000S1
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$31.77 |
Max. Negotiated Rate |
$57.65 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.50
|
Rate for Payer: Aetna of WY Medicare |
$38.05
|
Rate for Payer: Altius Auto/Workers Compensation |
$55.34
|
Rate for Payer: Altius Commercial |
$55.34
|
Rate for Payer: Beech Street Commercial |
$56.50
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.33
|
Rate for Payer: Cash Price |
$40.35
|
Rate for Payer: ChoiceCare Network Commercial |
$55.92
|
Rate for Payer: Cigna of WY Commercial |
$56.50
|
Rate for Payer: Entrust Commercial |
$54.77
|
Rate for Payer: First Choice Health Commercial |
$54.77
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.77
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.44
|
Rate for Payer: HealthUtah PPO |
$57.65
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.92
|
Rate for Payer: Multiplan Medicare/VA |
$31.77
|
Rate for Payer: One Health Plan of WY PPO |
$56.50
|
Rate for Payer: PacificSource Commercial |
$51.88
|
Rate for Payer: PHCS PPO |
$56.50
|
Rate for Payer: Three Rivers PPO |
$43.24
|
Rate for Payer: TriWest Veterans Administration |
$33.44
|
Rate for Payer: United Healthcare Commercial |
$50.16
|
Rate for Payer: United Healthcare Medicare |
$33.44
|
Rate for Payer: WINHealth Partners Commercial |
$56.50
|
Rate for Payer: Wise Provider Network Commercial |
$54.77
|
|
DW OUTFLO CAS/TUBE SET AR-6430
|
Facility
|
OP
|
$163.52
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$90.10 |
Max. Negotiated Rate |
$163.52 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.25
|
Rate for Payer: Aetna of WY Medicare |
$107.92
|
Rate for Payer: Altius Auto/Workers Compensation |
$156.98
|
Rate for Payer: Altius Commercial |
$156.98
|
Rate for Payer: Beech Street Commercial |
$160.25
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.25
|
Rate for Payer: Cash Price |
$114.46
|
Rate for Payer: ChoiceCare Network Commercial |
$158.61
|
Rate for Payer: Cigna of WY Commercial |
$160.25
|
Rate for Payer: Entrust Commercial |
$155.34
|
Rate for Payer: First Choice Health Commercial |
$155.34
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.34
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.84
|
Rate for Payer: HealthUtah PPO |
$163.52
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.61
|
Rate for Payer: Multiplan Medicare/VA |
$90.10
|
Rate for Payer: One Health Plan of WY PPO |
$160.25
|
Rate for Payer: PacificSource Commercial |
$147.17
|
Rate for Payer: PHCS PPO |
$160.25
|
Rate for Payer: Three Rivers PPO |
$122.64
|
Rate for Payer: TriWest Veterans Administration |
$94.84
|
Rate for Payer: United Healthcare Commercial |
$142.26
|
Rate for Payer: United Healthcare Medicare |
$94.84
|
Rate for Payer: WINHealth Partners Commercial |
$160.25
|
Rate for Payer: Wise Provider Network Commercial |
$155.34
|
|
DW OUTFLO CAS/TUBE SET AR-6430
|
Facility
|
IP
|
$163.52
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$102.53 |
Max. Negotiated Rate |
$163.52 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.25
|
Rate for Payer: Altius Auto/Workers Compensation |
$156.98
|
Rate for Payer: Altius Commercial |
$156.98
|
Rate for Payer: Beech Street Commercial |
$160.25
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.25
|
Rate for Payer: Cash Price |
$114.46
|
Rate for Payer: ChoiceCare Network Commercial |
$158.61
|
Rate for Payer: Cigna of WY Commercial |
$160.25
|
Rate for Payer: Entrust Commercial |
$155.34
|
Rate for Payer: First Choice Health Commercial |
$155.34
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.34
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.92
|
Rate for Payer: HealthUtah PPO |
$163.52
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.61
|
Rate for Payer: Multiplan Medicare/VA |
$102.53
|
Rate for Payer: One Health Plan of WY PPO |
$160.25
|
Rate for Payer: PacificSource Commercial |
$147.17
|
Rate for Payer: PHCS PPO |
$160.25
|
Rate for Payer: Three Rivers PPO |
$122.64
|
Rate for Payer: TriWest Veterans Administration |
$107.92
|
Rate for Payer: United Healthcare Commercial |
$142.26
|
Rate for Payer: United Healthcare Medicare |
$107.92
|
Rate for Payer: WINHealth Partners Commercial |
$155.34
|
Rate for Payer: Wise Provider Network Commercial |
$155.34
|
|
EAR TUBE ARMSTRONG BEVELED 1.14MM
|
Facility
|
IP
|
$74.36
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$46.62 |
Max. Negotiated Rate |
$74.36 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.87
|
Rate for Payer: Altius Auto/Workers Compensation |
$71.39
|
Rate for Payer: Altius Commercial |
$71.39
|
Rate for Payer: Beech Street Commercial |
$72.87
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.05
|
Rate for Payer: Cash Price |
$52.05
|
Rate for Payer: ChoiceCare Network Commercial |
$72.13
|
Rate for Payer: Cigna of WY Commercial |
$72.87
|
Rate for Payer: Entrust Commercial |
$70.64
|
Rate for Payer: First Choice Health Commercial |
$70.64
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.64
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.08
|
Rate for Payer: HealthUtah PPO |
$74.36
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.13
|
Rate for Payer: Multiplan Medicare/VA |
$46.62
|
Rate for Payer: One Health Plan of WY PPO |
$72.87
|
Rate for Payer: PacificSource Commercial |
$66.92
|
Rate for Payer: PHCS PPO |
$72.87
|
Rate for Payer: Three Rivers PPO |
$55.77
|
Rate for Payer: TriWest Veterans Administration |
$49.08
|
Rate for Payer: United Healthcare Commercial |
$64.69
|
Rate for Payer: United Healthcare Medicare |
$49.08
|
Rate for Payer: WINHealth Partners Commercial |
$70.64
|
Rate for Payer: Wise Provider Network Commercial |
$70.64
|
|
EAR TUBE ARMSTRONG BEVELED 1.14MM
|
Facility
|
OP
|
$74.36
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.97 |
Max. Negotiated Rate |
$74.36 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$72.87
|
Rate for Payer: Aetna of WY Medicare |
$49.08
|
Rate for Payer: Altius Auto/Workers Compensation |
$71.39
|
Rate for Payer: Altius Commercial |
$71.39
|
Rate for Payer: Beech Street Commercial |
$72.87
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.05
|
Rate for Payer: Cash Price |
$52.05
|
Rate for Payer: ChoiceCare Network Commercial |
$72.13
|
Rate for Payer: Cigna of WY Commercial |
$72.87
|
Rate for Payer: Entrust Commercial |
$70.64
|
Rate for Payer: First Choice Health Commercial |
$70.64
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.64
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.13
|
Rate for Payer: HealthUtah PPO |
$74.36
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.13
|
Rate for Payer: Multiplan Medicare/VA |
$40.97
|
Rate for Payer: One Health Plan of WY PPO |
$72.87
|
Rate for Payer: PacificSource Commercial |
$66.92
|
Rate for Payer: PHCS PPO |
$72.87
|
Rate for Payer: Three Rivers PPO |
$55.77
|
Rate for Payer: TriWest Veterans Administration |
$43.13
|
Rate for Payer: United Healthcare Commercial |
$64.69
|
Rate for Payer: United Healthcare Medicare |
$43.13
|
Rate for Payer: WINHealth Partners Commercial |
$72.87
|
Rate for Payer: Wise Provider Network Commercial |
$70.64
|
|
EAR TUBE BAXTER BEVELED 1.27MM
|
Facility
|
IP
|
$72.59
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$45.51 |
Max. Negotiated Rate |
$72.59 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.14
|
Rate for Payer: Altius Auto/Workers Compensation |
$69.69
|
Rate for Payer: Altius Commercial |
$69.69
|
Rate for Payer: Beech Street Commercial |
$71.14
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.60
|
Rate for Payer: Cash Price |
$50.82
|
Rate for Payer: ChoiceCare Network Commercial |
$70.41
|
Rate for Payer: Cigna of WY Commercial |
$71.14
|
Rate for Payer: Entrust Commercial |
$68.96
|
Rate for Payer: First Choice Health Commercial |
$68.96
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.96
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.91
|
Rate for Payer: HealthUtah PPO |
$72.59
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.41
|
Rate for Payer: Multiplan Medicare/VA |
$45.51
|
Rate for Payer: One Health Plan of WY PPO |
$71.14
|
Rate for Payer: PacificSource Commercial |
$65.33
|
Rate for Payer: PHCS PPO |
$71.14
|
Rate for Payer: Three Rivers PPO |
$54.44
|
Rate for Payer: TriWest Veterans Administration |
$47.91
|
Rate for Payer: United Healthcare Commercial |
$63.15
|
Rate for Payer: United Healthcare Medicare |
$47.91
|
Rate for Payer: WINHealth Partners Commercial |
$68.96
|
Rate for Payer: Wise Provider Network Commercial |
$68.96
|
|
EAR TUBE BAXTER BEVELED 1.27MM
|
Facility
|
OP
|
$72.59
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$40.00 |
Max. Negotiated Rate |
$72.59 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.14
|
Rate for Payer: Aetna of WY Medicare |
$47.91
|
Rate for Payer: Altius Auto/Workers Compensation |
$69.69
|
Rate for Payer: Altius Commercial |
$69.69
|
Rate for Payer: Beech Street Commercial |
$71.14
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.60
|
Rate for Payer: Cash Price |
$50.82
|
Rate for Payer: ChoiceCare Network Commercial |
$70.41
|
Rate for Payer: Cigna of WY Commercial |
$71.14
|
Rate for Payer: Entrust Commercial |
$68.96
|
Rate for Payer: First Choice Health Commercial |
$68.96
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$68.96
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.10
|
Rate for Payer: HealthUtah PPO |
$72.59
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.41
|
Rate for Payer: Multiplan Medicare/VA |
$40.00
|
Rate for Payer: One Health Plan of WY PPO |
$71.14
|
Rate for Payer: PacificSource Commercial |
$65.33
|
Rate for Payer: PHCS PPO |
$71.14
|
Rate for Payer: Three Rivers PPO |
$54.44
|
Rate for Payer: TriWest Veterans Administration |
$42.10
|
Rate for Payer: United Healthcare Commercial |
$63.15
|
Rate for Payer: United Healthcare Medicare |
$42.10
|
Rate for Payer: WINHealth Partners Commercial |
$71.14
|
Rate for Payer: Wise Provider Network Commercial |
$68.96
|
|
EAR TUBE DONALDSON
|
Facility
|
OP
|
$58.33
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$32.14 |
Max. Negotiated Rate |
$58.33 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.16
|
Rate for Payer: Aetna of WY Medicare |
$38.50
|
Rate for Payer: Altius Auto/Workers Compensation |
$56.00
|
Rate for Payer: Altius Commercial |
$56.00
|
Rate for Payer: Beech Street Commercial |
$57.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.89
|
Rate for Payer: Cash Price |
$40.83
|
Rate for Payer: ChoiceCare Network Commercial |
$56.58
|
Rate for Payer: Cigna of WY Commercial |
$57.16
|
Rate for Payer: Entrust Commercial |
$55.41
|
Rate for Payer: First Choice Health Commercial |
$55.41
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.41
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.83
|
Rate for Payer: HealthUtah PPO |
$58.33
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.58
|
Rate for Payer: Multiplan Medicare/VA |
$32.14
|
Rate for Payer: One Health Plan of WY PPO |
$57.16
|
Rate for Payer: PacificSource Commercial |
$52.50
|
Rate for Payer: PHCS PPO |
$57.16
|
Rate for Payer: Three Rivers PPO |
$43.75
|
Rate for Payer: TriWest Veterans Administration |
$33.83
|
Rate for Payer: United Healthcare Commercial |
$50.75
|
Rate for Payer: United Healthcare Medicare |
$33.83
|
Rate for Payer: WINHealth Partners Commercial |
$57.16
|
Rate for Payer: Wise Provider Network Commercial |
$55.41
|
|
EAR TUBE DONALDSON
|
Facility
|
IP
|
$58.33
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$36.57 |
Max. Negotiated Rate |
$58.33 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$57.16
|
Rate for Payer: Altius Auto/Workers Compensation |
$56.00
|
Rate for Payer: Altius Commercial |
$56.00
|
Rate for Payer: Beech Street Commercial |
$57.16
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.89
|
Rate for Payer: Cash Price |
$40.83
|
Rate for Payer: ChoiceCare Network Commercial |
$56.58
|
Rate for Payer: Cigna of WY Commercial |
$57.16
|
Rate for Payer: Entrust Commercial |
$55.41
|
Rate for Payer: First Choice Health Commercial |
$55.41
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$55.41
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.50
|
Rate for Payer: HealthUtah PPO |
$58.33
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.58
|
Rate for Payer: Multiplan Medicare/VA |
$36.57
|
Rate for Payer: One Health Plan of WY PPO |
$57.16
|
Rate for Payer: PacificSource Commercial |
$52.50
|
Rate for Payer: PHCS PPO |
$57.16
|
Rate for Payer: Three Rivers PPO |
$43.75
|
Rate for Payer: TriWest Veterans Administration |
$38.50
|
Rate for Payer: United Healthcare Commercial |
$50.75
|
Rate for Payer: United Healthcare Medicare |
$38.50
|
Rate for Payer: WINHealth Partners Commercial |
$55.41
|
Rate for Payer: Wise Provider Network Commercial |
$55.41
|
|
EAR TUBE RICHARD MOD T
|
Facility
|
IP
|
$156.92
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$98.39 |
Max. Negotiated Rate |
$156.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$153.78
|
Rate for Payer: Altius Auto/Workers Compensation |
$150.64
|
Rate for Payer: Altius Commercial |
$150.64
|
Rate for Payer: Beech Street Commercial |
$153.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.83
|
Rate for Payer: Cash Price |
$109.84
|
Rate for Payer: ChoiceCare Network Commercial |
$152.21
|
Rate for Payer: Cigna of WY Commercial |
$153.78
|
Rate for Payer: Entrust Commercial |
$149.07
|
Rate for Payer: First Choice Health Commercial |
$149.07
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.07
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.57
|
Rate for Payer: HealthUtah PPO |
$156.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.21
|
Rate for Payer: Multiplan Medicare/VA |
$98.39
|
Rate for Payer: One Health Plan of WY PPO |
$153.78
|
Rate for Payer: PacificSource Commercial |
$141.23
|
Rate for Payer: PHCS PPO |
$153.78
|
Rate for Payer: Three Rivers PPO |
$117.69
|
Rate for Payer: TriWest Veterans Administration |
$103.57
|
Rate for Payer: United Healthcare Commercial |
$136.52
|
Rate for Payer: United Healthcare Medicare |
$103.57
|
Rate for Payer: WINHealth Partners Commercial |
$149.07
|
Rate for Payer: Wise Provider Network Commercial |
$149.07
|
|
EAR TUBE RICHARD MOD T
|
Facility
|
OP
|
$156.92
|
|
Hospital Charge Code |
27800000S1
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$86.46 |
Max. Negotiated Rate |
$156.92 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$153.78
|
Rate for Payer: Aetna of WY Medicare |
$103.57
|
Rate for Payer: Altius Auto/Workers Compensation |
$150.64
|
Rate for Payer: Altius Commercial |
$150.64
|
Rate for Payer: Beech Street Commercial |
$153.78
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$128.83
|
Rate for Payer: Cash Price |
$109.84
|
Rate for Payer: ChoiceCare Network Commercial |
$152.21
|
Rate for Payer: Cigna of WY Commercial |
$153.78
|
Rate for Payer: Entrust Commercial |
$149.07
|
Rate for Payer: First Choice Health Commercial |
$149.07
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.07
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.01
|
Rate for Payer: HealthUtah PPO |
$156.92
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.21
|
Rate for Payer: Multiplan Medicare/VA |
$86.46
|
Rate for Payer: One Health Plan of WY PPO |
$153.78
|
Rate for Payer: PacificSource Commercial |
$141.23
|
Rate for Payer: PHCS PPO |
$153.78
|
Rate for Payer: Three Rivers PPO |
$117.69
|
Rate for Payer: TriWest Veterans Administration |
$91.01
|
Rate for Payer: United Healthcare Commercial |
$136.52
|
Rate for Payer: United Healthcare Medicare |
$91.01
|
Rate for Payer: WINHealth Partners Commercial |
$153.78
|
Rate for Payer: Wise Provider Network Commercial |
$149.07
|
|
EASY CAP CO2 DETECTOR
|
Facility
|
OP
|
$27.49
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$15.15 |
Max. Negotiated Rate |
$27.49 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.94
|
Rate for Payer: Aetna of WY Medicare |
$18.14
|
Rate for Payer: Altius Auto/Workers Compensation |
$26.39
|
Rate for Payer: Altius Commercial |
$26.39
|
Rate for Payer: Beech Street Commercial |
$26.94
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.57
|
Rate for Payer: Cash Price |
$19.24
|
Rate for Payer: ChoiceCare Network Commercial |
$26.67
|
Rate for Payer: Cigna of WY Commercial |
$26.94
|
Rate for Payer: Entrust Commercial |
$26.12
|
Rate for Payer: First Choice Health Commercial |
$26.12
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.12
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.94
|
Rate for Payer: HealthUtah PPO |
$27.49
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.67
|
Rate for Payer: Multiplan Medicare/VA |
$15.15
|
Rate for Payer: One Health Plan of WY PPO |
$26.94
|
Rate for Payer: PacificSource Commercial |
$24.74
|
Rate for Payer: PHCS PPO |
$26.94
|
Rate for Payer: Three Rivers PPO |
$20.62
|
Rate for Payer: TriWest Veterans Administration |
$15.94
|
Rate for Payer: United Healthcare Commercial |
$23.92
|
Rate for Payer: United Healthcare Medicare |
$15.94
|
Rate for Payer: WINHealth Partners Commercial |
$26.94
|
Rate for Payer: Wise Provider Network Commercial |
$26.12
|
|
EASY CAP CO2 DETECTOR
|
Facility
|
IP
|
$27.49
|
|
Hospital Charge Code |
27200000S1
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$17.24 |
Max. Negotiated Rate |
$27.49 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.94
|
Rate for Payer: Altius Auto/Workers Compensation |
$26.39
|
Rate for Payer: Altius Commercial |
$26.39
|
Rate for Payer: Beech Street Commercial |
$26.94
|
Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.57
|
Rate for Payer: Cash Price |
$19.24
|
Rate for Payer: ChoiceCare Network Commercial |
$26.67
|
Rate for Payer: Cigna of WY Commercial |
$26.94
|
Rate for Payer: Entrust Commercial |
$26.12
|
Rate for Payer: First Choice Health Commercial |
$26.12
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.12
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.14
|
Rate for Payer: HealthUtah PPO |
$27.49
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.67
|
Rate for Payer: Multiplan Medicare/VA |
$17.24
|
Rate for Payer: One Health Plan of WY PPO |
$26.94
|
Rate for Payer: PacificSource Commercial |
$24.74
|
Rate for Payer: PHCS PPO |
$26.94
|
Rate for Payer: Three Rivers PPO |
$20.62
|
Rate for Payer: TriWest Veterans Administration |
$18.14
|
Rate for Payer: United Healthcare Commercial |
$23.92
|
Rate for Payer: United Healthcare Medicare |
$18.14
|
Rate for Payer: WINHealth Partners Commercial |
$26.12
|
Rate for Payer: Wise Provider Network Commercial |
$26.12
|
|
ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$64.00
|
|
Service Code
|
HCPCS 93010
|
Hospital Charge Code |
93010
|
Min. Negotiated Rate |
$6.60 |
Max. Negotiated Rate |
$64.00 |
Rate for Payer: Aetna of WY Commercial/Medical Rental |
$62.72
|
Rate for Payer: Aetna of WY Medicare |
$7.77
|
Rate for Payer: Beech Street Commercial |
$60.80
|
Rate for Payer: Cash Price |
$44.80
|
Rate for Payer: Cash Price |
$44.80
|
Rate for Payer: ChoiceCare Network Commercial |
$62.08
|
Rate for Payer: Cigna of WY Commercial |
$62.72
|
Rate for Payer: First Choice Health Commercial |
$57.60
|
Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$60.80
|
Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
Rate for Payer: HealthUtah PPO |
$64.00
|
Rate for Payer: Idaho Integrated Healthcare Commercial |
$62.08
|
Rate for Payer: Multiplan Medicare/VA |
$6.60
|
Rate for Payer: One Health Plan of WY PPO |
$62.72
|
Rate for Payer: PacificSource Commercial |
$57.60
|
Rate for Payer: PHCS PPO |
$60.80
|
Rate for Payer: Three Rivers PPO |
$48.00
|
Rate for Payer: TriWest Veterans Administration |
$7.77
|
Rate for Payer: United Healthcare Commercial |
$55.68
|
Rate for Payer: United Healthcare Medicare |
$7.77
|
Rate for Payer: WINHealth Partners Commercial |
$60.80
|
|