|
EMTRICITABINE 200 MG CAPSULE [28956]
|
Facility
|
OP
|
$40.24
|
|
|
Service Code
|
NDC 6195806011
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
IP
|
$33.58
|
|
|
Service Code
|
NDC 0143978701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.24
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.16
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$21.05
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$22.16
|
| Rate for Payer: United Healthcare Commercial |
$29.21
|
| Rate for Payer: United Healthcare Medicare |
$22.16
|
| Rate for Payer: WINHealth Partners Commercial |
$31.90
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
OP
|
$33.58
|
|
|
Service Code
|
NDC 0143978710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Aetna of WY Medicare |
$22.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.24
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.48
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$18.50
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$19.48
|
| Rate for Payer: United Healthcare Commercial |
$29.21
|
| Rate for Payer: United Healthcare Medicare |
$19.48
|
| Rate for Payer: WINHealth Partners Commercial |
$32.91
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
IP
|
$33.58
|
|
|
Service Code
|
NDC 0143978710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.24
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.16
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$21.05
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$22.16
|
| Rate for Payer: United Healthcare Commercial |
$29.21
|
| Rate for Payer: United Healthcare Medicare |
$22.16
|
| Rate for Payer: WINHealth Partners Commercial |
$31.90
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
|
ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [7516]
|
Facility
|
OP
|
$33.58
|
|
|
Service Code
|
NDC 0143978701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.91
|
| Rate for Payer: Aetna of WY Medicare |
$22.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.24
|
| Rate for Payer: Altius Commercial |
$32.24
|
| Rate for Payer: Beech Street Commercial |
$32.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.57
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.57
|
| Rate for Payer: Cigna of WY Commercial |
$32.91
|
| Rate for Payer: Entrust Commercial |
$31.90
|
| Rate for Payer: First Choice Health Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.48
|
| Rate for Payer: HealthUtah PPO |
$33.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.57
|
| Rate for Payer: Multiplan Medicare/VA |
$18.50
|
| Rate for Payer: One Health Plan of WY PPO |
$32.91
|
| Rate for Payer: PacificSource Commercial |
$30.22
|
| Rate for Payer: PHCS PPO |
$32.91
|
| Rate for Payer: Three Rivers PPO |
$25.18
|
| Rate for Payer: TriWest Veterans Administration |
$19.48
|
| Rate for Payer: United Healthcare Commercial |
$29.21
|
| Rate for Payer: United Healthcare Medicare |
$19.48
|
| Rate for Payer: WINHealth Partners Commercial |
$32.91
|
| Rate for Payer: Wise Provider Network Commercial |
$31.90
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [2387]
|
Facility
|
IP
|
$7.78
|
|
|
Service Code
|
NDC 5167240391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.47
|
| Rate for Payer: Altius Commercial |
$7.47
|
| Rate for Payer: Beech Street Commercial |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.39
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.55
|
| Rate for Payer: Cigna of WY Commercial |
$7.62
|
| Rate for Payer: Entrust Commercial |
$7.39
|
| Rate for Payer: First Choice Health Commercial |
$7.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.13
|
| Rate for Payer: HealthUtah PPO |
$7.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.55
|
| Rate for Payer: Multiplan Medicare/VA |
$4.88
|
| Rate for Payer: One Health Plan of WY PPO |
$7.62
|
| Rate for Payer: PacificSource Commercial |
$7.00
|
| Rate for Payer: PHCS PPO |
$7.62
|
| Rate for Payer: Three Rivers PPO |
$5.84
|
| Rate for Payer: TriWest Veterans Administration |
$5.13
|
| Rate for Payer: United Healthcare Commercial |
$6.77
|
| Rate for Payer: United Healthcare Medicare |
$5.13
|
| Rate for Payer: WINHealth Partners Commercial |
$7.39
|
| Rate for Payer: Wise Provider Network Commercial |
$7.39
|
|
|
ENALAPRIL MALEATE 10 MG TABLET [2387]
|
Facility
|
OP
|
$7.78
|
|
|
Service Code
|
NDC 5167240391
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$7.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.62
|
| Rate for Payer: Aetna of WY Medicare |
$5.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.47
|
| Rate for Payer: Altius Commercial |
$7.47
|
| Rate for Payer: Beech Street Commercial |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.39
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.55
|
| Rate for Payer: Cigna of WY Commercial |
$7.62
|
| Rate for Payer: Entrust Commercial |
$7.39
|
| Rate for Payer: First Choice Health Commercial |
$7.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.51
|
| Rate for Payer: HealthUtah PPO |
$7.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.55
|
| Rate for Payer: Multiplan Medicare/VA |
$4.29
|
| Rate for Payer: One Health Plan of WY PPO |
$7.62
|
| Rate for Payer: PacificSource Commercial |
$7.00
|
| Rate for Payer: PHCS PPO |
$7.62
|
| Rate for Payer: Three Rivers PPO |
$5.84
|
| Rate for Payer: TriWest Veterans Administration |
$4.51
|
| Rate for Payer: United Healthcare Commercial |
$6.77
|
| Rate for Payer: United Healthcare Medicare |
$4.51
|
| Rate for Payer: WINHealth Partners Commercial |
$7.62
|
| Rate for Payer: Wise Provider Network Commercial |
$7.39
|
|
|
ENDOBRONCHIAL TUBE LEFT 35 FR
|
Facility
|
IP
|
$163.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.22 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.51
|
| Rate for Payer: Altius Commercial |
$156.51
|
| Rate for Payer: Beech Street Commercial |
$159.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.85
|
| Rate for Payer: Cash Price |
$114.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.14
|
| Rate for Payer: Cigna of WY Commercial |
$159.77
|
| Rate for Payer: Entrust Commercial |
$154.88
|
| Rate for Payer: First Choice Health Commercial |
$154.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.60
|
| Rate for Payer: HealthUtah PPO |
$163.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.14
|
| Rate for Payer: Multiplan Medicare/VA |
$102.22
|
| Rate for Payer: One Health Plan of WY PPO |
$159.77
|
| Rate for Payer: PacificSource Commercial |
$146.73
|
| Rate for Payer: PHCS PPO |
$159.77
|
| Rate for Payer: Three Rivers PPO |
$122.27
|
| Rate for Payer: TriWest Veterans Administration |
$107.60
|
| Rate for Payer: United Healthcare Commercial |
$141.84
|
| Rate for Payer: United Healthcare Medicare |
$107.60
|
| Rate for Payer: WINHealth Partners Commercial |
$154.88
|
| Rate for Payer: Wise Provider Network Commercial |
$154.88
|
|
|
ENDOBRONCHIAL TUBE LEFT 35 FR
|
Facility
|
OP
|
$163.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$163.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$159.77
|
| Rate for Payer: Aetna of WY Medicare |
$107.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.51
|
| Rate for Payer: Altius Commercial |
$156.51
|
| Rate for Payer: Beech Street Commercial |
$159.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$133.85
|
| Rate for Payer: Cash Price |
$114.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.14
|
| Rate for Payer: Cigna of WY Commercial |
$159.77
|
| Rate for Payer: Entrust Commercial |
$154.88
|
| Rate for Payer: First Choice Health Commercial |
$154.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$154.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.56
|
| Rate for Payer: HealthUtah PPO |
$163.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.14
|
| Rate for Payer: Multiplan Medicare/VA |
$89.83
|
| Rate for Payer: One Health Plan of WY PPO |
$159.77
|
| Rate for Payer: PacificSource Commercial |
$146.73
|
| Rate for Payer: PHCS PPO |
$159.77
|
| Rate for Payer: Three Rivers PPO |
$122.27
|
| Rate for Payer: TriWest Veterans Administration |
$94.56
|
| Rate for Payer: United Healthcare Commercial |
$141.84
|
| Rate for Payer: United Healthcare Medicare |
$94.56
|
| Rate for Payer: WINHealth Partners Commercial |
$159.77
|
| Rate for Payer: Wise Provider Network Commercial |
$154.88
|
|
|
ENDOBRONCHIAL TUBE LEFT 37 FR
|
Facility
|
IP
|
$163.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.75
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.05
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.76
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$102.38
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$107.76
|
| Rate for Payer: United Healthcare Commercial |
$142.05
|
| Rate for Payer: United Healthcare Medicare |
$107.76
|
| Rate for Payer: WINHealth Partners Commercial |
$155.12
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 37 FR
|
Facility
|
OP
|
$163.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.97 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$107.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.75
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.05
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.70
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.97
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$94.70
|
| Rate for Payer: United Healthcare Commercial |
$142.05
|
| Rate for Payer: United Healthcare Medicare |
$94.70
|
| Rate for Payer: WINHealth Partners Commercial |
$160.01
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 39 FR
|
Facility
|
IP
|
$163.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.75
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.05
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.76
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$102.38
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$107.76
|
| Rate for Payer: United Healthcare Commercial |
$142.05
|
| Rate for Payer: United Healthcare Medicare |
$107.76
|
| Rate for Payer: WINHealth Partners Commercial |
$155.12
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOBRONCHIAL TUBE LEFT 39 FR
|
Facility
|
OP
|
$163.28
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.97 |
| Max. Negotiated Rate |
$163.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.01
|
| Rate for Payer: Aetna of WY Medicare |
$107.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$156.75
|
| Rate for Payer: Altius Commercial |
$156.75
|
| Rate for Payer: Beech Street Commercial |
$160.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$134.05
|
| Rate for Payer: Cash Price |
$114.29
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.38
|
| Rate for Payer: Cigna of WY Commercial |
$160.01
|
| Rate for Payer: Entrust Commercial |
$155.12
|
| Rate for Payer: First Choice Health Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.70
|
| Rate for Payer: HealthUtah PPO |
$163.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.38
|
| Rate for Payer: Multiplan Medicare/VA |
$89.97
|
| Rate for Payer: One Health Plan of WY PPO |
$160.01
|
| Rate for Payer: PacificSource Commercial |
$146.95
|
| Rate for Payer: PHCS PPO |
$160.01
|
| Rate for Payer: Three Rivers PPO |
$122.46
|
| Rate for Payer: TriWest Veterans Administration |
$94.70
|
| Rate for Payer: United Healthcare Commercial |
$142.05
|
| Rate for Payer: United Healthcare Medicare |
$94.70
|
| Rate for Payer: WINHealth Partners Commercial |
$160.01
|
| Rate for Payer: Wise Provider Network Commercial |
$155.12
|
|
|
ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$494.90
|
| Rate for Payer: Aetna of WY Medicare |
$107.00
|
| Rate for Payer: Beech Street Commercial |
$479.75
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: Cash Price |
$353.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$489.85
|
| Rate for Payer: Cigna of WY Commercial |
$494.90
|
| Rate for Payer: First Choice Health Commercial |
$454.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$479.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$107.00
|
| Rate for Payer: HealthUtah PPO |
$505.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$489.85
|
| Rate for Payer: Multiplan Medicare/VA |
$90.95
|
| Rate for Payer: One Health Plan of WY PPO |
$494.90
|
| Rate for Payer: PacificSource Commercial |
$454.50
|
| Rate for Payer: PHCS PPO |
$479.75
|
| Rate for Payer: Three Rivers PPO |
$378.75
|
| Rate for Payer: TriWest Veterans Administration |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$439.35
|
| Rate for Payer: United Healthcare Medicare |
$107.00
|
| Rate for Payer: WINHealth Partners Commercial |
$429.25
|
|
|
ENDOCLOT APPLICATOR
|
Facility
|
IP
|
$178.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.92 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.36
|
| Rate for Payer: Altius Commercial |
$171.36
|
| Rate for Payer: Beech Street Commercial |
$174.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.55
|
| Rate for Payer: Cash Price |
$124.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.14
|
| Rate for Payer: Cigna of WY Commercial |
$174.93
|
| Rate for Payer: Entrust Commercial |
$169.58
|
| Rate for Payer: First Choice Health Commercial |
$169.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.81
|
| Rate for Payer: HealthUtah PPO |
$178.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.14
|
| Rate for Payer: Multiplan Medicare/VA |
$111.92
|
| Rate for Payer: One Health Plan of WY PPO |
$174.93
|
| Rate for Payer: PacificSource Commercial |
$160.65
|
| Rate for Payer: PHCS PPO |
$174.93
|
| Rate for Payer: Three Rivers PPO |
$133.88
|
| Rate for Payer: TriWest Veterans Administration |
$117.81
|
| Rate for Payer: United Healthcare Commercial |
$155.30
|
| Rate for Payer: United Healthcare Medicare |
$117.81
|
| Rate for Payer: WINHealth Partners Commercial |
$169.58
|
| Rate for Payer: Wise Provider Network Commercial |
$169.58
|
|
|
ENDOCLOT APPLICATOR
|
Facility
|
OP
|
$178.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.93
|
| Rate for Payer: Aetna of WY Medicare |
$117.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.36
|
| Rate for Payer: Altius Commercial |
$171.36
|
| Rate for Payer: Beech Street Commercial |
$174.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.55
|
| Rate for Payer: Cash Price |
$124.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$173.14
|
| Rate for Payer: Cigna of WY Commercial |
$174.93
|
| Rate for Payer: Entrust Commercial |
$169.58
|
| Rate for Payer: First Choice Health Commercial |
$169.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.53
|
| Rate for Payer: HealthUtah PPO |
$178.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$173.14
|
| Rate for Payer: Multiplan Medicare/VA |
$98.35
|
| Rate for Payer: One Health Plan of WY PPO |
$174.93
|
| Rate for Payer: PacificSource Commercial |
$160.65
|
| Rate for Payer: PHCS PPO |
$174.93
|
| Rate for Payer: Three Rivers PPO |
$133.88
|
| Rate for Payer: TriWest Veterans Administration |
$103.53
|
| Rate for Payer: United Healthcare Commercial |
$155.30
|
| Rate for Payer: United Healthcare Medicare |
$103.53
|
| Rate for Payer: WINHealth Partners Commercial |
$174.93
|
| Rate for Payer: Wise Provider Network Commercial |
$169.58
|
|
|
ENDOCLOT PHS 3G
|
Facility
|
IP
|
$4,340.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,721.18 |
| Max. Negotiated Rate |
$4,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,253.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,166.40
|
| Rate for Payer: Altius Commercial |
$4,166.40
|
| Rate for Payer: Beech Street Commercial |
$4,253.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,563.14
|
| Rate for Payer: Cash Price |
$3,038.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,209.80
|
| Rate for Payer: Cigna of WY Commercial |
$4,253.20
|
| Rate for Payer: Entrust Commercial |
$4,123.00
|
| Rate for Payer: First Choice Health Commercial |
$4,123.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,123.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,864.40
|
| Rate for Payer: HealthUtah PPO |
$4,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,209.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,721.18
|
| Rate for Payer: One Health Plan of WY PPO |
$4,253.20
|
| Rate for Payer: PacificSource Commercial |
$3,906.00
|
| Rate for Payer: PHCS PPO |
$4,253.20
|
| Rate for Payer: Three Rivers PPO |
$3,255.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,864.40
|
| Rate for Payer: United Healthcare Commercial |
$3,775.80
|
| Rate for Payer: United Healthcare Medicare |
$2,864.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4,123.00
|
| Rate for Payer: Wise Provider Network Commercial |
$4,123.00
|
|
|
ENDOCLOT PHS 3G
|
Facility
|
OP
|
$4,340.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,391.34 |
| Max. Negotiated Rate |
$4,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,253.20
|
| Rate for Payer: Aetna of WY Medicare |
$2,864.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4,166.40
|
| Rate for Payer: Altius Commercial |
$4,166.40
|
| Rate for Payer: Beech Street Commercial |
$4,253.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,563.14
|
| Rate for Payer: Cash Price |
$3,038.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,209.80
|
| Rate for Payer: Cigna of WY Commercial |
$4,253.20
|
| Rate for Payer: Entrust Commercial |
$4,123.00
|
| Rate for Payer: First Choice Health Commercial |
$4,123.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,123.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,517.20
|
| Rate for Payer: HealthUtah PPO |
$4,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,209.80
|
| Rate for Payer: Multiplan Medicare/VA |
$2,391.34
|
| Rate for Payer: One Health Plan of WY PPO |
$4,253.20
|
| Rate for Payer: PacificSource Commercial |
$3,906.00
|
| Rate for Payer: PHCS PPO |
$4,253.20
|
| Rate for Payer: Three Rivers PPO |
$3,255.00
|
| Rate for Payer: TriWest Veterans Administration |
$2,517.20
|
| Rate for Payer: United Healthcare Commercial |
$3,775.80
|
| Rate for Payer: United Healthcare Medicare |
$2,517.20
|
| Rate for Payer: WINHealth Partners Commercial |
$4,253.20
|
| Rate for Payer: Wise Provider Network Commercial |
$4,123.00
|
|
|
ENDOLOOP PDS II LIGATURE
|
Facility
|
IP
|
$94.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.12
|
| Rate for Payer: Altius Commercial |
$91.12
|
| Rate for Payer: Beech Street Commercial |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.93
|
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.07
|
| Rate for Payer: Cigna of WY Commercial |
$93.02
|
| Rate for Payer: Entrust Commercial |
$90.17
|
| Rate for Payer: First Choice Health Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$62.65
|
| Rate for Payer: HealthUtah PPO |
$94.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.07
|
| Rate for Payer: Multiplan Medicare/VA |
$59.51
|
| Rate for Payer: One Health Plan of WY PPO |
$93.02
|
| Rate for Payer: PacificSource Commercial |
$85.43
|
| Rate for Payer: PHCS PPO |
$93.02
|
| Rate for Payer: Three Rivers PPO |
$71.19
|
| Rate for Payer: TriWest Veterans Administration |
$62.65
|
| Rate for Payer: United Healthcare Commercial |
$82.58
|
| Rate for Payer: United Healthcare Medicare |
$62.65
|
| Rate for Payer: WINHealth Partners Commercial |
$90.17
|
| Rate for Payer: Wise Provider Network Commercial |
$90.17
|
|
|
ENDOLOOP PDS II LIGATURE
|
Facility
|
OP
|
$94.92
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.02
|
| Rate for Payer: Aetna of WY Medicare |
$62.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$91.12
|
| Rate for Payer: Altius Commercial |
$91.12
|
| Rate for Payer: Beech Street Commercial |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$77.93
|
| Rate for Payer: Cash Price |
$66.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.07
|
| Rate for Payer: Cigna of WY Commercial |
$93.02
|
| Rate for Payer: Entrust Commercial |
$90.17
|
| Rate for Payer: First Choice Health Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.05
|
| Rate for Payer: HealthUtah PPO |
$94.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.07
|
| Rate for Payer: Multiplan Medicare/VA |
$52.30
|
| Rate for Payer: One Health Plan of WY PPO |
$93.02
|
| Rate for Payer: PacificSource Commercial |
$85.43
|
| Rate for Payer: PHCS PPO |
$93.02
|
| Rate for Payer: Three Rivers PPO |
$71.19
|
| Rate for Payer: TriWest Veterans Administration |
$55.05
|
| Rate for Payer: United Healthcare Commercial |
$82.58
|
| Rate for Payer: United Healthcare Medicare |
$55.05
|
| Rate for Payer: WINHealth Partners Commercial |
$93.02
|
| Rate for Payer: Wise Provider Network Commercial |
$90.17
|
|
|
ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$4,891.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
58353
|
| Min. Negotiated Rate |
$189.64 |
| Max. Negotiated Rate |
$4,891.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,793.18
|
| Rate for Payer: Aetna of WY Medicare |
$223.10
|
| Rate for Payer: Beech Street Commercial |
$4,646.45
|
| Rate for Payer: Cash Price |
$3,423.70
|
| Rate for Payer: Cash Price |
$3,423.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,744.27
|
| Rate for Payer: Cigna of WY Commercial |
$4,793.18
|
| Rate for Payer: First Choice Health Commercial |
$4,401.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,646.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$223.10
|
| Rate for Payer: HealthUtah PPO |
$4,891.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,744.27
|
| Rate for Payer: Multiplan Medicare/VA |
$189.64
|
| Rate for Payer: One Health Plan of WY PPO |
$4,793.18
|
| Rate for Payer: PacificSource Commercial |
$4,401.90
|
| Rate for Payer: PHCS PPO |
$4,646.45
|
| Rate for Payer: Three Rivers PPO |
$3,668.25
|
| Rate for Payer: TriWest Veterans Administration |
$223.10
|
| Rate for Payer: United Healthcare Commercial |
$4,255.17
|
| Rate for Payer: United Healthcare Medicare |
$223.10
|
| Rate for Payer: WINHealth Partners Commercial |
$4,157.35
|
|
|
ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 58110
|
| Hospital Charge Code |
58110
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$202.86
|
| Rate for Payer: Aetna of WY Medicare |
$38.18
|
| Rate for Payer: Beech Street Commercial |
$196.65
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$200.79
|
| Rate for Payer: Cigna of WY Commercial |
$202.86
|
| Rate for Payer: First Choice Health Commercial |
$186.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$196.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.18
|
| Rate for Payer: HealthUtah PPO |
$207.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$200.79
|
| Rate for Payer: Multiplan Medicare/VA |
$32.45
|
| Rate for Payer: One Health Plan of WY PPO |
$202.86
|
| Rate for Payer: PacificSource Commercial |
$186.30
|
| Rate for Payer: PHCS PPO |
$196.65
|
| Rate for Payer: Three Rivers PPO |
$155.25
|
| Rate for Payer: TriWest Veterans Administration |
$38.18
|
| Rate for Payer: United Healthcare Commercial |
$180.09
|
| Rate for Payer: United Healthcare Medicare |
$38.18
|
| Rate for Payer: WINHealth Partners Commercial |
$175.95
|
|
|
ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
58100
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$316.54
|
| Rate for Payer: Aetna of WY Medicare |
$60.18
|
| Rate for Payer: Beech Street Commercial |
$306.85
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$313.31
|
| Rate for Payer: Cigna of WY Commercial |
$316.54
|
| Rate for Payer: First Choice Health Commercial |
$290.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$306.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.18
|
| Rate for Payer: HealthUtah PPO |
$323.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$313.31
|
| Rate for Payer: Multiplan Medicare/VA |
$51.15
|
| Rate for Payer: One Health Plan of WY PPO |
$316.54
|
| Rate for Payer: PacificSource Commercial |
$290.70
|
| Rate for Payer: PHCS PPO |
$306.85
|
| Rate for Payer: Three Rivers PPO |
$242.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.18
|
| Rate for Payer: United Healthcare Commercial |
$281.01
|
| Rate for Payer: United Healthcare Medicare |
$60.18
|
| Rate for Payer: WINHealth Partners Commercial |
$274.55
|
|
|
ENDOSCOPE VALVE SET DISP 3PC
|
Facility
|
OP
|
$27.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.49
|
| Rate for Payer: Aetna of WY Medicare |
$17.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.95
|
| Rate for Payer: Altius Commercial |
$25.95
|
| Rate for Payer: Beech Street Commercial |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.19
|
| Rate for Payer: Cash Price |
$18.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.22
|
| Rate for Payer: Cigna of WY Commercial |
$26.49
|
| Rate for Payer: Entrust Commercial |
$25.68
|
| Rate for Payer: First Choice Health Commercial |
$25.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.68
|
| Rate for Payer: HealthUtah PPO |
$27.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.22
|
| Rate for Payer: Multiplan Medicare/VA |
$14.89
|
| Rate for Payer: One Health Plan of WY PPO |
$26.49
|
| Rate for Payer: PacificSource Commercial |
$24.33
|
| Rate for Payer: PHCS PPO |
$26.49
|
| Rate for Payer: Three Rivers PPO |
$20.27
|
| Rate for Payer: TriWest Veterans Administration |
$15.68
|
| Rate for Payer: United Healthcare Commercial |
$23.52
|
| Rate for Payer: United Healthcare Medicare |
$15.68
|
| Rate for Payer: WINHealth Partners Commercial |
$26.49
|
| Rate for Payer: Wise Provider Network Commercial |
$25.68
|
|
|
ENDOSCOPE VALVE SET DISP 3PC
|
Facility
|
IP
|
$27.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.95
|
| Rate for Payer: Altius Commercial |
$25.95
|
| Rate for Payer: Beech Street Commercial |
$26.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.19
|
| Rate for Payer: Cash Price |
$18.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.22
|
| Rate for Payer: Cigna of WY Commercial |
$26.49
|
| Rate for Payer: Entrust Commercial |
$25.68
|
| Rate for Payer: First Choice Health Commercial |
$25.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.84
|
| Rate for Payer: HealthUtah PPO |
$27.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.22
|
| Rate for Payer: Multiplan Medicare/VA |
$16.95
|
| Rate for Payer: One Health Plan of WY PPO |
$26.49
|
| Rate for Payer: PacificSource Commercial |
$24.33
|
| Rate for Payer: PHCS PPO |
$26.49
|
| Rate for Payer: Three Rivers PPO |
$20.27
|
| Rate for Payer: TriWest Veterans Administration |
$17.84
|
| Rate for Payer: United Healthcare Commercial |
$23.52
|
| Rate for Payer: United Healthcare Medicare |
$17.84
|
| Rate for Payer: WINHealth Partners Commercial |
$25.68
|
| Rate for Payer: Wise Provider Network Commercial |
$25.68
|
|
