|
ENDO SCRUB TUBING
|
Facility
|
OP
|
$154.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.96 |
| Max. Negotiated Rate |
$154.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.11
|
| Rate for Payer: Aetna of WY Medicare |
$101.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.02
|
| Rate for Payer: Altius Commercial |
$148.02
|
| Rate for Payer: Beech Street Commercial |
$151.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.59
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.56
|
| Rate for Payer: Cigna of WY Commercial |
$151.11
|
| Rate for Payer: Entrust Commercial |
$146.48
|
| Rate for Payer: First Choice Health Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.43
|
| Rate for Payer: HealthUtah PPO |
$154.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.56
|
| Rate for Payer: Multiplan Medicare/VA |
$84.96
|
| Rate for Payer: One Health Plan of WY PPO |
$151.11
|
| Rate for Payer: PacificSource Commercial |
$138.77
|
| Rate for Payer: PHCS PPO |
$151.11
|
| Rate for Payer: Three Rivers PPO |
$115.64
|
| Rate for Payer: TriWest Veterans Administration |
$89.43
|
| Rate for Payer: United Healthcare Commercial |
$134.15
|
| Rate for Payer: United Healthcare Medicare |
$89.43
|
| Rate for Payer: WINHealth Partners Commercial |
$151.11
|
| Rate for Payer: Wise Provider Network Commercial |
$146.48
|
|
|
ENDO SCRUB TUBING
|
Facility
|
IP
|
$154.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.68 |
| Max. Negotiated Rate |
$154.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$151.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$148.02
|
| Rate for Payer: Altius Commercial |
$148.02
|
| Rate for Payer: Beech Street Commercial |
$151.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$126.59
|
| Rate for Payer: Cash Price |
$107.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$149.56
|
| Rate for Payer: Cigna of WY Commercial |
$151.11
|
| Rate for Payer: Entrust Commercial |
$146.48
|
| Rate for Payer: First Choice Health Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$146.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.77
|
| Rate for Payer: HealthUtah PPO |
$154.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$149.56
|
| Rate for Payer: Multiplan Medicare/VA |
$96.68
|
| Rate for Payer: One Health Plan of WY PPO |
$151.11
|
| Rate for Payer: PacificSource Commercial |
$138.77
|
| Rate for Payer: PHCS PPO |
$151.11
|
| Rate for Payer: Three Rivers PPO |
$115.64
|
| Rate for Payer: TriWest Veterans Administration |
$101.77
|
| Rate for Payer: United Healthcare Commercial |
$134.15
|
| Rate for Payer: United Healthcare Medicare |
$101.77
|
| Rate for Payer: WINHealth Partners Commercial |
$146.48
|
| Rate for Payer: Wise Provider Network Commercial |
$146.48
|
|
|
ENDO SHEAR
|
Facility
|
OP
|
$89.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.57
|
| Rate for Payer: Aetna of WY Medicare |
$58.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.79
|
| Rate for Payer: Altius Commercial |
$85.79
|
| Rate for Payer: Beech Street Commercial |
$87.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.36
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.68
|
| Rate for Payer: Cigna of WY Commercial |
$87.57
|
| Rate for Payer: Entrust Commercial |
$84.89
|
| Rate for Payer: First Choice Health Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$51.83
|
| Rate for Payer: HealthUtah PPO |
$89.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.68
|
| Rate for Payer: Multiplan Medicare/VA |
$49.24
|
| Rate for Payer: One Health Plan of WY PPO |
$87.57
|
| Rate for Payer: PacificSource Commercial |
$80.42
|
| Rate for Payer: PHCS PPO |
$87.57
|
| Rate for Payer: Three Rivers PPO |
$67.02
|
| Rate for Payer: TriWest Veterans Administration |
$51.83
|
| Rate for Payer: United Healthcare Commercial |
$77.74
|
| Rate for Payer: United Healthcare Medicare |
$51.83
|
| Rate for Payer: WINHealth Partners Commercial |
$87.57
|
| Rate for Payer: Wise Provider Network Commercial |
$84.89
|
|
|
ENDO SHEAR
|
Facility
|
IP
|
$89.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$89.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$85.79
|
| Rate for Payer: Altius Commercial |
$85.79
|
| Rate for Payer: Beech Street Commercial |
$87.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$73.36
|
| Rate for Payer: Cash Price |
$62.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.68
|
| Rate for Payer: Cigna of WY Commercial |
$87.57
|
| Rate for Payer: Entrust Commercial |
$84.89
|
| Rate for Payer: First Choice Health Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$58.98
|
| Rate for Payer: HealthUtah PPO |
$89.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.68
|
| Rate for Payer: Multiplan Medicare/VA |
$56.03
|
| Rate for Payer: One Health Plan of WY PPO |
$87.57
|
| Rate for Payer: PacificSource Commercial |
$80.42
|
| Rate for Payer: PHCS PPO |
$87.57
|
| Rate for Payer: Three Rivers PPO |
$67.02
|
| Rate for Payer: TriWest Veterans Administration |
$58.98
|
| Rate for Payer: United Healthcare Commercial |
$77.74
|
| Rate for Payer: United Healthcare Medicare |
$58.98
|
| Rate for Payer: WINHealth Partners Commercial |
$84.89
|
| Rate for Payer: Wise Provider Network Commercial |
$84.89
|
|
|
ENDOSTCH POLYSORB 0 ES9 170056
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ENDOSTCH POLYSORB 0 ES9 170056
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ENDOSTITCH 10MM SUTUR DEV
|
Facility
|
IP
|
$665.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$416.96 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$438.90
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$416.96
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$438.90
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$438.90
|
| Rate for Payer: WINHealth Partners Commercial |
$631.75
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
ENDOSTITCH 10MM SUTUR DEV
|
Facility
|
OP
|
$665.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.42 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$651.70
|
| Rate for Payer: Aetna of WY Medicare |
$438.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$638.40
|
| Rate for Payer: Altius Commercial |
$638.40
|
| Rate for Payer: Beech Street Commercial |
$651.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$545.96
|
| Rate for Payer: Cash Price |
$465.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$645.05
|
| Rate for Payer: Cigna of WY Commercial |
$651.70
|
| Rate for Payer: Entrust Commercial |
$631.75
|
| Rate for Payer: First Choice Health Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$631.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$385.70
|
| Rate for Payer: HealthUtah PPO |
$665.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$645.05
|
| Rate for Payer: Multiplan Medicare/VA |
$366.42
|
| Rate for Payer: One Health Plan of WY PPO |
$651.70
|
| Rate for Payer: PacificSource Commercial |
$598.50
|
| Rate for Payer: PHCS PPO |
$651.70
|
| Rate for Payer: Three Rivers PPO |
$498.75
|
| Rate for Payer: TriWest Veterans Administration |
$385.70
|
| Rate for Payer: United Healthcare Commercial |
$578.55
|
| Rate for Payer: United Healthcare Medicare |
$385.70
|
| Rate for Payer: WINHealth Partners Commercial |
$651.70
|
| Rate for Payer: Wise Provider Network Commercial |
$631.75
|
|
|
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$2,881.00
|
|
|
Service Code
|
HCPCS 36475 50
|
| Hospital Charge Code |
36475
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$2,881.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,823.38
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$2,736.95
|
| Rate for Payer: Cash Price |
$2,016.70
|
| Rate for Payer: Cash Price |
$2,016.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,794.57
|
| Rate for Payer: Cigna of WY Commercial |
$2,823.38
|
| Rate for Payer: First Choice Health Commercial |
$2,592.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,736.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$2,881.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,794.57
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$2,823.38
|
| Rate for Payer: PacificSource Commercial |
$2,592.90
|
| Rate for Payer: PHCS PPO |
$2,736.95
|
| Rate for Payer: Three Rivers PPO |
$2,160.75
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$2,506.47
|
| Rate for Payer: United Healthcare Medicare |
$257.04
|
| Rate for Payer: WINHealth Partners Commercial |
$2,448.85
|
|
|
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 36475
|
| Hospital Charge Code |
36475
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,411.20
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$1,368.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,396.80
|
| Rate for Payer: Cigna of WY Commercial |
$1,411.20
|
| Rate for Payer: First Choice Health Commercial |
$1,296.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,368.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$1,440.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,396.80
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,411.20
|
| Rate for Payer: PacificSource Commercial |
$1,296.00
|
| Rate for Payer: PHCS PPO |
$1,368.00
|
| Rate for Payer: Three Rivers PPO |
$1,080.00
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$1,252.80
|
| Rate for Payer: United Healthcare Medicare |
$257.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,224.00
|
|
|
ENERGEL WOUND GEL
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.54
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$11.91
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.54
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$12.54
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
ENERGEL WOUND GEL
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.24
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.60
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.02
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$10.47
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.02
|
| Rate for Payer: United Healthcare Commercial |
$16.53
|
| Rate for Payer: United Healthcare Medicare |
$11.02
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [23878]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.95
|
| Rate for Payer: Altius Commercial |
$37.95
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$27.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$38.74
|
| Rate for Payer: Entrust Commercial |
$37.55
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$37.55
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.09
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$39.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: Multiplan Medicare/VA |
$24.79
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$38.74
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$35.58
|
| Rate for Payer: PHCS PPO |
$38.74
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$29.65
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: TriWest Veterans Administration |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: United Healthcare Medicare |
$26.09
|
| Rate for Payer: WINHealth Partners Commercial |
$37.55
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$37.55
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [23878]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.74
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$26.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$37.95
|
| Rate for Payer: Beech Street Commercial |
$38.74
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.45
|
| Rate for Payer: Cash Price |
$27.67
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.34
|
| Rate for Payer: Cigna of WY Commercial |
$38.74
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$37.55
|
| Rate for Payer: First Choice Health Commercial |
$37.55
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.93
|
| Rate for Payer: HealthUtah PPO |
$39.53
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: Multiplan Medicare/VA |
$21.78
|
| Rate for Payer: One Health Plan of WY PPO |
$38.74
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$35.58
|
| Rate for Payer: PHCS PPO |
$38.74
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$29.65
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: TriWest Veterans Administration |
$22.93
|
| Rate for Payer: United Healthcare Commercial |
$34.39
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$22.93
|
| Rate for Payer: WINHealth Partners Commercial |
$38.74
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$37.55
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [25713]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$33.06
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [25713]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$37.62
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [15913]
|
Facility
|
OP
|
$53.39
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.32
|
| Rate for Payer: Aetna of WY Medicare |
$35.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.25
|
| Rate for Payer: Altius Commercial |
$51.25
|
| Rate for Payer: Beech Street Commercial |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.83
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.79
|
| Rate for Payer: Cigna of WY Commercial |
$52.32
|
| Rate for Payer: Entrust Commercial |
$50.72
|
| Rate for Payer: First Choice Health Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.97
|
| Rate for Payer: HealthUtah PPO |
$53.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.79
|
| Rate for Payer: Multiplan Medicare/VA |
$29.42
|
| Rate for Payer: One Health Plan of WY PPO |
$52.32
|
| Rate for Payer: PacificSource Commercial |
$48.05
|
| Rate for Payer: PHCS PPO |
$52.32
|
| Rate for Payer: Three Rivers PPO |
$40.04
|
| Rate for Payer: TriWest Veterans Administration |
$30.97
|
| Rate for Payer: United Healthcare Commercial |
$46.45
|
| Rate for Payer: United Healthcare Medicare |
$30.97
|
| Rate for Payer: WINHealth Partners Commercial |
$52.32
|
| Rate for Payer: Wise Provider Network Commercial |
$50.72
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [15913]
|
Facility
|
IP
|
$53.39
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$51.25
|
| Rate for Payer: Altius Commercial |
$51.25
|
| Rate for Payer: Beech Street Commercial |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.83
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.79
|
| Rate for Payer: Cigna of WY Commercial |
$52.32
|
| Rate for Payer: Entrust Commercial |
$50.72
|
| Rate for Payer: First Choice Health Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.24
|
| Rate for Payer: HealthUtah PPO |
$53.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.79
|
| Rate for Payer: Multiplan Medicare/VA |
$33.48
|
| Rate for Payer: One Health Plan of WY PPO |
$52.32
|
| Rate for Payer: PacificSource Commercial |
$48.05
|
| Rate for Payer: PHCS PPO |
$52.32
|
| Rate for Payer: Three Rivers PPO |
$40.04
|
| Rate for Payer: TriWest Veterans Administration |
$35.24
|
| Rate for Payer: United Healthcare Commercial |
$46.45
|
| Rate for Payer: United Healthcare Medicare |
$35.24
|
| Rate for Payer: WINHealth Partners Commercial |
$50.72
|
| Rate for Payer: Wise Provider Network Commercial |
$50.72
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [23875]
|
Facility
|
IP
|
$41.02
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.72 |
| Max. Negotiated Rate |
$41.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$43.21
|
| Rate for Payer: Altius Commercial |
$39.38
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$44.11
|
| Rate for Payer: Beech Street Commercial |
$40.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.95
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.66
|
| Rate for Payer: Cigna of WY Commercial |
$44.11
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$40.20
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$38.97
|
| Rate for Payer: Entrust Commercial |
$42.76
|
| Rate for Payer: First Choice Health Commercial |
$42.76
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$38.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$41.02
|
| Rate for Payer: HealthUtah PPO |
$45.01
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.79
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: Multiplan Medicare/VA |
$25.72
|
| Rate for Payer: Multiplan Medicare/VA |
$28.22
|
| Rate for Payer: One Health Plan of WY PPO |
$40.20
|
| Rate for Payer: One Health Plan of WY PPO |
$44.11
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$36.92
|
| Rate for Payer: PacificSource Commercial |
$40.51
|
| Rate for Payer: PHCS PPO |
$44.11
|
| Rate for Payer: PHCS PPO |
$40.20
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.76
|
| Rate for Payer: Three Rivers PPO |
$30.76
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$29.71
|
| Rate for Payer: TriWest Veterans Administration |
$27.07
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$35.69
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Commercial |
$39.16
|
| Rate for Payer: United Healthcare Medicare |
$27.07
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: United Healthcare Medicare |
$29.71
|
| Rate for Payer: WINHealth Partners Commercial |
$42.76
|
| Rate for Payer: WINHealth Partners Commercial |
$38.97
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$38.97
|
| Rate for Payer: Wise Provider Network Commercial |
$42.76
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [23875]
|
Facility
|
OP
|
$45.01
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$45.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.11
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$29.71
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$27.07
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$43.21
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$39.38
|
| Rate for Payer: Beech Street Commercial |
$44.11
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$40.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.79
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$40.20
|
| Rate for Payer: Cigna of WY Commercial |
$44.11
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$42.76
|
| Rate for Payer: Entrust Commercial |
$38.97
|
| Rate for Payer: First Choice Health Commercial |
$42.76
|
| Rate for Payer: First Choice Health Commercial |
$38.97
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: HealthUtah PPO |
$41.02
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$45.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.66
|
| Rate for Payer: Multiplan Medicare/VA |
$22.60
|
| Rate for Payer: Multiplan Medicare/VA |
$24.80
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: One Health Plan of WY PPO |
$40.20
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$44.11
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$40.51
|
| Rate for Payer: PacificSource Commercial |
$36.92
|
| Rate for Payer: PHCS PPO |
$44.11
|
| Rate for Payer: PHCS PPO |
$40.20
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.76
|
| Rate for Payer: Three Rivers PPO |
$30.76
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: TriWest Veterans Administration |
$26.11
|
| Rate for Payer: TriWest Veterans Administration |
$23.79
|
| Rate for Payer: United Healthcare Commercial |
$35.69
|
| Rate for Payer: United Healthcare Commercial |
$39.16
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$23.79
|
| Rate for Payer: United Healthcare Medicare |
$26.11
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: WINHealth Partners Commercial |
$40.20
|
| Rate for Payer: WINHealth Partners Commercial |
$44.11
|
| Rate for Payer: Wise Provider Network Commercial |
$38.97
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$42.76
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [23879]
|
Facility
|
IP
|
$39.59
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$43.10
|
| Rate for Payer: Altius Commercial |
$38.01
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$44.00
|
| Rate for Payer: Beech Street Commercial |
$38.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.86
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cash Price |
$27.71
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.55
|
| Rate for Payer: Cigna of WY Commercial |
$44.00
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$38.80
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$37.61
|
| Rate for Payer: Entrust Commercial |
$42.66
|
| Rate for Payer: First Choice Health Commercial |
$42.66
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$37.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$39.59
|
| Rate for Payer: HealthUtah PPO |
$44.90
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.40
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: Multiplan Medicare/VA |
$24.82
|
| Rate for Payer: Multiplan Medicare/VA |
$28.15
|
| Rate for Payer: One Health Plan of WY PPO |
$38.80
|
| Rate for Payer: One Health Plan of WY PPO |
$44.00
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$35.63
|
| Rate for Payer: PacificSource Commercial |
$40.41
|
| Rate for Payer: PHCS PPO |
$44.00
|
| Rate for Payer: PHCS PPO |
$38.80
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.68
|
| Rate for Payer: Three Rivers PPO |
$29.69
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$29.63
|
| Rate for Payer: TriWest Veterans Administration |
$26.13
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$34.44
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Commercial |
$39.06
|
| Rate for Payer: United Healthcare Medicare |
$26.13
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: United Healthcare Medicare |
$29.63
|
| Rate for Payer: WINHealth Partners Commercial |
$42.66
|
| Rate for Payer: WINHealth Partners Commercial |
$37.61
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$37.61
|
| Rate for Payer: Wise Provider Network Commercial |
$42.66
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [23879]
|
Facility
|
OP
|
$44.90
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$44.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$29.63
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$26.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$43.10
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$38.01
|
| Rate for Payer: Beech Street Commercial |
$44.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$38.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.86
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cash Price |
$27.71
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.40
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$44.00
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$42.66
|
| Rate for Payer: Entrust Commercial |
$37.61
|
| Rate for Payer: First Choice Health Commercial |
$42.66
|
| Rate for Payer: First Choice Health Commercial |
$37.61
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: HealthUtah PPO |
$39.59
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$44.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.55
|
| Rate for Payer: Multiplan Medicare/VA |
$21.81
|
| Rate for Payer: Multiplan Medicare/VA |
$24.74
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: One Health Plan of WY PPO |
$38.80
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$44.00
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$40.41
|
| Rate for Payer: PacificSource Commercial |
$35.63
|
| Rate for Payer: PHCS PPO |
$44.00
|
| Rate for Payer: PHCS PPO |
$38.80
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.68
|
| Rate for Payer: Three Rivers PPO |
$29.69
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: TriWest Veterans Administration |
$26.04
|
| Rate for Payer: TriWest Veterans Administration |
$22.96
|
| Rate for Payer: United Healthcare Commercial |
$34.44
|
| Rate for Payer: United Healthcare Commercial |
$39.06
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$22.96
|
| Rate for Payer: United Healthcare Medicare |
$26.04
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: WINHealth Partners Commercial |
$38.80
|
| Rate for Payer: WINHealth Partners Commercial |
$44.00
|
| Rate for Payer: Wise Provider Network Commercial |
$37.61
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$42.66
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [23876]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.33
|
| Rate for Payer: Altius Commercial |
$42.33
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$43.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$43.21
|
| Rate for Payer: Entrust Commercial |
$41.89
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$41.89
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.10
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$44.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: Multiplan Medicare/VA |
$27.64
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$43.21
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$39.68
|
| Rate for Payer: PHCS PPO |
$43.21
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.07
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: TriWest Veterans Administration |
$29.10
|
| Rate for Payer: United Healthcare Commercial |
$38.36
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: United Healthcare Medicare |
$29.10
|
| Rate for Payer: WINHealth Partners Commercial |
$41.89
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$41.89
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [23876]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.21
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$29.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$42.33
|
| Rate for Payer: Beech Street Commercial |
$43.21
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.77
|
| Rate for Payer: Cigna of WY Commercial |
$43.21
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$41.89
|
| Rate for Payer: First Choice Health Commercial |
$41.89
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.57
|
| Rate for Payer: HealthUtah PPO |
$44.09
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: Multiplan Medicare/VA |
$24.29
|
| Rate for Payer: One Health Plan of WY PPO |
$43.21
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$39.68
|
| Rate for Payer: PHCS PPO |
$43.21
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.07
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: TriWest Veterans Administration |
$25.57
|
| Rate for Payer: United Healthcare Commercial |
$38.36
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: United Healthcare Medicare |
$25.57
|
| Rate for Payer: WINHealth Partners Commercial |
$43.21
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$41.89
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [23877]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.62
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.99
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.62
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$32.62
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
