|
GEMINI SR8 AR-6572
|
Facility
|
IP
|
$130.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$130.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.60
|
| Rate for Payer: Altius Commercial |
$125.60
|
| Rate for Payer: Beech Street Commercial |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.91
|
| Rate for Payer: Cigna of WY Commercial |
$128.21
|
| Rate for Payer: Entrust Commercial |
$124.29
|
| Rate for Payer: First Choice Health Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.35
|
| Rate for Payer: HealthUtah PPO |
$130.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.91
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$128.21
|
| Rate for Payer: PacificSource Commercial |
$117.75
|
| Rate for Payer: PHCS PPO |
$128.21
|
| Rate for Payer: Three Rivers PPO |
$98.12
|
| Rate for Payer: TriWest Veterans Administration |
$86.35
|
| Rate for Payer: United Healthcare Commercial |
$113.82
|
| Rate for Payer: United Healthcare Medicare |
$86.35
|
| Rate for Payer: WINHealth Partners Commercial |
$124.29
|
| Rate for Payer: Wise Provider Network Commercial |
$124.29
|
|
|
GEMINI SR8 AR-6572
|
Facility
|
OP
|
$130.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$130.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.21
|
| Rate for Payer: Aetna of WY Medicare |
$86.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.60
|
| Rate for Payer: Altius Commercial |
$125.60
|
| Rate for Payer: Beech Street Commercial |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.91
|
| Rate for Payer: Cigna of WY Commercial |
$128.21
|
| Rate for Payer: Entrust Commercial |
$124.29
|
| Rate for Payer: First Choice Health Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.88
|
| Rate for Payer: HealthUtah PPO |
$130.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.91
|
| Rate for Payer: Multiplan Medicare/VA |
$72.09
|
| Rate for Payer: One Health Plan of WY PPO |
$128.21
|
| Rate for Payer: PacificSource Commercial |
$117.75
|
| Rate for Payer: PHCS PPO |
$128.21
|
| Rate for Payer: Three Rivers PPO |
$98.12
|
| Rate for Payer: TriWest Veterans Administration |
$75.88
|
| Rate for Payer: United Healthcare Commercial |
$113.82
|
| Rate for Payer: United Healthcare Medicare |
$75.88
|
| Rate for Payer: WINHealth Partners Commercial |
$128.21
|
| Rate for Payer: Wise Provider Network Commercial |
$124.29
|
|
|
GENTAMICIN 0.3 % EYE DROPS [10905]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 6131463305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
| Rate for Payer: Aetna of WY Medicare |
$2.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.84
|
| Rate for Payer: Altius Commercial |
$3.84
|
| Rate for Payer: Beech Street Commercial |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
| Rate for Payer: Cigna of WY Commercial |
$3.92
|
| Rate for Payer: Entrust Commercial |
$3.80
|
| Rate for Payer: First Choice Health Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.32
|
| Rate for Payer: HealthUtah PPO |
$4.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2.20
|
| Rate for Payer: One Health Plan of WY PPO |
$3.92
|
| Rate for Payer: PacificSource Commercial |
$3.60
|
| Rate for Payer: PHCS PPO |
$3.92
|
| Rate for Payer: Three Rivers PPO |
$3.00
|
| Rate for Payer: TriWest Veterans Administration |
$2.32
|
| Rate for Payer: United Healthcare Commercial |
$3.48
|
| Rate for Payer: United Healthcare Medicare |
$2.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3.92
|
| Rate for Payer: Wise Provider Network Commercial |
$3.80
|
|
|
GENTAMICIN 0.3 % EYE DROPS [10905]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 6131463305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.84
|
| Rate for Payer: Altius Commercial |
$3.84
|
| Rate for Payer: Beech Street Commercial |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.88
|
| Rate for Payer: Cigna of WY Commercial |
$3.92
|
| Rate for Payer: Entrust Commercial |
$3.80
|
| Rate for Payer: First Choice Health Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.64
|
| Rate for Payer: HealthUtah PPO |
$4.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.88
|
| Rate for Payer: Multiplan Medicare/VA |
$2.51
|
| Rate for Payer: One Health Plan of WY PPO |
$3.92
|
| Rate for Payer: PacificSource Commercial |
$3.60
|
| Rate for Payer: PHCS PPO |
$3.92
|
| Rate for Payer: Three Rivers PPO |
$3.00
|
| Rate for Payer: TriWest Veterans Administration |
$2.64
|
| Rate for Payer: United Healthcare Commercial |
$3.48
|
| Rate for Payer: United Healthcare Medicare |
$2.64
|
| Rate for Payer: WINHealth Partners Commercial |
$3.80
|
| Rate for Payer: Wise Provider Network Commercial |
$3.80
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION [17722]
|
Facility
|
IP
|
$24.28
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.31
|
| Rate for Payer: Altius Commercial |
$23.31
|
| Rate for Payer: Beech Street Commercial |
$23.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.93
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.55
|
| Rate for Payer: Cigna of WY Commercial |
$23.79
|
| Rate for Payer: Entrust Commercial |
$23.07
|
| Rate for Payer: First Choice Health Commercial |
$23.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.02
|
| Rate for Payer: HealthUtah PPO |
$24.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.55
|
| Rate for Payer: Multiplan Medicare/VA |
$15.22
|
| Rate for Payer: One Health Plan of WY PPO |
$23.79
|
| Rate for Payer: PacificSource Commercial |
$21.85
|
| Rate for Payer: PHCS PPO |
$23.79
|
| Rate for Payer: Three Rivers PPO |
$18.21
|
| Rate for Payer: TriWest Veterans Administration |
$16.02
|
| Rate for Payer: United Healthcare Commercial |
$21.12
|
| Rate for Payer: United Healthcare Medicare |
$16.02
|
| Rate for Payer: WINHealth Partners Commercial |
$23.07
|
| Rate for Payer: Wise Provider Network Commercial |
$23.07
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION [17722]
|
Facility
|
OP
|
$24.28
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.79
|
| Rate for Payer: Aetna of WY Medicare |
$16.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.31
|
| Rate for Payer: Altius Commercial |
$23.31
|
| Rate for Payer: Beech Street Commercial |
$23.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.93
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.55
|
| Rate for Payer: Cigna of WY Commercial |
$23.79
|
| Rate for Payer: Entrust Commercial |
$23.07
|
| Rate for Payer: First Choice Health Commercial |
$23.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.08
|
| Rate for Payer: HealthUtah PPO |
$24.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.55
|
| Rate for Payer: Multiplan Medicare/VA |
$13.38
|
| Rate for Payer: One Health Plan of WY PPO |
$23.79
|
| Rate for Payer: PacificSource Commercial |
$21.85
|
| Rate for Payer: PHCS PPO |
$23.79
|
| Rate for Payer: Three Rivers PPO |
$18.21
|
| Rate for Payer: TriWest Veterans Administration |
$14.08
|
| Rate for Payer: United Healthcare Commercial |
$21.12
|
| Rate for Payer: United Healthcare Medicare |
$14.08
|
| Rate for Payer: WINHealth Partners Commercial |
$23.79
|
| Rate for Payer: Wise Provider Network Commercial |
$23.07
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [45058]
|
Facility
|
IP
|
$26.57
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.51
|
| Rate for Payer: Altius Commercial |
$25.51
|
| Rate for Payer: Beech Street Commercial |
$26.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.81
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.77
|
| Rate for Payer: Cigna of WY Commercial |
$26.04
|
| Rate for Payer: Entrust Commercial |
$25.24
|
| Rate for Payer: First Choice Health Commercial |
$25.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.54
|
| Rate for Payer: HealthUtah PPO |
$26.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.77
|
| Rate for Payer: Multiplan Medicare/VA |
$16.66
|
| Rate for Payer: One Health Plan of WY PPO |
$26.04
|
| Rate for Payer: PacificSource Commercial |
$23.91
|
| Rate for Payer: PHCS PPO |
$26.04
|
| Rate for Payer: Three Rivers PPO |
$19.93
|
| Rate for Payer: TriWest Veterans Administration |
$17.54
|
| Rate for Payer: United Healthcare Commercial |
$23.12
|
| Rate for Payer: United Healthcare Medicare |
$17.54
|
| Rate for Payer: WINHealth Partners Commercial |
$25.24
|
| Rate for Payer: Wise Provider Network Commercial |
$25.24
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [45058]
|
Facility
|
OP
|
$26.57
|
|
|
Service Code
|
HCPCS J1580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.04
|
| Rate for Payer: Aetna of WY Medicare |
$17.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.51
|
| Rate for Payer: Altius Commercial |
$25.51
|
| Rate for Payer: Beech Street Commercial |
$26.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.81
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.77
|
| Rate for Payer: Cigna of WY Commercial |
$26.04
|
| Rate for Payer: Entrust Commercial |
$25.24
|
| Rate for Payer: First Choice Health Commercial |
$25.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$25.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.41
|
| Rate for Payer: HealthUtah PPO |
$26.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.77
|
| Rate for Payer: Multiplan Medicare/VA |
$14.64
|
| Rate for Payer: One Health Plan of WY PPO |
$26.04
|
| Rate for Payer: PacificSource Commercial |
$23.91
|
| Rate for Payer: PHCS PPO |
$26.04
|
| Rate for Payer: Three Rivers PPO |
$19.93
|
| Rate for Payer: TriWest Veterans Administration |
$15.41
|
| Rate for Payer: United Healthcare Commercial |
$23.12
|
| Rate for Payer: United Healthcare Medicare |
$15.41
|
| Rate for Payer: WINHealth Partners Commercial |
$26.04
|
| Rate for Payer: Wise Provider Network Commercial |
$25.24
|
|
|
GENTIAN VIOLET 1 % TOPICAL SOLUTION [5027]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 2438500346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
GENTIAN VIOLET 1 % TOPICAL SOLUTION [5027]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 2438500346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.22
|
| Rate for Payer: Altius Commercial |
$0.22
|
| Rate for Payer: Beech Street Commercial |
$0.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.22
|
| Rate for Payer: Cigna of WY Commercial |
$0.23
|
| Rate for Payer: Entrust Commercial |
$0.22
|
| Rate for Payer: First Choice Health Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.22
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.23
|
| Rate for Payer: PacificSource Commercial |
$0.21
|
| Rate for Payer: PHCS PPO |
$0.23
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.22
|
|
|
GENVISC 850, INJ, 1MG
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS J7320
|
| Hospital Charge Code |
J7320
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.00
|
| Rate for Payer: Aetna of WY Medicare |
$5.16
|
| Rate for Payer: Beech Street Commercial |
$47.50
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$48.50
|
| Rate for Payer: Cigna of WY Commercial |
$49.00
|
| Rate for Payer: First Choice Health Commercial |
$45.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$47.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.16
|
| Rate for Payer: HealthUtah PPO |
$50.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$48.50
|
| Rate for Payer: Multiplan Medicare/VA |
$4.39
|
| Rate for Payer: One Health Plan of WY PPO |
$49.00
|
| Rate for Payer: PacificSource Commercial |
$45.00
|
| Rate for Payer: PHCS PPO |
$47.50
|
| Rate for Payer: Three Rivers PPO |
$37.50
|
| Rate for Payer: TriWest Veterans Administration |
$5.16
|
| Rate for Payer: United Healthcare Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicare |
$5.16
|
| Rate for Payer: WINHealth Partners Commercial |
$47.50
|
|
|
GII QUICKANC + ETHIBOND 212034
|
Facility
|
OP
|
$798.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.70 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$782.04
|
| Rate for Payer: Aetna of WY Medicare |
$526.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$766.08
|
| Rate for Payer: Altius Commercial |
$766.08
|
| Rate for Payer: Beech Street Commercial |
$782.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$655.16
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$774.06
|
| Rate for Payer: Cigna of WY Commercial |
$782.04
|
| Rate for Payer: Entrust Commercial |
$758.10
|
| Rate for Payer: First Choice Health Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$462.84
|
| Rate for Payer: HealthUtah PPO |
$798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$774.06
|
| Rate for Payer: Multiplan Medicare/VA |
$439.70
|
| Rate for Payer: One Health Plan of WY PPO |
$782.04
|
| Rate for Payer: PacificSource Commercial |
$718.20
|
| Rate for Payer: PHCS PPO |
$782.04
|
| Rate for Payer: Three Rivers PPO |
$598.50
|
| Rate for Payer: TriWest Veterans Administration |
$462.84
|
| Rate for Payer: United Healthcare Commercial |
$694.26
|
| Rate for Payer: United Healthcare Medicare |
$462.84
|
| Rate for Payer: WINHealth Partners Commercial |
$782.04
|
| Rate for Payer: Wise Provider Network Commercial |
$758.10
|
|
|
GII QUICKANC + ETHIBOND 212034
|
Facility
|
IP
|
$798.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.35 |
| Max. Negotiated Rate |
$798.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$782.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$766.08
|
| Rate for Payer: Altius Commercial |
$766.08
|
| Rate for Payer: Beech Street Commercial |
$782.04
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$655.16
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$774.06
|
| Rate for Payer: Cigna of WY Commercial |
$782.04
|
| Rate for Payer: Entrust Commercial |
$758.10
|
| Rate for Payer: First Choice Health Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$758.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$526.68
|
| Rate for Payer: HealthUtah PPO |
$798.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$774.06
|
| Rate for Payer: Multiplan Medicare/VA |
$500.35
|
| Rate for Payer: One Health Plan of WY PPO |
$782.04
|
| Rate for Payer: PacificSource Commercial |
$718.20
|
| Rate for Payer: PHCS PPO |
$782.04
|
| Rate for Payer: Three Rivers PPO |
$598.50
|
| Rate for Payer: TriWest Veterans Administration |
$526.68
|
| Rate for Payer: United Healthcare Commercial |
$694.26
|
| Rate for Payer: United Healthcare Medicare |
$526.68
|
| Rate for Payer: WINHealth Partners Commercial |
$758.10
|
| Rate for Payer: Wise Provider Network Commercial |
$758.10
|
|
|
GLIDESCOPE RIGID STYLET
|
Facility
|
OP
|
$138.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$136.00
|
| Rate for Payer: Aetna of WY Medicare |
$91.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$133.23
|
| Rate for Payer: Altius Commercial |
$133.23
|
| Rate for Payer: Beech Street Commercial |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.94
|
| Rate for Payer: Cash Price |
$97.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.62
|
| Rate for Payer: Cigna of WY Commercial |
$136.00
|
| Rate for Payer: Entrust Commercial |
$131.84
|
| Rate for Payer: First Choice Health Commercial |
$131.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.49
|
| Rate for Payer: HealthUtah PPO |
$138.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.62
|
| Rate for Payer: Multiplan Medicare/VA |
$76.47
|
| Rate for Payer: One Health Plan of WY PPO |
$136.00
|
| Rate for Payer: PacificSource Commercial |
$124.90
|
| Rate for Payer: PHCS PPO |
$136.00
|
| Rate for Payer: Three Rivers PPO |
$104.08
|
| Rate for Payer: TriWest Veterans Administration |
$80.49
|
| Rate for Payer: United Healthcare Commercial |
$120.74
|
| Rate for Payer: United Healthcare Medicare |
$80.49
|
| Rate for Payer: WINHealth Partners Commercial |
$136.00
|
| Rate for Payer: Wise Provider Network Commercial |
$131.84
|
|
|
GLIDESCOPE RIGID STYLET
|
Facility
|
IP
|
$138.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$138.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$136.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$133.23
|
| Rate for Payer: Altius Commercial |
$133.23
|
| Rate for Payer: Beech Street Commercial |
$136.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$113.94
|
| Rate for Payer: Cash Price |
$97.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$134.62
|
| Rate for Payer: Cigna of WY Commercial |
$136.00
|
| Rate for Payer: Entrust Commercial |
$131.84
|
| Rate for Payer: First Choice Health Commercial |
$131.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$131.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.59
|
| Rate for Payer: HealthUtah PPO |
$138.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$134.62
|
| Rate for Payer: Multiplan Medicare/VA |
$87.02
|
| Rate for Payer: One Health Plan of WY PPO |
$136.00
|
| Rate for Payer: PacificSource Commercial |
$124.90
|
| Rate for Payer: PHCS PPO |
$136.00
|
| Rate for Payer: Three Rivers PPO |
$104.08
|
| Rate for Payer: TriWest Veterans Administration |
$91.59
|
| Rate for Payer: United Healthcare Commercial |
$120.74
|
| Rate for Payer: United Healthcare Medicare |
$91.59
|
| Rate for Payer: WINHealth Partners Commercial |
$131.84
|
| Rate for Payer: Wise Provider Network Commercial |
$131.84
|
|
|
GLIDESCOPE SZ 1 LOPRO SPECTRUM
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.27 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Aetna of WY Medicare |
$114.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.98
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.95
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.28
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$95.27
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$100.28
|
| Rate for Payer: United Healthcare Commercial |
$150.42
|
| Rate for Payer: United Healthcare Medicare |
$100.28
|
| Rate for Payer: WINHealth Partners Commercial |
$169.44
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 1 LOPRO SPECTRUM
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.98
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.95
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.11
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$108.41
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$150.42
|
| Rate for Payer: United Healthcare Medicare |
$114.11
|
| Rate for Payer: WINHealth Partners Commercial |
$164.26
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 2 LOPRO SPECTRUM
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.27 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Aetna of WY Medicare |
$114.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.98
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.95
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.28
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$95.27
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$100.28
|
| Rate for Payer: United Healthcare Commercial |
$150.42
|
| Rate for Payer: United Healthcare Medicare |
$100.28
|
| Rate for Payer: WINHealth Partners Commercial |
$169.44
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 2 LOPRO SPECTRUM
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$169.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$165.98
|
| Rate for Payer: Altius Commercial |
$165.98
|
| Rate for Payer: Beech Street Commercial |
$169.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$141.95
|
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$167.71
|
| Rate for Payer: Cigna of WY Commercial |
$169.44
|
| Rate for Payer: Entrust Commercial |
$164.26
|
| Rate for Payer: First Choice Health Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$164.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$114.11
|
| Rate for Payer: HealthUtah PPO |
$172.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$167.71
|
| Rate for Payer: Multiplan Medicare/VA |
$108.41
|
| Rate for Payer: One Health Plan of WY PPO |
$169.44
|
| Rate for Payer: PacificSource Commercial |
$155.61
|
| Rate for Payer: PHCS PPO |
$169.44
|
| Rate for Payer: Three Rivers PPO |
$129.68
|
| Rate for Payer: TriWest Veterans Administration |
$114.11
|
| Rate for Payer: United Healthcare Commercial |
$150.42
|
| Rate for Payer: United Healthcare Medicare |
$114.11
|
| Rate for Payer: WINHealth Partners Commercial |
$164.26
|
| Rate for Payer: Wise Provider Network Commercial |
$164.26
|
|
|
GLIDESCOPE SZ 3 DVM SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.28 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.14
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$73.28
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.14
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$77.14
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 3 DVM SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 3 LOPRO SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.28 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.14
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$73.28
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.14
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$77.14
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 3 LOPRO SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 4 DVM SPECTRUM
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.28 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.14
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$73.28
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$77.14
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$77.14
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
GLIDESCOPE SZ 4 DVM SPECTRUM
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.68
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$109.19
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.78
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$83.39
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$87.78
|
| Rate for Payer: United Healthcare Commercial |
$115.71
|
| Rate for Payer: United Healthcare Medicare |
$87.78
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
