|
GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
15769
|
| Min. Negotiated Rate |
$393.86 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,646.40
|
| Rate for Payer: Aetna of WY Medicare |
$463.37
|
| Rate for Payer: Beech Street Commercial |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,629.60
|
| Rate for Payer: Cigna of WY Commercial |
$1,646.40
|
| Rate for Payer: First Choice Health Commercial |
$1,512.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,596.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$463.37
|
| Rate for Payer: HealthUtah PPO |
$1,680.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,629.60
|
| Rate for Payer: Multiplan Medicare/VA |
$393.86
|
| Rate for Payer: One Health Plan of WY PPO |
$1,646.40
|
| Rate for Payer: PacificSource Commercial |
$1,512.00
|
| Rate for Payer: PHCS PPO |
$1,596.00
|
| Rate for Payer: Three Rivers PPO |
$1,260.00
|
| Rate for Payer: TriWest Veterans Administration |
$463.37
|
| Rate for Payer: United Healthcare Commercial |
$1,461.60
|
| Rate for Payer: United Healthcare Medicare |
$463.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1,428.00
|
|
|
GRAFT TENSION BREAK PINS
|
Facility
|
IP
|
$130.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.57 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.90
|
| Rate for Payer: Altius Commercial |
$124.90
|
| Rate for Payer: Beech Street Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.81
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.20
|
| Rate for Payer: Cigna of WY Commercial |
$127.50
|
| Rate for Payer: Entrust Commercial |
$123.60
|
| Rate for Payer: First Choice Health Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$85.87
|
| Rate for Payer: HealthUtah PPO |
$130.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.20
|
| Rate for Payer: Multiplan Medicare/VA |
$81.57
|
| Rate for Payer: One Health Plan of WY PPO |
$127.50
|
| Rate for Payer: PacificSource Commercial |
$117.09
|
| Rate for Payer: PHCS PPO |
$127.50
|
| Rate for Payer: Three Rivers PPO |
$97.58
|
| Rate for Payer: TriWest Veterans Administration |
$85.87
|
| Rate for Payer: United Healthcare Commercial |
$113.19
|
| Rate for Payer: United Healthcare Medicare |
$85.87
|
| Rate for Payer: WINHealth Partners Commercial |
$123.60
|
| Rate for Payer: Wise Provider Network Commercial |
$123.60
|
|
|
GRAFT TENSION BREAK PINS
|
Facility
|
OP
|
$130.10
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$127.50
|
| Rate for Payer: Aetna of WY Medicare |
$85.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$124.90
|
| Rate for Payer: Altius Commercial |
$124.90
|
| Rate for Payer: Beech Street Commercial |
$127.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$106.81
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.20
|
| Rate for Payer: Cigna of WY Commercial |
$127.50
|
| Rate for Payer: Entrust Commercial |
$123.60
|
| Rate for Payer: First Choice Health Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$123.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.46
|
| Rate for Payer: HealthUtah PPO |
$130.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.20
|
| Rate for Payer: Multiplan Medicare/VA |
$71.69
|
| Rate for Payer: One Health Plan of WY PPO |
$127.50
|
| Rate for Payer: PacificSource Commercial |
$117.09
|
| Rate for Payer: PHCS PPO |
$127.50
|
| Rate for Payer: Three Rivers PPO |
$97.58
|
| Rate for Payer: TriWest Veterans Administration |
$75.46
|
| Rate for Payer: United Healthcare Commercial |
$113.19
|
| Rate for Payer: United Healthcare Medicare |
$75.46
|
| Rate for Payer: WINHealth Partners Commercial |
$127.50
|
| Rate for Payer: Wise Provider Network Commercial |
$123.60
|
|
|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION [46063]
|
Facility
|
IP
|
$47.50
|
|
|
Service Code
|
HCPCS J1626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.35
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$29.78
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$31.35
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$31.35
|
| Rate for Payer: WINHealth Partners Commercial |
$45.12
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION [46063]
|
Facility
|
OP
|
$47.50
|
|
|
Service Code
|
HCPCS J1626
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.55
|
| Rate for Payer: Aetna of WY Medicare |
$31.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.60
|
| Rate for Payer: Altius Commercial |
$45.60
|
| Rate for Payer: Beech Street Commercial |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$33.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.08
|
| Rate for Payer: Cigna of WY Commercial |
$46.55
|
| Rate for Payer: Entrust Commercial |
$45.12
|
| Rate for Payer: First Choice Health Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.55
|
| Rate for Payer: HealthUtah PPO |
$47.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.08
|
| Rate for Payer: Multiplan Medicare/VA |
$26.17
|
| Rate for Payer: One Health Plan of WY PPO |
$46.55
|
| Rate for Payer: PacificSource Commercial |
$42.75
|
| Rate for Payer: PHCS PPO |
$46.55
|
| Rate for Payer: Three Rivers PPO |
$35.62
|
| Rate for Payer: TriWest Veterans Administration |
$27.55
|
| Rate for Payer: United Healthcare Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicare |
$27.55
|
| Rate for Payer: WINHealth Partners Commercial |
$46.55
|
| Rate for Payer: Wise Provider Network Commercial |
$45.12
|
|
|
GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90853
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.34
|
| Rate for Payer: Aetna of WY Medicare |
$23.40
|
| Rate for Payer: Beech Street Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: Cash Price |
$163.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.01
|
| Rate for Payer: Cigna of WY Commercial |
$228.34
|
| Rate for Payer: First Choice Health Commercial |
$209.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.40
|
| Rate for Payer: HealthUtah PPO |
$233.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.01
|
| Rate for Payer: Multiplan Medicare/VA |
$19.89
|
| Rate for Payer: One Health Plan of WY PPO |
$228.34
|
| Rate for Payer: PacificSource Commercial |
$209.70
|
| Rate for Payer: PHCS PPO |
$221.35
|
| Rate for Payer: Three Rivers PPO |
$174.75
|
| Rate for Payer: TriWest Veterans Administration |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$202.71
|
| Rate for Payer: United Healthcare Medicare |
$23.40
|
| Rate for Payer: WINHealth Partners Commercial |
$221.35
|
|
|
GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$6,478.00
|
|
|
Service Code
|
HCPCS 43633
|
| Hospital Charge Code |
43633
|
| Min. Negotiated Rate |
$1,543.34 |
| Max. Negotiated Rate |
$6,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,348.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,815.70
|
| Rate for Payer: Beech Street Commercial |
$6,154.10
|
| Rate for Payer: Cash Price |
$4,534.60
|
| Rate for Payer: Cash Price |
$4,534.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,283.66
|
| Rate for Payer: Cigna of WY Commercial |
$6,348.44
|
| Rate for Payer: First Choice Health Commercial |
$5,830.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,154.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,815.70
|
| Rate for Payer: HealthUtah PPO |
$6,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,283.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,543.34
|
| Rate for Payer: One Health Plan of WY PPO |
$6,348.44
|
| Rate for Payer: PacificSource Commercial |
$5,830.20
|
| Rate for Payer: PHCS PPO |
$6,154.10
|
| Rate for Payer: Three Rivers PPO |
$4,858.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,815.70
|
| Rate for Payer: United Healthcare Commercial |
$5,635.86
|
| Rate for Payer: United Healthcare Medicare |
$1,815.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,506.30
|
|
|
GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$6,478.00
|
|
|
Service Code
|
HCPCS 43633 80
|
| Hospital Charge Code |
43633
|
| Min. Negotiated Rate |
$1,543.34 |
| Max. Negotiated Rate |
$6,478.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,348.44
|
| Rate for Payer: Aetna of WY Medicare |
$1,815.70
|
| Rate for Payer: Beech Street Commercial |
$6,154.10
|
| Rate for Payer: Cash Price |
$4,534.60
|
| Rate for Payer: Cash Price |
$4,534.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,283.66
|
| Rate for Payer: Cigna of WY Commercial |
$6,348.44
|
| Rate for Payer: First Choice Health Commercial |
$5,830.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,154.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,815.70
|
| Rate for Payer: HealthUtah PPO |
$6,478.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,283.66
|
| Rate for Payer: Multiplan Medicare/VA |
$1,543.34
|
| Rate for Payer: One Health Plan of WY PPO |
$6,348.44
|
| Rate for Payer: PacificSource Commercial |
$5,830.20
|
| Rate for Payer: PHCS PPO |
$6,154.10
|
| Rate for Payer: Three Rivers PPO |
$4,858.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,815.70
|
| Rate for Payer: United Healthcare Commercial |
$5,635.86
|
| Rate for Payer: United Healthcare Medicare |
$1,815.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,506.30
|
|
|
GUAIFENESIN ER 1,200 MG TABLET, EXTENDED RELEASE 12 HR [45204]
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 6382402328
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.06
|
| Rate for Payer: Aetna of WY Medicare |
$2.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.00
|
| Rate for Payer: Altius Commercial |
$3.00
|
| Rate for Payer: Beech Street Commercial |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.03
|
| Rate for Payer: Cigna of WY Commercial |
$3.06
|
| Rate for Payer: Entrust Commercial |
$2.96
|
| Rate for Payer: First Choice Health Commercial |
$2.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.81
|
| Rate for Payer: HealthUtah PPO |
$3.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1.72
|
| Rate for Payer: One Health Plan of WY PPO |
$3.06
|
| Rate for Payer: PacificSource Commercial |
$2.81
|
| Rate for Payer: PHCS PPO |
$3.06
|
| Rate for Payer: Three Rivers PPO |
$2.34
|
| Rate for Payer: TriWest Veterans Administration |
$1.81
|
| Rate for Payer: United Healthcare Commercial |
$2.71
|
| Rate for Payer: United Healthcare Medicare |
$1.81
|
| Rate for Payer: WINHealth Partners Commercial |
$3.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2.96
|
|
|
GUAIFENESIN ER 1,200 MG TABLET, EXTENDED RELEASE 12 HR [45204]
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 6382402328
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.00
|
| Rate for Payer: Altius Commercial |
$3.00
|
| Rate for Payer: Beech Street Commercial |
$3.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.03
|
| Rate for Payer: Cigna of WY Commercial |
$3.06
|
| Rate for Payer: Entrust Commercial |
$2.96
|
| Rate for Payer: First Choice Health Commercial |
$2.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.06
|
| Rate for Payer: HealthUtah PPO |
$3.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3.06
|
| Rate for Payer: PacificSource Commercial |
$2.81
|
| Rate for Payer: PHCS PPO |
$3.06
|
| Rate for Payer: Three Rivers PPO |
$2.34
|
| Rate for Payer: TriWest Veterans Administration |
$2.06
|
| Rate for Payer: United Healthcare Commercial |
$2.71
|
| Rate for Payer: United Healthcare Medicare |
$2.06
|
| Rate for Payer: WINHealth Partners Commercial |
$2.96
|
| Rate for Payer: Wise Provider Network Commercial |
$2.96
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [136027]
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 0536116361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.87
|
| Rate for Payer: Aetna of WY Medicare |
$1.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.83
|
| Rate for Payer: Altius Commercial |
$1.83
|
| Rate for Payer: Beech Street Commercial |
$1.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.85
|
| Rate for Payer: Cigna of WY Commercial |
$1.87
|
| Rate for Payer: Entrust Commercial |
$1.81
|
| Rate for Payer: First Choice Health Commercial |
$1.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.11
|
| Rate for Payer: HealthUtah PPO |
$1.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.85
|
| Rate for Payer: Multiplan Medicare/VA |
$1.05
|
| Rate for Payer: One Health Plan of WY PPO |
$1.87
|
| Rate for Payer: PacificSource Commercial |
$1.72
|
| Rate for Payer: PHCS PPO |
$1.87
|
| Rate for Payer: Three Rivers PPO |
$1.43
|
| Rate for Payer: TriWest Veterans Administration |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
| Rate for Payer: United Healthcare Medicare |
$1.11
|
| Rate for Payer: WINHealth Partners Commercial |
$1.87
|
| Rate for Payer: Wise Provider Network Commercial |
$1.81
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [136027]
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
NDC 6808457211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.27
|
| Rate for Payer: Aetna of WY Medicare |
$2.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.21
|
| Rate for Payer: Altius Commercial |
$3.21
|
| Rate for Payer: Beech Street Commercial |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.24
|
| Rate for Payer: Cigna of WY Commercial |
$3.27
|
| Rate for Payer: Entrust Commercial |
$3.17
|
| Rate for Payer: First Choice Health Commercial |
$3.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.94
|
| Rate for Payer: HealthUtah PPO |
$3.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.24
|
| Rate for Payer: Multiplan Medicare/VA |
$1.84
|
| Rate for Payer: One Health Plan of WY PPO |
$3.27
|
| Rate for Payer: PacificSource Commercial |
$3.01
|
| Rate for Payer: PHCS PPO |
$3.27
|
| Rate for Payer: Three Rivers PPO |
$2.50
|
| Rate for Payer: TriWest Veterans Administration |
$1.94
|
| Rate for Payer: United Healthcare Commercial |
$2.91
|
| Rate for Payer: United Healthcare Medicare |
$1.94
|
| Rate for Payer: WINHealth Partners Commercial |
$3.27
|
| Rate for Payer: Wise Provider Network Commercial |
$3.17
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [136027]
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
NDC 6808457211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$3.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.21
|
| Rate for Payer: Altius Commercial |
$3.21
|
| Rate for Payer: Beech Street Commercial |
$3.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.24
|
| Rate for Payer: Cigna of WY Commercial |
$3.27
|
| Rate for Payer: Entrust Commercial |
$3.17
|
| Rate for Payer: First Choice Health Commercial |
$3.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.20
|
| Rate for Payer: HealthUtah PPO |
$3.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.24
|
| Rate for Payer: Multiplan Medicare/VA |
$2.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3.27
|
| Rate for Payer: PacificSource Commercial |
$3.01
|
| Rate for Payer: PHCS PPO |
$3.27
|
| Rate for Payer: Three Rivers PPO |
$2.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.91
|
| Rate for Payer: United Healthcare Medicare |
$2.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3.17
|
| Rate for Payer: Wise Provider Network Commercial |
$3.17
|
|
|
GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR [136027]
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 0536116361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.83
|
| Rate for Payer: Altius Commercial |
$1.83
|
| Rate for Payer: Beech Street Commercial |
$1.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.85
|
| Rate for Payer: Cigna of WY Commercial |
$1.87
|
| Rate for Payer: Entrust Commercial |
$1.81
|
| Rate for Payer: First Choice Health Commercial |
$1.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.26
|
| Rate for Payer: HealthUtah PPO |
$1.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.85
|
| Rate for Payer: Multiplan Medicare/VA |
$1.20
|
| Rate for Payer: One Health Plan of WY PPO |
$1.87
|
| Rate for Payer: PacificSource Commercial |
$1.72
|
| Rate for Payer: PHCS PPO |
$1.87
|
| Rate for Payer: Three Rivers PPO |
$1.43
|
| Rate for Payer: TriWest Veterans Administration |
$1.26
|
| Rate for Payer: United Healthcare Commercial |
$1.66
|
| Rate for Payer: United Healthcare Medicare |
$1.26
|
| Rate for Payer: WINHealth Partners Commercial |
$1.81
|
| Rate for Payer: Wise Provider Network Commercial |
$1.81
|
|
|
GUIDEWIRE .014x190 HI TORQ BAL MID WT
|
Facility
|
OP
|
$312.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.12 |
| Max. Negotiated Rate |
$312.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.13
|
| Rate for Payer: Aetna of WY Medicare |
$206.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$299.88
|
| Rate for Payer: Altius Commercial |
$299.88
|
| Rate for Payer: Beech Street Commercial |
$306.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$256.46
|
| Rate for Payer: Cash Price |
$218.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.01
|
| Rate for Payer: Cigna of WY Commercial |
$306.13
|
| Rate for Payer: Entrust Commercial |
$296.76
|
| Rate for Payer: First Choice Health Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.18
|
| Rate for Payer: HealthUtah PPO |
$312.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.01
|
| Rate for Payer: Multiplan Medicare/VA |
$172.12
|
| Rate for Payer: One Health Plan of WY PPO |
$306.13
|
| Rate for Payer: PacificSource Commercial |
$281.14
|
| Rate for Payer: PHCS PPO |
$306.13
|
| Rate for Payer: Three Rivers PPO |
$234.28
|
| Rate for Payer: TriWest Veterans Administration |
$181.18
|
| Rate for Payer: United Healthcare Commercial |
$271.77
|
| Rate for Payer: United Healthcare Medicare |
$181.18
|
| Rate for Payer: WINHealth Partners Commercial |
$306.13
|
| Rate for Payer: Wise Provider Network Commercial |
$296.76
|
|
|
GUIDEWIRE .014x190 HI TORQ BAL MID WT
|
Facility
|
IP
|
$312.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.86 |
| Max. Negotiated Rate |
$312.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$299.88
|
| Rate for Payer: Altius Commercial |
$299.88
|
| Rate for Payer: Beech Street Commercial |
$306.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$256.46
|
| Rate for Payer: Cash Price |
$218.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.01
|
| Rate for Payer: Cigna of WY Commercial |
$306.13
|
| Rate for Payer: Entrust Commercial |
$296.76
|
| Rate for Payer: First Choice Health Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.17
|
| Rate for Payer: HealthUtah PPO |
$312.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.01
|
| Rate for Payer: Multiplan Medicare/VA |
$195.86
|
| Rate for Payer: One Health Plan of WY PPO |
$306.13
|
| Rate for Payer: PacificSource Commercial |
$281.14
|
| Rate for Payer: PHCS PPO |
$306.13
|
| Rate for Payer: Three Rivers PPO |
$234.28
|
| Rate for Payer: TriWest Veterans Administration |
$206.17
|
| Rate for Payer: United Healthcare Commercial |
$271.77
|
| Rate for Payer: United Healthcare Medicare |
$206.17
|
| Rate for Payer: WINHealth Partners Commercial |
$296.76
|
| Rate for Payer: Wise Provider Network Commercial |
$296.76
|
|
|
GUIDE WIRE .014X190 PILOT 50 HI TORQUE
|
Facility
|
OP
|
$312.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.12 |
| Max. Negotiated Rate |
$312.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.13
|
| Rate for Payer: Aetna of WY Medicare |
$206.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$299.88
|
| Rate for Payer: Altius Commercial |
$299.88
|
| Rate for Payer: Beech Street Commercial |
$306.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$256.46
|
| Rate for Payer: Cash Price |
$218.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.01
|
| Rate for Payer: Cigna of WY Commercial |
$306.13
|
| Rate for Payer: Entrust Commercial |
$296.76
|
| Rate for Payer: First Choice Health Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$181.18
|
| Rate for Payer: HealthUtah PPO |
$312.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.01
|
| Rate for Payer: Multiplan Medicare/VA |
$172.12
|
| Rate for Payer: One Health Plan of WY PPO |
$306.13
|
| Rate for Payer: PacificSource Commercial |
$281.14
|
| Rate for Payer: PHCS PPO |
$306.13
|
| Rate for Payer: Three Rivers PPO |
$234.28
|
| Rate for Payer: TriWest Veterans Administration |
$181.18
|
| Rate for Payer: United Healthcare Commercial |
$271.77
|
| Rate for Payer: United Healthcare Medicare |
$181.18
|
| Rate for Payer: WINHealth Partners Commercial |
$306.13
|
| Rate for Payer: Wise Provider Network Commercial |
$296.76
|
|
|
GUIDE WIRE .014X190 PILOT 50 HI TORQUE
|
Facility
|
IP
|
$312.38
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.86 |
| Max. Negotiated Rate |
$312.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$306.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$299.88
|
| Rate for Payer: Altius Commercial |
$299.88
|
| Rate for Payer: Beech Street Commercial |
$306.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$256.46
|
| Rate for Payer: Cash Price |
$218.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$303.01
|
| Rate for Payer: Cigna of WY Commercial |
$306.13
|
| Rate for Payer: Entrust Commercial |
$296.76
|
| Rate for Payer: First Choice Health Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$296.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.17
|
| Rate for Payer: HealthUtah PPO |
$312.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$303.01
|
| Rate for Payer: Multiplan Medicare/VA |
$195.86
|
| Rate for Payer: One Health Plan of WY PPO |
$306.13
|
| Rate for Payer: PacificSource Commercial |
$281.14
|
| Rate for Payer: PHCS PPO |
$306.13
|
| Rate for Payer: Three Rivers PPO |
$234.28
|
| Rate for Payer: TriWest Veterans Administration |
$206.17
|
| Rate for Payer: United Healthcare Commercial |
$271.77
|
| Rate for Payer: United Healthcare Medicare |
$206.17
|
| Rate for Payer: WINHealth Partners Commercial |
$296.76
|
| Rate for Payer: Wise Provider Network Commercial |
$296.76
|
|
|
GUIDEWIRE .025X150 3CM J SWAN
|
Facility
|
IP
|
$29.29
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$29.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.12
|
| Rate for Payer: Altius Commercial |
$28.12
|
| Rate for Payer: Beech Street Commercial |
$28.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.05
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.41
|
| Rate for Payer: Cigna of WY Commercial |
$28.70
|
| Rate for Payer: Entrust Commercial |
$27.83
|
| Rate for Payer: First Choice Health Commercial |
$27.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.33
|
| Rate for Payer: HealthUtah PPO |
$29.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.41
|
| Rate for Payer: Multiplan Medicare/VA |
$18.36
|
| Rate for Payer: One Health Plan of WY PPO |
$28.70
|
| Rate for Payer: PacificSource Commercial |
$26.36
|
| Rate for Payer: PHCS PPO |
$28.70
|
| Rate for Payer: Three Rivers PPO |
$21.97
|
| Rate for Payer: TriWest Veterans Administration |
$19.33
|
| Rate for Payer: United Healthcare Commercial |
$25.48
|
| Rate for Payer: United Healthcare Medicare |
$19.33
|
| Rate for Payer: WINHealth Partners Commercial |
$27.83
|
| Rate for Payer: Wise Provider Network Commercial |
$27.83
|
|
|
GUIDEWIRE .025X150 3CM J SWAN
|
Facility
|
OP
|
$29.29
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$29.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$28.70
|
| Rate for Payer: Aetna of WY Medicare |
$19.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.12
|
| Rate for Payer: Altius Commercial |
$28.12
|
| Rate for Payer: Beech Street Commercial |
$28.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.05
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$28.41
|
| Rate for Payer: Cigna of WY Commercial |
$28.70
|
| Rate for Payer: Entrust Commercial |
$27.83
|
| Rate for Payer: First Choice Health Commercial |
$27.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.99
|
| Rate for Payer: HealthUtah PPO |
$29.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$28.41
|
| Rate for Payer: Multiplan Medicare/VA |
$16.14
|
| Rate for Payer: One Health Plan of WY PPO |
$28.70
|
| Rate for Payer: PacificSource Commercial |
$26.36
|
| Rate for Payer: PHCS PPO |
$28.70
|
| Rate for Payer: Three Rivers PPO |
$21.97
|
| Rate for Payer: TriWest Veterans Administration |
$16.99
|
| Rate for Payer: United Healthcare Commercial |
$25.48
|
| Rate for Payer: United Healthcare Medicare |
$16.99
|
| Rate for Payer: WINHealth Partners Commercial |
$28.70
|
| Rate for Payer: Wise Provider Network Commercial |
$27.83
|
|
|
GUIDEWIRE .025X150CM VNUS
|
Facility
|
OP
|
$46.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$46.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.80
|
| Rate for Payer: Aetna of WY Medicare |
$30.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.86
|
| Rate for Payer: Altius Commercial |
$44.86
|
| Rate for Payer: Beech Street Commercial |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.33
|
| Rate for Payer: Cigna of WY Commercial |
$45.80
|
| Rate for Payer: Entrust Commercial |
$44.39
|
| Rate for Payer: First Choice Health Commercial |
$44.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.10
|
| Rate for Payer: HealthUtah PPO |
$46.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.33
|
| Rate for Payer: Multiplan Medicare/VA |
$25.75
|
| Rate for Payer: One Health Plan of WY PPO |
$45.80
|
| Rate for Payer: PacificSource Commercial |
$42.06
|
| Rate for Payer: PHCS PPO |
$45.80
|
| Rate for Payer: Three Rivers PPO |
$35.05
|
| Rate for Payer: TriWest Veterans Administration |
$27.10
|
| Rate for Payer: United Healthcare Commercial |
$40.66
|
| Rate for Payer: United Healthcare Medicare |
$27.10
|
| Rate for Payer: WINHealth Partners Commercial |
$45.80
|
| Rate for Payer: Wise Provider Network Commercial |
$44.39
|
|
|
GUIDEWIRE .025X150CM VNUS
|
Facility
|
IP
|
$46.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.30 |
| Max. Negotiated Rate |
$46.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$45.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.86
|
| Rate for Payer: Altius Commercial |
$44.86
|
| Rate for Payer: Beech Street Commercial |
$45.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$32.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.33
|
| Rate for Payer: Cigna of WY Commercial |
$45.80
|
| Rate for Payer: Entrust Commercial |
$44.39
|
| Rate for Payer: First Choice Health Commercial |
$44.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.84
|
| Rate for Payer: HealthUtah PPO |
$46.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.33
|
| Rate for Payer: Multiplan Medicare/VA |
$29.30
|
| Rate for Payer: One Health Plan of WY PPO |
$45.80
|
| Rate for Payer: PacificSource Commercial |
$42.06
|
| Rate for Payer: PHCS PPO |
$45.80
|
| Rate for Payer: Three Rivers PPO |
$35.05
|
| Rate for Payer: TriWest Veterans Administration |
$30.84
|
| Rate for Payer: United Healthcare Commercial |
$40.66
|
| Rate for Payer: United Healthcare Medicare |
$30.84
|
| Rate for Payer: WINHealth Partners Commercial |
$44.39
|
| Rate for Payer: Wise Provider Network Commercial |
$44.39
|
|
|
GUIDEWIRE .032X145 3MM J
|
Facility
|
IP
|
$27.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.82
|
| Rate for Payer: Altius Commercial |
$26.82
|
| Rate for Payer: Beech Street Commercial |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.94
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.10
|
| Rate for Payer: Cigna of WY Commercial |
$27.38
|
| Rate for Payer: Entrust Commercial |
$26.54
|
| Rate for Payer: First Choice Health Commercial |
$26.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.44
|
| Rate for Payer: HealthUtah PPO |
$27.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.10
|
| Rate for Payer: Multiplan Medicare/VA |
$17.52
|
| Rate for Payer: One Health Plan of WY PPO |
$27.38
|
| Rate for Payer: PacificSource Commercial |
$25.15
|
| Rate for Payer: PHCS PPO |
$27.38
|
| Rate for Payer: Three Rivers PPO |
$20.96
|
| Rate for Payer: TriWest Veterans Administration |
$18.44
|
| Rate for Payer: United Healthcare Commercial |
$24.31
|
| Rate for Payer: United Healthcare Medicare |
$18.44
|
| Rate for Payer: WINHealth Partners Commercial |
$26.54
|
| Rate for Payer: Wise Provider Network Commercial |
$26.54
|
|
|
GUIDEWIRE .032X145 3MM J
|
Facility
|
OP
|
$27.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$27.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.38
|
| Rate for Payer: Aetna of WY Medicare |
$18.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.82
|
| Rate for Payer: Altius Commercial |
$26.82
|
| Rate for Payer: Beech Street Commercial |
$27.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.94
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.10
|
| Rate for Payer: Cigna of WY Commercial |
$27.38
|
| Rate for Payer: Entrust Commercial |
$26.54
|
| Rate for Payer: First Choice Health Commercial |
$26.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.21
|
| Rate for Payer: HealthUtah PPO |
$27.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.10
|
| Rate for Payer: Multiplan Medicare/VA |
$15.39
|
| Rate for Payer: One Health Plan of WY PPO |
$27.38
|
| Rate for Payer: PacificSource Commercial |
$25.15
|
| Rate for Payer: PHCS PPO |
$27.38
|
| Rate for Payer: Three Rivers PPO |
$20.96
|
| Rate for Payer: TriWest Veterans Administration |
$16.21
|
| Rate for Payer: United Healthcare Commercial |
$24.31
|
| Rate for Payer: United Healthcare Medicare |
$16.21
|
| Rate for Payer: WINHealth Partners Commercial |
$27.38
|
| Rate for Payer: Wise Provider Network Commercial |
$26.54
|
|
|
GUIDEWIRE .035X150 3MM J
|
Facility
|
OP
|
$18.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.83
|
| Rate for Payer: Altius Commercial |
$17.83
|
| Rate for Payer: Beech Street Commercial |
$18.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.25
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.01
|
| Rate for Payer: Cigna of WY Commercial |
$18.20
|
| Rate for Payer: Entrust Commercial |
$17.64
|
| Rate for Payer: First Choice Health Commercial |
$17.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.77
|
| Rate for Payer: HealthUtah PPO |
$18.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.01
|
| Rate for Payer: Multiplan Medicare/VA |
$10.23
|
| Rate for Payer: One Health Plan of WY PPO |
$18.20
|
| Rate for Payer: PacificSource Commercial |
$16.71
|
| Rate for Payer: PHCS PPO |
$18.20
|
| Rate for Payer: Three Rivers PPO |
$13.93
|
| Rate for Payer: TriWest Veterans Administration |
$10.77
|
| Rate for Payer: United Healthcare Commercial |
$16.16
|
| Rate for Payer: United Healthcare Medicare |
$10.77
|
| Rate for Payer: WINHealth Partners Commercial |
$18.20
|
| Rate for Payer: Wise Provider Network Commercial |
$17.64
|
|
