|
GUIDEWIRE .035X150 3MM J
|
Facility
|
IP
|
$18.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.20
|
| 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 |
$12.26
|
| Rate for Payer: HealthUtah PPO |
$18.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.01
|
| Rate for Payer: Multiplan Medicare/VA |
$11.64
|
| 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 |
$12.26
|
| Rate for Payer: United Healthcare Commercial |
$16.16
|
| Rate for Payer: United Healthcare Medicare |
$12.26
|
| Rate for Payer: WINHealth Partners Commercial |
$17.64
|
| Rate for Payer: Wise Provider Network Commercial |
$17.64
|
|
|
GUIDEWIRE .035X260 3MM J
|
Facility
|
OP
|
$33.61
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$33.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.94
|
| Rate for Payer: Aetna of WY Medicare |
$22.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.27
|
| Rate for Payer: Altius Commercial |
$32.27
|
| Rate for Payer: Beech Street Commercial |
$32.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$23.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.60
|
| Rate for Payer: Cigna of WY Commercial |
$32.94
|
| Rate for Payer: Entrust Commercial |
$31.93
|
| Rate for Payer: First Choice Health Commercial |
$31.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.49
|
| Rate for Payer: HealthUtah PPO |
$33.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.60
|
| Rate for Payer: Multiplan Medicare/VA |
$18.52
|
| Rate for Payer: One Health Plan of WY PPO |
$32.94
|
| Rate for Payer: PacificSource Commercial |
$30.25
|
| Rate for Payer: PHCS PPO |
$32.94
|
| Rate for Payer: Three Rivers PPO |
$25.21
|
| Rate for Payer: TriWest Veterans Administration |
$19.49
|
| Rate for Payer: United Healthcare Commercial |
$29.24
|
| Rate for Payer: United Healthcare Medicare |
$19.49
|
| Rate for Payer: WINHealth Partners Commercial |
$32.94
|
| Rate for Payer: Wise Provider Network Commercial |
$31.93
|
|
|
GUIDEWIRE .035X260 3MM J
|
Facility
|
IP
|
$33.61
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$33.61 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.27
|
| Rate for Payer: Altius Commercial |
$32.27
|
| Rate for Payer: Beech Street Commercial |
$32.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$23.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.60
|
| Rate for Payer: Cigna of WY Commercial |
$32.94
|
| Rate for Payer: Entrust Commercial |
$31.93
|
| Rate for Payer: First Choice Health Commercial |
$31.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.18
|
| Rate for Payer: HealthUtah PPO |
$33.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.60
|
| Rate for Payer: Multiplan Medicare/VA |
$21.07
|
| Rate for Payer: One Health Plan of WY PPO |
$32.94
|
| Rate for Payer: PacificSource Commercial |
$30.25
|
| Rate for Payer: PHCS PPO |
$32.94
|
| Rate for Payer: Three Rivers PPO |
$25.21
|
| Rate for Payer: TriWest Veterans Administration |
$22.18
|
| Rate for Payer: United Healthcare Commercial |
$29.24
|
| Rate for Payer: United Healthcare Medicare |
$22.18
|
| Rate for Payer: WINHealth Partners Commercial |
$31.93
|
| Rate for Payer: Wise Provider Network Commercial |
$31.93
|
|
|
GUIDEWIRE .035X260 SS STR TIP STD TPR
|
Facility
|
OP
|
$38.59
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$38.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.82
|
| Rate for Payer: Aetna of WY Medicare |
$25.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.05
|
| Rate for Payer: Altius Commercial |
$37.05
|
| Rate for Payer: Beech Street Commercial |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.68
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.43
|
| Rate for Payer: Cigna of WY Commercial |
$37.82
|
| Rate for Payer: Entrust Commercial |
$36.66
|
| Rate for Payer: First Choice Health Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.38
|
| Rate for Payer: HealthUtah PPO |
$38.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.43
|
| Rate for Payer: Multiplan Medicare/VA |
$21.26
|
| Rate for Payer: One Health Plan of WY PPO |
$37.82
|
| Rate for Payer: PacificSource Commercial |
$34.73
|
| Rate for Payer: PHCS PPO |
$37.82
|
| Rate for Payer: Three Rivers PPO |
$28.94
|
| Rate for Payer: TriWest Veterans Administration |
$22.38
|
| Rate for Payer: United Healthcare Commercial |
$33.57
|
| Rate for Payer: United Healthcare Medicare |
$22.38
|
| Rate for Payer: WINHealth Partners Commercial |
$37.82
|
| Rate for Payer: Wise Provider Network Commercial |
$36.66
|
|
|
GUIDEWIRE .035X260 SS STR TIP STD TPR
|
Facility
|
IP
|
$38.59
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$38.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.05
|
| Rate for Payer: Altius Commercial |
$37.05
|
| Rate for Payer: Beech Street Commercial |
$37.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.68
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.43
|
| Rate for Payer: Cigna of WY Commercial |
$37.82
|
| Rate for Payer: Entrust Commercial |
$36.66
|
| Rate for Payer: First Choice Health Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.47
|
| Rate for Payer: HealthUtah PPO |
$38.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.43
|
| Rate for Payer: Multiplan Medicare/VA |
$24.20
|
| Rate for Payer: One Health Plan of WY PPO |
$37.82
|
| Rate for Payer: PacificSource Commercial |
$34.73
|
| Rate for Payer: PHCS PPO |
$37.82
|
| Rate for Payer: Three Rivers PPO |
$28.94
|
| Rate for Payer: TriWest Veterans Administration |
$25.47
|
| Rate for Payer: United Healthcare Commercial |
$33.57
|
| Rate for Payer: United Healthcare Medicare |
$25.47
|
| Rate for Payer: WINHealth Partners Commercial |
$36.66
|
| Rate for Payer: Wise Provider Network Commercial |
$36.66
|
|
|
GUIDEWIRE ACCESSORY KIT W/CO PILOT
|
Facility
|
OP
|
$122.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.05
|
| Rate for Payer: Aetna of WY Medicare |
$80.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.60
|
| Rate for Payer: Altius Commercial |
$117.60
|
| Rate for Payer: Beech Street Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.57
|
| Rate for Payer: Cash Price |
$85.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.82
|
| Rate for Payer: Cigna of WY Commercial |
$120.05
|
| Rate for Payer: Entrust Commercial |
$116.38
|
| Rate for Payer: First Choice Health Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.05
|
| Rate for Payer: HealthUtah PPO |
$122.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.82
|
| Rate for Payer: Multiplan Medicare/VA |
$67.50
|
| Rate for Payer: One Health Plan of WY PPO |
$120.05
|
| Rate for Payer: PacificSource Commercial |
$110.25
|
| Rate for Payer: PHCS PPO |
$120.05
|
| Rate for Payer: Three Rivers PPO |
$91.88
|
| Rate for Payer: TriWest Veterans Administration |
$71.05
|
| Rate for Payer: United Healthcare Commercial |
$106.58
|
| Rate for Payer: United Healthcare Medicare |
$71.05
|
| Rate for Payer: WINHealth Partners Commercial |
$120.05
|
| Rate for Payer: Wise Provider Network Commercial |
$116.38
|
|
|
GUIDEWIRE ACCESSORY KIT W/CO PILOT
|
Facility
|
IP
|
$122.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.81 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$117.60
|
| Rate for Payer: Altius Commercial |
$117.60
|
| Rate for Payer: Beech Street Commercial |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$100.57
|
| Rate for Payer: Cash Price |
$85.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$118.82
|
| Rate for Payer: Cigna of WY Commercial |
$120.05
|
| Rate for Payer: Entrust Commercial |
$116.38
|
| Rate for Payer: First Choice Health Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.85
|
| Rate for Payer: HealthUtah PPO |
$122.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$118.82
|
| Rate for Payer: Multiplan Medicare/VA |
$76.81
|
| Rate for Payer: One Health Plan of WY PPO |
$120.05
|
| Rate for Payer: PacificSource Commercial |
$110.25
|
| Rate for Payer: PHCS PPO |
$120.05
|
| Rate for Payer: Three Rivers PPO |
$91.88
|
| Rate for Payer: TriWest Veterans Administration |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$106.58
|
| Rate for Payer: United Healthcare Medicare |
$80.85
|
| Rate for Payer: WINHealth Partners Commercial |
$116.38
|
| Rate for Payer: Wise Provider Network Commercial |
$116.38
|
|
|
GUIDEWIRE AMPLATZ .038"X145CM
|
Facility
|
OP
|
$124.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$124.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.58
|
| Rate for Payer: Aetna of WY Medicare |
$81.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.10
|
| Rate for Payer: Altius Commercial |
$119.10
|
| Rate for Payer: Beech Street Commercial |
$121.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$86.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.34
|
| Rate for Payer: Cigna of WY Commercial |
$121.58
|
| Rate for Payer: Entrust Commercial |
$117.86
|
| Rate for Payer: First Choice Health Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.95
|
| Rate for Payer: HealthUtah PPO |
$124.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.34
|
| Rate for Payer: Multiplan Medicare/VA |
$68.36
|
| Rate for Payer: One Health Plan of WY PPO |
$121.58
|
| Rate for Payer: PacificSource Commercial |
$111.65
|
| Rate for Payer: PHCS PPO |
$121.58
|
| Rate for Payer: Three Rivers PPO |
$93.04
|
| Rate for Payer: TriWest Veterans Administration |
$71.95
|
| Rate for Payer: United Healthcare Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare |
$71.95
|
| Rate for Payer: WINHealth Partners Commercial |
$121.58
|
| Rate for Payer: Wise Provider Network Commercial |
$117.86
|
|
|
GUIDEWIRE AMPLATZ .038"X145CM
|
Facility
|
IP
|
$124.06
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.79 |
| Max. Negotiated Rate |
$124.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$121.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$119.10
|
| Rate for Payer: Altius Commercial |
$119.10
|
| Rate for Payer: Beech Street Commercial |
$121.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.85
|
| Rate for Payer: Cash Price |
$86.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$120.34
|
| Rate for Payer: Cigna of WY Commercial |
$121.58
|
| Rate for Payer: Entrust Commercial |
$117.86
|
| Rate for Payer: First Choice Health Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$117.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.88
|
| Rate for Payer: HealthUtah PPO |
$124.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$120.34
|
| Rate for Payer: Multiplan Medicare/VA |
$77.79
|
| Rate for Payer: One Health Plan of WY PPO |
$121.58
|
| Rate for Payer: PacificSource Commercial |
$111.65
|
| Rate for Payer: PHCS PPO |
$121.58
|
| Rate for Payer: Three Rivers PPO |
$93.04
|
| Rate for Payer: TriWest Veterans Administration |
$81.88
|
| Rate for Payer: United Healthcare Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare |
$81.88
|
| Rate for Payer: WINHealth Partners Commercial |
$117.86
|
| Rate for Payer: Wise Provider Network Commercial |
$117.86
|
|
|
GUIDEWIRE BOWL WITH LID
|
Facility
|
IP
|
$26.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.13
|
| Rate for Payer: Altius Commercial |
$25.13
|
| Rate for Payer: Beech Street Commercial |
$25.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.49
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.39
|
| Rate for Payer: Cigna of WY Commercial |
$25.66
|
| Rate for Payer: Entrust Commercial |
$24.87
|
| Rate for Payer: First Choice Health Commercial |
$24.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.28
|
| Rate for Payer: HealthUtah PPO |
$26.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.39
|
| Rate for Payer: Multiplan Medicare/VA |
$16.41
|
| Rate for Payer: One Health Plan of WY PPO |
$25.66
|
| Rate for Payer: PacificSource Commercial |
$23.56
|
| Rate for Payer: PHCS PPO |
$25.66
|
| Rate for Payer: Three Rivers PPO |
$19.64
|
| Rate for Payer: TriWest Veterans Administration |
$17.28
|
| Rate for Payer: United Healthcare Commercial |
$22.78
|
| Rate for Payer: United Healthcare Medicare |
$17.28
|
| Rate for Payer: WINHealth Partners Commercial |
$24.87
|
| Rate for Payer: Wise Provider Network Commercial |
$24.87
|
|
|
GUIDEWIRE BOWL WITH LID
|
Facility
|
OP
|
$26.18
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.66
|
| Rate for Payer: Aetna of WY Medicare |
$17.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$25.13
|
| Rate for Payer: Altius Commercial |
$25.13
|
| Rate for Payer: Beech Street Commercial |
$25.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.49
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.39
|
| Rate for Payer: Cigna of WY Commercial |
$25.66
|
| Rate for Payer: Entrust Commercial |
$24.87
|
| Rate for Payer: First Choice Health Commercial |
$24.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.18
|
| Rate for Payer: HealthUtah PPO |
$26.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.39
|
| Rate for Payer: Multiplan Medicare/VA |
$14.43
|
| Rate for Payer: One Health Plan of WY PPO |
$25.66
|
| Rate for Payer: PacificSource Commercial |
$23.56
|
| Rate for Payer: PHCS PPO |
$25.66
|
| Rate for Payer: Three Rivers PPO |
$19.64
|
| Rate for Payer: TriWest Veterans Administration |
$15.18
|
| Rate for Payer: United Healthcare Commercial |
$22.78
|
| Rate for Payer: United Healthcare Medicare |
$15.18
|
| Rate for Payer: WINHealth Partners Commercial |
$25.66
|
| Rate for Payer: Wise Provider Network Commercial |
$24.87
|
|
|
GUIDEWIRE PTFE COATED .038X150
|
Facility
|
IP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.17
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$15.36
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$16.17
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$16.17
|
| Rate for Payer: WINHealth Partners Commercial |
$23.28
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
GUIDEWIRE PTFE COATED .038X150
|
Facility
|
OP
|
$24.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.01
|
| Rate for Payer: Aetna of WY Medicare |
$16.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.52
|
| Rate for Payer: Altius Commercial |
$23.52
|
| Rate for Payer: Beech Street Commercial |
$24.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.11
|
| Rate for Payer: Cash Price |
$17.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.76
|
| Rate for Payer: Cigna of WY Commercial |
$24.01
|
| Rate for Payer: Entrust Commercial |
$23.28
|
| Rate for Payer: First Choice Health Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.21
|
| Rate for Payer: HealthUtah PPO |
$24.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.76
|
| Rate for Payer: Multiplan Medicare/VA |
$13.50
|
| Rate for Payer: One Health Plan of WY PPO |
$24.01
|
| Rate for Payer: PacificSource Commercial |
$22.05
|
| Rate for Payer: PHCS PPO |
$24.01
|
| Rate for Payer: Three Rivers PPO |
$18.38
|
| Rate for Payer: TriWest Veterans Administration |
$14.21
|
| Rate for Payer: United Healthcare Commercial |
$21.32
|
| Rate for Payer: United Healthcare Medicare |
$14.21
|
| Rate for Payer: WINHealth Partners Commercial |
$24.01
|
| Rate for Payer: Wise Provider Network Commercial |
$23.28
|
|
|
GUIDEWIRE SENSOR NITINOL ST .038"X150CM
|
Facility
|
IP
|
$195.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.52 |
| Max. Negotiated Rate |
$195.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.58
|
| Rate for Payer: Altius Commercial |
$187.58
|
| Rate for Payer: Beech Street Commercial |
$191.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.42
|
| Rate for Payer: Cash Price |
$136.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.54
|
| Rate for Payer: Cigna of WY Commercial |
$191.49
|
| Rate for Payer: Entrust Commercial |
$185.63
|
| Rate for Payer: First Choice Health Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$128.96
|
| Rate for Payer: HealthUtah PPO |
$195.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.54
|
| Rate for Payer: Multiplan Medicare/VA |
$122.52
|
| Rate for Payer: One Health Plan of WY PPO |
$191.49
|
| Rate for Payer: PacificSource Commercial |
$175.86
|
| Rate for Payer: PHCS PPO |
$191.49
|
| Rate for Payer: Three Rivers PPO |
$146.55
|
| Rate for Payer: TriWest Veterans Administration |
$128.96
|
| Rate for Payer: United Healthcare Commercial |
$170.00
|
| Rate for Payer: United Healthcare Medicare |
$128.96
|
| Rate for Payer: WINHealth Partners Commercial |
$185.63
|
| Rate for Payer: Wise Provider Network Commercial |
$185.63
|
|
|
GUIDEWIRE SENSOR NITINOL ST .038"X150CM
|
Facility
|
OP
|
$195.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.67 |
| Max. Negotiated Rate |
$195.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$191.49
|
| Rate for Payer: Aetna of WY Medicare |
$128.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$187.58
|
| Rate for Payer: Altius Commercial |
$187.58
|
| Rate for Payer: Beech Street Commercial |
$191.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$160.42
|
| Rate for Payer: Cash Price |
$136.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$189.54
|
| Rate for Payer: Cigna of WY Commercial |
$191.49
|
| Rate for Payer: Entrust Commercial |
$185.63
|
| Rate for Payer: First Choice Health Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$185.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.33
|
| Rate for Payer: HealthUtah PPO |
$195.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$189.54
|
| Rate for Payer: Multiplan Medicare/VA |
$107.67
|
| Rate for Payer: One Health Plan of WY PPO |
$191.49
|
| Rate for Payer: PacificSource Commercial |
$175.86
|
| Rate for Payer: PHCS PPO |
$191.49
|
| Rate for Payer: Three Rivers PPO |
$146.55
|
| Rate for Payer: TriWest Veterans Administration |
$113.33
|
| Rate for Payer: United Healthcare Commercial |
$170.00
|
| Rate for Payer: United Healthcare Medicare |
$113.33
|
| Rate for Payer: WINHealth Partners Commercial |
$191.49
|
| Rate for Payer: Wise Provider Network Commercial |
$185.63
|
|
|
GUIDEWIRE ZIPWIRE ANG.038X150
|
Facility
|
OP
|
$178.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$178.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.76
|
| Rate for Payer: Aetna of WY Medicare |
$117.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.20
|
| Rate for Payer: Altius Commercial |
$171.20
|
| Rate for Payer: Beech Street Commercial |
$174.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.41
|
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.98
|
| Rate for Payer: Cigna of WY Commercial |
$174.76
|
| Rate for Payer: Entrust Commercial |
$169.41
|
| Rate for Payer: First Choice Health Commercial |
$169.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.43
|
| Rate for Payer: HealthUtah PPO |
$178.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.98
|
| Rate for Payer: Multiplan Medicare/VA |
$98.26
|
| Rate for Payer: One Health Plan of WY PPO |
$174.76
|
| Rate for Payer: PacificSource Commercial |
$160.50
|
| Rate for Payer: PHCS PPO |
$174.76
|
| Rate for Payer: Three Rivers PPO |
$133.75
|
| Rate for Payer: TriWest Veterans Administration |
$103.43
|
| Rate for Payer: United Healthcare Commercial |
$155.15
|
| Rate for Payer: United Healthcare Medicare |
$103.43
|
| Rate for Payer: WINHealth Partners Commercial |
$174.76
|
| Rate for Payer: Wise Provider Network Commercial |
$169.41
|
|
|
GUIDEWIRE ZIPWIRE ANG.038X150
|
Facility
|
IP
|
$178.33
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$178.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$174.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$171.20
|
| Rate for Payer: Altius Commercial |
$171.20
|
| Rate for Payer: Beech Street Commercial |
$174.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$146.41
|
| Rate for Payer: Cash Price |
$124.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$172.98
|
| Rate for Payer: Cigna of WY Commercial |
$174.76
|
| Rate for Payer: Entrust Commercial |
$169.41
|
| Rate for Payer: First Choice Health Commercial |
$169.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$169.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.70
|
| Rate for Payer: HealthUtah PPO |
$178.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$172.98
|
| Rate for Payer: Multiplan Medicare/VA |
$111.81
|
| Rate for Payer: One Health Plan of WY PPO |
$174.76
|
| Rate for Payer: PacificSource Commercial |
$160.50
|
| Rate for Payer: PHCS PPO |
$174.76
|
| Rate for Payer: Three Rivers PPO |
$133.75
|
| Rate for Payer: TriWest Veterans Administration |
$117.70
|
| Rate for Payer: United Healthcare Commercial |
$155.15
|
| Rate for Payer: United Healthcare Medicare |
$117.70
|
| Rate for Payer: WINHealth Partners Commercial |
$169.41
|
| Rate for Payer: Wise Provider Network Commercial |
$169.41
|
|
|
GUIDEWIRE ZIPWIRE STR .038X150
|
Facility
|
IP
|
$255.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.44 |
| Max. Negotiated Rate |
$255.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.64
|
| Rate for Payer: Altius Commercial |
$245.64
|
| Rate for Payer: Beech Street Commercial |
$250.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.08
|
| Rate for Payer: Cash Price |
$179.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.20
|
| Rate for Payer: Cigna of WY Commercial |
$250.76
|
| Rate for Payer: Entrust Commercial |
$243.09
|
| Rate for Payer: First Choice Health Commercial |
$243.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$168.88
|
| Rate for Payer: HealthUtah PPO |
$255.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.20
|
| Rate for Payer: Multiplan Medicare/VA |
$160.44
|
| Rate for Payer: One Health Plan of WY PPO |
$250.76
|
| Rate for Payer: PacificSource Commercial |
$230.29
|
| Rate for Payer: PHCS PPO |
$250.76
|
| Rate for Payer: Three Rivers PPO |
$191.91
|
| Rate for Payer: TriWest Veterans Administration |
$168.88
|
| Rate for Payer: United Healthcare Commercial |
$222.62
|
| Rate for Payer: United Healthcare Medicare |
$168.88
|
| Rate for Payer: WINHealth Partners Commercial |
$243.09
|
| Rate for Payer: Wise Provider Network Commercial |
$243.09
|
|
|
GUIDEWIRE ZIPWIRE STR .038X150
|
Facility
|
OP
|
$255.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.99 |
| Max. Negotiated Rate |
$255.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$250.76
|
| Rate for Payer: Aetna of WY Medicare |
$168.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$245.64
|
| Rate for Payer: Altius Commercial |
$245.64
|
| Rate for Payer: Beech Street Commercial |
$250.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$210.08
|
| Rate for Payer: Cash Price |
$179.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$248.20
|
| Rate for Payer: Cigna of WY Commercial |
$250.76
|
| Rate for Payer: Entrust Commercial |
$243.09
|
| Rate for Payer: First Choice Health Commercial |
$243.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$243.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.41
|
| Rate for Payer: HealthUtah PPO |
$255.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$248.20
|
| Rate for Payer: Multiplan Medicare/VA |
$140.99
|
| Rate for Payer: One Health Plan of WY PPO |
$250.76
|
| Rate for Payer: PacificSource Commercial |
$230.29
|
| Rate for Payer: PHCS PPO |
$250.76
|
| Rate for Payer: Three Rivers PPO |
$191.91
|
| Rate for Payer: TriWest Veterans Administration |
$148.41
|
| Rate for Payer: United Healthcare Commercial |
$222.62
|
| Rate for Payer: United Healthcare Medicare |
$148.41
|
| Rate for Payer: WINHealth Partners Commercial |
$250.76
|
| Rate for Payer: Wise Provider Network Commercial |
$243.09
|
|
|
HAEM FILTER LEUKOCYTE REDUCT
|
Facility
|
OP
|
$84.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.94
|
| Rate for Payer: Aetna of WY Medicare |
$55.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.24
|
| Rate for Payer: Altius Commercial |
$81.24
|
| Rate for Payer: Beech Street Commercial |
$82.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.48
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.09
|
| Rate for Payer: Cigna of WY Commercial |
$82.94
|
| Rate for Payer: Entrust Commercial |
$80.40
|
| Rate for Payer: First Choice Health Commercial |
$80.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.09
|
| Rate for Payer: HealthUtah PPO |
$84.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.09
|
| Rate for Payer: Multiplan Medicare/VA |
$46.63
|
| Rate for Payer: One Health Plan of WY PPO |
$82.94
|
| Rate for Payer: PacificSource Commercial |
$76.17
|
| Rate for Payer: PHCS PPO |
$82.94
|
| Rate for Payer: Three Rivers PPO |
$63.47
|
| Rate for Payer: TriWest Veterans Administration |
$49.09
|
| Rate for Payer: United Healthcare Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare |
$49.09
|
| Rate for Payer: WINHealth Partners Commercial |
$82.94
|
| Rate for Payer: Wise Provider Network Commercial |
$80.40
|
|
|
HAEM FILTER LEUKOCYTE REDUCT
|
Facility
|
IP
|
$84.63
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.24
|
| Rate for Payer: Altius Commercial |
$81.24
|
| Rate for Payer: Beech Street Commercial |
$82.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$69.48
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.09
|
| Rate for Payer: Cigna of WY Commercial |
$82.94
|
| Rate for Payer: Entrust Commercial |
$80.40
|
| Rate for Payer: First Choice Health Commercial |
$80.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$80.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.86
|
| Rate for Payer: HealthUtah PPO |
$84.63
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.09
|
| Rate for Payer: Multiplan Medicare/VA |
$53.06
|
| Rate for Payer: One Health Plan of WY PPO |
$82.94
|
| Rate for Payer: PacificSource Commercial |
$76.17
|
| Rate for Payer: PHCS PPO |
$82.94
|
| Rate for Payer: Three Rivers PPO |
$63.47
|
| Rate for Payer: TriWest Veterans Administration |
$55.86
|
| Rate for Payer: United Healthcare Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare |
$55.86
|
| Rate for Payer: WINHealth Partners Commercial |
$80.40
|
| Rate for Payer: Wise Provider Network Commercial |
$80.40
|
|
|
HAEMOPHILUS B CONJ-TET,COMPONENT 2 OF 2 (PF) 10 MCG/0.5 ML IM SOLUTION [153138]
|
Facility
|
OP
|
$174.46
|
|
|
Service Code
|
NDC 4928154458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.13 |
| Max. Negotiated Rate |
$174.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.97
|
| Rate for Payer: Aetna of WY Medicare |
$115.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$167.48
|
| Rate for Payer: Altius Commercial |
$167.48
|
| Rate for Payer: Beech Street Commercial |
$170.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.23
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.23
|
| Rate for Payer: Cigna of WY Commercial |
$170.97
|
| Rate for Payer: Entrust Commercial |
$165.74
|
| Rate for Payer: First Choice Health Commercial |
$165.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.19
|
| Rate for Payer: HealthUtah PPO |
$174.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.23
|
| Rate for Payer: Multiplan Medicare/VA |
$96.13
|
| Rate for Payer: One Health Plan of WY PPO |
$170.97
|
| Rate for Payer: PacificSource Commercial |
$157.01
|
| Rate for Payer: PHCS PPO |
$170.97
|
| Rate for Payer: Three Rivers PPO |
$130.84
|
| Rate for Payer: TriWest Veterans Administration |
$101.19
|
| Rate for Payer: United Healthcare Commercial |
$151.78
|
| Rate for Payer: United Healthcare Medicare |
$101.19
|
| Rate for Payer: WINHealth Partners Commercial |
$170.97
|
| Rate for Payer: Wise Provider Network Commercial |
$165.74
|
|
|
HAEMOPHILUS B CONJ-TET,COMPONENT 2 OF 2 (PF) 10 MCG/0.5 ML IM SOLUTION [153138]
|
Facility
|
IP
|
$174.46
|
|
|
Service Code
|
NDC 4928154458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.39 |
| Max. Negotiated Rate |
$174.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$170.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$167.48
|
| Rate for Payer: Altius Commercial |
$167.48
|
| Rate for Payer: Beech Street Commercial |
$170.97
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$143.23
|
| Rate for Payer: Cash Price |
$122.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$169.23
|
| Rate for Payer: Cigna of WY Commercial |
$170.97
|
| Rate for Payer: Entrust Commercial |
$165.74
|
| Rate for Payer: First Choice Health Commercial |
$165.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$165.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.14
|
| Rate for Payer: HealthUtah PPO |
$174.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$169.23
|
| Rate for Payer: Multiplan Medicare/VA |
$109.39
|
| Rate for Payer: One Health Plan of WY PPO |
$170.97
|
| Rate for Payer: PacificSource Commercial |
$157.01
|
| Rate for Payer: PHCS PPO |
$170.97
|
| Rate for Payer: Three Rivers PPO |
$130.84
|
| Rate for Payer: TriWest Veterans Administration |
$115.14
|
| Rate for Payer: United Healthcare Commercial |
$151.78
|
| Rate for Payer: United Healthcare Medicare |
$115.14
|
| Rate for Payer: WINHealth Partners Commercial |
$165.74
|
| Rate for Payer: Wise Provider Network Commercial |
$165.74
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [46141]
|
Facility
|
OP
|
$34.80
|
|
|
Service Code
|
NDC 4928154503
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.10
|
| Rate for Payer: Aetna of WY Medicare |
$22.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.41
|
| Rate for Payer: Altius Commercial |
$33.41
|
| Rate for Payer: Beech Street Commercial |
$34.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.57
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.76
|
| Rate for Payer: Cigna of WY Commercial |
$34.10
|
| Rate for Payer: Entrust Commercial |
$33.06
|
| Rate for Payer: First Choice Health Commercial |
$33.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.18
|
| Rate for Payer: HealthUtah PPO |
$34.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.76
|
| Rate for Payer: Multiplan Medicare/VA |
$19.17
|
| Rate for Payer: One Health Plan of WY PPO |
$34.10
|
| Rate for Payer: PacificSource Commercial |
$31.32
|
| Rate for Payer: PHCS PPO |
$34.10
|
| Rate for Payer: Three Rivers PPO |
$26.10
|
| Rate for Payer: TriWest Veterans Administration |
$20.18
|
| Rate for Payer: United Healthcare Commercial |
$30.28
|
| Rate for Payer: United Healthcare Medicare |
$20.18
|
| Rate for Payer: WINHealth Partners Commercial |
$34.10
|
| Rate for Payer: Wise Provider Network Commercial |
$33.06
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN [46141]
|
Facility
|
IP
|
$34.80
|
|
|
Service Code
|
NDC 4928154503
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.82 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.41
|
| Rate for Payer: Altius Commercial |
$33.41
|
| Rate for Payer: Beech Street Commercial |
$34.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.57
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.76
|
| Rate for Payer: Cigna of WY Commercial |
$34.10
|
| Rate for Payer: Entrust Commercial |
$33.06
|
| Rate for Payer: First Choice Health Commercial |
$33.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.97
|
| Rate for Payer: HealthUtah PPO |
$34.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.76
|
| Rate for Payer: Multiplan Medicare/VA |
$21.82
|
| Rate for Payer: One Health Plan of WY PPO |
$34.10
|
| Rate for Payer: PacificSource Commercial |
$31.32
|
| Rate for Payer: PHCS PPO |
$34.10
|
| Rate for Payer: Three Rivers PPO |
$26.10
|
| Rate for Payer: TriWest Veterans Administration |
$22.97
|
| Rate for Payer: United Healthcare Commercial |
$30.28
|
| Rate for Payer: United Healthcare Medicare |
$22.97
|
| Rate for Payer: WINHealth Partners Commercial |
$33.06
|
| Rate for Payer: Wise Provider Network Commercial |
$33.06
|
|
