|
ENDOTRACH TUBE UC 5.5
|
Facility
|
OP
|
$3.90
|
|
| Hospital Charge Code |
2500103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.82
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Altius Commercial |
$3.74
|
| Rate for Payer: Beech Street Commercial |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.78
|
| Rate for Payer: Cigna of WY Commercial |
$3.82
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.22
|
| Rate for Payer: HealthUtah PPO |
$3.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.78
|
| Rate for Payer: Multiplan Medicare/VA |
$2.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3.82
|
| Rate for Payer: PacificSource Commercial |
$3.51
|
| Rate for Payer: PHCS PPO |
$3.82
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.22
|
| Rate for Payer: United Healthcare Commercial |
$3.72
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WINHealth Partners Commercial |
$3.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
ENDOTRACH TUBE UC 6.0
|
Facility
|
OP
|
$3.90
|
|
| Hospital Charge Code |
2500104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.82
|
| Rate for Payer: Aetna of WY Medicare |
$2.57
|
| Rate for Payer: Altius Commercial |
$3.74
|
| Rate for Payer: Beech Street Commercial |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.78
|
| Rate for Payer: Cigna of WY Commercial |
$3.82
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.22
|
| Rate for Payer: HealthUtah PPO |
$3.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.78
|
| Rate for Payer: Multiplan Medicare/VA |
$2.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3.82
|
| Rate for Payer: PacificSource Commercial |
$3.51
|
| Rate for Payer: PHCS PPO |
$3.82
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.22
|
| Rate for Payer: United Healthcare Commercial |
$3.72
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WINHealth Partners Commercial |
$3.82
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
ENDOTRACH TUBE UC 6.0
|
Facility
|
IP
|
$3.90
|
|
| Hospital Charge Code |
2500104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: United Healthcare Commercial |
$3.72
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.82
|
| Rate for Payer: Aetna of WY Medicare |
$2.50
|
| Rate for Payer: Altius Commercial |
$3.74
|
| Rate for Payer: Beech Street Commercial |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.78
|
| Rate for Payer: Cigna of WY Commercial |
$3.82
|
| Rate for Payer: Entrust Commercial |
$3.70
|
| Rate for Payer: First Choice Health Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.38
|
| Rate for Payer: HealthUtah PPO |
$3.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.78
|
| Rate for Payer: Multiplan Medicare/VA |
$2.26
|
| Rate for Payer: One Health Plan of WY PPO |
$3.82
|
| Rate for Payer: PacificSource Commercial |
$3.51
|
| Rate for Payer: PHCS PPO |
$3.82
|
| Rate for Payer: Three Rivers PPO |
$2.92
|
| Rate for Payer: TriWest Veterans Administration |
$2.38
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WINHealth Partners Commercial |
$3.70
|
| Rate for Payer: Wise Provider Network Commercial |
$3.70
|
|
|
ENDOTRACH XL TUBE 5.0
|
Facility
|
IP
|
$18.48
|
|
| Hospital Charge Code |
2500232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.11
|
| Rate for Payer: Aetna of WY Medicare |
$11.83
|
| Rate for Payer: Altius Commercial |
$17.74
|
| Rate for Payer: Beech Street Commercial |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.93
|
| Rate for Payer: Cigna of WY Commercial |
$18.11
|
| Rate for Payer: Entrust Commercial |
$17.56
|
| Rate for Payer: First Choice Health Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.27
|
| Rate for Payer: HealthUtah PPO |
$18.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.93
|
| Rate for Payer: Multiplan Medicare/VA |
$10.71
|
| Rate for Payer: One Health Plan of WY PPO |
$18.11
|
| Rate for Payer: PacificSource Commercial |
$16.63
|
| Rate for Payer: PHCS PPO |
$18.11
|
| Rate for Payer: Three Rivers PPO |
$13.86
|
| Rate for Payer: TriWest Veterans Administration |
$11.27
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$11.27
|
| Rate for Payer: WINHealth Partners Commercial |
$17.56
|
| Rate for Payer: Wise Provider Network Commercial |
$17.56
|
|
|
ENDOTRACH XL TUBE 5.0
|
Facility
|
OP
|
$18.48
|
|
| Hospital Charge Code |
2500232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.11
|
| Rate for Payer: Aetna of WY Medicare |
$12.20
|
| Rate for Payer: Altius Commercial |
$17.74
|
| Rate for Payer: Beech Street Commercial |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.93
|
| Rate for Payer: Cigna of WY Commercial |
$18.11
|
| Rate for Payer: Entrust Commercial |
$17.56
|
| Rate for Payer: First Choice Health Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$18.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.93
|
| Rate for Payer: Multiplan Medicare/VA |
$10.01
|
| Rate for Payer: One Health Plan of WY PPO |
$18.11
|
| Rate for Payer: PacificSource Commercial |
$16.63
|
| Rate for Payer: PHCS PPO |
$18.11
|
| Rate for Payer: Three Rivers PPO |
$13.86
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$18.11
|
| Rate for Payer: Wise Provider Network Commercial |
$17.56
|
|
|
ENDOTRACH XL TUBE 6.0
|
Facility
|
IP
|
$18.48
|
|
| Hospital Charge Code |
2500233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.11
|
| Rate for Payer: Aetna of WY Medicare |
$11.83
|
| Rate for Payer: Altius Commercial |
$17.74
|
| Rate for Payer: Beech Street Commercial |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.93
|
| Rate for Payer: Cigna of WY Commercial |
$18.11
|
| Rate for Payer: Entrust Commercial |
$17.56
|
| Rate for Payer: First Choice Health Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.27
|
| Rate for Payer: HealthUtah PPO |
$18.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.93
|
| Rate for Payer: Multiplan Medicare/VA |
$10.71
|
| Rate for Payer: One Health Plan of WY PPO |
$18.11
|
| Rate for Payer: PacificSource Commercial |
$16.63
|
| Rate for Payer: PHCS PPO |
$18.11
|
| Rate for Payer: Three Rivers PPO |
$13.86
|
| Rate for Payer: TriWest Veterans Administration |
$11.27
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$11.27
|
| Rate for Payer: WINHealth Partners Commercial |
$17.56
|
| Rate for Payer: Wise Provider Network Commercial |
$17.56
|
|
|
ENDOTRACH XL TUBE 6.0
|
Facility
|
OP
|
$18.48
|
|
| Hospital Charge Code |
2500233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.11
|
| Rate for Payer: Aetna of WY Medicare |
$12.20
|
| Rate for Payer: Altius Commercial |
$17.74
|
| Rate for Payer: Beech Street Commercial |
$18.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$12.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.93
|
| Rate for Payer: Cigna of WY Commercial |
$18.11
|
| Rate for Payer: Entrust Commercial |
$17.56
|
| Rate for Payer: First Choice Health Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.53
|
| Rate for Payer: HealthUtah PPO |
$18.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.93
|
| Rate for Payer: Multiplan Medicare/VA |
$10.01
|
| Rate for Payer: One Health Plan of WY PPO |
$18.11
|
| Rate for Payer: PacificSource Commercial |
$16.63
|
| Rate for Payer: PHCS PPO |
$18.11
|
| Rate for Payer: Three Rivers PPO |
$13.86
|
| Rate for Payer: TriWest Veterans Administration |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$17.65
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
| Rate for Payer: WINHealth Partners Commercial |
$18.11
|
| Rate for Payer: Wise Provider Network Commercial |
$17.56
|
|
|
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 36475 50
|
| Min. Negotiated Rate |
$1,844.25 |
| Max. Negotiated Rate |
$2,459.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,409.82
|
| Rate for Payer: Beech Street Commercial |
$2,336.05
|
| Rate for Payer: Cash Price |
$1,721.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,385.23
|
| Rate for Payer: Cigna of WY Commercial |
$2,409.82
|
| Rate for Payer: First Choice Health Commercial |
$2,213.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,336.05
|
| Rate for Payer: HealthUtah PPO |
$2,459.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,385.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2,409.82
|
| Rate for Payer: PacificSource Commercial |
$2,213.10
|
| Rate for Payer: PHCS PPO |
$2,336.05
|
| Rate for Payer: Three Rivers PPO |
$1,844.25
|
| Rate for Payer: United Healthcare Commercial |
$2,336.05
|
| Rate for Payer: WINHealth Partners Commercial |
$2,090.15
|
|
|
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
HCPCS 36475
|
| Min. Negotiated Rate |
$218.48 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,206.38
|
| Rate for Payer: Aetna of WY Medicare |
$257.04
|
| Rate for Payer: Beech Street Commercial |
$1,169.45
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: Cash Price |
$861.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,194.07
|
| Rate for Payer: Cigna of WY Commercial |
$1,206.38
|
| Rate for Payer: First Choice Health Commercial |
$1,107.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,169.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.04
|
| Rate for Payer: HealthUtah PPO |
$1,231.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,194.07
|
| Rate for Payer: Multiplan Medicare/VA |
$218.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,206.38
|
| Rate for Payer: PacificSource Commercial |
$1,107.90
|
| Rate for Payer: PHCS PPO |
$1,169.45
|
| Rate for Payer: Three Rivers PPO |
$923.25
|
| Rate for Payer: TriWest Veterans Administration |
$257.04
|
| Rate for Payer: United Healthcare Commercial |
$1,169.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,046.35
|
|
|
ENEMA BUCKET SET DYND70104
|
Facility
|
IP
|
$4.18
|
|
| Hospital Charge Code |
2400043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.10
|
| Rate for Payer: Aetna of WY Medicare |
$2.68
|
| Rate for Payer: Altius Commercial |
$4.01
|
| Rate for Payer: Beech Street Commercial |
$4.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.05
|
| Rate for Payer: Cigna of WY Commercial |
$4.10
|
| Rate for Payer: Entrust Commercial |
$3.97
|
| Rate for Payer: First Choice Health Commercial |
$3.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.55
|
| Rate for Payer: HealthUtah PPO |
$4.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.05
|
| Rate for Payer: Multiplan Medicare/VA |
$2.42
|
| Rate for Payer: One Health Plan of WY PPO |
$4.10
|
| Rate for Payer: PacificSource Commercial |
$3.76
|
| Rate for Payer: PHCS PPO |
$4.10
|
| Rate for Payer: Three Rivers PPO |
$3.14
|
| Rate for Payer: TriWest Veterans Administration |
$2.55
|
| Rate for Payer: United Healthcare Commercial |
$3.99
|
| Rate for Payer: United Healthcare Medicare |
$2.55
|
| Rate for Payer: WINHealth Partners Commercial |
$3.97
|
| Rate for Payer: Wise Provider Network Commercial |
$3.97
|
|
|
ENEMA BUCKET SET DYND70104
|
Facility
|
OP
|
$4.18
|
|
| Hospital Charge Code |
2400043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.10
|
| Rate for Payer: Aetna of WY Medicare |
$2.76
|
| Rate for Payer: Altius Commercial |
$4.01
|
| Rate for Payer: Beech Street Commercial |
$4.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.05
|
| Rate for Payer: Cigna of WY Commercial |
$4.10
|
| Rate for Payer: Entrust Commercial |
$3.97
|
| Rate for Payer: First Choice Health Commercial |
$3.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.38
|
| Rate for Payer: HealthUtah PPO |
$4.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.05
|
| Rate for Payer: Multiplan Medicare/VA |
$2.26
|
| Rate for Payer: One Health Plan of WY PPO |
$4.10
|
| Rate for Payer: PacificSource Commercial |
$3.76
|
| Rate for Payer: PHCS PPO |
$4.10
|
| Rate for Payer: Three Rivers PPO |
$3.14
|
| Rate for Payer: TriWest Veterans Administration |
$2.38
|
| Rate for Payer: United Healthcare Commercial |
$3.99
|
| Rate for Payer: United Healthcare Medicare |
$2.38
|
| Rate for Payer: WINHealth Partners Commercial |
$4.10
|
| Rate for Payer: Wise Provider Network Commercial |
$3.97
|
|
|
ENERGEL WOUND GEL
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
2650993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Medicare |
$12.16
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.43
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.59
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$11.01
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.59
|
| Rate for Payer: United Healthcare Commercial |
$18.14
|
| Rate for Payer: United Healthcare Medicare |
$11.59
|
| Rate for Payer: WINHealth Partners Commercial |
$18.05
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
ENERGEL WOUND GEL
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
2650993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.62
|
| Rate for Payer: Aetna of WY Medicare |
$12.54
|
| Rate for Payer: Altius Commercial |
$18.24
|
| Rate for Payer: Beech Street Commercial |
$18.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.43
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.43
|
| Rate for Payer: Cigna of WY Commercial |
$18.62
|
| Rate for Payer: Entrust Commercial |
$18.05
|
| Rate for Payer: First Choice Health Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.83
|
| Rate for Payer: HealthUtah PPO |
$19.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.43
|
| Rate for Payer: Multiplan Medicare/VA |
$10.29
|
| Rate for Payer: One Health Plan of WY PPO |
$18.62
|
| Rate for Payer: PacificSource Commercial |
$17.10
|
| Rate for Payer: PHCS PPO |
$18.62
|
| Rate for Payer: Three Rivers PPO |
$14.25
|
| Rate for Payer: TriWest Veterans Administration |
$10.83
|
| Rate for Payer: United Healthcare Commercial |
$18.14
|
| Rate for Payer: United Healthcare Medicare |
$10.83
|
| Rate for Payer: WINHealth Partners Commercial |
$18.62
|
| Rate for Payer: Wise Provider Network Commercial |
$18.05
|
|
|
ENHANCE CORTICAL FIBER 10CC
|
Facility
|
OP
|
$3,379.18
|
|
| Hospital Charge Code |
3004243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.83 |
| Max. Negotiated Rate |
$3,379.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,311.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,230.26
|
| Rate for Payer: Altius Commercial |
$3,244.01
|
| Rate for Payer: Beech Street Commercial |
$3,311.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,277.80
|
| Rate for Payer: Cash Price |
$2,365.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,277.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,311.60
|
| Rate for Payer: Entrust Commercial |
$3,210.22
|
| Rate for Payer: First Choice Health Commercial |
$3,210.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,210.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,926.13
|
| Rate for Payer: HealthUtah PPO |
$3,379.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,277.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,829.83
|
| Rate for Payer: One Health Plan of WY PPO |
$3,311.60
|
| Rate for Payer: PacificSource Commercial |
$3,041.26
|
| Rate for Payer: PHCS PPO |
$3,311.60
|
| Rate for Payer: Three Rivers PPO |
$2,534.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,926.13
|
| Rate for Payer: United Healthcare Commercial |
$3,227.12
|
| Rate for Payer: United Healthcare Medicare |
$1,926.13
|
| Rate for Payer: WINHealth Partners Commercial |
$3,311.60
|
| Rate for Payer: Wise Provider Network Commercial |
$3,210.22
|
|
|
ENHANCE CORTICAL FIBER 10CC
|
Facility
|
IP
|
$3,379.18
|
|
| Hospital Charge Code |
3004243
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,958.23 |
| Max. Negotiated Rate |
$3,379.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,311.60
|
| Rate for Payer: Aetna of WY Medicare |
$2,162.68
|
| Rate for Payer: Altius Commercial |
$3,244.01
|
| Rate for Payer: Beech Street Commercial |
$3,311.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3,277.80
|
| Rate for Payer: Cash Price |
$2,365.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,277.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,311.60
|
| Rate for Payer: Entrust Commercial |
$3,210.22
|
| Rate for Payer: First Choice Health Commercial |
$3,210.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,210.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,061.30
|
| Rate for Payer: HealthUtah PPO |
$3,379.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,277.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,958.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,311.60
|
| Rate for Payer: PacificSource Commercial |
$3,041.26
|
| Rate for Payer: PHCS PPO |
$3,311.60
|
| Rate for Payer: Three Rivers PPO |
$2,534.38
|
| Rate for Payer: TriWest Veterans Administration |
$2,061.30
|
| Rate for Payer: United Healthcare Commercial |
$3,227.12
|
| Rate for Payer: United Healthcare Medicare |
$2,061.30
|
| Rate for Payer: WINHealth Partners Commercial |
$3,210.22
|
| Rate for Payer: Wise Provider Network Commercial |
$3,210.22
|
|
|
ENHANCE CORTICAL FIBER 5CC
|
Facility
|
OP
|
$2,168.70
|
|
| Hospital Charge Code |
3004242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.35 |
| Max. Negotiated Rate |
$2,168.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,125.33
|
| Rate for Payer: Aetna of WY Medicare |
$1,431.34
|
| Rate for Payer: Altius Commercial |
$2,081.95
|
| Rate for Payer: Beech Street Commercial |
$2,125.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,103.64
|
| Rate for Payer: Cash Price |
$1,518.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,103.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,125.33
|
| Rate for Payer: Entrust Commercial |
$2,060.26
|
| Rate for Payer: First Choice Health Commercial |
$2,060.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,060.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,236.16
|
| Rate for Payer: HealthUtah PPO |
$2,168.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,103.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1,174.35
|
| Rate for Payer: One Health Plan of WY PPO |
$2,125.33
|
| Rate for Payer: PacificSource Commercial |
$1,951.83
|
| Rate for Payer: PHCS PPO |
$2,125.33
|
| Rate for Payer: Three Rivers PPO |
$1,626.52
|
| Rate for Payer: TriWest Veterans Administration |
$1,236.16
|
| Rate for Payer: United Healthcare Commercial |
$2,071.11
|
| Rate for Payer: United Healthcare Medicare |
$1,236.16
|
| Rate for Payer: WINHealth Partners Commercial |
$2,125.33
|
| Rate for Payer: Wise Provider Network Commercial |
$2,060.26
|
|
|
ENHANCE CORTICAL FIBER 5CC
|
Facility
|
IP
|
$2,168.70
|
|
| Hospital Charge Code |
3004242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.76 |
| Max. Negotiated Rate |
$2,168.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,125.33
|
| Rate for Payer: Aetna of WY Medicare |
$1,387.97
|
| Rate for Payer: Altius Commercial |
$2,081.95
|
| Rate for Payer: Beech Street Commercial |
$2,125.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,103.64
|
| Rate for Payer: Cash Price |
$1,518.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,103.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,125.33
|
| Rate for Payer: Entrust Commercial |
$2,060.26
|
| Rate for Payer: First Choice Health Commercial |
$2,060.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,060.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,322.91
|
| Rate for Payer: HealthUtah PPO |
$2,168.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,103.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1,256.76
|
| Rate for Payer: One Health Plan of WY PPO |
$2,125.33
|
| Rate for Payer: PacificSource Commercial |
$1,951.83
|
| Rate for Payer: PHCS PPO |
$2,125.33
|
| Rate for Payer: Three Rivers PPO |
$1,626.52
|
| Rate for Payer: TriWest Veterans Administration |
$1,322.91
|
| Rate for Payer: United Healthcare Commercial |
$2,071.11
|
| Rate for Payer: United Healthcare Medicare |
$1,322.91
|
| Rate for Payer: WINHealth Partners Commercial |
$2,060.26
|
| Rate for Payer: Wise Provider Network Commercial |
$2,060.26
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [23878]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$36.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.31
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$34.31
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$34.31
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE [23878]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.06
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.46
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$32.06
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$32.06
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [25713]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$38.40
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$34.77
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$36.60
|
| Rate for Payer: United Healthcare Commercial |
$57.30
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE [25713]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.20
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$32.49
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.20
|
| Rate for Payer: United Healthcare Commercial |
$57.30
|
| Rate for Payer: United Healthcare Medicare |
$34.20
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [15913]
|
Facility
|
OP
|
$53.39
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.32
|
| Rate for Payer: Aetna of WY Medicare |
$35.24
|
| Rate for Payer: Altius Commercial |
$51.25
|
| Rate for Payer: Beech Street Commercial |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.79
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.79
|
| Rate for Payer: Cigna of WY Commercial |
$52.32
|
| Rate for Payer: Entrust Commercial |
$50.72
|
| Rate for Payer: First Choice Health Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.43
|
| Rate for Payer: HealthUtah PPO |
$53.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.79
|
| Rate for Payer: Multiplan Medicare/VA |
$28.91
|
| Rate for Payer: One Health Plan of WY PPO |
$52.32
|
| Rate for Payer: PacificSource Commercial |
$48.05
|
| Rate for Payer: PHCS PPO |
$52.32
|
| Rate for Payer: Three Rivers PPO |
$40.04
|
| Rate for Payer: TriWest Veterans Administration |
$30.43
|
| Rate for Payer: United Healthcare Commercial |
$50.99
|
| Rate for Payer: United Healthcare Medicare |
$30.43
|
| Rate for Payer: WINHealth Partners Commercial |
$52.32
|
| Rate for Payer: Wise Provider Network Commercial |
$50.72
|
|
|
ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE [15913]
|
Facility
|
IP
|
$53.39
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$53.39 |
| Rate for Payer: Three Rivers PPO |
$40.04
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.32
|
| Rate for Payer: Aetna of WY Medicare |
$34.17
|
| Rate for Payer: Altius Commercial |
$51.25
|
| Rate for Payer: Beech Street Commercial |
$52.32
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.79
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$51.79
|
| Rate for Payer: Cigna of WY Commercial |
$52.32
|
| Rate for Payer: Entrust Commercial |
$50.72
|
| Rate for Payer: First Choice Health Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$50.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.57
|
| Rate for Payer: HealthUtah PPO |
$53.39
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$51.79
|
| Rate for Payer: Multiplan Medicare/VA |
$30.94
|
| Rate for Payer: One Health Plan of WY PPO |
$52.32
|
| Rate for Payer: PacificSource Commercial |
$48.05
|
| Rate for Payer: PHCS PPO |
$52.32
|
| Rate for Payer: TriWest Veterans Administration |
$32.57
|
| Rate for Payer: United Healthcare Commercial |
$50.99
|
| Rate for Payer: United Healthcare Medicare |
$32.57
|
| Rate for Payer: WINHealth Partners Commercial |
$50.72
|
| Rate for Payer: Wise Provider Network Commercial |
$50.72
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [23875]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.11
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$27.07
|
| Rate for Payer: Aetna of WY Medicare |
$29.71
|
| Rate for Payer: Altius Commercial |
$39.38
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$43.21
|
| Rate for Payer: Beech Street Commercial |
$44.11
|
| Rate for Payer: Beech Street Commercial |
$40.20
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.66
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.66
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$40.20
|
| Rate for Payer: Cigna of WY Commercial |
$44.11
|
| Rate for Payer: Entrust Commercial |
$42.76
|
| Rate for Payer: Entrust Commercial |
$38.97
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$42.76
|
| Rate for Payer: First Choice Health Commercial |
$38.97
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.66
|
| Rate for Payer: HealthUtah PPO |
$41.02
|
| Rate for Payer: HealthUtah PPO |
$45.01
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.79
|
| Rate for Payer: Multiplan Medicare/VA |
$30.46
|
| Rate for Payer: Multiplan Medicare/VA |
$22.21
|
| Rate for Payer: Multiplan Medicare/VA |
$24.37
|
| Rate for Payer: One Health Plan of WY PPO |
$44.11
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$40.20
|
| Rate for Payer: PacificSource Commercial |
$40.51
|
| Rate for Payer: PacificSource Commercial |
$36.92
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$44.11
|
| Rate for Payer: PHCS PPO |
$40.20
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.76
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: Three Rivers PPO |
$30.76
|
| Rate for Payer: TriWest Veterans Administration |
$23.38
|
| Rate for Payer: TriWest Veterans Administration |
$25.66
|
| Rate for Payer: TriWest Veterans Administration |
$32.06
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Commercial |
$39.17
|
| Rate for Payer: United Healthcare Medicare |
$23.38
|
| Rate for Payer: United Healthcare Medicare |
$25.66
|
| Rate for Payer: United Healthcare Medicare |
$32.06
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: WINHealth Partners Commercial |
$40.20
|
| Rate for Payer: WINHealth Partners Commercial |
$44.11
|
| Rate for Payer: Wise Provider Network Commercial |
$38.97
|
| Rate for Payer: Wise Provider Network Commercial |
$42.76
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE [23875]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.11
|
| Rate for Payer: Aetna of WY Medicare |
$28.81
|
| Rate for Payer: Aetna of WY Medicare |
$36.00
|
| Rate for Payer: Aetna of WY Medicare |
$26.25
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$39.38
|
| Rate for Payer: Altius Commercial |
$43.21
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$40.20
|
| Rate for Payer: Beech Street Commercial |
$44.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$39.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$31.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$39.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$44.11
|
| Rate for Payer: Cigna of WY Commercial |
$40.20
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$38.97
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$42.76
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$42.76
|
| Rate for Payer: First Choice Health Commercial |
$38.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$38.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.31
|
| Rate for Payer: HealthUtah PPO |
$45.01
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$41.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$39.79
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: Multiplan Medicare/VA |
$26.08
|
| Rate for Payer: Multiplan Medicare/VA |
$23.77
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$40.20
|
| Rate for Payer: One Health Plan of WY PPO |
$44.11
|
| Rate for Payer: PacificSource Commercial |
$36.92
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$40.51
|
| Rate for Payer: PHCS PPO |
$44.11
|
| Rate for Payer: PHCS PPO |
$40.20
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$33.76
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: Three Rivers PPO |
$30.76
|
| Rate for Payer: TriWest Veterans Administration |
$25.02
|
| Rate for Payer: TriWest Veterans Administration |
$34.31
|
| Rate for Payer: TriWest Veterans Administration |
$27.46
|
| Rate for Payer: United Healthcare Commercial |
$39.17
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$34.31
|
| Rate for Payer: United Healthcare Medicare |
$25.02
|
| Rate for Payer: United Healthcare Medicare |
$27.46
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: WINHealth Partners Commercial |
$38.97
|
| Rate for Payer: WINHealth Partners Commercial |
$42.76
|
| Rate for Payer: Wise Provider Network Commercial |
$38.97
|
| Rate for Payer: Wise Provider Network Commercial |
$42.76
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
