|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6808409901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
OP
|
$1.80
|
|
|
Service Code
|
NDC 6808409901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Aetna of WY Medicare |
$1.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.76
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 40 MG TABLET [709]
|
Facility
|
IP
|
$1.80
|
|
|
Service Code
|
NDC 6808409911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.73
|
| Rate for Payer: Altius Commercial |
$1.73
|
| Rate for Payer: Beech Street Commercial |
$1.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.75
|
| Rate for Payer: Cigna of WY Commercial |
$1.76
|
| Rate for Payer: Entrust Commercial |
$1.71
|
| Rate for Payer: First Choice Health Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.19
|
| Rate for Payer: HealthUtah PPO |
$1.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.75
|
| Rate for Payer: Multiplan Medicare/VA |
$1.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1.76
|
| Rate for Payer: PacificSource Commercial |
$1.62
|
| Rate for Payer: PHCS PPO |
$1.76
|
| Rate for Payer: Three Rivers PPO |
$1.35
|
| Rate for Payer: TriWest Veterans Administration |
$1.19
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Medicare |
$1.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1.71
|
| Rate for Payer: Wise Provider Network Commercial |
$1.71
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
NDC 0904629304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.66
|
| Rate for Payer: Altius Commercial |
$1.66
|
| Rate for Payer: Beech Street Commercial |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.68
|
| Rate for Payer: Cigna of WY Commercial |
$1.70
|
| Rate for Payer: Entrust Commercial |
$1.64
|
| Rate for Payer: First Choice Health Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.14
|
| Rate for Payer: HealthUtah PPO |
$1.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1.08
|
| Rate for Payer: One Health Plan of WY PPO |
$1.70
|
| Rate for Payer: PacificSource Commercial |
$1.56
|
| Rate for Payer: PHCS PPO |
$1.70
|
| Rate for Payer: Three Rivers PPO |
$1.30
|
| Rate for Payer: TriWest Veterans Administration |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
| Rate for Payer: United Healthcare Medicare |
$1.14
|
| Rate for Payer: WINHealth Partners Commercial |
$1.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1.64
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 0904629304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.70
|
| Rate for Payer: Aetna of WY Medicare |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.66
|
| Rate for Payer: Altius Commercial |
$1.66
|
| Rate for Payer: Beech Street Commercial |
$1.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.42
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.68
|
| Rate for Payer: Cigna of WY Commercial |
$1.70
|
| Rate for Payer: Entrust Commercial |
$1.64
|
| Rate for Payer: First Choice Health Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.00
|
| Rate for Payer: HealthUtah PPO |
$1.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.68
|
| Rate for Payer: Multiplan Medicare/VA |
$0.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1.70
|
| Rate for Payer: PacificSource Commercial |
$1.56
|
| Rate for Payer: PHCS PPO |
$1.70
|
| Rate for Payer: Three Rivers PPO |
$1.30
|
| Rate for Payer: TriWest Veterans Administration |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
| Rate for Payer: United Healthcare Medicare |
$1.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1.70
|
| Rate for Payer: Wise Provider Network Commercial |
$1.64
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
IP
|
$2.70
|
|
|
Service Code
|
NDC 6808459095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.59
|
| Rate for Payer: Altius Commercial |
$2.59
|
| Rate for Payer: Beech Street Commercial |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.62
|
| Rate for Payer: Cigna of WY Commercial |
$2.65
|
| Rate for Payer: Entrust Commercial |
$2.56
|
| Rate for Payer: First Choice Health Commercial |
$2.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.78
|
| Rate for Payer: HealthUtah PPO |
$2.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1.69
|
| Rate for Payer: One Health Plan of WY PPO |
$2.65
|
| Rate for Payer: PacificSource Commercial |
$2.43
|
| Rate for Payer: PHCS PPO |
$2.65
|
| Rate for Payer: Three Rivers PPO |
$2.02
|
| Rate for Payer: TriWest Veterans Administration |
$1.78
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare |
$1.78
|
| Rate for Payer: WINHealth Partners Commercial |
$2.56
|
| Rate for Payer: Wise Provider Network Commercial |
$2.56
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
OP
|
$2.70
|
|
|
Service Code
|
NDC 6808459095
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.65
|
| Rate for Payer: Aetna of WY Medicare |
$1.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.59
|
| Rate for Payer: Altius Commercial |
$2.59
|
| Rate for Payer: Beech Street Commercial |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.22
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.62
|
| Rate for Payer: Cigna of WY Commercial |
$2.65
|
| Rate for Payer: Entrust Commercial |
$2.56
|
| Rate for Payer: First Choice Health Commercial |
$2.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.57
|
| Rate for Payer: HealthUtah PPO |
$2.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.62
|
| Rate for Payer: Multiplan Medicare/VA |
$1.49
|
| Rate for Payer: One Health Plan of WY PPO |
$2.65
|
| Rate for Payer: PacificSource Commercial |
$2.43
|
| Rate for Payer: PHCS PPO |
$2.65
|
| Rate for Payer: Three Rivers PPO |
$2.02
|
| Rate for Payer: TriWest Veterans Administration |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$2.35
|
| Rate for Payer: United Healthcare Medicare |
$1.57
|
| Rate for Payer: WINHealth Partners Commercial |
$2.65
|
| Rate for Payer: Wise Provider Network Commercial |
$2.56
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 5026809611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.01
|
| Rate for Payer: Altius Commercial |
$2.01
|
| Rate for Payer: Beech Street Commercial |
$2.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.03
|
| Rate for Payer: Cigna of WY Commercial |
$2.05
|
| Rate for Payer: Entrust Commercial |
$1.99
|
| Rate for Payer: First Choice Health Commercial |
$1.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.38
|
| Rate for Payer: HealthUtah PPO |
$2.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1.31
|
| Rate for Payer: One Health Plan of WY PPO |
$2.05
|
| Rate for Payer: PacificSource Commercial |
$1.88
|
| Rate for Payer: PHCS PPO |
$2.05
|
| Rate for Payer: Three Rivers PPO |
$1.57
|
| Rate for Payer: TriWest Veterans Administration |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Medicare |
$1.38
|
| Rate for Payer: WINHealth Partners Commercial |
$1.99
|
| Rate for Payer: Wise Provider Network Commercial |
$1.99
|
|
|
ATORVASTATIN 80 MG TABLET [1213]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
NDC 5026809611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.05
|
| Rate for Payer: Aetna of WY Medicare |
$1.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.01
|
| Rate for Payer: Altius Commercial |
$2.01
|
| Rate for Payer: Beech Street Commercial |
$2.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.03
|
| Rate for Payer: Cigna of WY Commercial |
$2.05
|
| Rate for Payer: Entrust Commercial |
$1.99
|
| Rate for Payer: First Choice Health Commercial |
$1.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.21
|
| Rate for Payer: HealthUtah PPO |
$2.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.03
|
| Rate for Payer: Multiplan Medicare/VA |
$1.15
|
| Rate for Payer: One Health Plan of WY PPO |
$2.05
|
| Rate for Payer: PacificSource Commercial |
$1.88
|
| Rate for Payer: PHCS PPO |
$2.05
|
| Rate for Payer: Three Rivers PPO |
$1.57
|
| Rate for Payer: TriWest Veterans Administration |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Medicare |
$1.21
|
| Rate for Payer: WINHealth Partners Commercial |
$2.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1.99
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE [13079]
|
Facility
|
IP
|
$19.08
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.48
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Altius Commercial |
$18.32
|
| Rate for Payer: Altius Commercial |
$21.48
|
| Rate for Payer: Beech Street Commercial |
$21.93
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Beech Street Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$15.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Cigna of WY Commercial |
$21.93
|
| Rate for Payer: Cigna of WY Commercial |
$18.70
|
| Rate for Payer: Entrust Commercial |
$21.26
|
| Rate for Payer: Entrust Commercial |
$18.13
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$21.26
|
| Rate for Payer: First Choice Health Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.77
|
| Rate for Payer: HealthUtah PPO |
$19.08
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: HealthUtah PPO |
$22.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.51
|
| Rate for Payer: Multiplan Medicare/VA |
$14.03
|
| Rate for Payer: Multiplan Medicare/VA |
$11.96
|
| Rate for Payer: Multiplan Medicare/VA |
$12.28
|
| Rate for Payer: One Health Plan of WY PPO |
$18.70
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$21.93
|
| Rate for Payer: PacificSource Commercial |
$20.14
|
| Rate for Payer: PacificSource Commercial |
$17.17
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: PHCS PPO |
$18.70
|
| Rate for Payer: PHCS PPO |
$21.93
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$14.31
|
| Rate for Payer: Three Rivers PPO |
$16.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.92
|
| Rate for Payer: TriWest Veterans Administration |
$12.59
|
| Rate for Payer: TriWest Veterans Administration |
$14.77
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Commercial |
$19.47
|
| Rate for Payer: United Healthcare Commercial |
$17.03
|
| Rate for Payer: United Healthcare Medicare |
$12.59
|
| Rate for Payer: United Healthcare Medicare |
$14.77
|
| Rate for Payer: United Healthcare Medicare |
$12.92
|
| Rate for Payer: WINHealth Partners Commercial |
$18.60
|
| Rate for Payer: WINHealth Partners Commercial |
$18.13
|
| Rate for Payer: WINHealth Partners Commercial |
$21.26
|
| Rate for Payer: Wise Provider Network Commercial |
$21.26
|
| Rate for Payer: Wise Provider Network Commercial |
$18.13
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
|
|
ATROPINE 0.1 MG/ML INJECTION SYRINGE [13079]
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.19
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.93
|
| Rate for Payer: Aetna of WY Medicare |
$12.92
|
| Rate for Payer: Aetna of WY Medicare |
$14.77
|
| Rate for Payer: Aetna of WY Medicare |
$12.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.48
|
| Rate for Payer: Altius Commercial |
$18.80
|
| Rate for Payer: Altius Commercial |
$21.48
|
| Rate for Payer: Altius Commercial |
$18.32
|
| Rate for Payer: Beech Street Commercial |
$19.19
|
| Rate for Payer: Beech Street Commercial |
$21.93
|
| Rate for Payer: Beech Street Commercial |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.37
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$15.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.51
|
| Rate for Payer: Cigna of WY Commercial |
$21.93
|
| Rate for Payer: Cigna of WY Commercial |
$18.70
|
| Rate for Payer: Cigna of WY Commercial |
$19.19
|
| Rate for Payer: Entrust Commercial |
$21.26
|
| Rate for Payer: Entrust Commercial |
$18.60
|
| Rate for Payer: Entrust Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$18.60
|
| Rate for Payer: First Choice Health Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$21.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.98
|
| Rate for Payer: HealthUtah PPO |
$19.08
|
| Rate for Payer: HealthUtah PPO |
$22.38
|
| Rate for Payer: HealthUtah PPO |
$19.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.99
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: Multiplan Medicare/VA |
$10.79
|
| Rate for Payer: Multiplan Medicare/VA |
$12.33
|
| Rate for Payer: One Health Plan of WY PPO |
$18.70
|
| Rate for Payer: One Health Plan of WY PPO |
$21.93
|
| Rate for Payer: One Health Plan of WY PPO |
$19.19
|
| Rate for Payer: PacificSource Commercial |
$20.14
|
| Rate for Payer: PacificSource Commercial |
$17.62
|
| Rate for Payer: PacificSource Commercial |
$17.17
|
| Rate for Payer: PHCS PPO |
$19.19
|
| Rate for Payer: PHCS PPO |
$18.70
|
| Rate for Payer: PHCS PPO |
$21.93
|
| Rate for Payer: Three Rivers PPO |
$14.68
|
| Rate for Payer: Three Rivers PPO |
$14.31
|
| Rate for Payer: Three Rivers PPO |
$16.78
|
| Rate for Payer: TriWest Veterans Administration |
$12.98
|
| Rate for Payer: TriWest Veterans Administration |
$11.36
|
| Rate for Payer: TriWest Veterans Administration |
$11.07
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Commercial |
$17.03
|
| Rate for Payer: United Healthcare Commercial |
$19.47
|
| Rate for Payer: United Healthcare Medicare |
$12.98
|
| Rate for Payer: United Healthcare Medicare |
$11.07
|
| Rate for Payer: United Healthcare Medicare |
$11.36
|
| Rate for Payer: WINHealth Partners Commercial |
$21.93
|
| Rate for Payer: WINHealth Partners Commercial |
$18.70
|
| Rate for Payer: WINHealth Partners Commercial |
$19.19
|
| Rate for Payer: Wise Provider Network Commercial |
$18.13
|
| Rate for Payer: Wise Provider Network Commercial |
$21.26
|
| Rate for Payer: Wise Provider Network Commercial |
$18.60
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [160316]
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.66
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$31.98
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.66
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$33.66
|
| Rate for Payer: WINHealth Partners Commercial |
$48.45
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [160316]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Medicare |
$33.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.58
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$28.10
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.58
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
| Rate for Payer: WINHealth Partners Commercial |
$49.98
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 99464
|
| Hospital Charge Code |
99464
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$440.02
|
| Rate for Payer: Aetna of WY Medicare |
$69.55
|
| Rate for Payer: Beech Street Commercial |
$426.55
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: Cash Price |
$314.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$435.53
|
| Rate for Payer: Cigna of WY Commercial |
$440.02
|
| Rate for Payer: First Choice Health Commercial |
$404.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$426.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$69.55
|
| Rate for Payer: HealthUtah PPO |
$449.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$435.53
|
| Rate for Payer: Multiplan Medicare/VA |
$59.12
|
| Rate for Payer: One Health Plan of WY PPO |
$440.02
|
| Rate for Payer: PacificSource Commercial |
$404.10
|
| Rate for Payer: PHCS PPO |
$426.55
|
| Rate for Payer: Three Rivers PPO |
$336.75
|
| Rate for Payer: TriWest Veterans Administration |
$69.55
|
| Rate for Payer: United Healthcare Commercial |
$390.63
|
| Rate for Payer: United Healthcare Medicare |
$69.55
|
| Rate for Payer: WINHealth Partners Commercial |
$426.55
|
|
|
AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 20938 80
|
| Hospital Charge Code |
20938
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Aetna of WY Medicare |
$171.39
|
| Rate for Payer: Beech Street Commercial |
$897.75
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: First Choice Health Commercial |
$850.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.39
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$145.68
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$897.75
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$171.39
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$171.39
|
| Rate for Payer: WINHealth Partners Commercial |
$803.25
|
|
|
AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 20938 AS
|
| Hospital Charge Code |
20938
|
| Min. Negotiated Rate |
$145.68 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$926.10
|
| Rate for Payer: Aetna of WY Medicare |
$171.39
|
| Rate for Payer: Beech Street Commercial |
$897.75
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$916.65
|
| Rate for Payer: Cigna of WY Commercial |
$926.10
|
| Rate for Payer: First Choice Health Commercial |
$850.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$897.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$171.39
|
| Rate for Payer: HealthUtah PPO |
$945.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$916.65
|
| Rate for Payer: Multiplan Medicare/VA |
$145.68
|
| Rate for Payer: One Health Plan of WY PPO |
$926.10
|
| Rate for Payer: PacificSource Commercial |
$850.50
|
| Rate for Payer: PHCS PPO |
$897.75
|
| Rate for Payer: Three Rivers PPO |
$708.75
|
| Rate for Payer: TriWest Veterans Administration |
$171.39
|
| Rate for Payer: United Healthcare Commercial |
$822.15
|
| Rate for Payer: United Healthcare Medicare |
$171.39
|
| Rate for Payer: WINHealth Partners Commercial |
$803.25
|
|
|
AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 20936
|
| Hospital Charge Code |
20936
|
| Min. Negotiated Rate |
$977.25 |
| Max. Negotiated Rate |
$1,303.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,276.94
|
| Rate for Payer: Beech Street Commercial |
$1,237.85
|
| Rate for Payer: Cash Price |
$912.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,263.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,276.94
|
| Rate for Payer: First Choice Health Commercial |
$1,172.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,237.85
|
| Rate for Payer: HealthUtah PPO |
$1,303.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,263.91
|
| Rate for Payer: One Health Plan of WY PPO |
$1,276.94
|
| Rate for Payer: PacificSource Commercial |
$1,172.70
|
| Rate for Payer: PHCS PPO |
$1,237.85
|
| Rate for Payer: Three Rivers PPO |
$977.25
|
| Rate for Payer: United Healthcare Commercial |
$1,133.61
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.55
|
|
|
AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 20937 AS
|
| Hospital Charge Code |
20937
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$844.76
|
| Rate for Payer: Aetna of WY Medicare |
$156.23
|
| Rate for Payer: Beech Street Commercial |
$818.90
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$836.14
|
| Rate for Payer: Cigna of WY Commercial |
$844.76
|
| Rate for Payer: First Choice Health Commercial |
$775.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$818.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.23
|
| Rate for Payer: HealthUtah PPO |
$862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$836.14
|
| Rate for Payer: Multiplan Medicare/VA |
$132.80
|
| Rate for Payer: One Health Plan of WY PPO |
$844.76
|
| Rate for Payer: PacificSource Commercial |
$775.80
|
| Rate for Payer: PHCS PPO |
$818.90
|
| Rate for Payer: Three Rivers PPO |
$646.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.23
|
| Rate for Payer: United Healthcare Commercial |
$749.94
|
| Rate for Payer: United Healthcare Medicare |
$156.23
|
| Rate for Payer: WINHealth Partners Commercial |
$732.70
|
|
|
AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 20937
|
| Hospital Charge Code |
20937
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$844.76
|
| Rate for Payer: Aetna of WY Medicare |
$156.23
|
| Rate for Payer: Beech Street Commercial |
$818.90
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$836.14
|
| Rate for Payer: Cigna of WY Commercial |
$844.76
|
| Rate for Payer: First Choice Health Commercial |
$775.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$818.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.23
|
| Rate for Payer: HealthUtah PPO |
$862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$836.14
|
| Rate for Payer: Multiplan Medicare/VA |
$132.80
|
| Rate for Payer: One Health Plan of WY PPO |
$844.76
|
| Rate for Payer: PacificSource Commercial |
$775.80
|
| Rate for Payer: PHCS PPO |
$818.90
|
| Rate for Payer: Three Rivers PPO |
$646.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.23
|
| Rate for Payer: United Healthcare Commercial |
$749.94
|
| Rate for Payer: United Healthcare Medicare |
$156.23
|
| Rate for Payer: WINHealth Partners Commercial |
$732.70
|
|
|
AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 20937 80
|
| Hospital Charge Code |
20937
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$844.76
|
| Rate for Payer: Aetna of WY Medicare |
$156.23
|
| Rate for Payer: Beech Street Commercial |
$818.90
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: Cash Price |
$603.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$836.14
|
| Rate for Payer: Cigna of WY Commercial |
$844.76
|
| Rate for Payer: First Choice Health Commercial |
$775.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$818.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$156.23
|
| Rate for Payer: HealthUtah PPO |
$862.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$836.14
|
| Rate for Payer: Multiplan Medicare/VA |
$132.80
|
| Rate for Payer: One Health Plan of WY PPO |
$844.76
|
| Rate for Payer: PacificSource Commercial |
$775.80
|
| Rate for Payer: PHCS PPO |
$818.90
|
| Rate for Payer: Three Rivers PPO |
$646.50
|
| Rate for Payer: TriWest Veterans Administration |
$156.23
|
| Rate for Payer: United Healthcare Commercial |
$749.94
|
| Rate for Payer: United Healthcare Medicare |
$156.23
|
| Rate for Payer: WINHealth Partners Commercial |
$732.70
|
|
|
AUTOLOGOUS TISSUE COLLECTOR
|
Facility
|
OP
|
$1,573.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$867.21 |
| Max. Negotiated Rate |
$1,573.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,542.40
|
| Rate for Payer: Aetna of WY Medicare |
$1,038.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,510.92
|
| Rate for Payer: Altius Commercial |
$1,510.92
|
| Rate for Payer: Beech Street Commercial |
$1,542.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,292.16
|
| Rate for Payer: Cash Price |
$1,101.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,526.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,542.40
|
| Rate for Payer: Entrust Commercial |
$1,495.19
|
| Rate for Payer: First Choice Health Commercial |
$1,495.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,495.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$912.85
|
| Rate for Payer: HealthUtah PPO |
$1,573.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,526.66
|
| Rate for Payer: Multiplan Medicare/VA |
$867.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,542.40
|
| Rate for Payer: PacificSource Commercial |
$1,416.49
|
| Rate for Payer: PHCS PPO |
$1,542.40
|
| Rate for Payer: Three Rivers PPO |
$1,180.41
|
| Rate for Payer: TriWest Veterans Administration |
$912.85
|
| Rate for Payer: United Healthcare Commercial |
$1,369.28
|
| Rate for Payer: United Healthcare Medicare |
$912.85
|
| Rate for Payer: WINHealth Partners Commercial |
$1,542.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1,495.19
|
|
|
AUTOLOGOUS TISSUE COLLECTOR
|
Facility
|
IP
|
$1,573.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$986.82 |
| Max. Negotiated Rate |
$1,573.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,542.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,510.92
|
| Rate for Payer: Altius Commercial |
$1,510.92
|
| Rate for Payer: Beech Street Commercial |
$1,542.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,292.16
|
| Rate for Payer: Cash Price |
$1,101.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,526.66
|
| Rate for Payer: Cigna of WY Commercial |
$1,542.40
|
| Rate for Payer: Entrust Commercial |
$1,495.19
|
| Rate for Payer: First Choice Health Commercial |
$1,495.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,495.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,038.76
|
| Rate for Payer: HealthUtah PPO |
$1,573.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,526.66
|
| Rate for Payer: Multiplan Medicare/VA |
$986.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,542.40
|
| Rate for Payer: PacificSource Commercial |
$1,416.49
|
| Rate for Payer: PHCS PPO |
$1,542.40
|
| Rate for Payer: Three Rivers PPO |
$1,180.41
|
| Rate for Payer: TriWest Veterans Administration |
$1,038.76
|
| Rate for Payer: United Healthcare Commercial |
$1,369.28
|
| Rate for Payer: United Healthcare Medicare |
$1,038.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,495.19
|
| Rate for Payer: Wise Provider Network Commercial |
$1,495.19
|
|
|
AVOX 4000 CUVETTES
|
Facility
|
OP
|
$24.11
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.63
|
| Rate for Payer: Aetna of WY Medicare |
$15.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.15
|
| Rate for Payer: Altius Commercial |
$23.15
|
| Rate for Payer: Beech Street Commercial |
$23.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.79
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.39
|
| Rate for Payer: Cigna of WY Commercial |
$23.63
|
| Rate for Payer: Entrust Commercial |
$22.90
|
| Rate for Payer: First Choice Health Commercial |
$22.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.98
|
| Rate for Payer: HealthUtah PPO |
$24.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.39
|
| Rate for Payer: Multiplan Medicare/VA |
$13.28
|
| Rate for Payer: One Health Plan of WY PPO |
$23.63
|
| Rate for Payer: PacificSource Commercial |
$21.70
|
| Rate for Payer: PHCS PPO |
$23.63
|
| Rate for Payer: Three Rivers PPO |
$18.08
|
| Rate for Payer: TriWest Veterans Administration |
$13.98
|
| Rate for Payer: United Healthcare Commercial |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$13.98
|
| Rate for Payer: WINHealth Partners Commercial |
$23.63
|
| Rate for Payer: Wise Provider Network Commercial |
$22.90
|
|
|
AVOX 4000 CUVETTES
|
Facility
|
IP
|
$24.11
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.15
|
| Rate for Payer: Altius Commercial |
$23.15
|
| Rate for Payer: Beech Street Commercial |
$23.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.79
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.39
|
| Rate for Payer: Cigna of WY Commercial |
$23.63
|
| Rate for Payer: Entrust Commercial |
$22.90
|
| Rate for Payer: First Choice Health Commercial |
$22.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.91
|
| Rate for Payer: HealthUtah PPO |
$24.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.39
|
| Rate for Payer: Multiplan Medicare/VA |
$15.12
|
| Rate for Payer: One Health Plan of WY PPO |
$23.63
|
| Rate for Payer: PacificSource Commercial |
$21.70
|
| Rate for Payer: PHCS PPO |
$23.63
|
| Rate for Payer: Three Rivers PPO |
$18.08
|
| Rate for Payer: TriWest Veterans Administration |
$15.91
|
| Rate for Payer: United Healthcare Commercial |
$20.98
|
| Rate for Payer: United Healthcare Medicare |
$15.91
|
| Rate for Payer: WINHealth Partners Commercial |
$22.90
|
| Rate for Payer: Wise Provider Network Commercial |
$22.90
|
|
|
AVOX-4 CO OXIMETER CTRL LEVEL
|
Facility
|
IP
|
$68.64
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$68.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$67.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$65.89
|
| Rate for Payer: Altius Commercial |
$65.89
|
| Rate for Payer: Beech Street Commercial |
$67.27
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$56.35
|
| Rate for Payer: Cash Price |
$48.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$66.58
|
| Rate for Payer: Cigna of WY Commercial |
$67.27
|
| Rate for Payer: Entrust Commercial |
$65.21
|
| Rate for Payer: First Choice Health Commercial |
$65.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$65.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$45.30
|
| Rate for Payer: HealthUtah PPO |
$68.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$66.58
|
| Rate for Payer: Multiplan Medicare/VA |
$43.04
|
| Rate for Payer: One Health Plan of WY PPO |
$67.27
|
| Rate for Payer: PacificSource Commercial |
$61.78
|
| Rate for Payer: PHCS PPO |
$67.27
|
| Rate for Payer: Three Rivers PPO |
$51.48
|
| Rate for Payer: TriWest Veterans Administration |
$45.30
|
| Rate for Payer: United Healthcare Commercial |
$59.72
|
| Rate for Payer: United Healthcare Medicare |
$45.30
|
| Rate for Payer: WINHealth Partners Commercial |
$65.21
|
| Rate for Payer: Wise Provider Network Commercial |
$65.21
|
|
