|
IRRIG RANGER WARMING KIT 24750
|
Facility
|
OP
|
$132.74
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.14 |
| Max. Negotiated Rate |
$132.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.09
|
| Rate for Payer: Aetna of WY Medicare |
$87.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$127.43
|
| Rate for Payer: Altius Commercial |
$127.43
|
| Rate for Payer: Beech Street Commercial |
$130.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$108.98
|
| Rate for Payer: Cash Price |
$92.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.76
|
| Rate for Payer: Cigna of WY Commercial |
$130.09
|
| Rate for Payer: Entrust Commercial |
$126.10
|
| Rate for Payer: First Choice Health Commercial |
$126.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.99
|
| Rate for Payer: HealthUtah PPO |
$132.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.76
|
| Rate for Payer: Multiplan Medicare/VA |
$73.14
|
| Rate for Payer: One Health Plan of WY PPO |
$130.09
|
| Rate for Payer: PacificSource Commercial |
$119.47
|
| Rate for Payer: PHCS PPO |
$130.09
|
| Rate for Payer: Three Rivers PPO |
$99.56
|
| Rate for Payer: TriWest Veterans Administration |
$76.99
|
| Rate for Payer: United Healthcare Commercial |
$115.48
|
| Rate for Payer: United Healthcare Medicare |
$76.99
|
| Rate for Payer: WINHealth Partners Commercial |
$130.09
|
| Rate for Payer: Wise Provider Network Commercial |
$126.10
|
|
|
IRRIG SOL H2O 1L BOTTLE R5000
|
Facility
|
IP
|
$6.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.77
|
| Rate for Payer: Altius Commercial |
$5.77
|
| Rate for Payer: Beech Street Commercial |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.83
|
| Rate for Payer: Cigna of WY Commercial |
$5.89
|
| Rate for Payer: Entrust Commercial |
$5.71
|
| Rate for Payer: First Choice Health Commercial |
$5.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.97
|
| Rate for Payer: HealthUtah PPO |
$6.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.83
|
| Rate for Payer: Multiplan Medicare/VA |
$3.77
|
| Rate for Payer: One Health Plan of WY PPO |
$5.89
|
| Rate for Payer: PacificSource Commercial |
$5.41
|
| Rate for Payer: PHCS PPO |
$5.89
|
| Rate for Payer: Three Rivers PPO |
$4.51
|
| Rate for Payer: TriWest Veterans Administration |
$3.97
|
| Rate for Payer: United Healthcare Commercial |
$5.23
|
| Rate for Payer: United Healthcare Medicare |
$3.97
|
| Rate for Payer: WINHealth Partners Commercial |
$5.71
|
| Rate for Payer: Wise Provider Network Commercial |
$5.71
|
|
|
IRRIG SOL H2O 1L BOTTLE R5000
|
Facility
|
OP
|
$6.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.89
|
| Rate for Payer: Aetna of WY Medicare |
$3.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.77
|
| Rate for Payer: Altius Commercial |
$5.77
|
| Rate for Payer: Beech Street Commercial |
$5.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.83
|
| Rate for Payer: Cigna of WY Commercial |
$5.89
|
| Rate for Payer: Entrust Commercial |
$5.71
|
| Rate for Payer: First Choice Health Commercial |
$5.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.49
|
| Rate for Payer: HealthUtah PPO |
$6.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.83
|
| Rate for Payer: Multiplan Medicare/VA |
$3.31
|
| Rate for Payer: One Health Plan of WY PPO |
$5.89
|
| Rate for Payer: PacificSource Commercial |
$5.41
|
| Rate for Payer: PHCS PPO |
$5.89
|
| Rate for Payer: Three Rivers PPO |
$4.51
|
| Rate for Payer: TriWest Veterans Administration |
$3.49
|
| Rate for Payer: United Healthcare Commercial |
$5.23
|
| Rate for Payer: United Healthcare Medicare |
$3.49
|
| Rate for Payer: WINHealth Partners Commercial |
$5.89
|
| Rate for Payer: Wise Provider Network Commercial |
$5.71
|
|
|
IRRIG SOL LAC RINGER 3L R8306
|
Facility
|
OP
|
$44.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.92
|
| Rate for Payer: Aetna of WY Medicare |
$29.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.03
|
| Rate for Payer: Altius Commercial |
$43.03
|
| Rate for Payer: Beech Street Commercial |
$43.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.48
|
| Rate for Payer: Cigna of WY Commercial |
$43.92
|
| Rate for Payer: Entrust Commercial |
$42.58
|
| Rate for Payer: First Choice Health Commercial |
$42.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.00
|
| Rate for Payer: HealthUtah PPO |
$44.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.48
|
| Rate for Payer: Multiplan Medicare/VA |
$24.70
|
| Rate for Payer: One Health Plan of WY PPO |
$43.92
|
| Rate for Payer: PacificSource Commercial |
$40.34
|
| Rate for Payer: PHCS PPO |
$43.92
|
| Rate for Payer: Three Rivers PPO |
$33.62
|
| Rate for Payer: TriWest Veterans Administration |
$26.00
|
| Rate for Payer: United Healthcare Commercial |
$38.99
|
| Rate for Payer: United Healthcare Medicare |
$26.00
|
| Rate for Payer: WINHealth Partners Commercial |
$43.92
|
| Rate for Payer: Wise Provider Network Commercial |
$42.58
|
|
|
IRRIG SOL LAC RINGER 3L R8306
|
Facility
|
IP
|
$44.82
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.03
|
| Rate for Payer: Altius Commercial |
$43.03
|
| Rate for Payer: Beech Street Commercial |
$43.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.48
|
| Rate for Payer: Cigna of WY Commercial |
$43.92
|
| Rate for Payer: Entrust Commercial |
$42.58
|
| Rate for Payer: First Choice Health Commercial |
$42.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.58
|
| Rate for Payer: HealthUtah PPO |
$44.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.48
|
| Rate for Payer: Multiplan Medicare/VA |
$28.10
|
| Rate for Payer: One Health Plan of WY PPO |
$43.92
|
| Rate for Payer: PacificSource Commercial |
$40.34
|
| Rate for Payer: PHCS PPO |
$43.92
|
| Rate for Payer: Three Rivers PPO |
$33.62
|
| Rate for Payer: TriWest Veterans Administration |
$29.58
|
| Rate for Payer: United Healthcare Commercial |
$38.99
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
| Rate for Payer: WINHealth Partners Commercial |
$42.58
|
| Rate for Payer: Wise Provider Network Commercial |
$42.58
|
|
|
IRRIG SOL NACL .9% 3L R8206
|
Facility
|
OP
|
$43.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.15
|
| Rate for Payer: Aetna of WY Medicare |
$28.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.29
|
| Rate for Payer: Altius Commercial |
$41.29
|
| Rate for Payer: Beech Street Commercial |
$42.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.31
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.72
|
| Rate for Payer: Cigna of WY Commercial |
$42.15
|
| Rate for Payer: Entrust Commercial |
$40.86
|
| Rate for Payer: First Choice Health Commercial |
$40.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.95
|
| Rate for Payer: HealthUtah PPO |
$43.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.72
|
| Rate for Payer: Multiplan Medicare/VA |
$23.70
|
| Rate for Payer: One Health Plan of WY PPO |
$42.15
|
| Rate for Payer: PacificSource Commercial |
$38.71
|
| Rate for Payer: PHCS PPO |
$42.15
|
| Rate for Payer: Three Rivers PPO |
$32.26
|
| Rate for Payer: TriWest Veterans Administration |
$24.95
|
| Rate for Payer: United Healthcare Commercial |
$37.42
|
| Rate for Payer: United Healthcare Medicare |
$24.95
|
| Rate for Payer: WINHealth Partners Commercial |
$42.15
|
| Rate for Payer: Wise Provider Network Commercial |
$40.86
|
|
|
IRRIG SOL NACL .9% 3L R8206
|
Facility
|
IP
|
$43.01
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.29
|
| Rate for Payer: Altius Commercial |
$41.29
|
| Rate for Payer: Beech Street Commercial |
$42.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.31
|
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.72
|
| Rate for Payer: Cigna of WY Commercial |
$42.15
|
| Rate for Payer: Entrust Commercial |
$40.86
|
| Rate for Payer: First Choice Health Commercial |
$40.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.39
|
| Rate for Payer: HealthUtah PPO |
$43.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.72
|
| Rate for Payer: Multiplan Medicare/VA |
$26.97
|
| Rate for Payer: One Health Plan of WY PPO |
$42.15
|
| Rate for Payer: PacificSource Commercial |
$38.71
|
| Rate for Payer: PHCS PPO |
$42.15
|
| Rate for Payer: Three Rivers PPO |
$32.26
|
| Rate for Payer: TriWest Veterans Administration |
$28.39
|
| Rate for Payer: United Healthcare Commercial |
$37.42
|
| Rate for Payer: United Healthcare Medicare |
$28.39
|
| Rate for Payer: WINHealth Partners Commercial |
$40.86
|
| Rate for Payer: Wise Provider Network Commercial |
$40.86
|
|
|
IRRIG STERILE WATER 3L BAG
|
Facility
|
IP
|
$44.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.80
|
| Rate for Payer: Altius Commercial |
$42.80
|
| Rate for Payer: Beech Street Commercial |
$43.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.24
|
| Rate for Payer: Cigna of WY Commercial |
$43.69
|
| Rate for Payer: Entrust Commercial |
$42.35
|
| Rate for Payer: First Choice Health Commercial |
$42.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.42
|
| Rate for Payer: HealthUtah PPO |
$44.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.24
|
| Rate for Payer: Multiplan Medicare/VA |
$27.95
|
| Rate for Payer: One Health Plan of WY PPO |
$43.69
|
| Rate for Payer: PacificSource Commercial |
$40.12
|
| Rate for Payer: PHCS PPO |
$43.69
|
| Rate for Payer: Three Rivers PPO |
$33.44
|
| Rate for Payer: TriWest Veterans Administration |
$29.42
|
| Rate for Payer: United Healthcare Commercial |
$38.78
|
| Rate for Payer: United Healthcare Medicare |
$29.42
|
| Rate for Payer: WINHealth Partners Commercial |
$42.35
|
| Rate for Payer: Wise Provider Network Commercial |
$42.35
|
|
|
IRRIG STERILE WATER 3L BAG
|
Facility
|
OP
|
$44.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.69
|
| Rate for Payer: Aetna of WY Medicare |
$29.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.80
|
| Rate for Payer: Altius Commercial |
$42.80
|
| Rate for Payer: Beech Street Commercial |
$43.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$36.60
|
| Rate for Payer: Cash Price |
$31.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.24
|
| Rate for Payer: Cigna of WY Commercial |
$43.69
|
| Rate for Payer: Entrust Commercial |
$42.35
|
| Rate for Payer: First Choice Health Commercial |
$42.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.86
|
| Rate for Payer: HealthUtah PPO |
$44.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.24
|
| Rate for Payer: Multiplan Medicare/VA |
$24.56
|
| Rate for Payer: One Health Plan of WY PPO |
$43.69
|
| Rate for Payer: PacificSource Commercial |
$40.12
|
| Rate for Payer: PHCS PPO |
$43.69
|
| Rate for Payer: Three Rivers PPO |
$33.44
|
| Rate for Payer: TriWest Veterans Administration |
$25.86
|
| Rate for Payer: United Healthcare Commercial |
$38.78
|
| Rate for Payer: United Healthcare Medicare |
$25.86
|
| Rate for Payer: WINHealth Partners Commercial |
$43.69
|
| Rate for Payer: Wise Provider Network Commercial |
$42.35
|
|
|
IRRIG TUBING 4 LINE SET 313004
|
Facility
|
OP
|
$35.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$35.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.25
|
| Rate for Payer: Aetna of WY Medicare |
$23.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.53
|
| Rate for Payer: Altius Commercial |
$34.53
|
| Rate for Payer: Beech Street Commercial |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$25.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.89
|
| Rate for Payer: Cigna of WY Commercial |
$35.25
|
| Rate for Payer: Entrust Commercial |
$34.17
|
| Rate for Payer: First Choice Health Commercial |
$34.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.86
|
| Rate for Payer: HealthUtah PPO |
$35.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.89
|
| Rate for Payer: Multiplan Medicare/VA |
$19.82
|
| Rate for Payer: One Health Plan of WY PPO |
$35.25
|
| Rate for Payer: PacificSource Commercial |
$32.37
|
| Rate for Payer: PHCS PPO |
$35.25
|
| Rate for Payer: Three Rivers PPO |
$26.98
|
| Rate for Payer: TriWest Veterans Administration |
$20.86
|
| Rate for Payer: United Healthcare Commercial |
$31.29
|
| Rate for Payer: United Healthcare Medicare |
$20.86
|
| Rate for Payer: WINHealth Partners Commercial |
$35.25
|
| Rate for Payer: Wise Provider Network Commercial |
$34.17
|
|
|
IRRIG TUBING 4 LINE SET 313004
|
Facility
|
IP
|
$35.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$35.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$35.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$34.53
|
| Rate for Payer: Altius Commercial |
$34.53
|
| Rate for Payer: Beech Street Commercial |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$25.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$34.89
|
| Rate for Payer: Cigna of WY Commercial |
$35.25
|
| Rate for Payer: Entrust Commercial |
$34.17
|
| Rate for Payer: First Choice Health Commercial |
$34.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$34.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.74
|
| Rate for Payer: HealthUtah PPO |
$35.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$34.89
|
| Rate for Payer: Multiplan Medicare/VA |
$22.55
|
| Rate for Payer: One Health Plan of WY PPO |
$35.25
|
| Rate for Payer: PacificSource Commercial |
$32.37
|
| Rate for Payer: PHCS PPO |
$35.25
|
| Rate for Payer: Three Rivers PPO |
$26.98
|
| Rate for Payer: TriWest Veterans Administration |
$23.74
|
| Rate for Payer: United Healthcare Commercial |
$31.29
|
| Rate for Payer: United Healthcare Medicare |
$23.74
|
| Rate for Payer: WINHealth Partners Commercial |
$34.17
|
| Rate for Payer: Wise Provider Network Commercial |
$34.17
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [4784]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 6808459101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Aetna of WY Medicare |
$1.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.02
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.22
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Medicare |
$1.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [4784]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 6808459101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.02
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [4784]
|
Facility
|
OP
|
$1.52
|
|
|
Service Code
|
NDC 0904644961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.49
|
| Rate for Payer: Aetna of WY Medicare |
$1.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.46
|
| Rate for Payer: Altius Commercial |
$1.46
|
| Rate for Payer: Beech Street Commercial |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.47
|
| Rate for Payer: Cigna of WY Commercial |
$1.49
|
| Rate for Payer: Entrust Commercial |
$1.44
|
| Rate for Payer: First Choice Health Commercial |
$1.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.88
|
| Rate for Payer: HealthUtah PPO |
$1.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.84
|
| Rate for Payer: One Health Plan of WY PPO |
$1.49
|
| Rate for Payer: PacificSource Commercial |
$1.37
|
| Rate for Payer: PHCS PPO |
$1.49
|
| Rate for Payer: Three Rivers PPO |
$1.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
| Rate for Payer: United Healthcare Medicare |
$0.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1.49
|
| Rate for Payer: Wise Provider Network Commercial |
$1.44
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [4784]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 6808459111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.02
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.39
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.32
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Medicare |
$1.39
|
| Rate for Payer: WINHealth Partners Commercial |
$2.00
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [4784]
|
Facility
|
IP
|
$1.52
|
|
|
Service Code
|
NDC 0904644961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.46
|
| Rate for Payer: Altius Commercial |
$1.46
|
| Rate for Payer: Beech Street Commercial |
$1.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.47
|
| Rate for Payer: Cigna of WY Commercial |
$1.49
|
| Rate for Payer: Entrust Commercial |
$1.44
|
| Rate for Payer: First Choice Health Commercial |
$1.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.00
|
| Rate for Payer: HealthUtah PPO |
$1.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.47
|
| Rate for Payer: Multiplan Medicare/VA |
$0.95
|
| Rate for Payer: One Health Plan of WY PPO |
$1.49
|
| Rate for Payer: PacificSource Commercial |
$1.37
|
| Rate for Payer: PHCS PPO |
$1.49
|
| Rate for Payer: Three Rivers PPO |
$1.14
|
| Rate for Payer: TriWest Veterans Administration |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
| Rate for Payer: United Healthcare Medicare |
$1.00
|
| Rate for Payer: WINHealth Partners Commercial |
$1.44
|
| Rate for Payer: Wise Provider Network Commercial |
$1.44
|
|
|
ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [4784]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 6808459111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.06
|
| Rate for Payer: Aetna of WY Medicare |
$1.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.02
|
| Rate for Payer: Altius Commercial |
$2.02
|
| Rate for Payer: Beech Street Commercial |
$2.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.04
|
| Rate for Payer: Cigna of WY Commercial |
$2.06
|
| Rate for Payer: Entrust Commercial |
$2.00
|
| Rate for Payer: First Choice Health Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.22
|
| Rate for Payer: HealthUtah PPO |
$2.10
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.04
|
| Rate for Payer: Multiplan Medicare/VA |
$1.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2.06
|
| Rate for Payer: PacificSource Commercial |
$1.89
|
| Rate for Payer: PHCS PPO |
$2.06
|
| Rate for Payer: Three Rivers PPO |
$1.58
|
| Rate for Payer: TriWest Veterans Administration |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.83
|
| Rate for Payer: United Healthcare Medicare |
$1.22
|
| Rate for Payer: WINHealth Partners Commercial |
$2.06
|
| Rate for Payer: Wise Provider Network Commercial |
$2.00
|
|
|
IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
96361
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$179.34
|
| Rate for Payer: Aetna of WY Medicare |
$12.03
|
| Rate for Payer: Beech Street Commercial |
$173.85
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$177.51
|
| Rate for Payer: Cigna of WY Commercial |
$179.34
|
| Rate for Payer: First Choice Health Commercial |
$164.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$173.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.03
|
| Rate for Payer: HealthUtah PPO |
$183.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$177.51
|
| Rate for Payer: Multiplan Medicare/VA |
$10.23
|
| Rate for Payer: One Health Plan of WY PPO |
$179.34
|
| Rate for Payer: PacificSource Commercial |
$164.70
|
| Rate for Payer: PHCS PPO |
$173.85
|
| Rate for Payer: Three Rivers PPO |
$137.25
|
| Rate for Payer: TriWest Veterans Administration |
$12.03
|
| Rate for Payer: United Healthcare Commercial |
$159.21
|
| Rate for Payer: United Healthcare Medicare |
$12.03
|
| Rate for Payer: WINHealth Partners Commercial |
$173.85
|
|
|
IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
96360
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$201.88
|
| Rate for Payer: Aetna of WY Medicare |
$31.68
|
| Rate for Payer: Beech Street Commercial |
$195.70
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: Cash Price |
$144.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$199.82
|
| Rate for Payer: Cigna of WY Commercial |
$201.88
|
| Rate for Payer: First Choice Health Commercial |
$185.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$195.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.68
|
| Rate for Payer: HealthUtah PPO |
$206.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$199.82
|
| Rate for Payer: Multiplan Medicare/VA |
$26.93
|
| Rate for Payer: One Health Plan of WY PPO |
$201.88
|
| Rate for Payer: PacificSource Commercial |
$185.40
|
| Rate for Payer: PHCS PPO |
$195.70
|
| Rate for Payer: Three Rivers PPO |
$154.50
|
| Rate for Payer: TriWest Veterans Administration |
$31.68
|
| Rate for Payer: United Healthcare Commercial |
$179.22
|
| Rate for Payer: United Healthcare Medicare |
$31.68
|
| Rate for Payer: WINHealth Partners Commercial |
$195.70
|
|
|
IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
96365
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$220.50
|
| Rate for Payer: Aetna of WY Medicare |
$61.22
|
| Rate for Payer: Beech Street Commercial |
$213.75
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$218.25
|
| Rate for Payer: Cigna of WY Commercial |
$220.50
|
| Rate for Payer: First Choice Health Commercial |
$202.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$213.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.22
|
| Rate for Payer: HealthUtah PPO |
$225.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$218.25
|
| Rate for Payer: Multiplan Medicare/VA |
$52.04
|
| Rate for Payer: One Health Plan of WY PPO |
$220.50
|
| Rate for Payer: PacificSource Commercial |
$202.50
|
| Rate for Payer: PHCS PPO |
$213.75
|
| Rate for Payer: Three Rivers PPO |
$168.75
|
| Rate for Payer: TriWest Veterans Administration |
$61.22
|
| Rate for Payer: United Healthcare Commercial |
$195.75
|
| Rate for Payer: United Healthcare Medicare |
$61.22
|
| Rate for Payer: WINHealth Partners Commercial |
$213.75
|
|
|
IVL GENERATOR & CONNECTOR CABLE KIT
|
Facility
|
IP
|
$52,500.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32,917.50 |
| Max. Negotiated Rate |
$52,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51,450.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50,400.00
|
| Rate for Payer: Altius Commercial |
$50,400.00
|
| Rate for Payer: Beech Street Commercial |
$51,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43,102.50
|
| Rate for Payer: Cash Price |
$36,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$50,925.00
|
| Rate for Payer: Cigna of WY Commercial |
$51,450.00
|
| Rate for Payer: Entrust Commercial |
$49,875.00
|
| Rate for Payer: First Choice Health Commercial |
$49,875.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49,875.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34,650.00
|
| Rate for Payer: HealthUtah PPO |
$52,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50,925.00
|
| Rate for Payer: Multiplan Medicare/VA |
$32,917.50
|
| Rate for Payer: One Health Plan of WY PPO |
$51,450.00
|
| Rate for Payer: PacificSource Commercial |
$47,250.00
|
| Rate for Payer: PHCS PPO |
$51,450.00
|
| Rate for Payer: Three Rivers PPO |
$39,375.00
|
| Rate for Payer: TriWest Veterans Administration |
$34,650.00
|
| Rate for Payer: United Healthcare Commercial |
$45,675.00
|
| Rate for Payer: United Healthcare Medicare |
$34,650.00
|
| Rate for Payer: WINHealth Partners Commercial |
$49,875.00
|
| Rate for Payer: Wise Provider Network Commercial |
$49,875.00
|
|
|
IVL GENERATOR & CONNECTOR CABLE KIT
|
Facility
|
OP
|
$52,500.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28,927.50 |
| Max. Negotiated Rate |
$52,500.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$51,450.00
|
| Rate for Payer: Aetna of WY Medicare |
$34,650.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$50,400.00
|
| Rate for Payer: Altius Commercial |
$50,400.00
|
| Rate for Payer: Beech Street Commercial |
$51,450.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43,102.50
|
| Rate for Payer: Cash Price |
$36,750.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$50,925.00
|
| Rate for Payer: Cigna of WY Commercial |
$51,450.00
|
| Rate for Payer: Entrust Commercial |
$49,875.00
|
| Rate for Payer: First Choice Health Commercial |
$49,875.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$49,875.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30,450.00
|
| Rate for Payer: HealthUtah PPO |
$52,500.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$50,925.00
|
| Rate for Payer: Multiplan Medicare/VA |
$28,927.50
|
| Rate for Payer: One Health Plan of WY PPO |
$51,450.00
|
| Rate for Payer: PacificSource Commercial |
$47,250.00
|
| Rate for Payer: PHCS PPO |
$51,450.00
|
| Rate for Payer: Three Rivers PPO |
$39,375.00
|
| Rate for Payer: TriWest Veterans Administration |
$30,450.00
|
| Rate for Payer: United Healthcare Commercial |
$45,675.00
|
| Rate for Payer: United Healthcare Medicare |
$30,450.00
|
| Rate for Payer: WINHealth Partners Commercial |
$51,450.00
|
| Rate for Payer: Wise Provider Network Commercial |
$49,875.00
|
|
|
IV SOL 9% NACL INJ 250ML L8002
|
Facility
|
OP
|
$6.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.40
|
| Rate for Payer: Aetna of WY Medicare |
$4.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.27
|
| Rate for Payer: Altius Commercial |
$6.27
|
| Rate for Payer: Beech Street Commercial |
$6.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.33
|
| Rate for Payer: Cigna of WY Commercial |
$6.40
|
| Rate for Payer: Entrust Commercial |
$6.20
|
| Rate for Payer: First Choice Health Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.79
|
| Rate for Payer: HealthUtah PPO |
$6.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.33
|
| Rate for Payer: Multiplan Medicare/VA |
$3.60
|
| Rate for Payer: One Health Plan of WY PPO |
$6.40
|
| Rate for Payer: PacificSource Commercial |
$5.88
|
| Rate for Payer: PHCS PPO |
$6.40
|
| Rate for Payer: Three Rivers PPO |
$4.90
|
| Rate for Payer: TriWest Veterans Administration |
$3.79
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
| Rate for Payer: United Healthcare Medicare |
$3.79
|
| Rate for Payer: WINHealth Partners Commercial |
$6.40
|
| Rate for Payer: Wise Provider Network Commercial |
$6.20
|
|
|
IV SOL 9% NACL INJ 250ML L8002
|
Facility
|
IP
|
$6.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.27
|
| Rate for Payer: Altius Commercial |
$6.27
|
| Rate for Payer: Beech Street Commercial |
$6.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$4.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.33
|
| Rate for Payer: Cigna of WY Commercial |
$6.40
|
| Rate for Payer: Entrust Commercial |
$6.20
|
| Rate for Payer: First Choice Health Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.31
|
| Rate for Payer: HealthUtah PPO |
$6.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.33
|
| Rate for Payer: Multiplan Medicare/VA |
$4.09
|
| Rate for Payer: One Health Plan of WY PPO |
$6.40
|
| Rate for Payer: PacificSource Commercial |
$5.88
|
| Rate for Payer: PHCS PPO |
$6.40
|
| Rate for Payer: Three Rivers PPO |
$4.90
|
| Rate for Payer: TriWest Veterans Administration |
$4.31
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
| Rate for Payer: United Healthcare Medicare |
$4.31
|
| Rate for Payer: WINHealth Partners Commercial |
$6.20
|
| Rate for Payer: Wise Provider Network Commercial |
$6.20
|
|
|
IV SOL DX 5% LR 1L L7510
|
Facility
|
OP
|
$7.86
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$7.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.70
|
| Rate for Payer: Aetna of WY Medicare |
$5.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$7.55
|
| Rate for Payer: Altius Commercial |
$7.55
|
| Rate for Payer: Beech Street Commercial |
$7.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.45
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.62
|
| Rate for Payer: Cigna of WY Commercial |
$7.70
|
| Rate for Payer: Entrust Commercial |
$7.47
|
| Rate for Payer: First Choice Health Commercial |
$7.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.56
|
| Rate for Payer: HealthUtah PPO |
$7.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.62
|
| Rate for Payer: Multiplan Medicare/VA |
$4.33
|
| Rate for Payer: One Health Plan of WY PPO |
$7.70
|
| Rate for Payer: PacificSource Commercial |
$7.07
|
| Rate for Payer: PHCS PPO |
$7.70
|
| Rate for Payer: Three Rivers PPO |
$5.90
|
| Rate for Payer: TriWest Veterans Administration |
$4.56
|
| Rate for Payer: United Healthcare Commercial |
$6.84
|
| Rate for Payer: United Healthcare Medicare |
$4.56
|
| Rate for Payer: WINHealth Partners Commercial |
$7.70
|
| Rate for Payer: Wise Provider Network Commercial |
$7.47
|
|
