|
LIGASURE CURVED LARGE JAW 36MM 18CM
|
Facility
|
OP
|
$2,144.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,181.78 |
| Max. Negotiated Rate |
$2,144.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,101.89
|
| Rate for Payer: Aetna of WY Medicare |
$1,415.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,059.00
|
| Rate for Payer: Altius Commercial |
$2,059.00
|
| Rate for Payer: Beech Street Commercial |
$2,101.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,760.87
|
| Rate for Payer: Cash Price |
$1,501.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,080.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,101.89
|
| Rate for Payer: Entrust Commercial |
$2,037.55
|
| Rate for Payer: First Choice Health Commercial |
$2,037.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,037.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,243.98
|
| Rate for Payer: HealthUtah PPO |
$2,144.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,080.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,181.78
|
| Rate for Payer: One Health Plan of WY PPO |
$2,101.89
|
| Rate for Payer: PacificSource Commercial |
$1,930.31
|
| Rate for Payer: PHCS PPO |
$2,101.89
|
| Rate for Payer: Three Rivers PPO |
$1,608.59
|
| Rate for Payer: TriWest Veterans Administration |
$1,243.98
|
| Rate for Payer: United Healthcare Commercial |
$1,865.97
|
| Rate for Payer: United Healthcare Medicare |
$1,243.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,101.89
|
| Rate for Payer: Wise Provider Network Commercial |
$2,037.55
|
|
|
LIGASURE CURVED LARGE JAW 36MM 18CM
|
Facility
|
IP
|
$2,144.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,344.78 |
| Max. Negotiated Rate |
$2,144.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,101.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,059.00
|
| Rate for Payer: Altius Commercial |
$2,059.00
|
| Rate for Payer: Beech Street Commercial |
$2,101.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,760.87
|
| Rate for Payer: Cash Price |
$1,501.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,080.45
|
| Rate for Payer: Cigna of WY Commercial |
$2,101.89
|
| Rate for Payer: Entrust Commercial |
$2,037.55
|
| Rate for Payer: First Choice Health Commercial |
$2,037.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,037.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,415.56
|
| Rate for Payer: HealthUtah PPO |
$2,144.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,080.45
|
| Rate for Payer: Multiplan Medicare/VA |
$1,344.78
|
| Rate for Payer: One Health Plan of WY PPO |
$2,101.89
|
| Rate for Payer: PacificSource Commercial |
$1,930.31
|
| Rate for Payer: PHCS PPO |
$2,101.89
|
| Rate for Payer: Three Rivers PPO |
$1,608.59
|
| Rate for Payer: TriWest Veterans Administration |
$1,415.56
|
| Rate for Payer: United Healthcare Commercial |
$1,865.97
|
| Rate for Payer: United Healthcare Medicare |
$1,415.56
|
| Rate for Payer: WINHealth Partners Commercial |
$2,037.55
|
| Rate for Payer: Wise Provider Network Commercial |
$2,037.55
|
|
|
LIGASURE EXACT DISSECTOR 20.6MM 21CM
|
Facility
|
IP
|
$1,800.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,128.68 |
| Max. Negotiated Rate |
$1,800.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.12
|
| Rate for Payer: Altius Commercial |
$1,728.12
|
| Rate for Payer: Beech Street Commercial |
$1,764.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.90
|
| Rate for Payer: Cash Price |
$1,260.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.12
|
| Rate for Payer: Entrust Commercial |
$1,710.11
|
| Rate for Payer: First Choice Health Commercial |
$1,710.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,188.08
|
| Rate for Payer: HealthUtah PPO |
$1,800.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.12
|
| Rate for Payer: Multiplan Medicare/VA |
$1,128.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.12
|
| Rate for Payer: PacificSource Commercial |
$1,620.11
|
| Rate for Payer: PHCS PPO |
$1,764.12
|
| Rate for Payer: Three Rivers PPO |
$1,350.09
|
| Rate for Payer: TriWest Veterans Administration |
$1,188.08
|
| Rate for Payer: United Healthcare Commercial |
$1,566.10
|
| Rate for Payer: United Healthcare Medicare |
$1,188.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,710.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.11
|
|
|
LIGASURE EXACT DISSECTOR 20.6MM 21CM
|
Facility
|
OP
|
$1,800.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.87 |
| Max. Negotiated Rate |
$1,800.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,764.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,188.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,728.12
|
| Rate for Payer: Altius Commercial |
$1,728.12
|
| Rate for Payer: Beech Street Commercial |
$1,764.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,477.90
|
| Rate for Payer: Cash Price |
$1,260.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,746.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,764.12
|
| Rate for Payer: Entrust Commercial |
$1,710.11
|
| Rate for Payer: First Choice Health Commercial |
$1,710.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,710.11
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,044.07
|
| Rate for Payer: HealthUtah PPO |
$1,800.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,746.12
|
| Rate for Payer: Multiplan Medicare/VA |
$991.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1,764.12
|
| Rate for Payer: PacificSource Commercial |
$1,620.11
|
| Rate for Payer: PHCS PPO |
$1,764.12
|
| Rate for Payer: Three Rivers PPO |
$1,350.09
|
| Rate for Payer: TriWest Veterans Administration |
$1,044.07
|
| Rate for Payer: United Healthcare Commercial |
$1,566.10
|
| Rate for Payer: United Healthcare Medicare |
$1,044.07
|
| Rate for Payer: WINHealth Partners Commercial |
$1,764.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1,710.11
|
|
|
LIGASURE MARYLAND 5MM 44CM
|
Facility
|
OP
|
$2,082.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,147.67 |
| Max. Negotiated Rate |
$2,082.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,041.23
|
| Rate for Payer: Aetna of WY Medicare |
$1,374.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,999.57
|
| Rate for Payer: Altius Commercial |
$1,999.57
|
| Rate for Payer: Beech Street Commercial |
$2,041.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,710.05
|
| Rate for Payer: Cash Price |
$1,458.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,020.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,041.23
|
| Rate for Payer: Entrust Commercial |
$1,978.75
|
| Rate for Payer: First Choice Health Commercial |
$1,978.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,978.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,208.08
|
| Rate for Payer: HealthUtah PPO |
$2,082.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,020.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,147.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2,041.23
|
| Rate for Payer: PacificSource Commercial |
$1,874.60
|
| Rate for Payer: PHCS PPO |
$2,041.23
|
| Rate for Payer: Three Rivers PPO |
$1,562.17
|
| Rate for Payer: TriWest Veterans Administration |
$1,208.08
|
| Rate for Payer: United Healthcare Commercial |
$1,812.11
|
| Rate for Payer: United Healthcare Medicare |
$1,208.08
|
| Rate for Payer: WINHealth Partners Commercial |
$2,041.23
|
| Rate for Payer: Wise Provider Network Commercial |
$1,978.75
|
|
|
LIGASURE MARYLAND 5MM 44CM
|
Facility
|
IP
|
$2,082.89
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,305.97 |
| Max. Negotiated Rate |
$2,082.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,041.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,999.57
|
| Rate for Payer: Altius Commercial |
$1,999.57
|
| Rate for Payer: Beech Street Commercial |
$2,041.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,710.05
|
| Rate for Payer: Cash Price |
$1,458.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,020.40
|
| Rate for Payer: Cigna of WY Commercial |
$2,041.23
|
| Rate for Payer: Entrust Commercial |
$1,978.75
|
| Rate for Payer: First Choice Health Commercial |
$1,978.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,978.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,374.71
|
| Rate for Payer: HealthUtah PPO |
$2,082.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,020.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1,305.97
|
| Rate for Payer: One Health Plan of WY PPO |
$2,041.23
|
| Rate for Payer: PacificSource Commercial |
$1,874.60
|
| Rate for Payer: PHCS PPO |
$2,041.23
|
| Rate for Payer: Three Rivers PPO |
$1,562.17
|
| Rate for Payer: TriWest Veterans Administration |
$1,374.71
|
| Rate for Payer: United Healthcare Commercial |
$1,812.11
|
| Rate for Payer: United Healthcare Medicare |
$1,374.71
|
| Rate for Payer: WINHealth Partners Commercial |
$1,978.75
|
| Rate for Payer: Wise Provider Network Commercial |
$1,978.75
|
|
|
LIGASURE MARYLAND JAW 5MM 23CM
|
Facility
|
IP
|
$1,937.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,215.11 |
| Max. Negotiated Rate |
$1,937.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,899.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,860.45
|
| Rate for Payer: Altius Commercial |
$1,860.45
|
| Rate for Payer: Beech Street Commercial |
$1,899.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,591.07
|
| Rate for Payer: Cash Price |
$1,356.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,879.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,899.21
|
| Rate for Payer: Entrust Commercial |
$1,841.07
|
| Rate for Payer: First Choice Health Commercial |
$1,841.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,841.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,279.06
|
| Rate for Payer: HealthUtah PPO |
$1,937.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,879.83
|
| Rate for Payer: Multiplan Medicare/VA |
$1,215.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1,899.21
|
| Rate for Payer: PacificSource Commercial |
$1,744.17
|
| Rate for Payer: PHCS PPO |
$1,899.21
|
| Rate for Payer: Three Rivers PPO |
$1,453.48
|
| Rate for Payer: TriWest Veterans Administration |
$1,279.06
|
| Rate for Payer: United Healthcare Commercial |
$1,686.03
|
| Rate for Payer: United Healthcare Medicare |
$1,279.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1,841.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1,841.07
|
|
|
LIGASURE MARYLAND JAW 5MM 23CM
|
Facility
|
OP
|
$1,937.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,067.82 |
| Max. Negotiated Rate |
$1,937.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,899.21
|
| Rate for Payer: Aetna of WY Medicare |
$1,279.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,860.45
|
| Rate for Payer: Altius Commercial |
$1,860.45
|
| Rate for Payer: Beech Street Commercial |
$1,899.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,591.07
|
| Rate for Payer: Cash Price |
$1,356.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,879.83
|
| Rate for Payer: Cigna of WY Commercial |
$1,899.21
|
| Rate for Payer: Entrust Commercial |
$1,841.07
|
| Rate for Payer: First Choice Health Commercial |
$1,841.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,841.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,124.02
|
| Rate for Payer: HealthUtah PPO |
$1,937.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,879.83
|
| Rate for Payer: Multiplan Medicare/VA |
$1,067.82
|
| Rate for Payer: One Health Plan of WY PPO |
$1,899.21
|
| Rate for Payer: PacificSource Commercial |
$1,744.17
|
| Rate for Payer: PHCS PPO |
$1,899.21
|
| Rate for Payer: Three Rivers PPO |
$1,453.48
|
| Rate for Payer: TriWest Veterans Administration |
$1,124.02
|
| Rate for Payer: United Healthcare Commercial |
$1,686.03
|
| Rate for Payer: United Healthcare Medicare |
$1,124.02
|
| Rate for Payer: WINHealth Partners Commercial |
$1,899.21
|
| Rate for Payer: Wise Provider Network Commercial |
$1,841.07
|
|
|
LIGASURE MARYLAND & L-HOOK 5MM 37CM
|
Facility
|
OP
|
$2,210.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.14 |
| Max. Negotiated Rate |
$2,210.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,166.56
|
| Rate for Payer: Aetna of WY Medicare |
$1,459.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,122.35
|
| Rate for Payer: Altius Commercial |
$2,122.35
|
| Rate for Payer: Beech Street Commercial |
$2,166.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,815.05
|
| Rate for Payer: Cash Price |
$1,547.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,144.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,166.56
|
| Rate for Payer: Entrust Commercial |
$2,100.24
|
| Rate for Payer: First Choice Health Commercial |
$2,100.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,100.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,282.25
|
| Rate for Payer: HealthUtah PPO |
$2,210.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,144.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1,218.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2,166.56
|
| Rate for Payer: PacificSource Commercial |
$1,989.70
|
| Rate for Payer: PHCS PPO |
$2,166.56
|
| Rate for Payer: Three Rivers PPO |
$1,658.08
|
| Rate for Payer: TriWest Veterans Administration |
$1,282.25
|
| Rate for Payer: United Healthcare Commercial |
$1,923.38
|
| Rate for Payer: United Healthcare Medicare |
$1,282.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,166.56
|
| Rate for Payer: Wise Provider Network Commercial |
$2,100.24
|
|
|
LIGASURE MARYLAND & L-HOOK 5MM 37CM
|
Facility
|
IP
|
$2,210.78
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.16 |
| Max. Negotiated Rate |
$2,210.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,166.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,122.35
|
| Rate for Payer: Altius Commercial |
$2,122.35
|
| Rate for Payer: Beech Street Commercial |
$2,166.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,815.05
|
| Rate for Payer: Cash Price |
$1,547.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,144.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,166.56
|
| Rate for Payer: Entrust Commercial |
$2,100.24
|
| Rate for Payer: First Choice Health Commercial |
$2,100.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,100.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,459.11
|
| Rate for Payer: HealthUtah PPO |
$2,210.78
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,144.46
|
| Rate for Payer: Multiplan Medicare/VA |
$1,386.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,166.56
|
| Rate for Payer: PacificSource Commercial |
$1,989.70
|
| Rate for Payer: PHCS PPO |
$2,166.56
|
| Rate for Payer: Three Rivers PPO |
$1,658.08
|
| Rate for Payer: TriWest Veterans Administration |
$1,459.11
|
| Rate for Payer: United Healthcare Commercial |
$1,923.38
|
| Rate for Payer: United Healthcare Medicare |
$1,459.11
|
| Rate for Payer: WINHealth Partners Commercial |
$2,100.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2,100.24
|
|
|
LIGATING CLIPS HORIZON RED
|
Facility
|
IP
|
$7.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.91
|
| Rate for Payer: Altius Commercial |
$6.91
|
| Rate for Payer: Beech Street Commercial |
$7.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.91
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.98
|
| Rate for Payer: Cigna of WY Commercial |
$7.06
|
| Rate for Payer: Entrust Commercial |
$6.84
|
| Rate for Payer: First Choice Health Commercial |
$6.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.75
|
| Rate for Payer: HealthUtah PPO |
$7.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.98
|
| Rate for Payer: Multiplan Medicare/VA |
$4.51
|
| Rate for Payer: One Health Plan of WY PPO |
$7.06
|
| Rate for Payer: PacificSource Commercial |
$6.48
|
| Rate for Payer: PHCS PPO |
$7.06
|
| Rate for Payer: Three Rivers PPO |
$5.40
|
| Rate for Payer: TriWest Veterans Administration |
$4.75
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$4.75
|
| Rate for Payer: WINHealth Partners Commercial |
$6.84
|
| Rate for Payer: Wise Provider Network Commercial |
$6.84
|
|
|
LIGATING CLIPS HORIZON RED
|
Facility
|
OP
|
$7.20
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.06
|
| Rate for Payer: Aetna of WY Medicare |
$4.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.91
|
| Rate for Payer: Altius Commercial |
$6.91
|
| Rate for Payer: Beech Street Commercial |
$7.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.91
|
| Rate for Payer: Cash Price |
$5.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.98
|
| Rate for Payer: Cigna of WY Commercial |
$7.06
|
| Rate for Payer: Entrust Commercial |
$6.84
|
| Rate for Payer: First Choice Health Commercial |
$6.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.18
|
| Rate for Payer: HealthUtah PPO |
$7.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.98
|
| Rate for Payer: Multiplan Medicare/VA |
$3.97
|
| Rate for Payer: One Health Plan of WY PPO |
$7.06
|
| Rate for Payer: PacificSource Commercial |
$6.48
|
| Rate for Payer: PHCS PPO |
$7.06
|
| Rate for Payer: Three Rivers PPO |
$5.40
|
| Rate for Payer: TriWest Veterans Administration |
$4.18
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$4.18
|
| Rate for Payer: WINHealth Partners Commercial |
$7.06
|
| Rate for Payer: Wise Provider Network Commercial |
$6.84
|
|
|
LIGATING CLIPS HORIZON WHITE
|
Facility
|
OP
|
$11.62
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.39
|
| Rate for Payer: Aetna of WY Medicare |
$7.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.16
|
| Rate for Payer: Altius Commercial |
$11.16
|
| Rate for Payer: Beech Street Commercial |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.27
|
| Rate for Payer: Cigna of WY Commercial |
$11.39
|
| Rate for Payer: Entrust Commercial |
$11.04
|
| Rate for Payer: First Choice Health Commercial |
$11.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.74
|
| Rate for Payer: HealthUtah PPO |
$11.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.27
|
| Rate for Payer: Multiplan Medicare/VA |
$6.40
|
| Rate for Payer: One Health Plan of WY PPO |
$11.39
|
| Rate for Payer: PacificSource Commercial |
$10.46
|
| Rate for Payer: PHCS PPO |
$11.39
|
| Rate for Payer: Three Rivers PPO |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$6.74
|
| Rate for Payer: United Healthcare Commercial |
$10.11
|
| Rate for Payer: United Healthcare Medicare |
$6.74
|
| Rate for Payer: WINHealth Partners Commercial |
$11.39
|
| Rate for Payer: Wise Provider Network Commercial |
$11.04
|
|
|
LIGATING CLIPS HORIZON WHITE
|
Facility
|
IP
|
$11.62
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.16
|
| Rate for Payer: Altius Commercial |
$11.16
|
| Rate for Payer: Beech Street Commercial |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.54
|
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.27
|
| Rate for Payer: Cigna of WY Commercial |
$11.39
|
| Rate for Payer: Entrust Commercial |
$11.04
|
| Rate for Payer: First Choice Health Commercial |
$11.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.67
|
| Rate for Payer: HealthUtah PPO |
$11.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.27
|
| Rate for Payer: Multiplan Medicare/VA |
$7.29
|
| Rate for Payer: One Health Plan of WY PPO |
$11.39
|
| Rate for Payer: PacificSource Commercial |
$10.46
|
| Rate for Payer: PHCS PPO |
$11.39
|
| Rate for Payer: Three Rivers PPO |
$8.72
|
| Rate for Payer: TriWest Veterans Administration |
$7.67
|
| Rate for Payer: United Healthcare Commercial |
$10.11
|
| Rate for Payer: United Healthcare Medicare |
$7.67
|
| Rate for Payer: WINHealth Partners Commercial |
$11.04
|
| Rate for Payer: Wise Provider Network Commercial |
$11.04
|
|
|
LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$2,141.00
|
|
|
Service Code
|
HCPCS 37609 50
|
| Hospital Charge Code |
37609
|
| Min. Negotiated Rate |
$165.41 |
| Max. Negotiated Rate |
$2,141.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,098.18
|
| Rate for Payer: Aetna of WY Medicare |
$194.60
|
| Rate for Payer: Beech Street Commercial |
$2,033.95
|
| Rate for Payer: Cash Price |
$1,498.70
|
| Rate for Payer: Cash Price |
$1,498.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,076.77
|
| Rate for Payer: Cigna of WY Commercial |
$2,098.18
|
| Rate for Payer: First Choice Health Commercial |
$1,926.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,033.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.60
|
| Rate for Payer: HealthUtah PPO |
$2,141.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,076.77
|
| Rate for Payer: Multiplan Medicare/VA |
$165.41
|
| Rate for Payer: One Health Plan of WY PPO |
$2,098.18
|
| Rate for Payer: PacificSource Commercial |
$1,926.90
|
| Rate for Payer: PHCS PPO |
$2,033.95
|
| Rate for Payer: Three Rivers PPO |
$1,605.75
|
| Rate for Payer: TriWest Veterans Administration |
$194.60
|
| Rate for Payer: United Healthcare Commercial |
$1,862.67
|
| Rate for Payer: United Healthcare Medicare |
$194.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,819.85
|
|
|
LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 37609
|
| Hospital Charge Code |
37609
|
| Min. Negotiated Rate |
$165.41 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,049.58
|
| Rate for Payer: Aetna of WY Medicare |
$194.60
|
| Rate for Payer: Beech Street Commercial |
$1,017.45
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,038.87
|
| Rate for Payer: Cigna of WY Commercial |
$1,049.58
|
| Rate for Payer: First Choice Health Commercial |
$963.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,017.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$194.60
|
| Rate for Payer: HealthUtah PPO |
$1,071.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,038.87
|
| Rate for Payer: Multiplan Medicare/VA |
$165.41
|
| Rate for Payer: One Health Plan of WY PPO |
$1,049.58
|
| Rate for Payer: PacificSource Commercial |
$963.90
|
| Rate for Payer: PHCS PPO |
$1,017.45
|
| Rate for Payer: Three Rivers PPO |
$803.25
|
| Rate for Payer: TriWest Veterans Administration |
$194.60
|
| Rate for Payer: United Healthcare Commercial |
$931.77
|
| Rate for Payer: United Healthcare Medicare |
$194.60
|
| Rate for Payer: WINHealth Partners Commercial |
$910.35
|
|
|
LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
58611
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,617.00
|
| Rate for Payer: Aetna of WY Medicare |
$71.62
|
| Rate for Payer: Beech Street Commercial |
$1,567.50
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,600.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,617.00
|
| Rate for Payer: First Choice Health Commercial |
$1,485.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,567.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.62
|
| Rate for Payer: HealthUtah PPO |
$1,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,600.50
|
| Rate for Payer: Multiplan Medicare/VA |
$60.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,617.00
|
| Rate for Payer: PacificSource Commercial |
$1,485.00
|
| Rate for Payer: PHCS PPO |
$1,567.50
|
| Rate for Payer: Three Rivers PPO |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.62
|
| Rate for Payer: United Healthcare Commercial |
$1,435.50
|
| Rate for Payer: United Healthcare Medicare |
$71.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,402.50
|
|
|
LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 58611 80
|
| Hospital Charge Code |
58611
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,617.00
|
| Rate for Payer: Aetna of WY Medicare |
$71.62
|
| Rate for Payer: Beech Street Commercial |
$1,567.50
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,600.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,617.00
|
| Rate for Payer: First Choice Health Commercial |
$1,485.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,567.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.62
|
| Rate for Payer: HealthUtah PPO |
$1,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,600.50
|
| Rate for Payer: Multiplan Medicare/VA |
$60.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,617.00
|
| Rate for Payer: PacificSource Commercial |
$1,485.00
|
| Rate for Payer: PHCS PPO |
$1,567.50
|
| Rate for Payer: Three Rivers PPO |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.62
|
| Rate for Payer: United Healthcare Commercial |
$1,435.50
|
| Rate for Payer: United Healthcare Medicare |
$71.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,402.50
|
|
|
LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 58611 AS
|
| Hospital Charge Code |
58611
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,617.00
|
| Rate for Payer: Aetna of WY Medicare |
$71.62
|
| Rate for Payer: Beech Street Commercial |
$1,567.50
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: Cash Price |
$1,155.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,600.50
|
| Rate for Payer: Cigna of WY Commercial |
$1,617.00
|
| Rate for Payer: First Choice Health Commercial |
$1,485.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,567.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.62
|
| Rate for Payer: HealthUtah PPO |
$1,650.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,600.50
|
| Rate for Payer: Multiplan Medicare/VA |
$60.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1,617.00
|
| Rate for Payer: PacificSource Commercial |
$1,485.00
|
| Rate for Payer: PHCS PPO |
$1,567.50
|
| Rate for Payer: Three Rivers PPO |
$1,237.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.62
|
| Rate for Payer: United Healthcare Commercial |
$1,435.50
|
| Rate for Payer: United Healthcare Medicare |
$71.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,402.50
|
|
|
LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
HCPCS 58605 80
|
| Hospital Charge Code |
58605
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$2,978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,918.44
|
| Rate for Payer: Aetna of WY Medicare |
$326.63
|
| Rate for Payer: Beech Street Commercial |
$2,829.10
|
| Rate for Payer: Cash Price |
$2,084.60
|
| Rate for Payer: Cash Price |
$2,084.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,888.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,918.44
|
| Rate for Payer: First Choice Health Commercial |
$2,680.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,829.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.63
|
| Rate for Payer: HealthUtah PPO |
$2,978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,888.66
|
| Rate for Payer: Multiplan Medicare/VA |
$277.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,918.44
|
| Rate for Payer: PacificSource Commercial |
$2,680.20
|
| Rate for Payer: PHCS PPO |
$2,829.10
|
| Rate for Payer: Three Rivers PPO |
$2,233.50
|
| Rate for Payer: TriWest Veterans Administration |
$326.63
|
| Rate for Payer: United Healthcare Commercial |
$2,590.86
|
| Rate for Payer: United Healthcare Medicare |
$326.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,531.30
|
|
|
LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
HCPCS 58605 AS
|
| Hospital Charge Code |
58605
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$2,978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,918.44
|
| Rate for Payer: Aetna of WY Medicare |
$326.63
|
| Rate for Payer: Beech Street Commercial |
$2,829.10
|
| Rate for Payer: Cash Price |
$2,084.60
|
| Rate for Payer: Cash Price |
$2,084.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,888.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,918.44
|
| Rate for Payer: First Choice Health Commercial |
$2,680.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,829.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.63
|
| Rate for Payer: HealthUtah PPO |
$2,978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,888.66
|
| Rate for Payer: Multiplan Medicare/VA |
$277.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,918.44
|
| Rate for Payer: PacificSource Commercial |
$2,680.20
|
| Rate for Payer: PHCS PPO |
$2,829.10
|
| Rate for Payer: Three Rivers PPO |
$2,233.50
|
| Rate for Payer: TriWest Veterans Administration |
$326.63
|
| Rate for Payer: United Healthcare Commercial |
$2,590.86
|
| Rate for Payer: United Healthcare Medicare |
$326.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,531.30
|
|
|
LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$2,978.00
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
58605
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$2,978.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,918.44
|
| Rate for Payer: Aetna of WY Medicare |
$326.63
|
| Rate for Payer: Beech Street Commercial |
$2,829.10
|
| Rate for Payer: Cash Price |
$2,084.60
|
| Rate for Payer: Cash Price |
$2,084.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,888.66
|
| Rate for Payer: Cigna of WY Commercial |
$2,918.44
|
| Rate for Payer: First Choice Health Commercial |
$2,680.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,829.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$326.63
|
| Rate for Payer: HealthUtah PPO |
$2,978.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,888.66
|
| Rate for Payer: Multiplan Medicare/VA |
$277.64
|
| Rate for Payer: One Health Plan of WY PPO |
$2,918.44
|
| Rate for Payer: PacificSource Commercial |
$2,680.20
|
| Rate for Payer: PHCS PPO |
$2,829.10
|
| Rate for Payer: Three Rivers PPO |
$2,233.50
|
| Rate for Payer: TriWest Veterans Administration |
$326.63
|
| Rate for Payer: United Healthcare Commercial |
$2,590.86
|
| Rate for Payer: United Healthcare Medicare |
$326.63
|
| Rate for Payer: WINHealth Partners Commercial |
$2,531.30
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [25393]
|
Facility
|
OP
|
$15.60
|
|
|
Service Code
|
HCPCS J2020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.29
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.30
|
| Rate for Payer: Aetna of WY Medicare |
$10.30
|
| Rate for Payer: Aetna of WY Medicare |
$10.30
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.99
|
| Rate for Payer: Altius Commercial |
$14.98
|
| Rate for Payer: Altius Commercial |
$14.99
|
| Rate for Payer: Altius Commercial |
$14.64
|
| Rate for Payer: Beech Street Commercial |
$15.29
|
| Rate for Payer: Beech Street Commercial |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.82
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.79
|
| Rate for Payer: Cigna of WY Commercial |
$15.30
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.29
|
| Rate for Payer: Entrust Commercial |
$14.83
|
| Rate for Payer: Entrust Commercial |
$14.82
|
| Rate for Payer: Entrust Commercial |
$14.49
|
| Rate for Payer: First Choice Health Commercial |
$14.82
|
| Rate for Payer: First Choice Health Commercial |
$14.49
|
| Rate for Payer: First Choice Health Commercial |
$14.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.05
|
| Rate for Payer: HealthUtah PPO |
$15.25
|
| Rate for Payer: HealthUtah PPO |
$15.61
|
| Rate for Payer: HealthUtah PPO |
$15.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.13
|
| Rate for Payer: Multiplan Medicare/VA |
$8.40
|
| Rate for Payer: Multiplan Medicare/VA |
$8.60
|
| Rate for Payer: Multiplan Medicare/VA |
$8.60
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: One Health Plan of WY PPO |
$15.30
|
| Rate for Payer: One Health Plan of WY PPO |
$15.29
|
| Rate for Payer: PacificSource Commercial |
$14.05
|
| Rate for Payer: PacificSource Commercial |
$14.04
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$15.29
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: PHCS PPO |
$15.30
|
| Rate for Payer: Three Rivers PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: Three Rivers PPO |
$11.71
|
| Rate for Payer: TriWest Veterans Administration |
$9.05
|
| Rate for Payer: TriWest Veterans Administration |
$9.05
|
| Rate for Payer: TriWest Veterans Administration |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
| Rate for Payer: United Healthcare Commercial |
$13.57
|
| Rate for Payer: United Healthcare Commercial |
$13.58
|
| Rate for Payer: United Healthcare Medicare |
$9.05
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: United Healthcare Medicare |
$9.05
|
| Rate for Payer: WINHealth Partners Commercial |
$15.30
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: WINHealth Partners Commercial |
$15.29
|
| Rate for Payer: Wise Provider Network Commercial |
$14.49
|
| Rate for Payer: Wise Provider Network Commercial |
$14.83
|
| Rate for Payer: Wise Provider Network Commercial |
$14.82
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK [25393]
|
Facility
|
IP
|
$15.25
|
|
|
Service Code
|
HCPCS J2020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.29
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.30
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.99
|
| Rate for Payer: Altius Commercial |
$14.98
|
| Rate for Payer: Altius Commercial |
$14.64
|
| Rate for Payer: Altius Commercial |
$14.99
|
| Rate for Payer: Beech Street Commercial |
$15.30
|
| Rate for Payer: Beech Street Commercial |
$15.29
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cash Price |
$10.93
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.13
|
| Rate for Payer: Cigna of WY Commercial |
$15.29
|
| Rate for Payer: Cigna of WY Commercial |
$15.30
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.83
|
| Rate for Payer: Entrust Commercial |
$14.49
|
| Rate for Payer: Entrust Commercial |
$14.82
|
| Rate for Payer: First Choice Health Commercial |
$14.82
|
| Rate for Payer: First Choice Health Commercial |
$14.83
|
| Rate for Payer: First Choice Health Commercial |
$14.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.30
|
| Rate for Payer: HealthUtah PPO |
$15.25
|
| Rate for Payer: HealthUtah PPO |
$15.60
|
| Rate for Payer: HealthUtah PPO |
$15.61
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.79
|
| Rate for Payer: Multiplan Medicare/VA |
$9.79
|
| Rate for Payer: Multiplan Medicare/VA |
$9.56
|
| Rate for Payer: Multiplan Medicare/VA |
$9.78
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: One Health Plan of WY PPO |
$15.29
|
| Rate for Payer: One Health Plan of WY PPO |
$15.30
|
| Rate for Payer: PacificSource Commercial |
$14.05
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$14.04
|
| Rate for Payer: PHCS PPO |
$15.29
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: PHCS PPO |
$15.30
|
| Rate for Payer: Three Rivers PPO |
$11.70
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: Three Rivers PPO |
$11.71
|
| Rate for Payer: TriWest Veterans Administration |
$10.30
|
| Rate for Payer: TriWest Veterans Administration |
$10.06
|
| Rate for Payer: TriWest Veterans Administration |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
| Rate for Payer: United Healthcare Commercial |
$13.58
|
| Rate for Payer: United Healthcare Commercial |
$13.57
|
| Rate for Payer: United Healthcare Medicare |
$10.06
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: WINHealth Partners Commercial |
$14.82
|
| Rate for Payer: WINHealth Partners Commercial |
$14.49
|
| Rate for Payer: WINHealth Partners Commercial |
$14.83
|
| Rate for Payer: Wise Provider Network Commercial |
$14.83
|
| Rate for Payer: Wise Provider Network Commercial |
$14.49
|
| Rate for Payer: Wise Provider Network Commercial |
$14.82
|
|
|
LIOTHYRONINE 5 MCG TABLET [7694]
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 4279401812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.61
|
| Rate for Payer: Altius Commercial |
$2.61
|
| Rate for Payer: Beech Street Commercial |
$2.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.23
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.64
|
| Rate for Payer: Cigna of WY Commercial |
$2.67
|
| Rate for Payer: Entrust Commercial |
$2.58
|
| Rate for Payer: First Choice Health Commercial |
$2.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.80
|
| Rate for Payer: HealthUtah PPO |
$2.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1.71
|
| Rate for Payer: One Health Plan of WY PPO |
$2.67
|
| Rate for Payer: PacificSource Commercial |
$2.45
|
| Rate for Payer: PHCS PPO |
$2.67
|
| Rate for Payer: Three Rivers PPO |
$2.04
|
| Rate for Payer: TriWest Veterans Administration |
$1.80
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2.58
|
| Rate for Payer: Wise Provider Network Commercial |
$2.58
|
|
