|
MEROPENEM 1 G/20 ML IV (WET SOLR VIAL) [43017380]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J2185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$39.60
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$37.62
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$39.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$39.60
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
MEROPENEM 1 G/20 ML IV (WET SOLR VIAL) [43017380]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J2185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$57.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$49.26
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.80
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$33.06
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$34.80
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [13094]
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS J2185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.02 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$47.02
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$49.50
|
| Rate for Payer: WINHealth Partners Commercial |
$71.25
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
MEROPENEM 1 GRAM INTRAVENOUS SOLUTION [13094]
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS J2185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.50
|
| Rate for Payer: Aetna of WY Medicare |
$49.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.00
|
| Rate for Payer: Altius Commercial |
$72.00
|
| Rate for Payer: Beech Street Commercial |
$73.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.75
|
| Rate for Payer: Cigna of WY Commercial |
$73.50
|
| Rate for Payer: Entrust Commercial |
$71.25
|
| Rate for Payer: First Choice Health Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.50
|
| Rate for Payer: HealthUtah PPO |
$75.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.75
|
| Rate for Payer: Multiplan Medicare/VA |
$41.32
|
| Rate for Payer: One Health Plan of WY PPO |
$73.50
|
| Rate for Payer: PacificSource Commercial |
$67.50
|
| Rate for Payer: PHCS PPO |
$73.50
|
| Rate for Payer: Three Rivers PPO |
$56.25
|
| Rate for Payer: TriWest Veterans Administration |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare |
$43.50
|
| Rate for Payer: WINHealth Partners Commercial |
$73.50
|
| Rate for Payer: Wise Provider Network Commercial |
$71.25
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE [87076]
|
Facility
|
OP
|
$37.58
|
|
|
Service Code
|
NDC 6068740825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$37.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.83
|
| Rate for Payer: Aetna of WY Medicare |
$24.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.08
|
| Rate for Payer: Altius Commercial |
$36.08
|
| Rate for Payer: Beech Street Commercial |
$36.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.85
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.45
|
| Rate for Payer: Cigna of WY Commercial |
$36.83
|
| Rate for Payer: Entrust Commercial |
$35.70
|
| Rate for Payer: First Choice Health Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.80
|
| Rate for Payer: HealthUtah PPO |
$37.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.45
|
| Rate for Payer: Multiplan Medicare/VA |
$20.71
|
| Rate for Payer: One Health Plan of WY PPO |
$36.83
|
| Rate for Payer: PacificSource Commercial |
$33.82
|
| Rate for Payer: PHCS PPO |
$36.83
|
| Rate for Payer: Three Rivers PPO |
$28.18
|
| Rate for Payer: TriWest Veterans Administration |
$21.80
|
| Rate for Payer: United Healthcare Commercial |
$32.69
|
| Rate for Payer: United Healthcare Medicare |
$21.80
|
| Rate for Payer: WINHealth Partners Commercial |
$36.83
|
| Rate for Payer: Wise Provider Network Commercial |
$35.70
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE [87076]
|
Facility
|
IP
|
$37.58
|
|
|
Service Code
|
NDC 6068740825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$37.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.08
|
| Rate for Payer: Altius Commercial |
$36.08
|
| Rate for Payer: Beech Street Commercial |
$36.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.85
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.45
|
| Rate for Payer: Cigna of WY Commercial |
$36.83
|
| Rate for Payer: Entrust Commercial |
$35.70
|
| Rate for Payer: First Choice Health Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.80
|
| Rate for Payer: HealthUtah PPO |
$37.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.45
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$36.83
|
| Rate for Payer: PacificSource Commercial |
$33.82
|
| Rate for Payer: PHCS PPO |
$36.83
|
| Rate for Payer: Three Rivers PPO |
$28.18
|
| Rate for Payer: TriWest Veterans Administration |
$24.80
|
| Rate for Payer: United Healthcare Commercial |
$32.69
|
| Rate for Payer: United Healthcare Medicare |
$24.80
|
| Rate for Payer: WINHealth Partners Commercial |
$35.70
|
| Rate for Payer: Wise Provider Network Commercial |
$35.70
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE [87076]
|
Facility
|
IP
|
$37.58
|
|
|
Service Code
|
NDC 6068740895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$37.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.08
|
| Rate for Payer: Altius Commercial |
$36.08
|
| Rate for Payer: Beech Street Commercial |
$36.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.85
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.45
|
| Rate for Payer: Cigna of WY Commercial |
$36.83
|
| Rate for Payer: Entrust Commercial |
$35.70
|
| Rate for Payer: First Choice Health Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.80
|
| Rate for Payer: HealthUtah PPO |
$37.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.45
|
| Rate for Payer: Multiplan Medicare/VA |
$23.56
|
| Rate for Payer: One Health Plan of WY PPO |
$36.83
|
| Rate for Payer: PacificSource Commercial |
$33.82
|
| Rate for Payer: PHCS PPO |
$36.83
|
| Rate for Payer: Three Rivers PPO |
$28.18
|
| Rate for Payer: TriWest Veterans Administration |
$24.80
|
| Rate for Payer: United Healthcare Commercial |
$32.69
|
| Rate for Payer: United Healthcare Medicare |
$24.80
|
| Rate for Payer: WINHealth Partners Commercial |
$35.70
|
| Rate for Payer: Wise Provider Network Commercial |
$35.70
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE [87076]
|
Facility
|
OP
|
$37.58
|
|
|
Service Code
|
NDC 6068740895
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$37.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.83
|
| Rate for Payer: Aetna of WY Medicare |
$24.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$36.08
|
| Rate for Payer: Altius Commercial |
$36.08
|
| Rate for Payer: Beech Street Commercial |
$36.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$30.85
|
| Rate for Payer: Cash Price |
$26.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$36.45
|
| Rate for Payer: Cigna of WY Commercial |
$36.83
|
| Rate for Payer: Entrust Commercial |
$35.70
|
| Rate for Payer: First Choice Health Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.80
|
| Rate for Payer: HealthUtah PPO |
$37.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$36.45
|
| Rate for Payer: Multiplan Medicare/VA |
$20.71
|
| Rate for Payer: One Health Plan of WY PPO |
$36.83
|
| Rate for Payer: PacificSource Commercial |
$33.82
|
| Rate for Payer: PHCS PPO |
$36.83
|
| Rate for Payer: Three Rivers PPO |
$28.18
|
| Rate for Payer: TriWest Veterans Administration |
$21.80
|
| Rate for Payer: United Healthcare Commercial |
$32.69
|
| Rate for Payer: United Healthcare Medicare |
$21.80
|
| Rate for Payer: WINHealth Partners Commercial |
$36.83
|
| Rate for Payer: Wise Provider Network Commercial |
$35.70
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE [87076]
|
Facility
|
IP
|
$25.97
|
|
|
Service Code
|
NDC 6838243528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.93
|
| Rate for Payer: Altius Commercial |
$24.93
|
| Rate for Payer: Beech Street Commercial |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.19
|
| Rate for Payer: Cigna of WY Commercial |
$25.45
|
| Rate for Payer: Entrust Commercial |
$24.67
|
| Rate for Payer: First Choice Health Commercial |
$24.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.14
|
| Rate for Payer: HealthUtah PPO |
$25.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.19
|
| Rate for Payer: Multiplan Medicare/VA |
$16.28
|
| Rate for Payer: One Health Plan of WY PPO |
$25.45
|
| Rate for Payer: PacificSource Commercial |
$23.37
|
| Rate for Payer: PHCS PPO |
$25.45
|
| Rate for Payer: Three Rivers PPO |
$19.48
|
| Rate for Payer: TriWest Veterans Administration |
$17.14
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare |
$17.14
|
| Rate for Payer: WINHealth Partners Commercial |
$24.67
|
| Rate for Payer: Wise Provider Network Commercial |
$24.67
|
|
|
MESALAMINE 800 MG TABLET,DELAYED RELEASE [87076]
|
Facility
|
OP
|
$25.97
|
|
|
Service Code
|
NDC 6838243528
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.45
|
| Rate for Payer: Aetna of WY Medicare |
$17.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.93
|
| Rate for Payer: Altius Commercial |
$24.93
|
| Rate for Payer: Beech Street Commercial |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.19
|
| Rate for Payer: Cigna of WY Commercial |
$25.45
|
| Rate for Payer: Entrust Commercial |
$24.67
|
| Rate for Payer: First Choice Health Commercial |
$24.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.06
|
| Rate for Payer: HealthUtah PPO |
$25.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.19
|
| Rate for Payer: Multiplan Medicare/VA |
$14.31
|
| Rate for Payer: One Health Plan of WY PPO |
$25.45
|
| Rate for Payer: PacificSource Commercial |
$23.37
|
| Rate for Payer: PHCS PPO |
$25.45
|
| Rate for Payer: Three Rivers PPO |
$19.48
|
| Rate for Payer: TriWest Veterans Administration |
$15.06
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare |
$15.06
|
| Rate for Payer: WINHealth Partners Commercial |
$25.45
|
| Rate for Payer: Wise Provider Network Commercial |
$24.67
|
|
|
MESH 15X30CM ULTRAPRO UPA1530
|
Facility
|
OP
|
$452.94
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$452.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$443.88
|
| Rate for Payer: Aetna of WY Medicare |
$298.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$434.82
|
| Rate for Payer: Altius Commercial |
$434.82
|
| Rate for Payer: Beech Street Commercial |
$443.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$371.86
|
| Rate for Payer: Cash Price |
$317.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$439.35
|
| Rate for Payer: Cigna of WY Commercial |
$443.88
|
| Rate for Payer: Entrust Commercial |
$430.29
|
| Rate for Payer: First Choice Health Commercial |
$430.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$430.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.71
|
| Rate for Payer: HealthUtah PPO |
$452.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$439.35
|
| Rate for Payer: Multiplan Medicare/VA |
$249.57
|
| Rate for Payer: One Health Plan of WY PPO |
$443.88
|
| Rate for Payer: PacificSource Commercial |
$407.65
|
| Rate for Payer: PHCS PPO |
$443.88
|
| Rate for Payer: Three Rivers PPO |
$339.70
|
| Rate for Payer: TriWest Veterans Administration |
$262.71
|
| Rate for Payer: United Healthcare Commercial |
$394.06
|
| Rate for Payer: United Healthcare Medicare |
$262.71
|
| Rate for Payer: WINHealth Partners Commercial |
$443.88
|
| Rate for Payer: Wise Provider Network Commercial |
$430.29
|
|
|
MESH 15X30CM ULTRAPRO UPA1530
|
Facility
|
IP
|
$452.94
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.99 |
| Max. Negotiated Rate |
$452.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$443.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$434.82
|
| Rate for Payer: Altius Commercial |
$434.82
|
| Rate for Payer: Beech Street Commercial |
$443.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$371.86
|
| Rate for Payer: Cash Price |
$317.05
|
| Rate for Payer: ChoiceCare Network Commercial |
$439.35
|
| Rate for Payer: Cigna of WY Commercial |
$443.88
|
| Rate for Payer: Entrust Commercial |
$430.29
|
| Rate for Payer: First Choice Health Commercial |
$430.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$430.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.94
|
| Rate for Payer: HealthUtah PPO |
$452.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$439.35
|
| Rate for Payer: Multiplan Medicare/VA |
$283.99
|
| Rate for Payer: One Health Plan of WY PPO |
$443.88
|
| Rate for Payer: PacificSource Commercial |
$407.65
|
| Rate for Payer: PHCS PPO |
$443.88
|
| Rate for Payer: Three Rivers PPO |
$339.70
|
| Rate for Payer: TriWest Veterans Administration |
$298.94
|
| Rate for Payer: United Healthcare Commercial |
$394.06
|
| Rate for Payer: United Healthcare Medicare |
$298.94
|
| Rate for Payer: WINHealth Partners Commercial |
$430.29
|
| Rate for Payer: Wise Provider Network Commercial |
$430.29
|
|
|
MESH OPEN VENTRAL SZ 6 PCO6VP
|
Facility
|
IP
|
$1,129.28
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.06 |
| Max. Negotiated Rate |
$1,129.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,106.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.11
|
| Rate for Payer: Altius Commercial |
$1,084.11
|
| Rate for Payer: Beech Street Commercial |
$1,106.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.14
|
| Rate for Payer: Cash Price |
$790.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,095.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,106.69
|
| Rate for Payer: Entrust Commercial |
$1,072.82
|
| Rate for Payer: First Choice Health Commercial |
$1,072.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,072.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.32
|
| Rate for Payer: HealthUtah PPO |
$1,129.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,095.40
|
| Rate for Payer: Multiplan Medicare/VA |
$708.06
|
| Rate for Payer: One Health Plan of WY PPO |
$1,106.69
|
| Rate for Payer: PacificSource Commercial |
$1,016.35
|
| Rate for Payer: PHCS PPO |
$1,106.69
|
| Rate for Payer: Three Rivers PPO |
$846.96
|
| Rate for Payer: TriWest Veterans Administration |
$745.32
|
| Rate for Payer: United Healthcare Commercial |
$982.47
|
| Rate for Payer: United Healthcare Medicare |
$745.32
|
| Rate for Payer: WINHealth Partners Commercial |
$1,072.82
|
| Rate for Payer: Wise Provider Network Commercial |
$1,072.82
|
|
|
MESH OPEN VENTRAL SZ 6 PCO6VP
|
Facility
|
OP
|
$1,129.28
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.23 |
| Max. Negotiated Rate |
$1,129.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,106.69
|
| Rate for Payer: Aetna of WY Medicare |
$745.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.11
|
| Rate for Payer: Altius Commercial |
$1,084.11
|
| Rate for Payer: Beech Street Commercial |
$1,106.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.14
|
| Rate for Payer: Cash Price |
$790.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,095.40
|
| Rate for Payer: Cigna of WY Commercial |
$1,106.69
|
| Rate for Payer: Entrust Commercial |
$1,072.82
|
| Rate for Payer: First Choice Health Commercial |
$1,072.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,072.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$654.98
|
| Rate for Payer: HealthUtah PPO |
$1,129.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,095.40
|
| Rate for Payer: Multiplan Medicare/VA |
$622.23
|
| Rate for Payer: One Health Plan of WY PPO |
$1,106.69
|
| Rate for Payer: PacificSource Commercial |
$1,016.35
|
| Rate for Payer: PHCS PPO |
$1,106.69
|
| Rate for Payer: Three Rivers PPO |
$846.96
|
| Rate for Payer: TriWest Veterans Administration |
$654.98
|
| Rate for Payer: United Healthcare Commercial |
$982.47
|
| Rate for Payer: United Healthcare Medicare |
$654.98
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.69
|
| Rate for Payer: Wise Provider Network Commercial |
$1,072.82
|
|
|
MESH OPEN VENTRAL SZ 8 PC08VP
|
Facility
|
OP
|
$1,450.54
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.25 |
| Max. Negotiated Rate |
$1,450.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.53
|
| Rate for Payer: Aetna of WY Medicare |
$957.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,392.52
|
| Rate for Payer: Altius Commercial |
$1,392.52
|
| Rate for Payer: Beech Street Commercial |
$1,421.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,190.89
|
| Rate for Payer: Cash Price |
$1,015.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.53
|
| Rate for Payer: Entrust Commercial |
$1,378.01
|
| Rate for Payer: First Choice Health Commercial |
$1,378.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$841.31
|
| Rate for Payer: HealthUtah PPO |
$1,450.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.02
|
| Rate for Payer: Multiplan Medicare/VA |
$799.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.53
|
| Rate for Payer: PacificSource Commercial |
$1,305.49
|
| Rate for Payer: PHCS PPO |
$1,421.53
|
| Rate for Payer: Three Rivers PPO |
$1,087.90
|
| Rate for Payer: TriWest Veterans Administration |
$841.31
|
| Rate for Payer: United Healthcare Commercial |
$1,261.97
|
| Rate for Payer: United Healthcare Medicare |
$841.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1,421.53
|
| Rate for Payer: Wise Provider Network Commercial |
$1,378.01
|
|
|
MESH OPEN VENTRAL SZ 8 PC08VP
|
Facility
|
IP
|
$1,450.54
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.49 |
| Max. Negotiated Rate |
$1,450.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,421.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,392.52
|
| Rate for Payer: Altius Commercial |
$1,392.52
|
| Rate for Payer: Beech Street Commercial |
$1,421.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,190.89
|
| Rate for Payer: Cash Price |
$1,015.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,407.02
|
| Rate for Payer: Cigna of WY Commercial |
$1,421.53
|
| Rate for Payer: Entrust Commercial |
$1,378.01
|
| Rate for Payer: First Choice Health Commercial |
$1,378.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,378.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$957.36
|
| Rate for Payer: HealthUtah PPO |
$1,450.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,407.02
|
| Rate for Payer: Multiplan Medicare/VA |
$909.49
|
| Rate for Payer: One Health Plan of WY PPO |
$1,421.53
|
| Rate for Payer: PacificSource Commercial |
$1,305.49
|
| Rate for Payer: PHCS PPO |
$1,421.53
|
| Rate for Payer: Three Rivers PPO |
$1,087.90
|
| Rate for Payer: TriWest Veterans Administration |
$957.36
|
| Rate for Payer: United Healthcare Commercial |
$1,261.97
|
| Rate for Payer: United Healthcare Medicare |
$957.36
|
| Rate for Payer: WINHealth Partners Commercial |
$1,378.01
|
| Rate for Payer: Wise Provider Network Commercial |
$1,378.01
|
|
|
MESH PARIETEX ROUND 12CM
|
Facility
|
IP
|
$1,129.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.38 |
| Max. Negotiated Rate |
$1,129.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.61
|
| Rate for Payer: Altius Commercial |
$1,084.61
|
| Rate for Payer: Beech Street Commercial |
$1,107.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.57
|
| Rate for Payer: Cash Price |
$790.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,095.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.20
|
| Rate for Payer: Entrust Commercial |
$1,073.31
|
| Rate for Payer: First Choice Health Commercial |
$1,073.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.67
|
| Rate for Payer: HealthUtah PPO |
$1,129.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,095.91
|
| Rate for Payer: Multiplan Medicare/VA |
$708.38
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.20
|
| Rate for Payer: PacificSource Commercial |
$1,016.82
|
| Rate for Payer: PHCS PPO |
$1,107.20
|
| Rate for Payer: Three Rivers PPO |
$847.35
|
| Rate for Payer: TriWest Veterans Administration |
$745.67
|
| Rate for Payer: United Healthcare Commercial |
$982.93
|
| Rate for Payer: United Healthcare Medicare |
$745.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,073.31
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.31
|
|
|
MESH PARIETEX ROUND 12CM
|
Facility
|
OP
|
$1,129.80
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.52 |
| Max. Negotiated Rate |
$1,129.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,107.20
|
| Rate for Payer: Aetna of WY Medicare |
$745.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,084.61
|
| Rate for Payer: Altius Commercial |
$1,084.61
|
| Rate for Payer: Beech Street Commercial |
$1,107.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$927.57
|
| Rate for Payer: Cash Price |
$790.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,095.91
|
| Rate for Payer: Cigna of WY Commercial |
$1,107.20
|
| Rate for Payer: Entrust Commercial |
$1,073.31
|
| Rate for Payer: First Choice Health Commercial |
$1,073.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,073.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$655.28
|
| Rate for Payer: HealthUtah PPO |
$1,129.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,095.91
|
| Rate for Payer: Multiplan Medicare/VA |
$622.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,107.20
|
| Rate for Payer: PacificSource Commercial |
$1,016.82
|
| Rate for Payer: PHCS PPO |
$1,107.20
|
| Rate for Payer: Three Rivers PPO |
$847.35
|
| Rate for Payer: TriWest Veterans Administration |
$655.28
|
| Rate for Payer: United Healthcare Commercial |
$982.93
|
| Rate for Payer: United Healthcare Medicare |
$655.28
|
| Rate for Payer: WINHealth Partners Commercial |
$1,107.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,073.31
|
|
|
MESH PARIETEX ROUND 15CM
|
Facility
|
OP
|
$1,401.15
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$772.03 |
| Max. Negotiated Rate |
$1,401.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,373.13
|
| Rate for Payer: Aetna of WY Medicare |
$924.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,345.10
|
| Rate for Payer: Altius Commercial |
$1,345.10
|
| Rate for Payer: Beech Street Commercial |
$1,373.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,150.34
|
| Rate for Payer: Cash Price |
$980.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,359.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,373.13
|
| Rate for Payer: Entrust Commercial |
$1,331.09
|
| Rate for Payer: First Choice Health Commercial |
$1,331.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,331.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$812.67
|
| Rate for Payer: HealthUtah PPO |
$1,401.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,359.12
|
| Rate for Payer: Multiplan Medicare/VA |
$772.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,373.13
|
| Rate for Payer: PacificSource Commercial |
$1,261.04
|
| Rate for Payer: PHCS PPO |
$1,373.13
|
| Rate for Payer: Three Rivers PPO |
$1,050.86
|
| Rate for Payer: TriWest Veterans Administration |
$812.67
|
| Rate for Payer: United Healthcare Commercial |
$1,219.00
|
| Rate for Payer: United Healthcare Medicare |
$812.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1,373.13
|
| Rate for Payer: Wise Provider Network Commercial |
$1,331.09
|
|
|
MESH PARIETEX ROUND 15CM
|
Facility
|
IP
|
$1,401.15
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$878.52 |
| Max. Negotiated Rate |
$1,401.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,373.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,345.10
|
| Rate for Payer: Altius Commercial |
$1,345.10
|
| Rate for Payer: Beech Street Commercial |
$1,373.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,150.34
|
| Rate for Payer: Cash Price |
$980.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,359.12
|
| Rate for Payer: Cigna of WY Commercial |
$1,373.13
|
| Rate for Payer: Entrust Commercial |
$1,331.09
|
| Rate for Payer: First Choice Health Commercial |
$1,331.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,331.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$924.76
|
| Rate for Payer: HealthUtah PPO |
$1,401.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,359.12
|
| Rate for Payer: Multiplan Medicare/VA |
$878.52
|
| Rate for Payer: One Health Plan of WY PPO |
$1,373.13
|
| Rate for Payer: PacificSource Commercial |
$1,261.04
|
| Rate for Payer: PHCS PPO |
$1,373.13
|
| Rate for Payer: Three Rivers PPO |
$1,050.86
|
| Rate for Payer: TriWest Veterans Administration |
$924.76
|
| Rate for Payer: United Healthcare Commercial |
$1,219.00
|
| Rate for Payer: United Healthcare Medicare |
$924.76
|
| Rate for Payer: WINHealth Partners Commercial |
$1,331.09
|
| Rate for Payer: Wise Provider Network Commercial |
$1,331.09
|
|
|
MESH PARIETEX ROUND 9CM
|
Facility
|
OP
|
$853.93
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.52 |
| Max. Negotiated Rate |
$853.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.85
|
| Rate for Payer: Aetna of WY Medicare |
$563.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$819.77
|
| Rate for Payer: Altius Commercial |
$819.77
|
| Rate for Payer: Beech Street Commercial |
$836.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.08
|
| Rate for Payer: Cash Price |
$597.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.31
|
| Rate for Payer: Cigna of WY Commercial |
$836.85
|
| Rate for Payer: Entrust Commercial |
$811.23
|
| Rate for Payer: First Choice Health Commercial |
$811.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$495.28
|
| Rate for Payer: HealthUtah PPO |
$853.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.31
|
| Rate for Payer: Multiplan Medicare/VA |
$470.52
|
| Rate for Payer: One Health Plan of WY PPO |
$836.85
|
| Rate for Payer: PacificSource Commercial |
$768.54
|
| Rate for Payer: PHCS PPO |
$836.85
|
| Rate for Payer: Three Rivers PPO |
$640.45
|
| Rate for Payer: TriWest Veterans Administration |
$495.28
|
| Rate for Payer: United Healthcare Commercial |
$742.92
|
| Rate for Payer: United Healthcare Medicare |
$495.28
|
| Rate for Payer: WINHealth Partners Commercial |
$836.85
|
| Rate for Payer: Wise Provider Network Commercial |
$811.23
|
|
|
MESH PARIETEX ROUND 9CM
|
Facility
|
IP
|
$853.93
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.41 |
| Max. Negotiated Rate |
$853.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$819.77
|
| Rate for Payer: Altius Commercial |
$819.77
|
| Rate for Payer: Beech Street Commercial |
$836.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$701.08
|
| Rate for Payer: Cash Price |
$597.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.31
|
| Rate for Payer: Cigna of WY Commercial |
$836.85
|
| Rate for Payer: Entrust Commercial |
$811.23
|
| Rate for Payer: First Choice Health Commercial |
$811.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$563.59
|
| Rate for Payer: HealthUtah PPO |
$853.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.31
|
| Rate for Payer: Multiplan Medicare/VA |
$535.41
|
| Rate for Payer: One Health Plan of WY PPO |
$836.85
|
| Rate for Payer: PacificSource Commercial |
$768.54
|
| Rate for Payer: PHCS PPO |
$836.85
|
| Rate for Payer: Three Rivers PPO |
$640.45
|
| Rate for Payer: TriWest Veterans Administration |
$563.59
|
| Rate for Payer: United Healthcare Commercial |
$742.92
|
| Rate for Payer: United Healthcare Medicare |
$563.59
|
| Rate for Payer: WINHealth Partners Commercial |
$811.23
|
| Rate for Payer: Wise Provider Network Commercial |
$811.23
|
|
|
MESH PROGRIP ING TEM1208GL
|
Facility
|
IP
|
$722.16
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.79 |
| Max. Negotiated Rate |
$722.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$707.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$693.27
|
| Rate for Payer: Altius Commercial |
$693.27
|
| Rate for Payer: Beech Street Commercial |
$707.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$592.89
|
| Rate for Payer: Cash Price |
$505.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$700.50
|
| Rate for Payer: Cigna of WY Commercial |
$707.72
|
| Rate for Payer: Entrust Commercial |
$686.05
|
| Rate for Payer: First Choice Health Commercial |
$686.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$686.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$476.63
|
| Rate for Payer: HealthUtah PPO |
$722.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$700.50
|
| Rate for Payer: Multiplan Medicare/VA |
$452.79
|
| Rate for Payer: One Health Plan of WY PPO |
$707.72
|
| Rate for Payer: PacificSource Commercial |
$649.94
|
| Rate for Payer: PHCS PPO |
$707.72
|
| Rate for Payer: Three Rivers PPO |
$541.62
|
| Rate for Payer: TriWest Veterans Administration |
$476.63
|
| Rate for Payer: United Healthcare Commercial |
$628.28
|
| Rate for Payer: United Healthcare Medicare |
$476.63
|
| Rate for Payer: WINHealth Partners Commercial |
$686.05
|
| Rate for Payer: Wise Provider Network Commercial |
$686.05
|
|
|
MESH PROGRIP ING TEM1208GL
|
Facility
|
OP
|
$722.16
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.91 |
| Max. Negotiated Rate |
$722.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$707.72
|
| Rate for Payer: Aetna of WY Medicare |
$476.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$693.27
|
| Rate for Payer: Altius Commercial |
$693.27
|
| Rate for Payer: Beech Street Commercial |
$707.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$592.89
|
| Rate for Payer: Cash Price |
$505.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$700.50
|
| Rate for Payer: Cigna of WY Commercial |
$707.72
|
| Rate for Payer: Entrust Commercial |
$686.05
|
| Rate for Payer: First Choice Health Commercial |
$686.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$686.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$418.85
|
| Rate for Payer: HealthUtah PPO |
$722.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$700.50
|
| Rate for Payer: Multiplan Medicare/VA |
$397.91
|
| Rate for Payer: One Health Plan of WY PPO |
$707.72
|
| Rate for Payer: PacificSource Commercial |
$649.94
|
| Rate for Payer: PHCS PPO |
$707.72
|
| Rate for Payer: Three Rivers PPO |
$541.62
|
| Rate for Payer: TriWest Veterans Administration |
$418.85
|
| Rate for Payer: United Healthcare Commercial |
$628.28
|
| Rate for Payer: United Healthcare Medicare |
$418.85
|
| Rate for Payer: WINHealth Partners Commercial |
$707.72
|
| Rate for Payer: Wise Provider Network Commercial |
$686.05
|
|
|
MESH PROGRIP ING TEM1208GR
|
Facility
|
OP
|
$744.48
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.21 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$729.59
|
| Rate for Payer: Aetna of WY Medicare |
$491.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$714.70
|
| Rate for Payer: Altius Commercial |
$714.70
|
| Rate for Payer: Beech Street Commercial |
$729.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$611.22
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: ChoiceCare Network Commercial |
$722.15
|
| Rate for Payer: Cigna of WY Commercial |
$729.59
|
| Rate for Payer: Entrust Commercial |
$707.26
|
| Rate for Payer: First Choice Health Commercial |
$707.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$707.26
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$431.80
|
| Rate for Payer: HealthUtah PPO |
$744.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$722.15
|
| Rate for Payer: Multiplan Medicare/VA |
$410.21
|
| Rate for Payer: One Health Plan of WY PPO |
$729.59
|
| Rate for Payer: PacificSource Commercial |
$670.03
|
| Rate for Payer: PHCS PPO |
$729.59
|
| Rate for Payer: Three Rivers PPO |
$558.36
|
| Rate for Payer: TriWest Veterans Administration |
$431.80
|
| Rate for Payer: United Healthcare Commercial |
$647.70
|
| Rate for Payer: United Healthcare Medicare |
$431.80
|
| Rate for Payer: WINHealth Partners Commercial |
$729.59
|
| Rate for Payer: Wise Provider Network Commercial |
$707.26
|
|
