|
CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [97619]
|
Facility
|
OP
|
$2.12
|
|
|
Service Code
|
NDC 1650002322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Aetna of WY Medicare |
$1.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.23
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.17
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.23
|
| Rate for Payer: WINHealth Partners Commercial |
$2.08
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [97619]
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 5707400177
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.61
|
| Rate for Payer: Aetna of WY Medicare |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.55
|
| Rate for Payer: Altius Commercial |
$2.55
|
| Rate for Payer: Beech Street Commercial |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.58
|
| Rate for Payer: Cigna of WY Commercial |
$2.61
|
| Rate for Payer: Entrust Commercial |
$2.53
|
| Rate for Payer: First Choice Health Commercial |
$2.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.54
|
| Rate for Payer: HealthUtah PPO |
$2.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.58
|
| Rate for Payer: Multiplan Medicare/VA |
$1.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2.61
|
| Rate for Payer: PacificSource Commercial |
$2.39
|
| Rate for Payer: PHCS PPO |
$2.61
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.54
|
| Rate for Payer: United Healthcare Commercial |
$2.31
|
| Rate for Payer: United Healthcare Medicare |
$1.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2.61
|
| Rate for Payer: Wise Provider Network Commercial |
$2.53
|
|
|
CALCIUM ACETATE 952 MG-ALUMINUM SULFATE 1,347 MG TOPICAL POWDER PACKET [97619]
|
Facility
|
IP
|
$2.12
|
|
|
Service Code
|
NDC 1650002322
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.04
|
| Rate for Payer: Altius Commercial |
$2.04
|
| Rate for Payer: Beech Street Commercial |
$2.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.06
|
| Rate for Payer: Cigna of WY Commercial |
$2.08
|
| Rate for Payer: Entrust Commercial |
$2.01
|
| Rate for Payer: First Choice Health Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.40
|
| Rate for Payer: HealthUtah PPO |
$2.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.06
|
| Rate for Payer: Multiplan Medicare/VA |
$1.33
|
| Rate for Payer: One Health Plan of WY PPO |
$2.08
|
| Rate for Payer: PacificSource Commercial |
$1.91
|
| Rate for Payer: PHCS PPO |
$2.08
|
| Rate for Payer: Three Rivers PPO |
$1.59
|
| Rate for Payer: TriWest Veterans Administration |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.84
|
| Rate for Payer: United Healthcare Medicare |
$1.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2.01
|
| Rate for Payer: Wise Provider Network Commercial |
$2.01
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [24708]
|
Facility
|
IP
|
$18.60
|
|
|
Service Code
|
NDC 6425390030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.86
|
| Rate for Payer: Altius Commercial |
$17.86
|
| Rate for Payer: Beech Street Commercial |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.04
|
| Rate for Payer: Cigna of WY Commercial |
$18.23
|
| Rate for Payer: Entrust Commercial |
$17.67
|
| Rate for Payer: First Choice Health Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.28
|
| Rate for Payer: HealthUtah PPO |
$18.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.04
|
| Rate for Payer: Multiplan Medicare/VA |
$11.66
|
| Rate for Payer: One Health Plan of WY PPO |
$18.23
|
| Rate for Payer: PacificSource Commercial |
$16.74
|
| Rate for Payer: PHCS PPO |
$18.23
|
| Rate for Payer: Three Rivers PPO |
$13.95
|
| Rate for Payer: TriWest Veterans Administration |
$12.28
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Medicare |
$12.28
|
| Rate for Payer: WINHealth Partners Commercial |
$17.67
|
| Rate for Payer: Wise Provider Network Commercial |
$17.67
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [24708]
|
Facility
|
IP
|
$20.05
|
|
|
Service Code
|
NDC 0409163140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.25
|
| Rate for Payer: Altius Commercial |
$19.25
|
| Rate for Payer: Beech Street Commercial |
$19.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.46
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.45
|
| Rate for Payer: Cigna of WY Commercial |
$19.65
|
| Rate for Payer: Entrust Commercial |
$19.05
|
| Rate for Payer: First Choice Health Commercial |
$19.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.23
|
| Rate for Payer: HealthUtah PPO |
$20.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.45
|
| Rate for Payer: Multiplan Medicare/VA |
$12.57
|
| Rate for Payer: One Health Plan of WY PPO |
$19.65
|
| Rate for Payer: PacificSource Commercial |
$18.04
|
| Rate for Payer: PHCS PPO |
$19.65
|
| Rate for Payer: Three Rivers PPO |
$15.04
|
| Rate for Payer: TriWest Veterans Administration |
$13.23
|
| Rate for Payer: United Healthcare Commercial |
$17.44
|
| Rate for Payer: United Healthcare Medicare |
$13.23
|
| Rate for Payer: WINHealth Partners Commercial |
$19.05
|
| Rate for Payer: Wise Provider Network Commercial |
$19.05
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [24708]
|
Facility
|
OP
|
$18.60
|
|
|
Service Code
|
NDC 6425390030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.23
|
| Rate for Payer: Aetna of WY Medicare |
$12.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.86
|
| Rate for Payer: Altius Commercial |
$17.86
|
| Rate for Payer: Beech Street Commercial |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.27
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.04
|
| Rate for Payer: Cigna of WY Commercial |
$18.23
|
| Rate for Payer: Entrust Commercial |
$17.67
|
| Rate for Payer: First Choice Health Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.79
|
| Rate for Payer: HealthUtah PPO |
$18.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.04
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| Rate for Payer: One Health Plan of WY PPO |
$18.23
|
| Rate for Payer: PacificSource Commercial |
$16.74
|
| Rate for Payer: PHCS PPO |
$18.23
|
| Rate for Payer: Three Rivers PPO |
$13.95
|
| Rate for Payer: TriWest Veterans Administration |
$10.79
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Medicare |
$10.79
|
| Rate for Payer: WINHealth Partners Commercial |
$18.23
|
| Rate for Payer: Wise Provider Network Commercial |
$17.67
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS SYRINGE [24708]
|
Facility
|
OP
|
$20.05
|
|
|
Service Code
|
NDC 0409163140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.65
|
| Rate for Payer: Aetna of WY Medicare |
$13.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.25
|
| Rate for Payer: Altius Commercial |
$19.25
|
| Rate for Payer: Beech Street Commercial |
$19.65
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.46
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.45
|
| Rate for Payer: Cigna of WY Commercial |
$19.65
|
| Rate for Payer: Entrust Commercial |
$19.05
|
| Rate for Payer: First Choice Health Commercial |
$19.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.63
|
| Rate for Payer: HealthUtah PPO |
$20.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.45
|
| Rate for Payer: Multiplan Medicare/VA |
$11.05
|
| Rate for Payer: One Health Plan of WY PPO |
$19.65
|
| Rate for Payer: PacificSource Commercial |
$18.04
|
| Rate for Payer: PHCS PPO |
$19.65
|
| Rate for Payer: Three Rivers PPO |
$15.04
|
| Rate for Payer: TriWest Veterans Administration |
$11.63
|
| Rate for Payer: United Healthcare Commercial |
$17.44
|
| Rate for Payer: United Healthcare Medicare |
$11.63
|
| Rate for Payer: WINHealth Partners Commercial |
$19.65
|
| Rate for Payer: Wise Provider Network Commercial |
$19.05
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION [154650]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 4456762001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.52
|
| Rate for Payer: Altius Commercial |
$1.52
|
| Rate for Payer: Beech Street Commercial |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.53
|
| Rate for Payer: Cigna of WY Commercial |
$1.55
|
| Rate for Payer: Entrust Commercial |
$1.50
|
| Rate for Payer: First Choice Health Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.55
|
| Rate for Payer: PacificSource Commercial |
$1.42
|
| Rate for Payer: PHCS PPO |
$1.55
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1.50
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION [154650]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 8083023621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.52
|
| Rate for Payer: Altius Commercial |
$1.52
|
| Rate for Payer: Beech Street Commercial |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.53
|
| Rate for Payer: Cigna of WY Commercial |
$1.55
|
| Rate for Payer: Entrust Commercial |
$1.50
|
| Rate for Payer: First Choice Health Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.04
|
| Rate for Payer: HealthUtah PPO |
$1.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.99
|
| Rate for Payer: One Health Plan of WY PPO |
$1.55
|
| Rate for Payer: PacificSource Commercial |
$1.42
|
| Rate for Payer: PHCS PPO |
$1.55
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$1.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1.50
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION [154650]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 4456762001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.55
|
| Rate for Payer: Aetna of WY Medicare |
$1.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.52
|
| Rate for Payer: Altius Commercial |
$1.52
|
| Rate for Payer: Beech Street Commercial |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.53
|
| Rate for Payer: Cigna of WY Commercial |
$1.55
|
| Rate for Payer: Entrust Commercial |
$1.50
|
| Rate for Payer: First Choice Health Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.92
|
| Rate for Payer: HealthUtah PPO |
$1.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1.55
|
| Rate for Payer: PacificSource Commercial |
$1.42
|
| Rate for Payer: PHCS PPO |
$1.55
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$0.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1.50
|
|
|
CALCIUM GLUCONATE 1 GRAM/50 ML IN SODIUM CHLORIDE, ISO-OSM IV SOLUTION [154650]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 8083023621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.55
|
| Rate for Payer: Aetna of WY Medicare |
$1.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.52
|
| Rate for Payer: Altius Commercial |
$1.52
|
| Rate for Payer: Beech Street Commercial |
$1.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.53
|
| Rate for Payer: Cigna of WY Commercial |
$1.55
|
| Rate for Payer: Entrust Commercial |
$1.50
|
| Rate for Payer: First Choice Health Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.92
|
| Rate for Payer: HealthUtah PPO |
$1.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.53
|
| Rate for Payer: Multiplan Medicare/VA |
$0.87
|
| Rate for Payer: One Health Plan of WY PPO |
$1.55
|
| Rate for Payer: PacificSource Commercial |
$1.42
|
| Rate for Payer: PHCS PPO |
$1.55
|
| Rate for Payer: Three Rivers PPO |
$1.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$0.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1.50
|
|
|
CALFACTANT 35 MG/ML IN 0.9% SODIUM CHLORIDE INTRATRACHEAL SUSPENSION [64]
|
Facility
|
IP
|
$227.24
|
|
|
Service Code
|
NDC 6193845603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$227.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.70
|
| Rate for Payer: Altius Auto/Workers Compensation |
$218.15
|
| Rate for Payer: Altius Commercial |
$218.15
|
| Rate for Payer: Beech Street Commercial |
$222.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.56
|
| Rate for Payer: Cash Price |
$159.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.42
|
| Rate for Payer: Cigna of WY Commercial |
$222.70
|
| Rate for Payer: Entrust Commercial |
$215.88
|
| Rate for Payer: First Choice Health Commercial |
$215.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$149.98
|
| Rate for Payer: HealthUtah PPO |
$227.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.42
|
| Rate for Payer: Multiplan Medicare/VA |
$142.48
|
| Rate for Payer: One Health Plan of WY PPO |
$222.70
|
| Rate for Payer: PacificSource Commercial |
$204.52
|
| Rate for Payer: PHCS PPO |
$222.70
|
| Rate for Payer: Three Rivers PPO |
$170.43
|
| Rate for Payer: TriWest Veterans Administration |
$149.98
|
| Rate for Payer: United Healthcare Commercial |
$197.70
|
| Rate for Payer: United Healthcare Medicare |
$149.98
|
| Rate for Payer: WINHealth Partners Commercial |
$215.88
|
| Rate for Payer: Wise Provider Network Commercial |
$215.88
|
|
|
CALFACTANT 35 MG/ML IN 0.9% SODIUM CHLORIDE INTRATRACHEAL SUSPENSION [64]
|
Facility
|
OP
|
$227.24
|
|
|
Service Code
|
NDC 6193845603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$227.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$222.70
|
| Rate for Payer: Aetna of WY Medicare |
$149.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$218.15
|
| Rate for Payer: Altius Commercial |
$218.15
|
| Rate for Payer: Beech Street Commercial |
$222.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$186.56
|
| Rate for Payer: Cash Price |
$159.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$220.42
|
| Rate for Payer: Cigna of WY Commercial |
$222.70
|
| Rate for Payer: Entrust Commercial |
$215.88
|
| Rate for Payer: First Choice Health Commercial |
$215.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$215.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$131.80
|
| Rate for Payer: HealthUtah PPO |
$227.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$220.42
|
| Rate for Payer: Multiplan Medicare/VA |
$125.21
|
| Rate for Payer: One Health Plan of WY PPO |
$222.70
|
| Rate for Payer: PacificSource Commercial |
$204.52
|
| Rate for Payer: PHCS PPO |
$222.70
|
| Rate for Payer: Three Rivers PPO |
$170.43
|
| Rate for Payer: TriWest Veterans Administration |
$131.80
|
| Rate for Payer: United Healthcare Commercial |
$197.70
|
| Rate for Payer: United Healthcare Medicare |
$131.80
|
| Rate for Payer: WINHealth Partners Commercial |
$222.70
|
| Rate for Payer: Wise Provider Network Commercial |
$215.88
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 95992
|
| Hospital Charge Code |
95992
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.66
|
| Rate for Payer: Aetna of WY Medicare |
$34.45
|
| Rate for Payer: Beech Street Commercial |
$158.65
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: Cash Price |
$116.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.99
|
| Rate for Payer: Cigna of WY Commercial |
$163.66
|
| Rate for Payer: First Choice Health Commercial |
$150.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.45
|
| Rate for Payer: HealthUtah PPO |
$167.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.99
|
| Rate for Payer: Multiplan Medicare/VA |
$29.28
|
| Rate for Payer: One Health Plan of WY PPO |
$163.66
|
| Rate for Payer: PacificSource Commercial |
$150.30
|
| Rate for Payer: PHCS PPO |
$158.65
|
| Rate for Payer: Three Rivers PPO |
$125.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.45
|
| Rate for Payer: United Healthcare Commercial |
$145.29
|
| Rate for Payer: United Healthcare Medicare |
$34.45
|
| Rate for Payer: WINHealth Partners Commercial |
$158.65
|
|
|
CANCELLOUS CUBES 4-6 15CC
|
Facility
|
OP
|
$632.45
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.48 |
| Max. Negotiated Rate |
$632.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$619.80
|
| Rate for Payer: Aetna of WY Medicare |
$417.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$607.15
|
| Rate for Payer: Altius Commercial |
$607.15
|
| Rate for Payer: Beech Street Commercial |
$619.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$519.24
|
| Rate for Payer: Cash Price |
$442.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$613.48
|
| Rate for Payer: Cigna of WY Commercial |
$619.80
|
| Rate for Payer: Entrust Commercial |
$600.83
|
| Rate for Payer: First Choice Health Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$366.82
|
| Rate for Payer: HealthUtah PPO |
$632.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$613.48
|
| Rate for Payer: Multiplan Medicare/VA |
$348.48
|
| Rate for Payer: One Health Plan of WY PPO |
$619.80
|
| Rate for Payer: PacificSource Commercial |
$569.20
|
| Rate for Payer: PHCS PPO |
$619.80
|
| Rate for Payer: Three Rivers PPO |
$474.34
|
| Rate for Payer: TriWest Veterans Administration |
$366.82
|
| Rate for Payer: United Healthcare Commercial |
$550.23
|
| Rate for Payer: United Healthcare Medicare |
$366.82
|
| Rate for Payer: WINHealth Partners Commercial |
$619.80
|
| Rate for Payer: Wise Provider Network Commercial |
$600.83
|
|
|
CANCELLOUS CUBES 4-6 15CC
|
Facility
|
IP
|
$632.45
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$396.55 |
| Max. Negotiated Rate |
$632.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$619.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$607.15
|
| Rate for Payer: Altius Commercial |
$607.15
|
| Rate for Payer: Beech Street Commercial |
$619.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$519.24
|
| Rate for Payer: Cash Price |
$442.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$613.48
|
| Rate for Payer: Cigna of WY Commercial |
$619.80
|
| Rate for Payer: Entrust Commercial |
$600.83
|
| Rate for Payer: First Choice Health Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$417.42
|
| Rate for Payer: HealthUtah PPO |
$632.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$613.48
|
| Rate for Payer: Multiplan Medicare/VA |
$396.55
|
| Rate for Payer: One Health Plan of WY PPO |
$619.80
|
| Rate for Payer: PacificSource Commercial |
$569.20
|
| Rate for Payer: PHCS PPO |
$619.80
|
| Rate for Payer: Three Rivers PPO |
$474.34
|
| Rate for Payer: TriWest Veterans Administration |
$417.42
|
| Rate for Payer: United Healthcare Commercial |
$550.23
|
| Rate for Payer: United Healthcare Medicare |
$417.42
|
| Rate for Payer: WINHealth Partners Commercial |
$600.83
|
| Rate for Payer: Wise Provider Network Commercial |
$600.83
|
|
|
CANCELLOUS CUBES 5CC BIO
|
Facility
|
OP
|
$234.32
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.11 |
| Max. Negotiated Rate |
$234.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.63
|
| Rate for Payer: Aetna of WY Medicare |
$154.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$224.95
|
| Rate for Payer: Altius Commercial |
$224.95
|
| Rate for Payer: Beech Street Commercial |
$229.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.38
|
| Rate for Payer: Cash Price |
$164.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.29
|
| Rate for Payer: Cigna of WY Commercial |
$229.63
|
| Rate for Payer: Entrust Commercial |
$222.60
|
| Rate for Payer: First Choice Health Commercial |
$222.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.91
|
| Rate for Payer: HealthUtah PPO |
$234.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.29
|
| Rate for Payer: Multiplan Medicare/VA |
$129.11
|
| Rate for Payer: One Health Plan of WY PPO |
$229.63
|
| Rate for Payer: PacificSource Commercial |
$210.89
|
| Rate for Payer: PHCS PPO |
$229.63
|
| Rate for Payer: Three Rivers PPO |
$175.74
|
| Rate for Payer: TriWest Veterans Administration |
$135.91
|
| Rate for Payer: United Healthcare Commercial |
$203.86
|
| Rate for Payer: United Healthcare Medicare |
$135.91
|
| Rate for Payer: WINHealth Partners Commercial |
$229.63
|
| Rate for Payer: Wise Provider Network Commercial |
$222.60
|
|
|
CANCELLOUS CUBES 5CC BIO
|
Facility
|
IP
|
$234.32
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.92 |
| Max. Negotiated Rate |
$234.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$224.95
|
| Rate for Payer: Altius Commercial |
$224.95
|
| Rate for Payer: Beech Street Commercial |
$229.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$192.38
|
| Rate for Payer: Cash Price |
$164.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.29
|
| Rate for Payer: Cigna of WY Commercial |
$229.63
|
| Rate for Payer: Entrust Commercial |
$222.60
|
| Rate for Payer: First Choice Health Commercial |
$222.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.65
|
| Rate for Payer: HealthUtah PPO |
$234.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.29
|
| Rate for Payer: Multiplan Medicare/VA |
$146.92
|
| Rate for Payer: One Health Plan of WY PPO |
$229.63
|
| Rate for Payer: PacificSource Commercial |
$210.89
|
| Rate for Payer: PHCS PPO |
$229.63
|
| Rate for Payer: Three Rivers PPO |
$175.74
|
| Rate for Payer: TriWest Veterans Administration |
$154.65
|
| Rate for Payer: United Healthcare Commercial |
$203.86
|
| Rate for Payer: United Healthcare Medicare |
$154.65
|
| Rate for Payer: WINHealth Partners Commercial |
$222.60
|
| Rate for Payer: Wise Provider Network Commercial |
$222.60
|
|
|
CANNULA MINI WHISKERS SECURE DEVICE
|
Facility
|
OP
|
$15.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.25
|
| Rate for Payer: Aetna of WY Medicare |
$10.27
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.94
|
| Rate for Payer: Altius Commercial |
$14.94
|
| Rate for Payer: Beech Street Commercial |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.09
|
| Rate for Payer: Cigna of WY Commercial |
$15.25
|
| Rate for Payer: Entrust Commercial |
$14.78
|
| Rate for Payer: First Choice Health Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.02
|
| Rate for Payer: HealthUtah PPO |
$15.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.09
|
| Rate for Payer: Multiplan Medicare/VA |
$8.57
|
| Rate for Payer: One Health Plan of WY PPO |
$15.25
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.25
|
| Rate for Payer: Three Rivers PPO |
$11.67
|
| Rate for Payer: TriWest Veterans Administration |
$9.02
|
| Rate for Payer: United Healthcare Commercial |
$13.54
|
| Rate for Payer: United Healthcare Medicare |
$9.02
|
| Rate for Payer: WINHealth Partners Commercial |
$15.25
|
| Rate for Payer: Wise Provider Network Commercial |
$14.78
|
|
|
CANNULA MINI WHISKERS SECURE DEVICE
|
Facility
|
IP
|
$15.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$15.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.94
|
| Rate for Payer: Altius Commercial |
$14.94
|
| Rate for Payer: Beech Street Commercial |
$15.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$10.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.09
|
| Rate for Payer: Cigna of WY Commercial |
$15.25
|
| Rate for Payer: Entrust Commercial |
$14.78
|
| Rate for Payer: First Choice Health Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.27
|
| Rate for Payer: HealthUtah PPO |
$15.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.09
|
| Rate for Payer: Multiplan Medicare/VA |
$9.76
|
| Rate for Payer: One Health Plan of WY PPO |
$15.25
|
| Rate for Payer: PacificSource Commercial |
$14.00
|
| Rate for Payer: PHCS PPO |
$15.25
|
| Rate for Payer: Three Rivers PPO |
$11.67
|
| Rate for Payer: TriWest Veterans Administration |
$10.27
|
| Rate for Payer: United Healthcare Commercial |
$13.54
|
| Rate for Payer: United Healthcare Medicare |
$10.27
|
| Rate for Payer: WINHealth Partners Commercial |
$14.78
|
| Rate for Payer: Wise Provider Network Commercial |
$14.78
|
|
|
CANNULA NASAL CO2 LOW FLOW ADULT CAPNOFLEX
|
Facility
|
OP
|
$66.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.42
|
| Rate for Payer: Aetna of WY Medicare |
$44.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.09
|
| Rate for Payer: Altius Commercial |
$64.09
|
| Rate for Payer: Beech Street Commercial |
$65.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.81
|
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.76
|
| Rate for Payer: Cigna of WY Commercial |
$65.42
|
| Rate for Payer: Entrust Commercial |
$63.42
|
| Rate for Payer: First Choice Health Commercial |
$63.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.72
|
| Rate for Payer: HealthUtah PPO |
$66.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.76
|
| Rate for Payer: Multiplan Medicare/VA |
$36.78
|
| Rate for Payer: One Health Plan of WY PPO |
$65.42
|
| Rate for Payer: PacificSource Commercial |
$60.08
|
| Rate for Payer: PHCS PPO |
$65.42
|
| Rate for Payer: Three Rivers PPO |
$50.07
|
| Rate for Payer: TriWest Veterans Administration |
$38.72
|
| Rate for Payer: United Healthcare Commercial |
$58.08
|
| Rate for Payer: United Healthcare Medicare |
$38.72
|
| Rate for Payer: WINHealth Partners Commercial |
$65.42
|
| Rate for Payer: Wise Provider Network Commercial |
$63.42
|
|
|
CANNULA NASAL CO2 LOW FLOW ADULT CAPNOFLEX
|
Facility
|
IP
|
$66.76
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$66.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$64.09
|
| Rate for Payer: Altius Commercial |
$64.09
|
| Rate for Payer: Beech Street Commercial |
$65.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.81
|
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.76
|
| Rate for Payer: Cigna of WY Commercial |
$65.42
|
| Rate for Payer: Entrust Commercial |
$63.42
|
| Rate for Payer: First Choice Health Commercial |
$63.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.06
|
| Rate for Payer: HealthUtah PPO |
$66.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.76
|
| Rate for Payer: Multiplan Medicare/VA |
$41.86
|
| Rate for Payer: One Health Plan of WY PPO |
$65.42
|
| Rate for Payer: PacificSource Commercial |
$60.08
|
| Rate for Payer: PHCS PPO |
$65.42
|
| Rate for Payer: Three Rivers PPO |
$50.07
|
| Rate for Payer: TriWest Veterans Administration |
$44.06
|
| Rate for Payer: United Healthcare Commercial |
$58.08
|
| Rate for Payer: United Healthcare Medicare |
$44.06
|
| Rate for Payer: WINHealth Partners Commercial |
$63.42
|
| Rate for Payer: Wise Provider Network Commercial |
$63.42
|
|
|
CANNULA TWISTIN GOLD AR-6530
|
Facility
|
OP
|
$102.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Aetna of WY Medicare |
$67.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.11
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.91
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.28
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$56.31
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$59.28
|
| Rate for Payer: United Healthcare Commercial |
$88.91
|
| Rate for Payer: United Healthcare Medicare |
$59.28
|
| Rate for Payer: WINHealth Partners Commercial |
$100.16
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
CANNULA TWISTIN GOLD AR-6530
|
Facility
|
IP
|
$102.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.08 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.11
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.91
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.45
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$64.08
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$67.45
|
| Rate for Payer: United Healthcare Commercial |
$88.91
|
| Rate for Payer: United Healthcare Medicare |
$67.45
|
| Rate for Payer: WINHealth Partners Commercial |
$97.09
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
|
CANNULA TWISTIN GREEN AR-6535
|
Facility
|
IP
|
$102.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.08 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$98.11
|
| Rate for Payer: Altius Commercial |
$98.11
|
| Rate for Payer: Beech Street Commercial |
$100.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$83.91
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.13
|
| Rate for Payer: Cigna of WY Commercial |
$100.16
|
| Rate for Payer: Entrust Commercial |
$97.09
|
| Rate for Payer: First Choice Health Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.45
|
| Rate for Payer: HealthUtah PPO |
$102.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.13
|
| Rate for Payer: Multiplan Medicare/VA |
$64.08
|
| Rate for Payer: One Health Plan of WY PPO |
$100.16
|
| Rate for Payer: PacificSource Commercial |
$91.98
|
| Rate for Payer: PHCS PPO |
$100.16
|
| Rate for Payer: Three Rivers PPO |
$76.65
|
| Rate for Payer: TriWest Veterans Administration |
$67.45
|
| Rate for Payer: United Healthcare Commercial |
$88.91
|
| Rate for Payer: United Healthcare Medicare |
$67.45
|
| Rate for Payer: WINHealth Partners Commercial |
$97.09
|
| Rate for Payer: Wise Provider Network Commercial |
$97.09
|
|
