|
PASSPORT BUTTON CANNULA 10MM
|
Facility
|
OP
|
$130.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$130.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.21
|
| Rate for Payer: Aetna of WY Medicare |
$86.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.60
|
| Rate for Payer: Altius Commercial |
$125.60
|
| Rate for Payer: Beech Street Commercial |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.91
|
| Rate for Payer: Cigna of WY Commercial |
$128.21
|
| Rate for Payer: Entrust Commercial |
$124.29
|
| Rate for Payer: First Choice Health Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.88
|
| Rate for Payer: HealthUtah PPO |
$130.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.91
|
| Rate for Payer: Multiplan Medicare/VA |
$72.09
|
| Rate for Payer: One Health Plan of WY PPO |
$128.21
|
| Rate for Payer: PacificSource Commercial |
$117.75
|
| Rate for Payer: PHCS PPO |
$128.21
|
| Rate for Payer: Three Rivers PPO |
$98.12
|
| Rate for Payer: TriWest Veterans Administration |
$75.88
|
| Rate for Payer: United Healthcare Commercial |
$113.82
|
| Rate for Payer: United Healthcare Medicare |
$75.88
|
| Rate for Payer: WINHealth Partners Commercial |
$128.21
|
| Rate for Payer: Wise Provider Network Commercial |
$124.29
|
|
|
PASSPORT BUTTON CANNULA 10MM
|
Facility
|
IP
|
$130.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$130.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$128.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$125.60
|
| Rate for Payer: Altius Commercial |
$125.60
|
| Rate for Payer: Beech Street Commercial |
$128.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$107.41
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$126.91
|
| Rate for Payer: Cigna of WY Commercial |
$128.21
|
| Rate for Payer: Entrust Commercial |
$124.29
|
| Rate for Payer: First Choice Health Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$124.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.35
|
| Rate for Payer: HealthUtah PPO |
$130.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$126.91
|
| Rate for Payer: Multiplan Medicare/VA |
$82.03
|
| Rate for Payer: One Health Plan of WY PPO |
$128.21
|
| Rate for Payer: PacificSource Commercial |
$117.75
|
| Rate for Payer: PHCS PPO |
$128.21
|
| Rate for Payer: Three Rivers PPO |
$98.12
|
| Rate for Payer: TriWest Veterans Administration |
$86.35
|
| Rate for Payer: United Healthcare Commercial |
$113.82
|
| Rate for Payer: United Healthcare Medicare |
$86.35
|
| Rate for Payer: WINHealth Partners Commercial |
$124.29
|
| Rate for Payer: Wise Provider Network Commercial |
$124.29
|
|
|
PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$7,052.00
|
|
|
Service Code
|
HCPCS 27350
|
| Hospital Charge Code |
27350
|
| Min. Negotiated Rate |
$542.90 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,910.96
|
| Rate for Payer: Aetna of WY Medicare |
$638.70
|
| Rate for Payer: Beech Street Commercial |
$6,699.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,840.44
|
| Rate for Payer: Cigna of WY Commercial |
$6,910.96
|
| Rate for Payer: First Choice Health Commercial |
$6,346.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,699.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.70
|
| Rate for Payer: HealthUtah PPO |
$7,052.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,840.44
|
| Rate for Payer: Multiplan Medicare/VA |
$542.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,910.96
|
| Rate for Payer: PacificSource Commercial |
$6,346.80
|
| Rate for Payer: PHCS PPO |
$6,699.40
|
| Rate for Payer: Three Rivers PPO |
$5,289.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.70
|
| Rate for Payer: United Healthcare Commercial |
$6,135.24
|
| Rate for Payer: United Healthcare Medicare |
$638.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,994.20
|
|
|
PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$7,052.00
|
|
|
Service Code
|
HCPCS 27350 AS
|
| Hospital Charge Code |
27350
|
| Min. Negotiated Rate |
$542.90 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,910.96
|
| Rate for Payer: Aetna of WY Medicare |
$638.70
|
| Rate for Payer: Beech Street Commercial |
$6,699.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,840.44
|
| Rate for Payer: Cigna of WY Commercial |
$6,910.96
|
| Rate for Payer: First Choice Health Commercial |
$6,346.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,699.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.70
|
| Rate for Payer: HealthUtah PPO |
$7,052.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,840.44
|
| Rate for Payer: Multiplan Medicare/VA |
$542.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,910.96
|
| Rate for Payer: PacificSource Commercial |
$6,346.80
|
| Rate for Payer: PHCS PPO |
$6,699.40
|
| Rate for Payer: Three Rivers PPO |
$5,289.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.70
|
| Rate for Payer: United Healthcare Commercial |
$6,135.24
|
| Rate for Payer: United Healthcare Medicare |
$638.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,994.20
|
|
|
PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$7,052.00
|
|
|
Service Code
|
HCPCS 27350 80
|
| Hospital Charge Code |
27350
|
| Min. Negotiated Rate |
$542.90 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,910.96
|
| Rate for Payer: Aetna of WY Medicare |
$638.70
|
| Rate for Payer: Beech Street Commercial |
$6,699.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: Cash Price |
$4,936.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,840.44
|
| Rate for Payer: Cigna of WY Commercial |
$6,910.96
|
| Rate for Payer: First Choice Health Commercial |
$6,346.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,699.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$638.70
|
| Rate for Payer: HealthUtah PPO |
$7,052.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,840.44
|
| Rate for Payer: Multiplan Medicare/VA |
$542.90
|
| Rate for Payer: One Health Plan of WY PPO |
$6,910.96
|
| Rate for Payer: PacificSource Commercial |
$6,346.80
|
| Rate for Payer: PHCS PPO |
$6,699.40
|
| Rate for Payer: Three Rivers PPO |
$5,289.00
|
| Rate for Payer: TriWest Veterans Administration |
$638.70
|
| Rate for Payer: United Healthcare Commercial |
$6,135.24
|
| Rate for Payer: United Healthcare Medicare |
$638.70
|
| Rate for Payer: WINHealth Partners Commercial |
$5,994.20
|
|
|
PATIENT TRACKER MEDTRONIC
|
Facility
|
IP
|
$682.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.95 |
| Max. Negotiated Rate |
$682.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$655.24
|
| Rate for Payer: Altius Commercial |
$655.24
|
| Rate for Payer: Beech Street Commercial |
$668.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$560.37
|
| Rate for Payer: Cash Price |
$477.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.06
|
| Rate for Payer: Cigna of WY Commercial |
$668.89
|
| Rate for Payer: Entrust Commercial |
$648.41
|
| Rate for Payer: First Choice Health Commercial |
$648.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$450.48
|
| Rate for Payer: HealthUtah PPO |
$682.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.06
|
| Rate for Payer: Multiplan Medicare/VA |
$427.95
|
| Rate for Payer: One Health Plan of WY PPO |
$668.89
|
| Rate for Payer: PacificSource Commercial |
$614.29
|
| Rate for Payer: PHCS PPO |
$668.89
|
| Rate for Payer: Three Rivers PPO |
$511.90
|
| Rate for Payer: TriWest Veterans Administration |
$450.48
|
| Rate for Payer: United Healthcare Commercial |
$593.81
|
| Rate for Payer: United Healthcare Medicare |
$450.48
|
| Rate for Payer: WINHealth Partners Commercial |
$648.41
|
| Rate for Payer: Wise Provider Network Commercial |
$648.41
|
|
|
PATIENT TRACKER MEDTRONIC
|
Facility
|
OP
|
$682.54
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.08 |
| Max. Negotiated Rate |
$682.54 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$668.89
|
| Rate for Payer: Aetna of WY Medicare |
$450.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$655.24
|
| Rate for Payer: Altius Commercial |
$655.24
|
| Rate for Payer: Beech Street Commercial |
$668.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$560.37
|
| Rate for Payer: Cash Price |
$477.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$662.06
|
| Rate for Payer: Cigna of WY Commercial |
$668.89
|
| Rate for Payer: Entrust Commercial |
$648.41
|
| Rate for Payer: First Choice Health Commercial |
$648.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$648.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$395.87
|
| Rate for Payer: HealthUtah PPO |
$682.54
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$662.06
|
| Rate for Payer: Multiplan Medicare/VA |
$376.08
|
| Rate for Payer: One Health Plan of WY PPO |
$668.89
|
| Rate for Payer: PacificSource Commercial |
$614.29
|
| Rate for Payer: PHCS PPO |
$668.89
|
| Rate for Payer: Three Rivers PPO |
$511.90
|
| Rate for Payer: TriWest Veterans Administration |
$395.87
|
| Rate for Payer: United Healthcare Commercial |
$593.81
|
| Rate for Payer: United Healthcare Medicare |
$395.87
|
| Rate for Payer: WINHealth Partners Commercial |
$668.89
|
| Rate for Payer: Wise Provider Network Commercial |
$648.41
|
|
|
PCA TUBING
|
Facility
|
OP
|
$8.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.56
|
| Rate for Payer: Aetna of WY Medicare |
$5.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.38
|
| Rate for Payer: Altius Commercial |
$8.38
|
| Rate for Payer: Beech Street Commercial |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.17
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.47
|
| Rate for Payer: Cigna of WY Commercial |
$8.56
|
| Rate for Payer: Entrust Commercial |
$8.29
|
| Rate for Payer: First Choice Health Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.06
|
| Rate for Payer: HealthUtah PPO |
$8.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.47
|
| Rate for Payer: Multiplan Medicare/VA |
$4.81
|
| Rate for Payer: One Health Plan of WY PPO |
$8.56
|
| Rate for Payer: PacificSource Commercial |
$7.86
|
| Rate for Payer: PHCS PPO |
$8.56
|
| Rate for Payer: Three Rivers PPO |
$6.55
|
| Rate for Payer: TriWest Veterans Administration |
$5.06
|
| Rate for Payer: United Healthcare Commercial |
$7.60
|
| Rate for Payer: United Healthcare Medicare |
$5.06
|
| Rate for Payer: WINHealth Partners Commercial |
$8.56
|
| Rate for Payer: Wise Provider Network Commercial |
$8.29
|
|
|
PCA TUBING
|
Facility
|
IP
|
$8.73
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.47 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.38
|
| Rate for Payer: Altius Commercial |
$8.38
|
| Rate for Payer: Beech Street Commercial |
$8.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.17
|
| Rate for Payer: Cash Price |
$6.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.47
|
| Rate for Payer: Cigna of WY Commercial |
$8.56
|
| Rate for Payer: Entrust Commercial |
$8.29
|
| Rate for Payer: First Choice Health Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.76
|
| Rate for Payer: HealthUtah PPO |
$8.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.47
|
| Rate for Payer: Multiplan Medicare/VA |
$5.47
|
| Rate for Payer: One Health Plan of WY PPO |
$8.56
|
| Rate for Payer: PacificSource Commercial |
$7.86
|
| Rate for Payer: PHCS PPO |
$8.56
|
| Rate for Payer: Three Rivers PPO |
$6.55
|
| Rate for Payer: TriWest Veterans Administration |
$5.76
|
| Rate for Payer: United Healthcare Commercial |
$7.60
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
| Rate for Payer: WINHealth Partners Commercial |
$8.29
|
| Rate for Payer: Wise Provider Network Commercial |
$8.29
|
|
|
PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
90670
|
| Min. Negotiated Rate |
$219.29 |
| Max. Negotiated Rate |
$537.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$526.26
|
| Rate for Payer: Aetna of WY Medicare |
$257.99
|
| Rate for Payer: Beech Street Commercial |
$510.15
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$520.89
|
| Rate for Payer: Cigna of WY Commercial |
$526.26
|
| Rate for Payer: First Choice Health Commercial |
$483.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$510.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$257.99
|
| Rate for Payer: HealthUtah PPO |
$537.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$520.89
|
| Rate for Payer: Multiplan Medicare/VA |
$219.29
|
| Rate for Payer: One Health Plan of WY PPO |
$526.26
|
| Rate for Payer: PacificSource Commercial |
$483.30
|
| Rate for Payer: PHCS PPO |
$510.15
|
| Rate for Payer: Three Rivers PPO |
$402.75
|
| Rate for Payer: TriWest Veterans Administration |
$257.99
|
| Rate for Payer: United Healthcare Commercial |
$467.19
|
| Rate for Payer: United Healthcare Medicare |
$257.99
|
| Rate for Payer: WINHealth Partners Commercial |
$537.00
|
|
|
PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90677 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$297.82 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$313.50
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$297.82
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$313.50
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$313.50
|
| Rate for Payer: WINHealth Partners Commercial |
$451.25
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
90677
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Medicare |
$298.04
|
| Rate for Payer: Beech Street Commercial |
$451.25
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: First Choice Health Commercial |
$427.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$298.04
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$253.33
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$451.25
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$298.04
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$298.04
|
| Rate for Payer: WINHealth Partners Commercial |
$475.00
|
|
|
PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$261.72 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$465.50
|
| Rate for Payer: Aetna of WY Medicare |
$313.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$456.00
|
| Rate for Payer: Altius Commercial |
$456.00
|
| Rate for Payer: Beech Street Commercial |
$465.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$389.98
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$460.75
|
| Rate for Payer: Cigna of WY Commercial |
$465.50
|
| Rate for Payer: Entrust Commercial |
$451.25
|
| Rate for Payer: First Choice Health Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$451.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$275.50
|
| Rate for Payer: HealthUtah PPO |
$475.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$460.75
|
| Rate for Payer: Multiplan Medicare/VA |
$261.72
|
| Rate for Payer: One Health Plan of WY PPO |
$465.50
|
| Rate for Payer: PacificSource Commercial |
$427.50
|
| Rate for Payer: PHCS PPO |
$465.50
|
| Rate for Payer: Three Rivers PPO |
$356.25
|
| Rate for Payer: TriWest Veterans Administration |
$275.50
|
| Rate for Payer: United Healthcare Commercial |
$413.25
|
| Rate for Payer: United Healthcare Medicare |
$298.04
|
| Rate for Payer: WINHealth Partners Commercial |
$465.50
|
| Rate for Payer: Wise Provider Network Commercial |
$451.25
|
|
|
PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90677 NONPBBPAYER,SL
|
| Hospital Charge Code |
6369067701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$298.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.01
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.01
|
| Rate for Payer: Altius Commercial |
$0.01
|
| Rate for Payer: Beech Street Commercial |
$0.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.01
|
| Rate for Payer: Cigna of WY Commercial |
$0.01
|
| Rate for Payer: Entrust Commercial |
$0.01
|
| Rate for Payer: First Choice Health Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.01
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.01
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.01
|
| Rate for Payer: PacificSource Commercial |
$0.01
|
| Rate for Payer: PHCS PPO |
$0.01
|
| Rate for Payer: Three Rivers PPO |
$0.01
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.01
|
| Rate for Payer: United Healthcare Medicare |
$298.04
|
| Rate for Payer: WINHealth Partners Commercial |
$0.01
|
| Rate for Payer: Wise Provider Network Commercial |
$0.01
|
|
|
PEAK FLOW METER ASTHMA CHECK
|
Facility
|
IP
|
$21.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$21.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.50
|
| Rate for Payer: Altius Commercial |
$20.50
|
| Rate for Payer: Beech Street Commercial |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.71
|
| Rate for Payer: Cigna of WY Commercial |
$20.92
|
| Rate for Payer: Entrust Commercial |
$20.28
|
| Rate for Payer: First Choice Health Commercial |
$20.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.09
|
| Rate for Payer: HealthUtah PPO |
$21.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.71
|
| Rate for Payer: Multiplan Medicare/VA |
$13.39
|
| Rate for Payer: One Health Plan of WY PPO |
$20.92
|
| Rate for Payer: PacificSource Commercial |
$19.22
|
| Rate for Payer: PHCS PPO |
$20.92
|
| Rate for Payer: Three Rivers PPO |
$16.01
|
| Rate for Payer: TriWest Veterans Administration |
$14.09
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare |
$14.09
|
| Rate for Payer: WINHealth Partners Commercial |
$20.28
|
| Rate for Payer: Wise Provider Network Commercial |
$20.28
|
|
|
PEAK FLOW METER ASTHMA CHECK
|
Facility
|
OP
|
$21.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$21.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.92
|
| Rate for Payer: Aetna of WY Medicare |
$14.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.50
|
| Rate for Payer: Altius Commercial |
$20.50
|
| Rate for Payer: Beech Street Commercial |
$20.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.71
|
| Rate for Payer: Cigna of WY Commercial |
$20.92
|
| Rate for Payer: Entrust Commercial |
$20.28
|
| Rate for Payer: First Choice Health Commercial |
$20.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.38
|
| Rate for Payer: HealthUtah PPO |
$21.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.71
|
| Rate for Payer: Multiplan Medicare/VA |
$11.76
|
| Rate for Payer: One Health Plan of WY PPO |
$20.92
|
| Rate for Payer: PacificSource Commercial |
$19.22
|
| Rate for Payer: PHCS PPO |
$20.92
|
| Rate for Payer: Three Rivers PPO |
$16.01
|
| Rate for Payer: TriWest Veterans Administration |
$12.38
|
| Rate for Payer: United Healthcare Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare |
$12.38
|
| Rate for Payer: WINHealth Partners Commercial |
$20.92
|
| Rate for Payer: Wise Provider Network Commercial |
$20.28
|
|
|
PEDIATRIC MULTIVIT NO.158-IRON FUM 18 MG-VIT K1 10 MCG CHEWABLE TABLET [151525]
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 0536344308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.23
|
| Rate for Payer: Altius Commercial |
$0.23
|
| Rate for Payer: Beech Street Commercial |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.23
|
| Rate for Payer: Cigna of WY Commercial |
$0.24
|
| Rate for Payer: Entrust Commercial |
$0.23
|
| Rate for Payer: First Choice Health Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.16
|
| Rate for Payer: HealthUtah PPO |
$0.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.23
|
| Rate for Payer: Multiplan Medicare/VA |
$0.15
|
| Rate for Payer: One Health Plan of WY PPO |
$0.24
|
| Rate for Payer: PacificSource Commercial |
$0.22
|
| Rate for Payer: PHCS PPO |
$0.24
|
| Rate for Payer: Three Rivers PPO |
$0.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.16
|
| Rate for Payer: United Healthcare Commercial |
$0.21
|
| Rate for Payer: United Healthcare Medicare |
$0.16
|
| Rate for Payer: WINHealth Partners Commercial |
$0.23
|
| Rate for Payer: Wise Provider Network Commercial |
$0.23
|
|
|
PEDIATRIC MULTIVIT NO.158-IRON FUM 18 MG-VIT K1 10 MCG CHEWABLE TABLET [151525]
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 0536344308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.24
|
| Rate for Payer: Aetna of WY Medicare |
$0.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.23
|
| Rate for Payer: Altius Commercial |
$0.23
|
| Rate for Payer: Beech Street Commercial |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.20
|
| Rate for Payer: Cash Price |
$0.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.23
|
| Rate for Payer: Cigna of WY Commercial |
$0.24
|
| Rate for Payer: Entrust Commercial |
$0.23
|
| Rate for Payer: First Choice Health Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.14
|
| Rate for Payer: HealthUtah PPO |
$0.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.23
|
| Rate for Payer: Multiplan Medicare/VA |
$0.13
|
| Rate for Payer: One Health Plan of WY PPO |
$0.24
|
| Rate for Payer: PacificSource Commercial |
$0.22
|
| Rate for Payer: PHCS PPO |
$0.24
|
| Rate for Payer: Three Rivers PPO |
$0.18
|
| Rate for Payer: TriWest Veterans Administration |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.21
|
| Rate for Payer: United Healthcare Medicare |
$0.14
|
| Rate for Payer: WINHealth Partners Commercial |
$0.24
|
| Rate for Payer: Wise Provider Network Commercial |
$0.23
|
|
|
PEDI-CAP NELCOR CO2
|
Facility
|
IP
|
$27.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$27.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.39
|
| Rate for Payer: Altius Commercial |
$26.39
|
| Rate for Payer: Beech Street Commercial |
$26.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.57
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.67
|
| Rate for Payer: Cigna of WY Commercial |
$26.94
|
| Rate for Payer: Entrust Commercial |
$26.12
|
| Rate for Payer: First Choice Health Commercial |
$26.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.14
|
| Rate for Payer: HealthUtah PPO |
$27.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.67
|
| Rate for Payer: Multiplan Medicare/VA |
$17.24
|
| Rate for Payer: One Health Plan of WY PPO |
$26.94
|
| Rate for Payer: PacificSource Commercial |
$24.74
|
| Rate for Payer: PHCS PPO |
$26.94
|
| Rate for Payer: Three Rivers PPO |
$20.62
|
| Rate for Payer: TriWest Veterans Administration |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$23.92
|
| Rate for Payer: United Healthcare Medicare |
$18.14
|
| Rate for Payer: WINHealth Partners Commercial |
$26.12
|
| Rate for Payer: Wise Provider Network Commercial |
$26.12
|
|
|
PEDI-CAP NELCOR CO2
|
Facility
|
OP
|
$27.49
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$27.49 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$26.94
|
| Rate for Payer: Aetna of WY Medicare |
$18.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$26.39
|
| Rate for Payer: Altius Commercial |
$26.39
|
| Rate for Payer: Beech Street Commercial |
$26.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$22.57
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$26.67
|
| Rate for Payer: Cigna of WY Commercial |
$26.94
|
| Rate for Payer: Entrust Commercial |
$26.12
|
| Rate for Payer: First Choice Health Commercial |
$26.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$26.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.94
|
| Rate for Payer: HealthUtah PPO |
$27.49
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$26.67
|
| Rate for Payer: Multiplan Medicare/VA |
$15.15
|
| Rate for Payer: One Health Plan of WY PPO |
$26.94
|
| Rate for Payer: PacificSource Commercial |
$24.74
|
| Rate for Payer: PHCS PPO |
$26.94
|
| Rate for Payer: Three Rivers PPO |
$20.62
|
| Rate for Payer: TriWest Veterans Administration |
$15.94
|
| Rate for Payer: United Healthcare Commercial |
$23.92
|
| Rate for Payer: United Healthcare Medicare |
$15.94
|
| Rate for Payer: WINHealth Partners Commercial |
$26.94
|
| Rate for Payer: Wise Provider Network Commercial |
$26.12
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [43636]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 4338609019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [43636]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 1057210001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [43636]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 1057210001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [43636]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 6438076621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.06
|
| Rate for Payer: Aetna of WY Medicare |
$0.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.06
|
| Rate for Payer: Altius Commercial |
$0.06
|
| Rate for Payer: Beech Street Commercial |
$0.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.06
|
| Rate for Payer: Cigna of WY Commercial |
$0.06
|
| Rate for Payer: Entrust Commercial |
$0.06
|
| Rate for Payer: First Choice Health Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.03
|
| Rate for Payer: HealthUtah PPO |
$0.06
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.06
|
| Rate for Payer: Multiplan Medicare/VA |
$0.03
|
| Rate for Payer: One Health Plan of WY PPO |
$0.06
|
| Rate for Payer: PacificSource Commercial |
$0.05
|
| Rate for Payer: PHCS PPO |
$0.06
|
| Rate for Payer: Three Rivers PPO |
$0.05
|
| Rate for Payer: TriWest Veterans Administration |
$0.03
|
| Rate for Payer: United Healthcare Commercial |
$0.05
|
| Rate for Payer: United Healthcare Medicare |
$0.03
|
| Rate for Payer: WINHealth Partners Commercial |
$0.06
|
| Rate for Payer: Wise Provider Network Commercial |
$0.06
|
|
