|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [39255]
|
Facility
|
IP
|
$168.94
|
|
|
Service Code
|
NDC 4928186010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.93 |
| Max. Negotiated Rate |
$168.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.18
|
| Rate for Payer: Altius Commercial |
$162.18
|
| Rate for Payer: Beech Street Commercial |
$165.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.70
|
| Rate for Payer: Cash Price |
$118.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.87
|
| Rate for Payer: Cigna of WY Commercial |
$165.56
|
| Rate for Payer: Entrust Commercial |
$160.49
|
| Rate for Payer: First Choice Health Commercial |
$160.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$111.50
|
| Rate for Payer: HealthUtah PPO |
$168.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.87
|
| Rate for Payer: Multiplan Medicare/VA |
$105.93
|
| Rate for Payer: One Health Plan of WY PPO |
$165.56
|
| Rate for Payer: PacificSource Commercial |
$152.05
|
| Rate for Payer: PHCS PPO |
$165.56
|
| Rate for Payer: Three Rivers PPO |
$126.70
|
| Rate for Payer: TriWest Veterans Administration |
$111.50
|
| Rate for Payer: United Healthcare Commercial |
$146.98
|
| Rate for Payer: United Healthcare Medicare |
$111.50
|
| Rate for Payer: WINHealth Partners Commercial |
$160.49
|
| Rate for Payer: Wise Provider Network Commercial |
$160.49
|
|
|
POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION [39255]
|
Facility
|
OP
|
$168.94
|
|
|
Service Code
|
NDC 4928186010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.09 |
| Max. Negotiated Rate |
$168.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$165.56
|
| Rate for Payer: Aetna of WY Medicare |
$111.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$162.18
|
| Rate for Payer: Altius Commercial |
$162.18
|
| Rate for Payer: Beech Street Commercial |
$165.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.70
|
| Rate for Payer: Cash Price |
$118.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$163.87
|
| Rate for Payer: Cigna of WY Commercial |
$165.56
|
| Rate for Payer: Entrust Commercial |
$160.49
|
| Rate for Payer: First Choice Health Commercial |
$160.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$160.49
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.99
|
| Rate for Payer: HealthUtah PPO |
$168.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$163.87
|
| Rate for Payer: Multiplan Medicare/VA |
$93.09
|
| Rate for Payer: One Health Plan of WY PPO |
$165.56
|
| Rate for Payer: PacificSource Commercial |
$152.05
|
| Rate for Payer: PHCS PPO |
$165.56
|
| Rate for Payer: Three Rivers PPO |
$126.70
|
| Rate for Payer: TriWest Veterans Administration |
$97.99
|
| Rate for Payer: United Healthcare Commercial |
$146.98
|
| Rate for Payer: United Healthcare Medicare |
$97.99
|
| Rate for Payer: WINHealth Partners Commercial |
$165.56
|
| Rate for Payer: Wise Provider Network Commercial |
$160.49
|
|
|
POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 90713
|
| Hospital Charge Code |
90713
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$143.08
|
| Rate for Payer: Beech Street Commercial |
$138.70
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$141.62
|
| Rate for Payer: Cigna of WY Commercial |
$143.08
|
| Rate for Payer: First Choice Health Commercial |
$131.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$138.70
|
| Rate for Payer: HealthUtah PPO |
$146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$141.62
|
| Rate for Payer: One Health Plan of WY PPO |
$143.08
|
| Rate for Payer: PacificSource Commercial |
$131.40
|
| Rate for Payer: PHCS PPO |
$138.70
|
| Rate for Payer: Three Rivers PPO |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: WINHealth Partners Commercial |
$146.00
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [17595]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 0113030603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Aetna of WY Medicare |
$0.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.13
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.12
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.13
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.13
|
| Rate for Payer: WINHealth Partners Commercial |
$0.22
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWDER [17595]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 0113030603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.21
|
| Rate for Payer: Altius Commercial |
$0.21
|
| Rate for Payer: Beech Street Commercial |
$0.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.21
|
| Rate for Payer: Cigna of WY Commercial |
$0.22
|
| Rate for Payer: Entrust Commercial |
$0.21
|
| Rate for Payer: First Choice Health Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.22
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.21
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.22
|
| Rate for Payer: PacificSource Commercial |
$0.20
|
| Rate for Payer: PHCS PPO |
$0.22
|
| Rate for Payer: Three Rivers PPO |
$0.17
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.19
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.21
|
| Rate for Payer: Wise Provider Network Commercial |
$0.21
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [2761]
|
Facility
|
IP
|
$6.74
|
|
|
Service Code
|
NDC 6068743198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.47
|
| Rate for Payer: Altius Commercial |
$6.47
|
| Rate for Payer: Beech Street Commercial |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.53
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.54
|
| Rate for Payer: Cigna of WY Commercial |
$6.61
|
| Rate for Payer: Entrust Commercial |
$6.40
|
| Rate for Payer: First Choice Health Commercial |
$6.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.45
|
| Rate for Payer: HealthUtah PPO |
$6.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.54
|
| Rate for Payer: Multiplan Medicare/VA |
$4.23
|
| Rate for Payer: One Health Plan of WY PPO |
$6.61
|
| Rate for Payer: PacificSource Commercial |
$6.07
|
| Rate for Payer: PHCS PPO |
$6.61
|
| Rate for Payer: Three Rivers PPO |
$5.06
|
| Rate for Payer: TriWest Veterans Administration |
$4.45
|
| Rate for Payer: United Healthcare Commercial |
$5.86
|
| Rate for Payer: United Healthcare Medicare |
$4.45
|
| Rate for Payer: WINHealth Partners Commercial |
$6.40
|
| Rate for Payer: Wise Provider Network Commercial |
$6.40
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [2761]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 6068743198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$6.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.61
|
| Rate for Payer: Aetna of WY Medicare |
$4.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.47
|
| Rate for Payer: Altius Commercial |
$6.47
|
| Rate for Payer: Beech Street Commercial |
$6.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.53
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.54
|
| Rate for Payer: Cigna of WY Commercial |
$6.61
|
| Rate for Payer: Entrust Commercial |
$6.40
|
| Rate for Payer: First Choice Health Commercial |
$6.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.91
|
| Rate for Payer: HealthUtah PPO |
$6.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.54
|
| Rate for Payer: Multiplan Medicare/VA |
$3.71
|
| Rate for Payer: One Health Plan of WY PPO |
$6.61
|
| Rate for Payer: PacificSource Commercial |
$6.07
|
| Rate for Payer: PHCS PPO |
$6.61
|
| Rate for Payer: Three Rivers PPO |
$5.06
|
| Rate for Payer: TriWest Veterans Administration |
$3.91
|
| Rate for Payer: United Healthcare Commercial |
$5.86
|
| Rate for Payer: United Healthcare Medicare |
$3.91
|
| Rate for Payer: WINHealth Partners Commercial |
$6.61
|
| Rate for Payer: Wise Provider Network Commercial |
$6.40
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [2761]
|
Facility
|
IP
|
$5.85
|
|
|
Service Code
|
NDC 6068743199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.62
|
| Rate for Payer: Altius Commercial |
$5.62
|
| Rate for Payer: Beech Street Commercial |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.67
|
| Rate for Payer: Cigna of WY Commercial |
$5.73
|
| Rate for Payer: Entrust Commercial |
$5.56
|
| Rate for Payer: First Choice Health Commercial |
$5.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.86
|
| Rate for Payer: HealthUtah PPO |
$5.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.67
|
| Rate for Payer: Multiplan Medicare/VA |
$3.67
|
| Rate for Payer: One Health Plan of WY PPO |
$5.73
|
| Rate for Payer: PacificSource Commercial |
$5.26
|
| Rate for Payer: PHCS PPO |
$5.73
|
| Rate for Payer: Three Rivers PPO |
$4.39
|
| Rate for Payer: TriWest Veterans Administration |
$3.86
|
| Rate for Payer: United Healthcare Commercial |
$5.09
|
| Rate for Payer: United Healthcare Medicare |
$3.86
|
| Rate for Payer: WINHealth Partners Commercial |
$5.56
|
| Rate for Payer: Wise Provider Network Commercial |
$5.56
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [2761]
|
Facility
|
OP
|
$5.85
|
|
|
Service Code
|
NDC 6068743199
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.73
|
| Rate for Payer: Aetna of WY Medicare |
$3.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.62
|
| Rate for Payer: Altius Commercial |
$5.62
|
| Rate for Payer: Beech Street Commercial |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.67
|
| Rate for Payer: Cigna of WY Commercial |
$5.73
|
| Rate for Payer: Entrust Commercial |
$5.56
|
| Rate for Payer: First Choice Health Commercial |
$5.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.39
|
| Rate for Payer: HealthUtah PPO |
$5.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.67
|
| Rate for Payer: Multiplan Medicare/VA |
$3.22
|
| Rate for Payer: One Health Plan of WY PPO |
$5.73
|
| Rate for Payer: PacificSource Commercial |
$5.26
|
| Rate for Payer: PHCS PPO |
$5.73
|
| Rate for Payer: Three Rivers PPO |
$4.39
|
| Rate for Payer: TriWest Veterans Administration |
$3.39
|
| Rate for Payer: United Healthcare Commercial |
$5.09
|
| Rate for Payer: United Healthcare Medicare |
$3.39
|
| Rate for Payer: WINHealth Partners Commercial |
$5.73
|
| Rate for Payer: Wise Provider Network Commercial |
$5.56
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [13383]
|
Facility
|
IP
|
$4.14
|
|
|
Service Code
|
NDC 6131462810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.97
|
| Rate for Payer: Altius Commercial |
$3.97
|
| Rate for Payer: Beech Street Commercial |
$4.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.02
|
| Rate for Payer: Cigna of WY Commercial |
$4.06
|
| Rate for Payer: Entrust Commercial |
$3.93
|
| Rate for Payer: First Choice Health Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.73
|
| Rate for Payer: HealthUtah PPO |
$4.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.02
|
| Rate for Payer: Multiplan Medicare/VA |
$2.60
|
| Rate for Payer: One Health Plan of WY PPO |
$4.06
|
| Rate for Payer: PacificSource Commercial |
$3.73
|
| Rate for Payer: PHCS PPO |
$4.06
|
| Rate for Payer: Three Rivers PPO |
$3.10
|
| Rate for Payer: TriWest Veterans Administration |
$2.73
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$2.73
|
| Rate for Payer: WINHealth Partners Commercial |
$3.93
|
| Rate for Payer: Wise Provider Network Commercial |
$3.93
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [13383]
|
Facility
|
OP
|
$4.14
|
|
|
Service Code
|
NDC 6131462810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.06
|
| Rate for Payer: Aetna of WY Medicare |
$2.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.97
|
| Rate for Payer: Altius Commercial |
$3.97
|
| Rate for Payer: Beech Street Commercial |
$4.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.02
|
| Rate for Payer: Cigna of WY Commercial |
$4.06
|
| Rate for Payer: Entrust Commercial |
$3.93
|
| Rate for Payer: First Choice Health Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.40
|
| Rate for Payer: HealthUtah PPO |
$4.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.02
|
| Rate for Payer: Multiplan Medicare/VA |
$2.28
|
| Rate for Payer: One Health Plan of WY PPO |
$4.06
|
| Rate for Payer: PacificSource Commercial |
$3.73
|
| Rate for Payer: PHCS PPO |
$4.06
|
| Rate for Payer: Three Rivers PPO |
$3.10
|
| Rate for Payer: TriWest Veterans Administration |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$3.60
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| Rate for Payer: WINHealth Partners Commercial |
$4.06
|
| Rate for Payer: Wise Provider Network Commercial |
$3.93
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [13383]
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 2420831510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.21
|
| Rate for Payer: Aetna of WY Medicare |
$2.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.13
|
| Rate for Payer: Altius Commercial |
$4.13
|
| Rate for Payer: Beech Street Commercial |
$4.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.17
|
| Rate for Payer: Cigna of WY Commercial |
$4.21
|
| Rate for Payer: Entrust Commercial |
$4.08
|
| Rate for Payer: First Choice Health Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.49
|
| Rate for Payer: HealthUtah PPO |
$4.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.17
|
| Rate for Payer: Multiplan Medicare/VA |
$2.37
|
| Rate for Payer: One Health Plan of WY PPO |
$4.21
|
| Rate for Payer: PacificSource Commercial |
$3.87
|
| Rate for Payer: PHCS PPO |
$4.21
|
| Rate for Payer: Three Rivers PPO |
$3.22
|
| Rate for Payer: TriWest Veterans Administration |
$2.49
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Medicare |
$2.49
|
| Rate for Payer: WINHealth Partners Commercial |
$4.21
|
| Rate for Payer: Wise Provider Network Commercial |
$4.08
|
|
|
POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS [13383]
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 2420831510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$4.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.13
|
| Rate for Payer: Altius Commercial |
$4.13
|
| Rate for Payer: Beech Street Commercial |
$4.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.17
|
| Rate for Payer: Cigna of WY Commercial |
$4.21
|
| Rate for Payer: Entrust Commercial |
$4.08
|
| Rate for Payer: First Choice Health Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.84
|
| Rate for Payer: HealthUtah PPO |
$4.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.17
|
| Rate for Payer: Multiplan Medicare/VA |
$2.70
|
| Rate for Payer: One Health Plan of WY PPO |
$4.21
|
| Rate for Payer: PacificSource Commercial |
$3.87
|
| Rate for Payer: PHCS PPO |
$4.21
|
| Rate for Payer: Three Rivers PPO |
$3.22
|
| Rate for Payer: TriWest Veterans Administration |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
| Rate for Payer: United Healthcare Medicare |
$2.84
|
| Rate for Payer: WINHealth Partners Commercial |
$4.08
|
| Rate for Payer: Wise Provider Network Commercial |
$4.08
|
|
|
POLYP TRAP DISP 4-CHAMBER
|
Facility
|
OP
|
$17.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Aetna of WY Medicare |
$11.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.80
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.37
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.15
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Multiplan Medicare/VA |
$9.64
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$10.15
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$10.15
|
| Rate for Payer: WINHealth Partners Commercial |
$17.15
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
POLYP TRAP DISP 4-CHAMBER
|
Facility
|
IP
|
$17.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.80
|
| Rate for Payer: Altius Commercial |
$16.80
|
| Rate for Payer: Beech Street Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.37
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.98
|
| Rate for Payer: Cigna of WY Commercial |
$17.15
|
| Rate for Payer: Entrust Commercial |
$16.62
|
| Rate for Payer: First Choice Health Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$16.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.55
|
| Rate for Payer: HealthUtah PPO |
$17.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.98
|
| Rate for Payer: Multiplan Medicare/VA |
$10.97
|
| Rate for Payer: One Health Plan of WY PPO |
$17.15
|
| Rate for Payer: PacificSource Commercial |
$15.75
|
| Rate for Payer: PHCS PPO |
$17.15
|
| Rate for Payer: Three Rivers PPO |
$13.12
|
| Rate for Payer: TriWest Veterans Administration |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$15.22
|
| Rate for Payer: United Healthcare Medicare |
$11.55
|
| Rate for Payer: WINHealth Partners Commercial |
$16.62
|
| Rate for Payer: Wise Provider Network Commercial |
$16.62
|
|
|
POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 95810 26
|
| Hospital Charge Code |
95810
|
| Min. Negotiated Rate |
$95.92 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$547.82
|
| Rate for Payer: Aetna of WY Medicare |
$112.85
|
| Rate for Payer: Beech Street Commercial |
$531.05
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$542.23
|
| Rate for Payer: Cigna of WY Commercial |
$547.82
|
| Rate for Payer: First Choice Health Commercial |
$503.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$531.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.85
|
| Rate for Payer: HealthUtah PPO |
$559.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$542.23
|
| Rate for Payer: Multiplan Medicare/VA |
$95.92
|
| Rate for Payer: One Health Plan of WY PPO |
$547.82
|
| Rate for Payer: PacificSource Commercial |
$503.10
|
| Rate for Payer: PHCS PPO |
$531.05
|
| Rate for Payer: Three Rivers PPO |
$419.25
|
| Rate for Payer: TriWest Veterans Administration |
$112.85
|
| Rate for Payer: United Healthcare Commercial |
$486.33
|
| Rate for Payer: United Healthcare Medicare |
$112.85
|
| Rate for Payer: WINHealth Partners Commercial |
$531.05
|
|
|
POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 95811 26
|
| Hospital Charge Code |
95811
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$559.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$547.82
|
| Rate for Payer: Aetna of WY Medicare |
$117.35
|
| Rate for Payer: Beech Street Commercial |
$531.05
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$542.23
|
| Rate for Payer: Cigna of WY Commercial |
$547.82
|
| Rate for Payer: First Choice Health Commercial |
$503.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$531.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$117.35
|
| Rate for Payer: HealthUtah PPO |
$559.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$542.23
|
| Rate for Payer: Multiplan Medicare/VA |
$99.75
|
| Rate for Payer: One Health Plan of WY PPO |
$547.82
|
| Rate for Payer: PacificSource Commercial |
$503.10
|
| Rate for Payer: PHCS PPO |
$531.05
|
| Rate for Payer: Three Rivers PPO |
$419.25
|
| Rate for Payer: TriWest Veterans Administration |
$117.35
|
| Rate for Payer: United Healthcare Commercial |
$486.33
|
| Rate for Payer: United Healthcare Medicare |
$117.35
|
| Rate for Payer: WINHealth Partners Commercial |
$531.05
|
|
|
POLYVINYL ALCOHOL-POVIDONE 0.5 %-0.6 % EYE DROPS [38725]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 8770110406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.09
|
| Rate for Payer: Altius Commercial |
$1.09
|
| Rate for Payer: Beech Street Commercial |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.11
|
| Rate for Payer: Cigna of WY Commercial |
$1.12
|
| Rate for Payer: Entrust Commercial |
$1.08
|
| Rate for Payer: First Choice Health Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.75
|
| Rate for Payer: HealthUtah PPO |
$1.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.12
|
| Rate for Payer: PacificSource Commercial |
$1.03
|
| Rate for Payer: PHCS PPO |
$1.12
|
| Rate for Payer: Three Rivers PPO |
$0.86
|
| Rate for Payer: TriWest Veterans Administration |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Medicare |
$0.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1.08
|
| Rate for Payer: Wise Provider Network Commercial |
$1.08
|
|
|
POLYVINYL ALCOHOL-POVIDONE 0.5 %-0.6 % EYE DROPS [38725]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
NDC 2438500605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.09
|
| Rate for Payer: Altius Commercial |
$1.09
|
| Rate for Payer: Beech Street Commercial |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.11
|
| Rate for Payer: Cigna of WY Commercial |
$1.12
|
| Rate for Payer: Entrust Commercial |
$1.08
|
| Rate for Payer: First Choice Health Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.75
|
| Rate for Payer: HealthUtah PPO |
$1.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.12
|
| Rate for Payer: PacificSource Commercial |
$1.03
|
| Rate for Payer: PHCS PPO |
$1.12
|
| Rate for Payer: Three Rivers PPO |
$0.86
|
| Rate for Payer: TriWest Veterans Administration |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Medicare |
$0.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1.08
|
| Rate for Payer: Wise Provider Network Commercial |
$1.08
|
|
|
POLYVINYL ALCOHOL-POVIDONE 0.5 %-0.6 % EYE DROPS [38725]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 2438500605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.12
|
| Rate for Payer: Aetna of WY Medicare |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.09
|
| Rate for Payer: Altius Commercial |
$1.09
|
| Rate for Payer: Beech Street Commercial |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.11
|
| Rate for Payer: Cigna of WY Commercial |
$1.12
|
| Rate for Payer: Entrust Commercial |
$1.08
|
| Rate for Payer: First Choice Health Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1.12
|
| Rate for Payer: PacificSource Commercial |
$1.03
|
| Rate for Payer: PHCS PPO |
$1.12
|
| Rate for Payer: Three Rivers PPO |
$0.86
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1.08
|
|
|
POLYVINYL ALCOHOL-POVIDONE 0.5 %-0.6 % EYE DROPS [38725]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
NDC 8770110406
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.12
|
| Rate for Payer: Aetna of WY Medicare |
$0.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.09
|
| Rate for Payer: Altius Commercial |
$1.09
|
| Rate for Payer: Beech Street Commercial |
$1.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.94
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.11
|
| Rate for Payer: Cigna of WY Commercial |
$1.12
|
| Rate for Payer: Entrust Commercial |
$1.08
|
| Rate for Payer: First Choice Health Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.11
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1.12
|
| Rate for Payer: PacificSource Commercial |
$1.03
|
| Rate for Payer: PHCS PPO |
$1.12
|
| Rate for Payer: Three Rivers PPO |
$0.86
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.99
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$1.12
|
| Rate for Payer: Wise Provider Network Commercial |
$1.08
|
|
|
PORTAL DILATION NEEDLE AR-6521
|
Facility
|
IP
|
$265.72
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.61 |
| Max. Negotiated Rate |
$265.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.09
|
| Rate for Payer: Altius Commercial |
$255.09
|
| Rate for Payer: Beech Street Commercial |
$260.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.75
|
| Rate for Payer: Cigna of WY Commercial |
$260.41
|
| Rate for Payer: Entrust Commercial |
$252.43
|
| Rate for Payer: First Choice Health Commercial |
$252.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.38
|
| Rate for Payer: HealthUtah PPO |
$265.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.75
|
| Rate for Payer: Multiplan Medicare/VA |
$166.61
|
| Rate for Payer: One Health Plan of WY PPO |
$260.41
|
| Rate for Payer: PacificSource Commercial |
$239.15
|
| Rate for Payer: PHCS PPO |
$260.41
|
| Rate for Payer: Three Rivers PPO |
$199.29
|
| Rate for Payer: TriWest Veterans Administration |
$175.38
|
| Rate for Payer: United Healthcare Commercial |
$231.18
|
| Rate for Payer: United Healthcare Medicare |
$175.38
|
| Rate for Payer: WINHealth Partners Commercial |
$252.43
|
| Rate for Payer: Wise Provider Network Commercial |
$252.43
|
|
|
PORTAL DILATION NEEDLE AR-6521
|
Facility
|
OP
|
$265.72
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.41 |
| Max. Negotiated Rate |
$265.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$260.41
|
| Rate for Payer: Aetna of WY Medicare |
$175.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$255.09
|
| Rate for Payer: Altius Commercial |
$255.09
|
| Rate for Payer: Beech Street Commercial |
$260.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$218.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$257.75
|
| Rate for Payer: Cigna of WY Commercial |
$260.41
|
| Rate for Payer: Entrust Commercial |
$252.43
|
| Rate for Payer: First Choice Health Commercial |
$252.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$252.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.12
|
| Rate for Payer: HealthUtah PPO |
$265.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$257.75
|
| Rate for Payer: Multiplan Medicare/VA |
$146.41
|
| Rate for Payer: One Health Plan of WY PPO |
$260.41
|
| Rate for Payer: PacificSource Commercial |
$239.15
|
| Rate for Payer: PHCS PPO |
$260.41
|
| Rate for Payer: Three Rivers PPO |
$199.29
|
| Rate for Payer: TriWest Veterans Administration |
$154.12
|
| Rate for Payer: United Healthcare Commercial |
$231.18
|
| Rate for Payer: United Healthcare Medicare |
$154.12
|
| Rate for Payer: WINHealth Partners Commercial |
$260.41
|
| Rate for Payer: Wise Provider Network Commercial |
$252.43
|
|
|
PORTER DISP BREATHING CIRCUIT 6FT
|
Facility
|
OP
|
$57.75
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.60
|
| Rate for Payer: Aetna of WY Medicare |
$38.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.44
|
| Rate for Payer: Altius Commercial |
$55.44
|
| Rate for Payer: Beech Street Commercial |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$40.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.02
|
| Rate for Payer: Cigna of WY Commercial |
$56.60
|
| Rate for Payer: Entrust Commercial |
$54.86
|
| Rate for Payer: First Choice Health Commercial |
$54.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.50
|
| Rate for Payer: HealthUtah PPO |
$57.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.02
|
| Rate for Payer: Multiplan Medicare/VA |
$31.82
|
| Rate for Payer: One Health Plan of WY PPO |
$56.60
|
| Rate for Payer: PacificSource Commercial |
$51.98
|
| Rate for Payer: PHCS PPO |
$56.60
|
| Rate for Payer: Three Rivers PPO |
$43.31
|
| Rate for Payer: TriWest Veterans Administration |
$33.50
|
| Rate for Payer: United Healthcare Commercial |
$50.24
|
| Rate for Payer: United Healthcare Medicare |
$33.50
|
| Rate for Payer: WINHealth Partners Commercial |
$56.60
|
| Rate for Payer: Wise Provider Network Commercial |
$54.86
|
|
|
PORTER DISP BREATHING CIRCUIT 6FT
|
Facility
|
IP
|
$57.75
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$57.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.44
|
| Rate for Payer: Altius Commercial |
$55.44
|
| Rate for Payer: Beech Street Commercial |
$56.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.41
|
| Rate for Payer: Cash Price |
$40.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$56.02
|
| Rate for Payer: Cigna of WY Commercial |
$56.60
|
| Rate for Payer: Entrust Commercial |
$54.86
|
| Rate for Payer: First Choice Health Commercial |
$54.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.12
|
| Rate for Payer: HealthUtah PPO |
$57.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$56.02
|
| Rate for Payer: Multiplan Medicare/VA |
$36.21
|
| Rate for Payer: One Health Plan of WY PPO |
$56.60
|
| Rate for Payer: PacificSource Commercial |
$51.98
|
| Rate for Payer: PHCS PPO |
$56.60
|
| Rate for Payer: Three Rivers PPO |
$43.31
|
| Rate for Payer: TriWest Veterans Administration |
$38.12
|
| Rate for Payer: United Healthcare Commercial |
$50.24
|
| Rate for Payer: United Healthcare Medicare |
$38.12
|
| Rate for Payer: WINHealth Partners Commercial |
$54.86
|
| Rate for Payer: Wise Provider Network Commercial |
$54.86
|
|
