|
CASTOR OIL 100 % ORAL [43747]
|
Facility
|
IP
|
$0.08
|
|
|
Service Code
|
NDC 8770140068
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.08
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.05
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
CASTOR OIL 100 % ORAL [43747]
|
Facility
|
OP
|
$0.08
|
|
|
Service Code
|
NDC 8770140068
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.08
|
| Rate for Payer: Aetna of WY Medicare |
$0.05
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.08
|
| Rate for Payer: Altius Commercial |
$0.08
|
| Rate for Payer: Beech Street Commercial |
$0.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.08
|
| Rate for Payer: Cigna of WY Commercial |
$0.08
|
| Rate for Payer: Entrust Commercial |
$0.08
|
| Rate for Payer: First Choice Health Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.05
|
| Rate for Payer: HealthUtah PPO |
$0.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.08
|
| Rate for Payer: Multiplan Medicare/VA |
$0.04
|
| Rate for Payer: One Health Plan of WY PPO |
$0.08
|
| Rate for Payer: PacificSource Commercial |
$0.07
|
| Rate for Payer: PHCS PPO |
$0.08
|
| Rate for Payer: Three Rivers PPO |
$0.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.05
|
| Rate for Payer: United Healthcare Commercial |
$0.07
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
| Rate for Payer: WINHealth Partners Commercial |
$0.08
|
| Rate for Payer: Wise Provider Network Commercial |
$0.08
|
|
|
CASTOR OIL ORAL [31265]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 3680088319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Aetna of WY Medicare |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
CASTOR OIL ORAL [31265]
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 3680088319
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.03
|
| Rate for Payer: Altius Commercial |
$0.03
|
| Rate for Payer: Beech Street Commercial |
$0.03
|
| 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 |
$0.03
|
| Rate for Payer: Cigna of WY Commercial |
$0.03
|
| Rate for Payer: Entrust Commercial |
$0.03
|
| Rate for Payer: First Choice Health Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.02
|
| Rate for Payer: HealthUtah PPO |
$0.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.03
|
| Rate for Payer: Multiplan Medicare/VA |
$0.02
|
| Rate for Payer: One Health Plan of WY PPO |
$0.03
|
| Rate for Payer: PacificSource Commercial |
$0.03
|
| Rate for Payer: PHCS PPO |
$0.03
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.02
|
| Rate for Payer: United Healthcare Commercial |
$0.03
|
| Rate for Payer: United Healthcare Medicare |
$0.02
|
| Rate for Payer: WINHealth Partners Commercial |
$0.03
|
| Rate for Payer: Wise Provider Network Commercial |
$0.03
|
|
|
CAST SUP SHT ARM ADULT FBRGL
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS Q4010
|
| Hospital Charge Code |
Q4010
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$155.82
|
| Rate for Payer: Aetna of WY Medicare |
$23.74
|
| Rate for Payer: Beech Street Commercial |
$151.05
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.23
|
| Rate for Payer: Cigna of WY Commercial |
$155.82
|
| Rate for Payer: First Choice Health Commercial |
$143.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.74
|
| Rate for Payer: HealthUtah PPO |
$159.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.23
|
| Rate for Payer: Multiplan Medicare/VA |
$20.18
|
| Rate for Payer: One Health Plan of WY PPO |
$155.82
|
| Rate for Payer: PacificSource Commercial |
$143.10
|
| Rate for Payer: PHCS PPO |
$151.05
|
| Rate for Payer: Three Rivers PPO |
$119.25
|
| Rate for Payer: TriWest Veterans Administration |
$23.74
|
| Rate for Payer: United Healthcare Commercial |
$138.33
|
| Rate for Payer: United Healthcare Medicare |
$23.74
|
| Rate for Payer: WINHealth Partners Commercial |
$151.05
|
|
|
CATH EPIDURAL VERSA-KATH 12"
|
Facility
|
IP
|
$235.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.93 |
| Max. Negotiated Rate |
$235.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$226.50
|
| Rate for Payer: Altius Commercial |
$226.50
|
| Rate for Payer: Beech Street Commercial |
$231.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.71
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.86
|
| Rate for Payer: Cigna of WY Commercial |
$231.22
|
| Rate for Payer: Entrust Commercial |
$224.14
|
| Rate for Payer: First Choice Health Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.72
|
| Rate for Payer: HealthUtah PPO |
$235.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.86
|
| Rate for Payer: Multiplan Medicare/VA |
$147.93
|
| Rate for Payer: One Health Plan of WY PPO |
$231.22
|
| Rate for Payer: PacificSource Commercial |
$212.35
|
| Rate for Payer: PHCS PPO |
$231.22
|
| Rate for Payer: Three Rivers PPO |
$176.96
|
| Rate for Payer: TriWest Veterans Administration |
$155.72
|
| Rate for Payer: United Healthcare Commercial |
$205.27
|
| Rate for Payer: United Healthcare Medicare |
$155.72
|
| Rate for Payer: WINHealth Partners Commercial |
$224.14
|
| Rate for Payer: Wise Provider Network Commercial |
$224.14
|
|
|
CATH EPIDURAL VERSA-KATH 12"
|
Facility
|
OP
|
$235.94
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$235.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$231.22
|
| Rate for Payer: Aetna of WY Medicare |
$155.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$226.50
|
| Rate for Payer: Altius Commercial |
$226.50
|
| Rate for Payer: Beech Street Commercial |
$231.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.71
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.86
|
| Rate for Payer: Cigna of WY Commercial |
$231.22
|
| Rate for Payer: Entrust Commercial |
$224.14
|
| Rate for Payer: First Choice Health Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$224.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.85
|
| Rate for Payer: HealthUtah PPO |
$235.94
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.86
|
| Rate for Payer: Multiplan Medicare/VA |
$130.00
|
| Rate for Payer: One Health Plan of WY PPO |
$231.22
|
| Rate for Payer: PacificSource Commercial |
$212.35
|
| Rate for Payer: PHCS PPO |
$231.22
|
| Rate for Payer: Three Rivers PPO |
$176.96
|
| Rate for Payer: TriWest Veterans Administration |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$205.27
|
| Rate for Payer: United Healthcare Medicare |
$136.85
|
| Rate for Payer: WINHealth Partners Commercial |
$231.22
|
| Rate for Payer: Wise Provider Network Commercial |
$224.14
|
|
|
CATHETER CPNB FLEXBLOCK KIT
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.57 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Aetna of WY Medicare |
$143.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.86
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$119.57
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$125.86
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$125.86
|
| Rate for Payer: WINHealth Partners Commercial |
$212.66
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
CATHETER CPNB FLEXBLOCK KIT
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.06 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$212.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$208.32
|
| Rate for Payer: Altius Commercial |
$208.32
|
| Rate for Payer: Beech Street Commercial |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$178.16
|
| Rate for Payer: Cash Price |
$151.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$210.49
|
| Rate for Payer: Cigna of WY Commercial |
$212.66
|
| Rate for Payer: Entrust Commercial |
$206.15
|
| Rate for Payer: First Choice Health Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$206.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$143.22
|
| Rate for Payer: HealthUtah PPO |
$217.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$210.49
|
| Rate for Payer: Multiplan Medicare/VA |
$136.06
|
| Rate for Payer: One Health Plan of WY PPO |
$212.66
|
| Rate for Payer: PacificSource Commercial |
$195.30
|
| Rate for Payer: PHCS PPO |
$212.66
|
| Rate for Payer: Three Rivers PPO |
$162.75
|
| Rate for Payer: TriWest Veterans Administration |
$143.22
|
| Rate for Payer: United Healthcare Commercial |
$188.79
|
| Rate for Payer: United Healthcare Medicare |
$143.22
|
| Rate for Payer: WINHealth Partners Commercial |
$206.15
|
| Rate for Payer: Wise Provider Network Commercial |
$206.15
|
|
|
CATHETER EPIDURAL TUN-L-XL
|
Facility
|
IP
|
$308.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$308.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$296.45
|
| Rate for Payer: Altius Commercial |
$296.45
|
| Rate for Payer: Beech Street Commercial |
$302.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.52
|
| Rate for Payer: Cash Price |
$216.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.54
|
| Rate for Payer: Cigna of WY Commercial |
$302.62
|
| Rate for Payer: Entrust Commercial |
$293.36
|
| Rate for Payer: First Choice Health Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.81
|
| Rate for Payer: HealthUtah PPO |
$308.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.54
|
| Rate for Payer: Multiplan Medicare/VA |
$193.62
|
| Rate for Payer: One Health Plan of WY PPO |
$302.62
|
| Rate for Payer: PacificSource Commercial |
$277.92
|
| Rate for Payer: PHCS PPO |
$302.62
|
| Rate for Payer: Three Rivers PPO |
$231.60
|
| Rate for Payer: TriWest Veterans Administration |
$203.81
|
| Rate for Payer: United Healthcare Commercial |
$268.66
|
| Rate for Payer: United Healthcare Medicare |
$203.81
|
| Rate for Payer: WINHealth Partners Commercial |
$293.36
|
| Rate for Payer: Wise Provider Network Commercial |
$293.36
|
|
|
CATHETER EPIDURAL TUN-L-XL
|
Facility
|
OP
|
$308.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.15 |
| Max. Negotiated Rate |
$308.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$302.62
|
| Rate for Payer: Aetna of WY Medicare |
$203.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$296.45
|
| Rate for Payer: Altius Commercial |
$296.45
|
| Rate for Payer: Beech Street Commercial |
$302.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.52
|
| Rate for Payer: Cash Price |
$216.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$299.54
|
| Rate for Payer: Cigna of WY Commercial |
$302.62
|
| Rate for Payer: Entrust Commercial |
$293.36
|
| Rate for Payer: First Choice Health Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$293.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.10
|
| Rate for Payer: HealthUtah PPO |
$308.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$299.54
|
| Rate for Payer: Multiplan Medicare/VA |
$170.15
|
| Rate for Payer: One Health Plan of WY PPO |
$302.62
|
| Rate for Payer: PacificSource Commercial |
$277.92
|
| Rate for Payer: PHCS PPO |
$302.62
|
| Rate for Payer: Three Rivers PPO |
$231.60
|
| Rate for Payer: TriWest Veterans Administration |
$179.10
|
| Rate for Payer: United Healthcare Commercial |
$268.66
|
| Rate for Payer: United Healthcare Medicare |
$179.10
|
| Rate for Payer: WINHealth Partners Commercial |
$302.62
|
| Rate for Payer: Wise Provider Network Commercial |
$293.36
|
|
|
CATHETER FOLEY 2 WAY 3CC 10FR
|
Facility
|
IP
|
$20.02
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.22
|
| Rate for Payer: Altius Commercial |
$19.22
|
| Rate for Payer: Beech Street Commercial |
$19.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.44
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.42
|
| Rate for Payer: Cigna of WY Commercial |
$19.62
|
| Rate for Payer: Entrust Commercial |
$19.02
|
| Rate for Payer: First Choice Health Commercial |
$19.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.21
|
| Rate for Payer: HealthUtah PPO |
$20.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.42
|
| Rate for Payer: Multiplan Medicare/VA |
$12.55
|
| Rate for Payer: One Health Plan of WY PPO |
$19.62
|
| Rate for Payer: PacificSource Commercial |
$18.02
|
| Rate for Payer: PHCS PPO |
$19.62
|
| Rate for Payer: Three Rivers PPO |
$15.02
|
| Rate for Payer: TriWest Veterans Administration |
$13.21
|
| Rate for Payer: United Healthcare Commercial |
$17.42
|
| Rate for Payer: United Healthcare Medicare |
$13.21
|
| Rate for Payer: WINHealth Partners Commercial |
$19.02
|
| Rate for Payer: Wise Provider Network Commercial |
$19.02
|
|
|
CATHETER FOLEY 2 WAY 3CC 10FR
|
Facility
|
OP
|
$20.02
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.62
|
| Rate for Payer: Aetna of WY Medicare |
$13.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.22
|
| Rate for Payer: Altius Commercial |
$19.22
|
| Rate for Payer: Beech Street Commercial |
$19.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.44
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.42
|
| Rate for Payer: Cigna of WY Commercial |
$19.62
|
| Rate for Payer: Entrust Commercial |
$19.02
|
| Rate for Payer: First Choice Health Commercial |
$19.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.61
|
| Rate for Payer: HealthUtah PPO |
$20.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.42
|
| Rate for Payer: Multiplan Medicare/VA |
$11.03
|
| Rate for Payer: One Health Plan of WY PPO |
$19.62
|
| Rate for Payer: PacificSource Commercial |
$18.02
|
| Rate for Payer: PHCS PPO |
$19.62
|
| Rate for Payer: Three Rivers PPO |
$15.02
|
| Rate for Payer: TriWest Veterans Administration |
$11.61
|
| Rate for Payer: United Healthcare Commercial |
$17.42
|
| Rate for Payer: United Healthcare Medicare |
$11.61
|
| Rate for Payer: WINHealth Partners Commercial |
$19.62
|
| Rate for Payer: Wise Provider Network Commercial |
$19.02
|
|
|
CATHETER FOLEY 2 WAY 3CC 8FR
|
Facility
|
IP
|
$19.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.43
|
| Rate for Payer: Altius Commercial |
$18.43
|
| Rate for Payer: Beech Street Commercial |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$18.82
|
| Rate for Payer: Entrust Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.67
|
| Rate for Payer: HealthUtah PPO |
$19.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.62
|
| Rate for Payer: Multiplan Medicare/VA |
$12.04
|
| Rate for Payer: One Health Plan of WY PPO |
$18.82
|
| Rate for Payer: PacificSource Commercial |
$17.28
|
| Rate for Payer: PHCS PPO |
$18.82
|
| Rate for Payer: Three Rivers PPO |
$14.40
|
| Rate for Payer: TriWest Veterans Administration |
$12.67
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$12.67
|
| Rate for Payer: WINHealth Partners Commercial |
$18.24
|
| Rate for Payer: Wise Provider Network Commercial |
$18.24
|
|
|
CATHETER FOLEY 2 WAY 3CC 8FR
|
Facility
|
OP
|
$19.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.82
|
| Rate for Payer: Aetna of WY Medicare |
$12.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.43
|
| Rate for Payer: Altius Commercial |
$18.43
|
| Rate for Payer: Beech Street Commercial |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.76
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$18.82
|
| Rate for Payer: Entrust Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.14
|
| Rate for Payer: HealthUtah PPO |
$19.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.62
|
| Rate for Payer: Multiplan Medicare/VA |
$10.58
|
| Rate for Payer: One Health Plan of WY PPO |
$18.82
|
| Rate for Payer: PacificSource Commercial |
$17.28
|
| Rate for Payer: PHCS PPO |
$18.82
|
| Rate for Payer: Three Rivers PPO |
$14.40
|
| Rate for Payer: TriWest Veterans Administration |
$11.14
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$11.14
|
| Rate for Payer: WINHealth Partners Commercial |
$18.82
|
| Rate for Payer: Wise Provider Network Commercial |
$18.24
|
|
|
CATHETER FOLEY 2 WAY 5CC 12FR
|
Facility
|
OP
|
$24.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.29
|
| Rate for Payer: Aetna of WY Medicare |
$16.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.80
|
| Rate for Payer: Altius Commercial |
$23.80
|
| Rate for Payer: Beech Street Commercial |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.35
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.05
|
| Rate for Payer: Cigna of WY Commercial |
$24.29
|
| Rate for Payer: Entrust Commercial |
$23.55
|
| Rate for Payer: First Choice Health Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.38
|
| Rate for Payer: HealthUtah PPO |
$24.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.05
|
| Rate for Payer: Multiplan Medicare/VA |
$13.66
|
| Rate for Payer: One Health Plan of WY PPO |
$24.29
|
| Rate for Payer: PacificSource Commercial |
$22.31
|
| Rate for Payer: PHCS PPO |
$24.29
|
| Rate for Payer: Three Rivers PPO |
$18.59
|
| Rate for Payer: TriWest Veterans Administration |
$14.38
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare |
$14.38
|
| Rate for Payer: WINHealth Partners Commercial |
$24.29
|
| Rate for Payer: Wise Provider Network Commercial |
$23.55
|
|
|
CATHETER FOLEY 2 WAY 5CC 12FR
|
Facility
|
IP
|
$24.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.80
|
| Rate for Payer: Altius Commercial |
$23.80
|
| Rate for Payer: Beech Street Commercial |
$24.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.35
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.05
|
| Rate for Payer: Cigna of WY Commercial |
$24.29
|
| Rate for Payer: Entrust Commercial |
$23.55
|
| Rate for Payer: First Choice Health Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.36
|
| Rate for Payer: HealthUtah PPO |
$24.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.05
|
| Rate for Payer: Multiplan Medicare/VA |
$15.54
|
| Rate for Payer: One Health Plan of WY PPO |
$24.29
|
| Rate for Payer: PacificSource Commercial |
$22.31
|
| Rate for Payer: PHCS PPO |
$24.29
|
| Rate for Payer: Three Rivers PPO |
$18.59
|
| Rate for Payer: TriWest Veterans Administration |
$16.36
|
| Rate for Payer: United Healthcare Commercial |
$21.57
|
| Rate for Payer: United Healthcare Medicare |
$16.36
|
| Rate for Payer: WINHealth Partners Commercial |
$23.55
|
| Rate for Payer: Wise Provider Network Commercial |
$23.55
|
|
|
CATHETER FOLEY 2 WAY 5CC 16FR SILICONE
|
Facility
|
IP
|
$23.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.30
|
| Rate for Payer: Altius Commercial |
$22.30
|
| Rate for Payer: Beech Street Commercial |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.53
|
| Rate for Payer: Cigna of WY Commercial |
$22.77
|
| Rate for Payer: Entrust Commercial |
$22.07
|
| Rate for Payer: First Choice Health Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.33
|
| Rate for Payer: HealthUtah PPO |
$23.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.53
|
| Rate for Payer: Multiplan Medicare/VA |
$14.57
|
| Rate for Payer: One Health Plan of WY PPO |
$22.77
|
| Rate for Payer: PacificSource Commercial |
$20.91
|
| Rate for Payer: PHCS PPO |
$22.77
|
| Rate for Payer: Three Rivers PPO |
$17.42
|
| Rate for Payer: TriWest Veterans Administration |
$15.33
|
| Rate for Payer: United Healthcare Commercial |
$20.21
|
| Rate for Payer: United Healthcare Medicare |
$15.33
|
| Rate for Payer: WINHealth Partners Commercial |
$22.07
|
| Rate for Payer: Wise Provider Network Commercial |
$22.07
|
|
|
CATHETER FOLEY 2 WAY 5CC 16FR SILICONE
|
Facility
|
OP
|
$23.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.77
|
| Rate for Payer: Aetna of WY Medicare |
$15.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.30
|
| Rate for Payer: Altius Commercial |
$22.30
|
| Rate for Payer: Beech Street Commercial |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.53
|
| Rate for Payer: Cigna of WY Commercial |
$22.77
|
| Rate for Payer: Entrust Commercial |
$22.07
|
| Rate for Payer: First Choice Health Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.47
|
| Rate for Payer: HealthUtah PPO |
$23.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.53
|
| Rate for Payer: Multiplan Medicare/VA |
$12.80
|
| Rate for Payer: One Health Plan of WY PPO |
$22.77
|
| Rate for Payer: PacificSource Commercial |
$20.91
|
| Rate for Payer: PHCS PPO |
$22.77
|
| Rate for Payer: Three Rivers PPO |
$17.42
|
| Rate for Payer: TriWest Veterans Administration |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$20.21
|
| Rate for Payer: United Healthcare Medicare |
$13.47
|
| Rate for Payer: WINHealth Partners Commercial |
$22.77
|
| Rate for Payer: Wise Provider Network Commercial |
$22.07
|
|
|
CATHETER FOLEY 2 WAY 5CC 18FR
|
Facility
|
OP
|
$21.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.82
|
| Rate for Payer: Aetna of WY Medicare |
$14.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.40
|
| Rate for Payer: Altius Commercial |
$20.40
|
| Rate for Payer: Beech Street Commercial |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.45
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.61
|
| Rate for Payer: Cigna of WY Commercial |
$20.82
|
| Rate for Payer: Entrust Commercial |
$20.19
|
| Rate for Payer: First Choice Health Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.32
|
| Rate for Payer: HealthUtah PPO |
$21.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.61
|
| Rate for Payer: Multiplan Medicare/VA |
$11.71
|
| Rate for Payer: One Health Plan of WY PPO |
$20.82
|
| Rate for Payer: PacificSource Commercial |
$19.12
|
| Rate for Payer: PHCS PPO |
$20.82
|
| Rate for Payer: Three Rivers PPO |
$15.94
|
| Rate for Payer: TriWest Veterans Administration |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: WINHealth Partners Commercial |
$20.82
|
| Rate for Payer: Wise Provider Network Commercial |
$20.19
|
|
|
CATHETER FOLEY 2 WAY 5CC 18FR
|
Facility
|
IP
|
$21.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.40
|
| Rate for Payer: Altius Commercial |
$20.40
|
| Rate for Payer: Beech Street Commercial |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.45
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.61
|
| Rate for Payer: Cigna of WY Commercial |
$20.82
|
| Rate for Payer: Entrust Commercial |
$20.19
|
| Rate for Payer: First Choice Health Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.02
|
| Rate for Payer: HealthUtah PPO |
$21.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.61
|
| Rate for Payer: Multiplan Medicare/VA |
$13.32
|
| Rate for Payer: One Health Plan of WY PPO |
$20.82
|
| Rate for Payer: PacificSource Commercial |
$19.12
|
| Rate for Payer: PHCS PPO |
$20.82
|
| Rate for Payer: Three Rivers PPO |
$15.94
|
| Rate for Payer: TriWest Veterans Administration |
$14.02
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare |
$14.02
|
| Rate for Payer: WINHealth Partners Commercial |
$20.19
|
| Rate for Payer: Wise Provider Network Commercial |
$20.19
|
|
|
CATHETER FOLEY 2 WAY 5CC 18FR SILICONE
|
Facility
|
IP
|
$23.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.30
|
| Rate for Payer: Altius Commercial |
$22.30
|
| Rate for Payer: Beech Street Commercial |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.53
|
| Rate for Payer: Cigna of WY Commercial |
$22.77
|
| Rate for Payer: Entrust Commercial |
$22.07
|
| Rate for Payer: First Choice Health Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$15.33
|
| Rate for Payer: HealthUtah PPO |
$23.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.53
|
| Rate for Payer: Multiplan Medicare/VA |
$14.57
|
| Rate for Payer: One Health Plan of WY PPO |
$22.77
|
| Rate for Payer: PacificSource Commercial |
$20.91
|
| Rate for Payer: PHCS PPO |
$22.77
|
| Rate for Payer: Three Rivers PPO |
$17.42
|
| Rate for Payer: TriWest Veterans Administration |
$15.33
|
| Rate for Payer: United Healthcare Commercial |
$20.21
|
| Rate for Payer: United Healthcare Medicare |
$15.33
|
| Rate for Payer: WINHealth Partners Commercial |
$22.07
|
| Rate for Payer: Wise Provider Network Commercial |
$22.07
|
|
|
CATHETER FOLEY 2 WAY 5CC 18FR SILICONE
|
Facility
|
OP
|
$23.23
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.77
|
| Rate for Payer: Aetna of WY Medicare |
$15.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$22.30
|
| Rate for Payer: Altius Commercial |
$22.30
|
| Rate for Payer: Beech Street Commercial |
$22.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.53
|
| Rate for Payer: Cigna of WY Commercial |
$22.77
|
| Rate for Payer: Entrust Commercial |
$22.07
|
| Rate for Payer: First Choice Health Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.47
|
| Rate for Payer: HealthUtah PPO |
$23.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.53
|
| Rate for Payer: Multiplan Medicare/VA |
$12.80
|
| Rate for Payer: One Health Plan of WY PPO |
$22.77
|
| Rate for Payer: PacificSource Commercial |
$20.91
|
| Rate for Payer: PHCS PPO |
$22.77
|
| Rate for Payer: Three Rivers PPO |
$17.42
|
| Rate for Payer: TriWest Veterans Administration |
$13.47
|
| Rate for Payer: United Healthcare Commercial |
$20.21
|
| Rate for Payer: United Healthcare Medicare |
$13.47
|
| Rate for Payer: WINHealth Partners Commercial |
$22.77
|
| Rate for Payer: Wise Provider Network Commercial |
$22.07
|
|
|
CATHETER FOLEY 2 WAY 5CC 24FR
|
Facility
|
OP
|
$21.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.82
|
| Rate for Payer: Aetna of WY Medicare |
$14.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.40
|
| Rate for Payer: Altius Commercial |
$20.40
|
| Rate for Payer: Beech Street Commercial |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.45
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.61
|
| Rate for Payer: Cigna of WY Commercial |
$20.82
|
| Rate for Payer: Entrust Commercial |
$20.19
|
| Rate for Payer: First Choice Health Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.32
|
| Rate for Payer: HealthUtah PPO |
$21.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.61
|
| Rate for Payer: Multiplan Medicare/VA |
$11.71
|
| Rate for Payer: One Health Plan of WY PPO |
$20.82
|
| Rate for Payer: PacificSource Commercial |
$19.12
|
| Rate for Payer: PHCS PPO |
$20.82
|
| Rate for Payer: Three Rivers PPO |
$15.94
|
| Rate for Payer: TriWest Veterans Administration |
$12.32
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare |
$12.32
|
| Rate for Payer: WINHealth Partners Commercial |
$20.82
|
| Rate for Payer: Wise Provider Network Commercial |
$20.19
|
|
|
CATHETER FOLEY 2 WAY 5CC 24FR
|
Facility
|
IP
|
$21.25
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.40
|
| Rate for Payer: Altius Commercial |
$20.40
|
| Rate for Payer: Beech Street Commercial |
$20.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.45
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.61
|
| Rate for Payer: Cigna of WY Commercial |
$20.82
|
| Rate for Payer: Entrust Commercial |
$20.19
|
| Rate for Payer: First Choice Health Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.02
|
| Rate for Payer: HealthUtah PPO |
$21.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.61
|
| Rate for Payer: Multiplan Medicare/VA |
$13.32
|
| Rate for Payer: One Health Plan of WY PPO |
$20.82
|
| Rate for Payer: PacificSource Commercial |
$19.12
|
| Rate for Payer: PHCS PPO |
$20.82
|
| Rate for Payer: Three Rivers PPO |
$15.94
|
| Rate for Payer: TriWest Veterans Administration |
$14.02
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare |
$14.02
|
| Rate for Payer: WINHealth Partners Commercial |
$20.19
|
| Rate for Payer: Wise Provider Network Commercial |
$20.19
|
|
