|
SUCTION D&C CURVED CURETTE 10MM
|
Facility
|
OP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Aetna of WY Medicare |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 12MM
|
Facility
|
IP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 12MM
|
Facility
|
OP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Aetna of WY Medicare |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 7MM
|
Facility
|
IP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 7MM
|
Facility
|
OP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Aetna of WY Medicare |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 8MM
|
Facility
|
IP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 8MM
|
Facility
|
OP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Aetna of WY Medicare |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 9MM
|
Facility
|
OP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Aetna of WY Medicare |
$3.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.76
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.62
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$2.76
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$2.76
|
| Rate for Payer: WINHealth Partners Commercial |
$4.66
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C CURVED CURETTE 9MM
|
Facility
|
IP
|
$4.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.56
|
| Rate for Payer: Altius Commercial |
$4.56
|
| Rate for Payer: Beech Street Commercial |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.90
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.61
|
| Rate for Payer: Cigna of WY Commercial |
$4.66
|
| Rate for Payer: Entrust Commercial |
$4.51
|
| Rate for Payer: First Choice Health Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.14
|
| Rate for Payer: HealthUtah PPO |
$4.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.61
|
| Rate for Payer: Multiplan Medicare/VA |
$2.98
|
| Rate for Payer: One Health Plan of WY PPO |
$4.66
|
| Rate for Payer: PacificSource Commercial |
$4.28
|
| Rate for Payer: PHCS PPO |
$4.66
|
| Rate for Payer: Three Rivers PPO |
$3.56
|
| Rate for Payer: TriWest Veterans Administration |
$3.14
|
| Rate for Payer: United Healthcare Commercial |
$4.13
|
| Rate for Payer: United Healthcare Medicare |
$3.14
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.51
|
|
|
SUCTION D&C TUBING
|
Facility
|
IP
|
$31.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$31.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.16
|
| Rate for Payer: Altius Commercial |
$30.16
|
| Rate for Payer: Beech Street Commercial |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$21.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.48
|
| Rate for Payer: Cigna of WY Commercial |
$30.79
|
| Rate for Payer: Entrust Commercial |
$29.85
|
| Rate for Payer: First Choice Health Commercial |
$29.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.74
|
| Rate for Payer: HealthUtah PPO |
$31.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.48
|
| Rate for Payer: Multiplan Medicare/VA |
$19.70
|
| Rate for Payer: One Health Plan of WY PPO |
$30.79
|
| Rate for Payer: PacificSource Commercial |
$28.28
|
| Rate for Payer: PHCS PPO |
$30.79
|
| Rate for Payer: Three Rivers PPO |
$23.56
|
| Rate for Payer: TriWest Veterans Administration |
$20.74
|
| Rate for Payer: United Healthcare Commercial |
$27.34
|
| Rate for Payer: United Healthcare Medicare |
$20.74
|
| Rate for Payer: WINHealth Partners Commercial |
$29.85
|
| Rate for Payer: Wise Provider Network Commercial |
$29.85
|
|
|
SUCTION D&C TUBING
|
Facility
|
OP
|
$31.42
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$31.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$30.79
|
| Rate for Payer: Aetna of WY Medicare |
$20.74
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.16
|
| Rate for Payer: Altius Commercial |
$30.16
|
| Rate for Payer: Beech Street Commercial |
$30.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$21.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.48
|
| Rate for Payer: Cigna of WY Commercial |
$30.79
|
| Rate for Payer: Entrust Commercial |
$29.85
|
| Rate for Payer: First Choice Health Commercial |
$29.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.22
|
| Rate for Payer: HealthUtah PPO |
$31.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.48
|
| Rate for Payer: Multiplan Medicare/VA |
$17.31
|
| Rate for Payer: One Health Plan of WY PPO |
$30.79
|
| Rate for Payer: PacificSource Commercial |
$28.28
|
| Rate for Payer: PHCS PPO |
$30.79
|
| Rate for Payer: Three Rivers PPO |
$23.56
|
| Rate for Payer: TriWest Veterans Administration |
$18.22
|
| Rate for Payer: United Healthcare Commercial |
$27.34
|
| Rate for Payer: United Healthcare Medicare |
$18.22
|
| Rate for Payer: WINHealth Partners Commercial |
$30.79
|
| Rate for Payer: Wise Provider Network Commercial |
$29.85
|
|
|
SUCTION INTERPULSE HANDPIECE
|
Facility
|
IP
|
$93.72
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.76 |
| Max. Negotiated Rate |
$93.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.97
|
| Rate for Payer: Altius Commercial |
$89.97
|
| Rate for Payer: Beech Street Commercial |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.94
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.91
|
| Rate for Payer: Cigna of WY Commercial |
$91.85
|
| Rate for Payer: Entrust Commercial |
$89.03
|
| Rate for Payer: First Choice Health Commercial |
$89.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.86
|
| Rate for Payer: HealthUtah PPO |
$93.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.91
|
| Rate for Payer: Multiplan Medicare/VA |
$58.76
|
| Rate for Payer: One Health Plan of WY PPO |
$91.85
|
| Rate for Payer: PacificSource Commercial |
$84.35
|
| Rate for Payer: PHCS PPO |
$91.85
|
| Rate for Payer: Three Rivers PPO |
$70.29
|
| Rate for Payer: TriWest Veterans Administration |
$61.86
|
| Rate for Payer: United Healthcare Commercial |
$81.54
|
| Rate for Payer: United Healthcare Medicare |
$61.86
|
| Rate for Payer: WINHealth Partners Commercial |
$89.03
|
| Rate for Payer: Wise Provider Network Commercial |
$89.03
|
|
|
SUCTION INTERPULSE HANDPIECE
|
Facility
|
OP
|
$93.72
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$93.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.85
|
| Rate for Payer: Aetna of WY Medicare |
$61.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$89.97
|
| Rate for Payer: Altius Commercial |
$89.97
|
| Rate for Payer: Beech Street Commercial |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.94
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.91
|
| Rate for Payer: Cigna of WY Commercial |
$91.85
|
| Rate for Payer: Entrust Commercial |
$89.03
|
| Rate for Payer: First Choice Health Commercial |
$89.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.36
|
| Rate for Payer: HealthUtah PPO |
$93.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.91
|
| Rate for Payer: Multiplan Medicare/VA |
$51.64
|
| Rate for Payer: One Health Plan of WY PPO |
$91.85
|
| Rate for Payer: PacificSource Commercial |
$84.35
|
| Rate for Payer: PHCS PPO |
$91.85
|
| Rate for Payer: Three Rivers PPO |
$70.29
|
| Rate for Payer: TriWest Veterans Administration |
$54.36
|
| Rate for Payer: United Healthcare Commercial |
$81.54
|
| Rate for Payer: United Healthcare Medicare |
$54.36
|
| Rate for Payer: WINHealth Partners Commercial |
$91.85
|
| Rate for Payer: Wise Provider Network Commercial |
$89.03
|
|
|
SUCTION IRRIGATOR 250-070-500
|
Facility
|
IP
|
$150.91
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.62 |
| Max. Negotiated Rate |
$150.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.87
|
| Rate for Payer: Altius Commercial |
$144.87
|
| Rate for Payer: Beech Street Commercial |
$147.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.90
|
| Rate for Payer: Cash Price |
$105.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.38
|
| Rate for Payer: Cigna of WY Commercial |
$147.89
|
| Rate for Payer: Entrust Commercial |
$143.36
|
| Rate for Payer: First Choice Health Commercial |
$143.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.60
|
| Rate for Payer: HealthUtah PPO |
$150.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.38
|
| Rate for Payer: Multiplan Medicare/VA |
$94.62
|
| Rate for Payer: One Health Plan of WY PPO |
$147.89
|
| Rate for Payer: PacificSource Commercial |
$135.82
|
| Rate for Payer: PHCS PPO |
$147.89
|
| Rate for Payer: Three Rivers PPO |
$113.18
|
| Rate for Payer: TriWest Veterans Administration |
$99.60
|
| Rate for Payer: United Healthcare Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare |
$99.60
|
| Rate for Payer: WINHealth Partners Commercial |
$143.36
|
| Rate for Payer: Wise Provider Network Commercial |
$143.36
|
|
|
SUCTION IRRIGATOR 250-070-500
|
Facility
|
OP
|
$150.91
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$150.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$147.89
|
| Rate for Payer: Aetna of WY Medicare |
$99.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$144.87
|
| Rate for Payer: Altius Commercial |
$144.87
|
| Rate for Payer: Beech Street Commercial |
$147.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$123.90
|
| Rate for Payer: Cash Price |
$105.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$146.38
|
| Rate for Payer: Cigna of WY Commercial |
$147.89
|
| Rate for Payer: Entrust Commercial |
$143.36
|
| Rate for Payer: First Choice Health Commercial |
$143.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$143.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.53
|
| Rate for Payer: HealthUtah PPO |
$150.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$146.38
|
| Rate for Payer: Multiplan Medicare/VA |
$83.15
|
| Rate for Payer: One Health Plan of WY PPO |
$147.89
|
| Rate for Payer: PacificSource Commercial |
$135.82
|
| Rate for Payer: PHCS PPO |
$147.89
|
| Rate for Payer: Three Rivers PPO |
$113.18
|
| Rate for Payer: TriWest Veterans Administration |
$87.53
|
| Rate for Payer: United Healthcare Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare |
$87.53
|
| Rate for Payer: WINHealth Partners Commercial |
$147.89
|
| Rate for Payer: Wise Provider Network Commercial |
$143.36
|
|
|
SUCTION KAM VAC
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.45 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.00
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$219.45
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$231.00
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$231.00
|
| Rate for Payer: WINHealth Partners Commercial |
$332.50
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
SUCTION KAM VAC
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.85 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$231.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$336.00
|
| Rate for Payer: Altius Commercial |
$336.00
|
| Rate for Payer: Beech Street Commercial |
$343.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$287.35
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: Entrust Commercial |
$332.50
|
| Rate for Payer: First Choice Health Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$203.00
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$192.85
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$343.00
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$203.00
|
| Rate for Payer: WINHealth Partners Commercial |
$343.00
|
| Rate for Payer: Wise Provider Network Commercial |
$332.50
|
|
|
SUCTION TUBING SILICONE NEURO 36"
|
Facility
|
OP
|
$43.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.17
|
| Rate for Payer: Aetna of WY Medicare |
$28.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.31
|
| Rate for Payer: Altius Commercial |
$41.31
|
| Rate for Payer: Beech Street Commercial |
$42.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.33
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.74
|
| Rate for Payer: Cigna of WY Commercial |
$42.17
|
| Rate for Payer: Entrust Commercial |
$40.88
|
| Rate for Payer: First Choice Health Commercial |
$40.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.96
|
| Rate for Payer: HealthUtah PPO |
$43.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.74
|
| Rate for Payer: Multiplan Medicare/VA |
$23.71
|
| Rate for Payer: One Health Plan of WY PPO |
$42.17
|
| Rate for Payer: PacificSource Commercial |
$38.73
|
| Rate for Payer: PHCS PPO |
$42.17
|
| Rate for Payer: Three Rivers PPO |
$32.27
|
| Rate for Payer: TriWest Veterans Administration |
$24.96
|
| Rate for Payer: United Healthcare Commercial |
$37.44
|
| Rate for Payer: United Healthcare Medicare |
$24.96
|
| Rate for Payer: WINHealth Partners Commercial |
$42.17
|
| Rate for Payer: Wise Provider Network Commercial |
$40.88
|
|
|
SUCTION TUBING SILICONE NEURO 36"
|
Facility
|
IP
|
$43.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$41.31
|
| Rate for Payer: Altius Commercial |
$41.31
|
| Rate for Payer: Beech Street Commercial |
$42.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.33
|
| Rate for Payer: Cash Price |
$30.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.74
|
| Rate for Payer: Cigna of WY Commercial |
$42.17
|
| Rate for Payer: Entrust Commercial |
$40.88
|
| Rate for Payer: First Choice Health Commercial |
$40.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.40
|
| Rate for Payer: HealthUtah PPO |
$43.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.74
|
| Rate for Payer: Multiplan Medicare/VA |
$26.98
|
| Rate for Payer: One Health Plan of WY PPO |
$42.17
|
| Rate for Payer: PacificSource Commercial |
$38.73
|
| Rate for Payer: PHCS PPO |
$42.17
|
| Rate for Payer: Three Rivers PPO |
$32.27
|
| Rate for Payer: TriWest Veterans Administration |
$28.40
|
| Rate for Payer: United Healthcare Commercial |
$37.44
|
| Rate for Payer: United Healthcare Medicare |
$28.40
|
| Rate for Payer: WINHealth Partners Commercial |
$40.88
|
| Rate for Payer: Wise Provider Network Commercial |
$40.88
|
|
|
SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION [10301]
|
Facility
|
OP
|
$45.67
|
|
|
Service Code
|
NDC 0409338221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.76
|
| Rate for Payer: Aetna of WY Medicare |
$30.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.84
|
| Rate for Payer: Altius Commercial |
$43.84
|
| Rate for Payer: Beech Street Commercial |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.30
|
| Rate for Payer: Cigna of WY Commercial |
$44.76
|
| Rate for Payer: Entrust Commercial |
$43.39
|
| Rate for Payer: First Choice Health Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.49
|
| Rate for Payer: HealthUtah PPO |
$45.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.30
|
| Rate for Payer: Multiplan Medicare/VA |
$25.16
|
| Rate for Payer: One Health Plan of WY PPO |
$44.76
|
| Rate for Payer: PacificSource Commercial |
$41.10
|
| Rate for Payer: PHCS PPO |
$44.76
|
| Rate for Payer: Three Rivers PPO |
$34.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.49
|
| Rate for Payer: United Healthcare Commercial |
$39.73
|
| Rate for Payer: United Healthcare Medicare |
$26.49
|
| Rate for Payer: WINHealth Partners Commercial |
$44.76
|
| Rate for Payer: Wise Provider Network Commercial |
$43.39
|
|
|
SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION [10301]
|
Facility
|
IP
|
$45.67
|
|
|
Service Code
|
NDC 0409338221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.84
|
| Rate for Payer: Altius Commercial |
$43.84
|
| Rate for Payer: Beech Street Commercial |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.30
|
| Rate for Payer: Cigna of WY Commercial |
$44.76
|
| Rate for Payer: Entrust Commercial |
$43.39
|
| Rate for Payer: First Choice Health Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.14
|
| Rate for Payer: HealthUtah PPO |
$45.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.30
|
| Rate for Payer: Multiplan Medicare/VA |
$28.64
|
| Rate for Payer: One Health Plan of WY PPO |
$44.76
|
| Rate for Payer: PacificSource Commercial |
$41.10
|
| Rate for Payer: PHCS PPO |
$44.76
|
| Rate for Payer: Three Rivers PPO |
$34.25
|
| Rate for Payer: TriWest Veterans Administration |
$30.14
|
| Rate for Payer: United Healthcare Commercial |
$39.73
|
| Rate for Payer: United Healthcare Medicare |
$30.14
|
| Rate for Payer: WINHealth Partners Commercial |
$43.39
|
| Rate for Payer: Wise Provider Network Commercial |
$43.39
|
|
|
SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION [10301]
|
Facility
|
OP
|
$45.67
|
|
|
Service Code
|
NDC 0409338211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.76
|
| Rate for Payer: Aetna of WY Medicare |
$30.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.84
|
| Rate for Payer: Altius Commercial |
$43.84
|
| Rate for Payer: Beech Street Commercial |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.30
|
| Rate for Payer: Cigna of WY Commercial |
$44.76
|
| Rate for Payer: Entrust Commercial |
$43.39
|
| Rate for Payer: First Choice Health Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.49
|
| Rate for Payer: HealthUtah PPO |
$45.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.30
|
| Rate for Payer: Multiplan Medicare/VA |
$25.16
|
| Rate for Payer: One Health Plan of WY PPO |
$44.76
|
| Rate for Payer: PacificSource Commercial |
$41.10
|
| Rate for Payer: PHCS PPO |
$44.76
|
| Rate for Payer: Three Rivers PPO |
$34.25
|
| Rate for Payer: TriWest Veterans Administration |
$26.49
|
| Rate for Payer: United Healthcare Commercial |
$39.73
|
| Rate for Payer: United Healthcare Medicare |
$26.49
|
| Rate for Payer: WINHealth Partners Commercial |
$44.76
|
| Rate for Payer: Wise Provider Network Commercial |
$43.39
|
|
|
SUFENTANIL CITRATE 50 MCG/ML INTRAVENOUS SOLUTION [10301]
|
Facility
|
IP
|
$45.67
|
|
|
Service Code
|
NDC 0409338211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$43.84
|
| Rate for Payer: Altius Commercial |
$43.84
|
| Rate for Payer: Beech Street Commercial |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.50
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.30
|
| Rate for Payer: Cigna of WY Commercial |
$44.76
|
| Rate for Payer: Entrust Commercial |
$43.39
|
| Rate for Payer: First Choice Health Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.14
|
| Rate for Payer: HealthUtah PPO |
$45.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.30
|
| Rate for Payer: Multiplan Medicare/VA |
$28.64
|
| Rate for Payer: One Health Plan of WY PPO |
$44.76
|
| Rate for Payer: PacificSource Commercial |
$41.10
|
| Rate for Payer: PHCS PPO |
$44.76
|
| Rate for Payer: Three Rivers PPO |
$34.25
|
| Rate for Payer: TriWest Veterans Administration |
$30.14
|
| Rate for Payer: United Healthcare Commercial |
$39.73
|
| Rate for Payer: United Healthcare Medicare |
$30.14
|
| Rate for Payer: WINHealth Partners Commercial |
$43.39
|
| Rate for Payer: Wise Provider Network Commercial |
$43.39
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [143382]
|
Facility
|
IP
|
$134.12
|
|
|
Service Code
|
NDC 0006542312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$134.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.76
|
| Rate for Payer: Altius Commercial |
$128.76
|
| Rate for Payer: Beech Street Commercial |
$131.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.11
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.10
|
| Rate for Payer: Cigna of WY Commercial |
$131.44
|
| Rate for Payer: Entrust Commercial |
$127.41
|
| Rate for Payer: First Choice Health Commercial |
$127.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.52
|
| Rate for Payer: HealthUtah PPO |
$134.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.10
|
| Rate for Payer: Multiplan Medicare/VA |
$84.09
|
| Rate for Payer: One Health Plan of WY PPO |
$131.44
|
| Rate for Payer: PacificSource Commercial |
$120.71
|
| Rate for Payer: PHCS PPO |
$131.44
|
| Rate for Payer: Three Rivers PPO |
$100.59
|
| Rate for Payer: TriWest Veterans Administration |
$88.52
|
| Rate for Payer: United Healthcare Commercial |
$116.68
|
| Rate for Payer: United Healthcare Medicare |
$88.52
|
| Rate for Payer: WINHealth Partners Commercial |
$127.41
|
| Rate for Payer: Wise Provider Network Commercial |
$127.41
|
|
|
SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [143382]
|
Facility
|
IP
|
$134.12
|
|
|
Service Code
|
NDC 0006542302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$134.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$131.44
|
| Rate for Payer: Altius Auto/Workers Compensation |
$128.76
|
| Rate for Payer: Altius Commercial |
$128.76
|
| Rate for Payer: Beech Street Commercial |
$131.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$110.11
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.10
|
| Rate for Payer: Cigna of WY Commercial |
$131.44
|
| Rate for Payer: Entrust Commercial |
$127.41
|
| Rate for Payer: First Choice Health Commercial |
$127.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$127.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.52
|
| Rate for Payer: HealthUtah PPO |
$134.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.10
|
| Rate for Payer: Multiplan Medicare/VA |
$84.09
|
| Rate for Payer: One Health Plan of WY PPO |
$131.44
|
| Rate for Payer: PacificSource Commercial |
$120.71
|
| Rate for Payer: PHCS PPO |
$131.44
|
| Rate for Payer: Three Rivers PPO |
$100.59
|
| Rate for Payer: TriWest Veterans Administration |
$88.52
|
| Rate for Payer: United Healthcare Commercial |
$116.68
|
| Rate for Payer: United Healthcare Medicare |
$88.52
|
| Rate for Payer: WINHealth Partners Commercial |
$127.41
|
| Rate for Payer: Wise Provider Network Commercial |
$127.41
|
|
