|
TERAZOSIN 5 MG CAPSULE [684]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 5026876615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.23
|
| Rate for Payer: Altius Commercial |
$3.23
|
| Rate for Payer: Beech Street Commercial |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.26
|
| Rate for Payer: Cigna of WY Commercial |
$3.29
|
| Rate for Payer: Entrust Commercial |
$3.19
|
| Rate for Payer: First Choice Health Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.22
|
| Rate for Payer: HealthUtah PPO |
$3.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.26
|
| Rate for Payer: Multiplan Medicare/VA |
$2.11
|
| Rate for Payer: One Health Plan of WY PPO |
$3.29
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.29
|
| Rate for Payer: Three Rivers PPO |
$2.52
|
| Rate for Payer: TriWest Veterans Administration |
$2.22
|
| Rate for Payer: United Healthcare Commercial |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WINHealth Partners Commercial |
$3.19
|
| Rate for Payer: Wise Provider Network Commercial |
$3.19
|
|
|
TERAZOSIN 5 MG CAPSULE [684]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 5026876615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.29
|
| Rate for Payer: Aetna of WY Medicare |
$2.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.23
|
| Rate for Payer: Altius Commercial |
$3.23
|
| Rate for Payer: Beech Street Commercial |
$3.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.26
|
| Rate for Payer: Cigna of WY Commercial |
$3.29
|
| Rate for Payer: Entrust Commercial |
$3.19
|
| Rate for Payer: First Choice Health Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.95
|
| Rate for Payer: HealthUtah PPO |
$3.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.26
|
| Rate for Payer: Multiplan Medicare/VA |
$1.85
|
| Rate for Payer: One Health Plan of WY PPO |
$3.29
|
| Rate for Payer: PacificSource Commercial |
$3.02
|
| Rate for Payer: PHCS PPO |
$3.29
|
| Rate for Payer: Three Rivers PPO |
$2.52
|
| Rate for Payer: TriWest Veterans Administration |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$2.92
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
| Rate for Payer: WINHealth Partners Commercial |
$3.29
|
| Rate for Payer: Wise Provider Network Commercial |
$3.19
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM [796]
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
NDC 2438552403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.35
|
| Rate for Payer: Altius Commercial |
$1.35
|
| Rate for Payer: Beech Street Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.37
|
| Rate for Payer: Cigna of WY Commercial |
$1.38
|
| Rate for Payer: Entrust Commercial |
$1.34
|
| Rate for Payer: First Choice Health Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.93
|
| Rate for Payer: HealthUtah PPO |
$1.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.88
|
| Rate for Payer: One Health Plan of WY PPO |
$1.38
|
| Rate for Payer: PacificSource Commercial |
$1.27
|
| Rate for Payer: PHCS PPO |
$1.38
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1.34
|
| Rate for Payer: Wise Provider Network Commercial |
$1.34
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM [796]
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 2438552403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.38
|
| Rate for Payer: Aetna of WY Medicare |
$0.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.35
|
| Rate for Payer: Altius Commercial |
$1.35
|
| Rate for Payer: Beech Street Commercial |
$1.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.37
|
| Rate for Payer: Cigna of WY Commercial |
$1.38
|
| Rate for Payer: Entrust Commercial |
$1.34
|
| Rate for Payer: First Choice Health Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.82
|
| Rate for Payer: HealthUtah PPO |
$1.41
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.78
|
| Rate for Payer: One Health Plan of WY PPO |
$1.38
|
| Rate for Payer: PacificSource Commercial |
$1.27
|
| Rate for Payer: PHCS PPO |
$1.38
|
| Rate for Payer: Three Rivers PPO |
$1.06
|
| Rate for Payer: TriWest Veterans Administration |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare |
$0.82
|
| Rate for Payer: WINHealth Partners Commercial |
$1.38
|
| Rate for Payer: Wise Provider Network Commercial |
$1.34
|
|
|
TERBINAFINE HCL 250 MG TABLET [9694]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 6586207930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.66
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.63
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.66
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.66
|
| Rate for Payer: WINHealth Partners Commercial |
$0.95
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
TERBINAFINE HCL 250 MG TABLET [9694]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 6586207930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.98
|
| Rate for Payer: Aetna of WY Medicare |
$0.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.96
|
| Rate for Payer: Altius Commercial |
$0.96
|
| Rate for Payer: Beech Street Commercial |
$0.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.97
|
| Rate for Payer: Cigna of WY Commercial |
$0.98
|
| Rate for Payer: Entrust Commercial |
$0.95
|
| Rate for Payer: First Choice Health Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.58
|
| Rate for Payer: HealthUtah PPO |
$1.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.97
|
| Rate for Payer: Multiplan Medicare/VA |
$0.55
|
| Rate for Payer: One Health Plan of WY PPO |
$0.98
|
| Rate for Payer: PacificSource Commercial |
$0.90
|
| Rate for Payer: PHCS PPO |
$0.98
|
| Rate for Payer: Three Rivers PPO |
$0.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.58
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.58
|
| Rate for Payer: WINHealth Partners Commercial |
$0.98
|
| Rate for Payer: Wise Provider Network Commercial |
$0.95
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [34998]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J3105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.80
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$18.81
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$19.80
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$19.80
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION [34998]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J3105
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Aetna of WY Medicare |
$19.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$28.80
|
| Rate for Payer: Altius Commercial |
$28.80
|
| Rate for Payer: Beech Street Commercial |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$24.63
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: Entrust Commercial |
$28.50
|
| Rate for Payer: First Choice Health Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.40
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: Multiplan Medicare/VA |
$16.53
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$29.40
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.40
|
| Rate for Payer: United Healthcare Commercial |
$26.10
|
| Rate for Payer: United Healthcare Medicare |
$17.40
|
| Rate for Payer: WINHealth Partners Commercial |
$29.40
|
| Rate for Payer: Wise Provider Network Commercial |
$28.50
|
|
|
TERUMO ANGIOSEAL VIP 6FR
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.62 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$577.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$548.62
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$577.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$577.50
|
| Rate for Payer: WINHealth Partners Commercial |
$831.25
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
TERUMO ANGIOSEAL VIP 6FR
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.12 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$857.50
|
| Rate for Payer: Aetna of WY Medicare |
$577.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$840.00
|
| Rate for Payer: Altius Commercial |
$840.00
|
| Rate for Payer: Beech Street Commercial |
$857.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$718.38
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$848.75
|
| Rate for Payer: Cigna of WY Commercial |
$857.50
|
| Rate for Payer: Entrust Commercial |
$831.25
|
| Rate for Payer: First Choice Health Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$831.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$507.50
|
| Rate for Payer: HealthUtah PPO |
$875.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$848.75
|
| Rate for Payer: Multiplan Medicare/VA |
$482.12
|
| Rate for Payer: One Health Plan of WY PPO |
$857.50
|
| Rate for Payer: PacificSource Commercial |
$787.50
|
| Rate for Payer: PHCS PPO |
$857.50
|
| Rate for Payer: Three Rivers PPO |
$656.25
|
| Rate for Payer: TriWest Veterans Administration |
$507.50
|
| Rate for Payer: United Healthcare Commercial |
$761.25
|
| Rate for Payer: United Healthcare Medicare |
$507.50
|
| Rate for Payer: WINHealth Partners Commercial |
$857.50
|
| Rate for Payer: Wise Provider Network Commercial |
$831.25
|
|
|
TERUMO FINECROSS M3 CATHETER 130CM
|
Facility
|
OP
|
$1,638.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.54 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,605.24
|
| Rate for Payer: Aetna of WY Medicare |
$1,081.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,572.48
|
| Rate for Payer: Altius Commercial |
$1,572.48
|
| Rate for Payer: Beech Street Commercial |
$1,605.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,588.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,605.24
|
| Rate for Payer: Entrust Commercial |
$1,556.10
|
| Rate for Payer: First Choice Health Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$950.04
|
| Rate for Payer: HealthUtah PPO |
$1,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,588.86
|
| Rate for Payer: Multiplan Medicare/VA |
$902.54
|
| Rate for Payer: One Health Plan of WY PPO |
$1,605.24
|
| Rate for Payer: PacificSource Commercial |
$1,474.20
|
| Rate for Payer: PHCS PPO |
$1,605.24
|
| Rate for Payer: Three Rivers PPO |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration |
$950.04
|
| Rate for Payer: United Healthcare Commercial |
$1,425.06
|
| Rate for Payer: United Healthcare Medicare |
$950.04
|
| Rate for Payer: WINHealth Partners Commercial |
$1,605.24
|
| Rate for Payer: Wise Provider Network Commercial |
$1,556.10
|
|
|
TERUMO FINECROSS M3 CATHETER 130CM
|
Facility
|
IP
|
$1,638.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,027.03 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,605.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,572.48
|
| Rate for Payer: Altius Commercial |
$1,572.48
|
| Rate for Payer: Beech Street Commercial |
$1,605.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,344.80
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,588.86
|
| Rate for Payer: Cigna of WY Commercial |
$1,605.24
|
| Rate for Payer: Entrust Commercial |
$1,556.10
|
| Rate for Payer: First Choice Health Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,556.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,081.08
|
| Rate for Payer: HealthUtah PPO |
$1,638.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,588.86
|
| Rate for Payer: Multiplan Medicare/VA |
$1,027.03
|
| Rate for Payer: One Health Plan of WY PPO |
$1,605.24
|
| Rate for Payer: PacificSource Commercial |
$1,474.20
|
| Rate for Payer: PHCS PPO |
$1,605.24
|
| Rate for Payer: Three Rivers PPO |
$1,228.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,081.08
|
| Rate for Payer: United Healthcare Commercial |
$1,425.06
|
| Rate for Payer: United Healthcare Medicare |
$1,081.08
|
| Rate for Payer: WINHealth Partners Commercial |
$1,556.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,556.10
|
|
|
TERUMO GLIDESHEATH SLENDER 5FR X 10CM
|
Facility
|
IP
|
$248.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.81 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.56
|
| Rate for Payer: Altius Commercial |
$238.56
|
| Rate for Payer: Beech Street Commercial |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.02
|
| Rate for Payer: Cash Price |
$173.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.04
|
| Rate for Payer: Cigna of WY Commercial |
$243.53
|
| Rate for Payer: Entrust Commercial |
$236.08
|
| Rate for Payer: First Choice Health Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.01
|
| Rate for Payer: HealthUtah PPO |
$248.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.04
|
| Rate for Payer: Multiplan Medicare/VA |
$155.81
|
| Rate for Payer: One Health Plan of WY PPO |
$243.53
|
| Rate for Payer: PacificSource Commercial |
$223.65
|
| Rate for Payer: PHCS PPO |
$243.53
|
| Rate for Payer: Three Rivers PPO |
$186.38
|
| Rate for Payer: TriWest Veterans Administration |
$164.01
|
| Rate for Payer: United Healthcare Commercial |
$216.20
|
| Rate for Payer: United Healthcare Medicare |
$164.01
|
| Rate for Payer: WINHealth Partners Commercial |
$236.08
|
| Rate for Payer: Wise Provider Network Commercial |
$236.08
|
|
|
TERUMO GLIDESHEATH SLENDER 5FR X 10CM
|
Facility
|
OP
|
$248.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.92 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.53
|
| Rate for Payer: Aetna of WY Medicare |
$164.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.56
|
| Rate for Payer: Altius Commercial |
$238.56
|
| Rate for Payer: Beech Street Commercial |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.02
|
| Rate for Payer: Cash Price |
$173.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.04
|
| Rate for Payer: Cigna of WY Commercial |
$243.53
|
| Rate for Payer: Entrust Commercial |
$236.08
|
| Rate for Payer: First Choice Health Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.13
|
| Rate for Payer: HealthUtah PPO |
$248.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.04
|
| Rate for Payer: Multiplan Medicare/VA |
$136.92
|
| Rate for Payer: One Health Plan of WY PPO |
$243.53
|
| Rate for Payer: PacificSource Commercial |
$223.65
|
| Rate for Payer: PHCS PPO |
$243.53
|
| Rate for Payer: Three Rivers PPO |
$186.38
|
| Rate for Payer: TriWest Veterans Administration |
$144.13
|
| Rate for Payer: United Healthcare Commercial |
$216.20
|
| Rate for Payer: United Healthcare Medicare |
$144.13
|
| Rate for Payer: WINHealth Partners Commercial |
$243.53
|
| Rate for Payer: Wise Provider Network Commercial |
$236.08
|
|
|
TERUMO GLIDESHEATH SLENDER 6FR X 10CM
|
Facility
|
IP
|
$248.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.81 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.56
|
| Rate for Payer: Altius Commercial |
$238.56
|
| Rate for Payer: Beech Street Commercial |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.02
|
| Rate for Payer: Cash Price |
$173.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.04
|
| Rate for Payer: Cigna of WY Commercial |
$243.53
|
| Rate for Payer: Entrust Commercial |
$236.08
|
| Rate for Payer: First Choice Health Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.01
|
| Rate for Payer: HealthUtah PPO |
$248.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.04
|
| Rate for Payer: Multiplan Medicare/VA |
$155.81
|
| Rate for Payer: One Health Plan of WY PPO |
$243.53
|
| Rate for Payer: PacificSource Commercial |
$223.65
|
| Rate for Payer: PHCS PPO |
$243.53
|
| Rate for Payer: Three Rivers PPO |
$186.38
|
| Rate for Payer: TriWest Veterans Administration |
$164.01
|
| Rate for Payer: United Healthcare Commercial |
$216.20
|
| Rate for Payer: United Healthcare Medicare |
$164.01
|
| Rate for Payer: WINHealth Partners Commercial |
$236.08
|
| Rate for Payer: Wise Provider Network Commercial |
$236.08
|
|
|
TERUMO GLIDESHEATH SLENDER 6FR X 10CM
|
Facility
|
OP
|
$248.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.92 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.53
|
| Rate for Payer: Aetna of WY Medicare |
$164.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.56
|
| Rate for Payer: Altius Commercial |
$238.56
|
| Rate for Payer: Beech Street Commercial |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.02
|
| Rate for Payer: Cash Price |
$173.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.04
|
| Rate for Payer: Cigna of WY Commercial |
$243.53
|
| Rate for Payer: Entrust Commercial |
$236.08
|
| Rate for Payer: First Choice Health Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.13
|
| Rate for Payer: HealthUtah PPO |
$248.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.04
|
| Rate for Payer: Multiplan Medicare/VA |
$136.92
|
| Rate for Payer: One Health Plan of WY PPO |
$243.53
|
| Rate for Payer: PacificSource Commercial |
$223.65
|
| Rate for Payer: PHCS PPO |
$243.53
|
| Rate for Payer: Three Rivers PPO |
$186.38
|
| Rate for Payer: TriWest Veterans Administration |
$144.13
|
| Rate for Payer: United Healthcare Commercial |
$216.20
|
| Rate for Payer: United Healthcare Medicare |
$144.13
|
| Rate for Payer: WINHealth Partners Commercial |
$243.53
|
| Rate for Payer: Wise Provider Network Commercial |
$236.08
|
|
|
TERUMO GLIDESHEATH SLENDER 7FR X 10CM
|
Facility
|
OP
|
$248.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.92 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.53
|
| Rate for Payer: Aetna of WY Medicare |
$164.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.56
|
| Rate for Payer: Altius Commercial |
$238.56
|
| Rate for Payer: Beech Street Commercial |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.02
|
| Rate for Payer: Cash Price |
$173.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.04
|
| Rate for Payer: Cigna of WY Commercial |
$243.53
|
| Rate for Payer: Entrust Commercial |
$236.08
|
| Rate for Payer: First Choice Health Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$144.13
|
| Rate for Payer: HealthUtah PPO |
$248.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.04
|
| Rate for Payer: Multiplan Medicare/VA |
$136.92
|
| Rate for Payer: One Health Plan of WY PPO |
$243.53
|
| Rate for Payer: PacificSource Commercial |
$223.65
|
| Rate for Payer: PHCS PPO |
$243.53
|
| Rate for Payer: Three Rivers PPO |
$186.38
|
| Rate for Payer: TriWest Veterans Administration |
$144.13
|
| Rate for Payer: United Healthcare Commercial |
$216.20
|
| Rate for Payer: United Healthcare Medicare |
$144.13
|
| Rate for Payer: WINHealth Partners Commercial |
$243.53
|
| Rate for Payer: Wise Provider Network Commercial |
$236.08
|
|
|
TERUMO GLIDESHEATH SLENDER 7FR X 10CM
|
Facility
|
IP
|
$248.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.81 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$243.53
|
| Rate for Payer: Altius Auto/Workers Compensation |
$238.56
|
| Rate for Payer: Altius Commercial |
$238.56
|
| Rate for Payer: Beech Street Commercial |
$243.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$204.02
|
| Rate for Payer: Cash Price |
$173.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$241.04
|
| Rate for Payer: Cigna of WY Commercial |
$243.53
|
| Rate for Payer: Entrust Commercial |
$236.08
|
| Rate for Payer: First Choice Health Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$236.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$164.01
|
| Rate for Payer: HealthUtah PPO |
$248.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$241.04
|
| Rate for Payer: Multiplan Medicare/VA |
$155.81
|
| Rate for Payer: One Health Plan of WY PPO |
$243.53
|
| Rate for Payer: PacificSource Commercial |
$223.65
|
| Rate for Payer: PHCS PPO |
$243.53
|
| Rate for Payer: Three Rivers PPO |
$186.38
|
| Rate for Payer: TriWest Veterans Administration |
$164.01
|
| Rate for Payer: United Healthcare Commercial |
$216.20
|
| Rate for Payer: United Healthcare Medicare |
$164.01
|
| Rate for Payer: WINHealth Partners Commercial |
$236.08
|
| Rate for Payer: Wise Provider Network Commercial |
$236.08
|
|
|
TERUMO LARGE TR BAND & INFLATOR
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.71 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$106.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.38
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$88.71
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$93.38
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$93.38
|
| Rate for Payer: WINHealth Partners Commercial |
$157.78
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
TERUMO LARGE TR BAND & INFLATOR
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.56
|
| Rate for Payer: Altius Commercial |
$154.56
|
| Rate for Payer: Beech Street Commercial |
$157.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.18
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: Entrust Commercial |
$152.95
|
| Rate for Payer: First Choice Health Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.26
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$100.95
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$157.78
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$106.26
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$106.26
|
| Rate for Payer: WINHealth Partners Commercial |
$152.95
|
| Rate for Payer: Wise Provider Network Commercial |
$152.95
|
|
|
TERUMO PINNACLE SHEATH .038" 5FR X 25CM
|
Facility
|
IP
|
$80.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.28
|
| Rate for Payer: Altius Commercial |
$77.28
|
| Rate for Payer: Beech Street Commercial |
$78.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.09
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.08
|
| Rate for Payer: Cigna of WY Commercial |
$78.89
|
| Rate for Payer: Entrust Commercial |
$76.48
|
| Rate for Payer: First Choice Health Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.13
|
| Rate for Payer: HealthUtah PPO |
$80.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.08
|
| Rate for Payer: Multiplan Medicare/VA |
$50.47
|
| Rate for Payer: One Health Plan of WY PPO |
$78.89
|
| Rate for Payer: PacificSource Commercial |
$72.45
|
| Rate for Payer: PHCS PPO |
$78.89
|
| Rate for Payer: Three Rivers PPO |
$60.38
|
| Rate for Payer: TriWest Veterans Administration |
$53.13
|
| Rate for Payer: United Healthcare Commercial |
$70.04
|
| Rate for Payer: United Healthcare Medicare |
$53.13
|
| Rate for Payer: WINHealth Partners Commercial |
$76.48
|
| Rate for Payer: Wise Provider Network Commercial |
$76.48
|
|
|
TERUMO PINNACLE SHEATH .038" 5FR X 25CM
|
Facility
|
OP
|
$80.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.89
|
| Rate for Payer: Aetna of WY Medicare |
$53.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.28
|
| Rate for Payer: Altius Commercial |
$77.28
|
| Rate for Payer: Beech Street Commercial |
$78.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.09
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.08
|
| Rate for Payer: Cigna of WY Commercial |
$78.89
|
| Rate for Payer: Entrust Commercial |
$76.48
|
| Rate for Payer: First Choice Health Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.69
|
| Rate for Payer: HealthUtah PPO |
$80.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.08
|
| Rate for Payer: Multiplan Medicare/VA |
$44.36
|
| Rate for Payer: One Health Plan of WY PPO |
$78.89
|
| Rate for Payer: PacificSource Commercial |
$72.45
|
| Rate for Payer: PHCS PPO |
$78.89
|
| Rate for Payer: Three Rivers PPO |
$60.38
|
| Rate for Payer: TriWest Veterans Administration |
$46.69
|
| Rate for Payer: United Healthcare Commercial |
$70.04
|
| Rate for Payer: United Healthcare Medicare |
$46.69
|
| Rate for Payer: WINHealth Partners Commercial |
$78.89
|
| Rate for Payer: Wise Provider Network Commercial |
$76.48
|
|
|
TERUMO PINNACLE SHEATH .038" 6FR X 25CM
|
Facility
|
IP
|
$80.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.28
|
| Rate for Payer: Altius Commercial |
$77.28
|
| Rate for Payer: Beech Street Commercial |
$78.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.09
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.08
|
| Rate for Payer: Cigna of WY Commercial |
$78.89
|
| Rate for Payer: Entrust Commercial |
$76.48
|
| Rate for Payer: First Choice Health Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.13
|
| Rate for Payer: HealthUtah PPO |
$80.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.08
|
| Rate for Payer: Multiplan Medicare/VA |
$50.47
|
| Rate for Payer: One Health Plan of WY PPO |
$78.89
|
| Rate for Payer: PacificSource Commercial |
$72.45
|
| Rate for Payer: PHCS PPO |
$78.89
|
| Rate for Payer: Three Rivers PPO |
$60.38
|
| Rate for Payer: TriWest Veterans Administration |
$53.13
|
| Rate for Payer: United Healthcare Commercial |
$70.04
|
| Rate for Payer: United Healthcare Medicare |
$53.13
|
| Rate for Payer: WINHealth Partners Commercial |
$76.48
|
| Rate for Payer: Wise Provider Network Commercial |
$76.48
|
|
|
TERUMO PINNACLE SHEATH .038" 6FR X 25CM
|
Facility
|
OP
|
$80.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.36 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$78.89
|
| Rate for Payer: Aetna of WY Medicare |
$53.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$77.28
|
| Rate for Payer: Altius Commercial |
$77.28
|
| Rate for Payer: Beech Street Commercial |
$78.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$66.09
|
| Rate for Payer: Cash Price |
$56.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$78.08
|
| Rate for Payer: Cigna of WY Commercial |
$78.89
|
| Rate for Payer: Entrust Commercial |
$76.48
|
| Rate for Payer: First Choice Health Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$76.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$46.69
|
| Rate for Payer: HealthUtah PPO |
$80.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$78.08
|
| Rate for Payer: Multiplan Medicare/VA |
$44.36
|
| Rate for Payer: One Health Plan of WY PPO |
$78.89
|
| Rate for Payer: PacificSource Commercial |
$72.45
|
| Rate for Payer: PHCS PPO |
$78.89
|
| Rate for Payer: Three Rivers PPO |
$60.38
|
| Rate for Payer: TriWest Veterans Administration |
$46.69
|
| Rate for Payer: United Healthcare Commercial |
$70.04
|
| Rate for Payer: United Healthcare Medicare |
$46.69
|
| Rate for Payer: WINHealth Partners Commercial |
$78.89
|
| Rate for Payer: Wise Provider Network Commercial |
$76.48
|
|
|
TERUMO PINNACLE SHEATH TIF TIP 5FR X 10CM
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$48.02
|
| Rate for Payer: Aetna of WY Medicare |
$32.34
|
| Rate for Payer: Altius Auto/Workers Compensation |
$47.04
|
| Rate for Payer: Altius Commercial |
$47.04
|
| Rate for Payer: Beech Street Commercial |
$48.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$40.23
|
| Rate for Payer: Cash Price |
$34.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$47.53
|
| Rate for Payer: Cigna of WY Commercial |
$48.02
|
| Rate for Payer: Entrust Commercial |
$46.55
|
| Rate for Payer: First Choice Health Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$46.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.42
|
| Rate for Payer: HealthUtah PPO |
$49.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$47.53
|
| Rate for Payer: Multiplan Medicare/VA |
$27.00
|
| Rate for Payer: One Health Plan of WY PPO |
$48.02
|
| Rate for Payer: PacificSource Commercial |
$44.10
|
| Rate for Payer: PHCS PPO |
$48.02
|
| Rate for Payer: Three Rivers PPO |
$36.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.42
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$28.42
|
| Rate for Payer: WINHealth Partners Commercial |
$48.02
|
| Rate for Payer: Wise Provider Network Commercial |
$46.55
|
|
