|
CALCIUM PHOSPHATE 250 MG-VIT D3 12.5 MCG (500 UNIT) CHEWABLE TABLET [99786]
|
Facility
|
OP
|
$15.40
|
|
|
Service Code
|
NDC 2791721447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| Rate for Payer: Aetna of WY Medicare |
$10.16
|
| Rate for Payer: Altius Commercial |
$14.78
|
| Rate for Payer: Beech Street Commercial |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.09
|
| Rate for Payer: Entrust Commercial |
$14.63
|
| Rate for Payer: First Choice Health Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.78
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$8.34
|
| Rate for Payer: One Health Plan of WY PPO |
$15.09
|
| Rate for Payer: PacificSource Commercial |
$13.86
|
| Rate for Payer: PHCS PPO |
$15.09
|
| Rate for Payer: Three Rivers PPO |
$11.55
|
| Rate for Payer: TriWest Veterans Administration |
$8.78
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$8.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.09
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
CALCIUM PHOSPHATE 250 MG-VIT D3 12.5 MCG (500 UNIT) CHEWABLE TABLET [99786]
|
Facility
|
IP
|
$15.40
|
|
|
Service Code
|
NDC 2791721447
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.09
|
| Rate for Payer: Aetna of WY Medicare |
$9.86
|
| Rate for Payer: Altius Commercial |
$14.78
|
| Rate for Payer: Beech Street Commercial |
$15.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.94
|
| Rate for Payer: Cash Price |
$10.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.94
|
| Rate for Payer: Cigna of WY Commercial |
$15.09
|
| Rate for Payer: Entrust Commercial |
$14.63
|
| Rate for Payer: First Choice Health Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.63
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.39
|
| Rate for Payer: HealthUtah PPO |
$15.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.94
|
| Rate for Payer: Multiplan Medicare/VA |
$8.92
|
| Rate for Payer: One Health Plan of WY PPO |
$15.09
|
| Rate for Payer: PacificSource Commercial |
$13.86
|
| Rate for Payer: PHCS PPO |
$15.09
|
| Rate for Payer: Three Rivers PPO |
$11.55
|
| Rate for Payer: TriWest Veterans Administration |
$9.39
|
| Rate for Payer: United Healthcare Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare |
$9.39
|
| Rate for Payer: WINHealth Partners Commercial |
$14.63
|
| Rate for Payer: Wise Provider Network Commercial |
$14.63
|
|
|
CALFACTANT 35 MG/ML IN 0.9% SODIUM CHLORIDE INTRATRACHEAL SUSPENSION [64]
|
Facility
|
IP
|
$242.24
|
|
|
Service Code
|
NDC 6193845603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$140.38 |
| Max. Negotiated Rate |
$242.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$237.40
|
| Rate for Payer: Aetna of WY Medicare |
$155.03
|
| Rate for Payer: Altius Commercial |
$232.55
|
| Rate for Payer: Beech Street Commercial |
$237.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$234.97
|
| Rate for Payer: Cash Price |
$169.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$234.97
|
| Rate for Payer: Cigna of WY Commercial |
$237.40
|
| Rate for Payer: Entrust Commercial |
$230.13
|
| Rate for Payer: First Choice Health Commercial |
$230.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.77
|
| Rate for Payer: HealthUtah PPO |
$242.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$234.97
|
| Rate for Payer: Multiplan Medicare/VA |
$140.38
|
| Rate for Payer: One Health Plan of WY PPO |
$237.40
|
| Rate for Payer: PacificSource Commercial |
$218.02
|
| Rate for Payer: PHCS PPO |
$237.40
|
| Rate for Payer: Three Rivers PPO |
$181.68
|
| Rate for Payer: TriWest Veterans Administration |
$147.77
|
| Rate for Payer: United Healthcare Commercial |
$231.34
|
| Rate for Payer: United Healthcare Medicare |
$147.77
|
| Rate for Payer: WINHealth Partners Commercial |
$230.13
|
| Rate for Payer: Wise Provider Network Commercial |
$230.13
|
|
|
CALFACTANT 35 MG/ML IN 0.9% SODIUM CHLORIDE INTRATRACHEAL SUSPENSION [64]
|
Facility
|
OP
|
$242.24
|
|
|
Service Code
|
NDC 6193845603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$242.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$237.40
|
| Rate for Payer: Aetna of WY Medicare |
$159.88
|
| Rate for Payer: Altius Commercial |
$232.55
|
| Rate for Payer: Beech Street Commercial |
$237.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$234.97
|
| Rate for Payer: Cash Price |
$169.57
|
| Rate for Payer: ChoiceCare Network Commercial |
$234.97
|
| Rate for Payer: Cigna of WY Commercial |
$237.40
|
| Rate for Payer: Entrust Commercial |
$230.13
|
| Rate for Payer: First Choice Health Commercial |
$230.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$230.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.08
|
| Rate for Payer: HealthUtah PPO |
$242.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$234.97
|
| Rate for Payer: Multiplan Medicare/VA |
$131.17
|
| Rate for Payer: One Health Plan of WY PPO |
$237.40
|
| Rate for Payer: PacificSource Commercial |
$218.02
|
| Rate for Payer: PHCS PPO |
$237.40
|
| Rate for Payer: Three Rivers PPO |
$181.68
|
| Rate for Payer: TriWest Veterans Administration |
$138.08
|
| Rate for Payer: United Healthcare Commercial |
$231.34
|
| Rate for Payer: United Healthcare Medicare |
$138.08
|
| Rate for Payer: WINHealth Partners Commercial |
$237.40
|
| Rate for Payer: Wise Provider Network Commercial |
$230.13
|
|
|
CAMERA HEAD 4K SYNERGYUHD4
|
Facility
|
IP
|
$5,582.50
|
|
| Hospital Charge Code |
3004287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,235.06 |
| Max. Negotiated Rate |
$5,582.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,470.85
|
| Rate for Payer: Aetna of WY Medicare |
$3,572.80
|
| Rate for Payer: Altius Commercial |
$5,359.20
|
| Rate for Payer: Beech Street Commercial |
$5,470.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,415.02
|
| Rate for Payer: Cash Price |
$3,907.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,415.02
|
| Rate for Payer: Cigna of WY Commercial |
$5,470.85
|
| Rate for Payer: Entrust Commercial |
$5,303.38
|
| Rate for Payer: First Choice Health Commercial |
$5,303.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,303.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,405.32
|
| Rate for Payer: HealthUtah PPO |
$5,582.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,415.02
|
| Rate for Payer: Multiplan Medicare/VA |
$3,235.06
|
| Rate for Payer: One Health Plan of WY PPO |
$5,470.85
|
| Rate for Payer: PacificSource Commercial |
$5,024.25
|
| Rate for Payer: PHCS PPO |
$5,470.85
|
| Rate for Payer: Three Rivers PPO |
$4,186.88
|
| Rate for Payer: TriWest Veterans Administration |
$3,405.32
|
| Rate for Payer: United Healthcare Commercial |
$5,331.29
|
| Rate for Payer: United Healthcare Medicare |
$3,405.32
|
| Rate for Payer: WINHealth Partners Commercial |
$5,303.38
|
| Rate for Payer: Wise Provider Network Commercial |
$5,303.38
|
|
|
CAMERA HEAD 4K SYNERGYUHD4
|
Facility
|
OP
|
$5,582.50
|
|
| Hospital Charge Code |
3004287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,022.92 |
| Max. Negotiated Rate |
$5,582.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,470.85
|
| Rate for Payer: Aetna of WY Medicare |
$3,684.45
|
| Rate for Payer: Altius Commercial |
$5,359.20
|
| Rate for Payer: Beech Street Commercial |
$5,470.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5,415.02
|
| Rate for Payer: Cash Price |
$3,907.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,415.02
|
| Rate for Payer: Cigna of WY Commercial |
$5,470.85
|
| Rate for Payer: Entrust Commercial |
$5,303.38
|
| Rate for Payer: First Choice Health Commercial |
$5,303.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,303.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,182.02
|
| Rate for Payer: HealthUtah PPO |
$5,582.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,415.02
|
| Rate for Payer: Multiplan Medicare/VA |
$3,022.92
|
| Rate for Payer: One Health Plan of WY PPO |
$5,470.85
|
| Rate for Payer: PacificSource Commercial |
$5,024.25
|
| Rate for Payer: PHCS PPO |
$5,470.85
|
| Rate for Payer: Three Rivers PPO |
$4,186.88
|
| Rate for Payer: TriWest Veterans Administration |
$3,182.02
|
| Rate for Payer: United Healthcare Commercial |
$5,331.29
|
| Rate for Payer: United Healthcare Medicare |
$3,182.02
|
| Rate for Payer: WINHealth Partners Commercial |
$5,470.85
|
| Rate for Payer: Wise Provider Network Commercial |
$5,303.38
|
|
|
CANALITH REPOSITIONING PROCEDURE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 95992
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.14
|
| Rate for Payer: Aetna of WY Medicare |
$34.45
|
| Rate for Payer: Beech Street Commercial |
$135.85
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.71
|
| Rate for Payer: Cigna of WY Commercial |
$140.14
|
| Rate for Payer: First Choice Health Commercial |
$128.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.45
|
| Rate for Payer: HealthUtah PPO |
$143.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.71
|
| Rate for Payer: Multiplan Medicare/VA |
$29.28
|
| Rate for Payer: One Health Plan of WY PPO |
$140.14
|
| Rate for Payer: PacificSource Commercial |
$128.70
|
| Rate for Payer: PHCS PPO |
$135.85
|
| Rate for Payer: Three Rivers PPO |
$107.25
|
| Rate for Payer: TriWest Veterans Administration |
$34.45
|
| Rate for Payer: United Healthcare Commercial |
$135.85
|
| Rate for Payer: WINHealth Partners Commercial |
$135.85
|
|
|
CANCELLOUS 1-4MM BIO CHIPS 15CC
|
Facility
|
IP
|
$1,164.24
|
|
| Hospital Charge Code |
3004631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.68 |
| Max. Negotiated Rate |
$1,164.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,140.96
|
| Rate for Payer: Aetna of WY Medicare |
$745.11
|
| Rate for Payer: Altius Commercial |
$1,117.67
|
| Rate for Payer: Beech Street Commercial |
$1,140.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,129.31
|
| Rate for Payer: Cash Price |
$814.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,140.96
|
| Rate for Payer: Entrust Commercial |
$1,106.03
|
| Rate for Payer: First Choice Health Commercial |
$1,106.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$710.19
|
| Rate for Payer: HealthUtah PPO |
$1,164.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.31
|
| Rate for Payer: Multiplan Medicare/VA |
$674.68
|
| Rate for Payer: One Health Plan of WY PPO |
$1,140.96
|
| Rate for Payer: PacificSource Commercial |
$1,047.82
|
| Rate for Payer: PHCS PPO |
$1,140.96
|
| Rate for Payer: Three Rivers PPO |
$873.18
|
| Rate for Payer: TriWest Veterans Administration |
$710.19
|
| Rate for Payer: United Healthcare Commercial |
$1,111.85
|
| Rate for Payer: United Healthcare Medicare |
$710.19
|
| Rate for Payer: WINHealth Partners Commercial |
$1,106.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.03
|
|
|
CANCELLOUS 1-4MM BIO CHIPS 15CC
|
Facility
|
OP
|
$1,164.24
|
|
| Hospital Charge Code |
3004631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.44 |
| Max. Negotiated Rate |
$1,164.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,140.96
|
| Rate for Payer: Aetna of WY Medicare |
$768.40
|
| Rate for Payer: Altius Commercial |
$1,117.67
|
| Rate for Payer: Beech Street Commercial |
$1,140.96
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,129.31
|
| Rate for Payer: Cash Price |
$814.97
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,129.31
|
| Rate for Payer: Cigna of WY Commercial |
$1,140.96
|
| Rate for Payer: Entrust Commercial |
$1,106.03
|
| Rate for Payer: First Choice Health Commercial |
$1,106.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,106.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$663.62
|
| Rate for Payer: HealthUtah PPO |
$1,164.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,129.31
|
| Rate for Payer: Multiplan Medicare/VA |
$630.44
|
| Rate for Payer: One Health Plan of WY PPO |
$1,140.96
|
| Rate for Payer: PacificSource Commercial |
$1,047.82
|
| Rate for Payer: PHCS PPO |
$1,140.96
|
| Rate for Payer: Three Rivers PPO |
$873.18
|
| Rate for Payer: TriWest Veterans Administration |
$663.62
|
| Rate for Payer: United Healthcare Commercial |
$1,111.85
|
| Rate for Payer: United Healthcare Medicare |
$663.62
|
| Rate for Payer: WINHealth Partners Commercial |
$1,140.96
|
| Rate for Payer: Wise Provider Network Commercial |
$1,106.03
|
|
|
CANCELLOUS 1-4MM BIO CHIPS 30CC
|
Facility
|
IP
|
$1,829.52
|
|
| Hospital Charge Code |
3004632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.21 |
| Max. Negotiated Rate |
$1,829.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,792.93
|
| Rate for Payer: Aetna of WY Medicare |
$1,170.89
|
| Rate for Payer: Altius Commercial |
$1,756.34
|
| Rate for Payer: Beech Street Commercial |
$1,792.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,774.63
|
| Rate for Payer: Cash Price |
$1,280.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,774.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,792.93
|
| Rate for Payer: Entrust Commercial |
$1,738.04
|
| Rate for Payer: First Choice Health Commercial |
$1,738.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,738.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,116.01
|
| Rate for Payer: HealthUtah PPO |
$1,829.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,774.63
|
| Rate for Payer: Multiplan Medicare/VA |
$1,060.21
|
| Rate for Payer: One Health Plan of WY PPO |
$1,792.93
|
| Rate for Payer: PacificSource Commercial |
$1,646.57
|
| Rate for Payer: PHCS PPO |
$1,792.93
|
| Rate for Payer: Three Rivers PPO |
$1,372.14
|
| Rate for Payer: TriWest Veterans Administration |
$1,116.01
|
| Rate for Payer: United Healthcare Commercial |
$1,747.19
|
| Rate for Payer: United Healthcare Medicare |
$1,116.01
|
| Rate for Payer: WINHealth Partners Commercial |
$1,738.04
|
| Rate for Payer: Wise Provider Network Commercial |
$1,738.04
|
|
|
CANCELLOUS 1-4MM BIO CHIPS 30CC
|
Facility
|
OP
|
$1,829.52
|
|
| Hospital Charge Code |
3004632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.69 |
| Max. Negotiated Rate |
$1,829.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,792.93
|
| Rate for Payer: Aetna of WY Medicare |
$1,207.48
|
| Rate for Payer: Altius Commercial |
$1,756.34
|
| Rate for Payer: Beech Street Commercial |
$1,792.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,774.63
|
| Rate for Payer: Cash Price |
$1,280.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,774.63
|
| Rate for Payer: Cigna of WY Commercial |
$1,792.93
|
| Rate for Payer: Entrust Commercial |
$1,738.04
|
| Rate for Payer: First Choice Health Commercial |
$1,738.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,738.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,042.83
|
| Rate for Payer: HealthUtah PPO |
$1,829.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,774.63
|
| Rate for Payer: Multiplan Medicare/VA |
$990.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,792.93
|
| Rate for Payer: PacificSource Commercial |
$1,646.57
|
| Rate for Payer: PHCS PPO |
$1,792.93
|
| Rate for Payer: Three Rivers PPO |
$1,372.14
|
| Rate for Payer: TriWest Veterans Administration |
$1,042.83
|
| Rate for Payer: United Healthcare Commercial |
$1,747.19
|
| Rate for Payer: United Healthcare Medicare |
$1,042.83
|
| Rate for Payer: WINHealth Partners Commercial |
$1,792.93
|
| Rate for Payer: Wise Provider Network Commercial |
$1,738.04
|
|
|
CANCELLOUS CUBES 4-6 15CC
|
Facility
|
OP
|
$632.45
|
|
| Hospital Charge Code |
3000430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.47 |
| Max. Negotiated Rate |
$632.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$619.80
|
| Rate for Payer: Aetna of WY Medicare |
$417.42
|
| Rate for Payer: Altius Commercial |
$607.15
|
| Rate for Payer: Beech Street Commercial |
$619.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$613.48
|
| Rate for Payer: Cash Price |
$442.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$613.48
|
| Rate for Payer: Cigna of WY Commercial |
$619.80
|
| Rate for Payer: Entrust Commercial |
$600.83
|
| Rate for Payer: First Choice Health Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$360.50
|
| Rate for Payer: HealthUtah PPO |
$632.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$613.48
|
| Rate for Payer: Multiplan Medicare/VA |
$342.47
|
| Rate for Payer: One Health Plan of WY PPO |
$619.80
|
| Rate for Payer: PacificSource Commercial |
$569.20
|
| Rate for Payer: PHCS PPO |
$619.80
|
| Rate for Payer: Three Rivers PPO |
$474.34
|
| Rate for Payer: TriWest Veterans Administration |
$360.50
|
| Rate for Payer: United Healthcare Commercial |
$603.99
|
| Rate for Payer: United Healthcare Medicare |
$360.50
|
| Rate for Payer: WINHealth Partners Commercial |
$619.80
|
| Rate for Payer: Wise Provider Network Commercial |
$600.83
|
|
|
CANCELLOUS CUBES 4-6 15CC
|
Facility
|
IP
|
$632.45
|
|
| Hospital Charge Code |
3000430
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.50 |
| Max. Negotiated Rate |
$632.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$619.80
|
| Rate for Payer: Aetna of WY Medicare |
$404.77
|
| Rate for Payer: Altius Commercial |
$607.15
|
| Rate for Payer: Beech Street Commercial |
$619.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$613.48
|
| Rate for Payer: Cash Price |
$442.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$613.48
|
| Rate for Payer: Cigna of WY Commercial |
$619.80
|
| Rate for Payer: Entrust Commercial |
$600.83
|
| Rate for Payer: First Choice Health Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$600.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$385.79
|
| Rate for Payer: HealthUtah PPO |
$632.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$613.48
|
| Rate for Payer: Multiplan Medicare/VA |
$366.50
|
| Rate for Payer: One Health Plan of WY PPO |
$619.80
|
| Rate for Payer: PacificSource Commercial |
$569.20
|
| Rate for Payer: PHCS PPO |
$619.80
|
| Rate for Payer: Three Rivers PPO |
$474.34
|
| Rate for Payer: TriWest Veterans Administration |
$385.79
|
| Rate for Payer: United Healthcare Commercial |
$603.99
|
| Rate for Payer: United Healthcare Medicare |
$385.79
|
| Rate for Payer: WINHealth Partners Commercial |
$600.83
|
| Rate for Payer: Wise Provider Network Commercial |
$600.83
|
|
|
CANCELLOUS CUBES 5CC BIO
|
Facility
|
OP
|
$234.33
|
|
| Hospital Charge Code |
3350067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.89 |
| Max. Negotiated Rate |
$234.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.64
|
| Rate for Payer: Aetna of WY Medicare |
$154.66
|
| Rate for Payer: Altius Commercial |
$224.96
|
| Rate for Payer: Beech Street Commercial |
$229.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.30
|
| Rate for Payer: Cash Price |
$164.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.30
|
| Rate for Payer: Cigna of WY Commercial |
$229.64
|
| Rate for Payer: Entrust Commercial |
$222.61
|
| Rate for Payer: First Choice Health Commercial |
$222.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$133.57
|
| Rate for Payer: HealthUtah PPO |
$234.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.30
|
| Rate for Payer: Multiplan Medicare/VA |
$126.89
|
| Rate for Payer: One Health Plan of WY PPO |
$229.64
|
| Rate for Payer: PacificSource Commercial |
$210.90
|
| Rate for Payer: PHCS PPO |
$229.64
|
| Rate for Payer: Three Rivers PPO |
$175.75
|
| Rate for Payer: TriWest Veterans Administration |
$133.57
|
| Rate for Payer: United Healthcare Commercial |
$223.79
|
| Rate for Payer: United Healthcare Medicare |
$133.57
|
| Rate for Payer: WINHealth Partners Commercial |
$229.64
|
| Rate for Payer: Wise Provider Network Commercial |
$222.61
|
|
|
CANCELLOUS CUBES 5CC BIO
|
Facility
|
IP
|
$234.33
|
|
| Hospital Charge Code |
3350067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.79 |
| Max. Negotiated Rate |
$234.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$229.64
|
| Rate for Payer: Aetna of WY Medicare |
$149.97
|
| Rate for Payer: Altius Commercial |
$224.96
|
| Rate for Payer: Beech Street Commercial |
$229.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$227.30
|
| Rate for Payer: Cash Price |
$164.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.30
|
| Rate for Payer: Cigna of WY Commercial |
$229.64
|
| Rate for Payer: Entrust Commercial |
$222.61
|
| Rate for Payer: First Choice Health Commercial |
$222.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$222.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.94
|
| Rate for Payer: HealthUtah PPO |
$234.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.30
|
| Rate for Payer: Multiplan Medicare/VA |
$135.79
|
| Rate for Payer: One Health Plan of WY PPO |
$229.64
|
| Rate for Payer: PacificSource Commercial |
$210.90
|
| Rate for Payer: PHCS PPO |
$229.64
|
| Rate for Payer: Three Rivers PPO |
$175.75
|
| Rate for Payer: TriWest Veterans Administration |
$142.94
|
| Rate for Payer: United Healthcare Commercial |
$223.79
|
| Rate for Payer: United Healthcare Medicare |
$142.94
|
| Rate for Payer: WINHealth Partners Commercial |
$222.61
|
| Rate for Payer: Wise Provider Network Commercial |
$222.61
|
|
|
CANCELLOUS GRANULES 10CC 1-4MM
|
Facility
|
IP
|
$717.50
|
|
| Hospital Charge Code |
2800207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.79 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$459.20
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$437.68
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$415.79
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$437.68
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$437.68
|
| Rate for Payer: WINHealth Partners Commercial |
$681.62
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CANCELLOUS GRANULES 10CC 1-4MM
|
Facility
|
OP
|
$717.50
|
|
| Hospital Charge Code |
2800207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.53 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$703.15
|
| Rate for Payer: Aetna of WY Medicare |
$473.55
|
| Rate for Payer: Altius Commercial |
$688.80
|
| Rate for Payer: Beech Street Commercial |
$703.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$695.98
|
| Rate for Payer: Cash Price |
$502.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$695.98
|
| Rate for Payer: Cigna of WY Commercial |
$703.15
|
| Rate for Payer: Entrust Commercial |
$681.62
|
| Rate for Payer: First Choice Health Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$681.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$408.98
|
| Rate for Payer: HealthUtah PPO |
$717.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$695.98
|
| Rate for Payer: Multiplan Medicare/VA |
$388.53
|
| Rate for Payer: One Health Plan of WY PPO |
$703.15
|
| Rate for Payer: PacificSource Commercial |
$645.75
|
| Rate for Payer: PHCS PPO |
$703.15
|
| Rate for Payer: Three Rivers PPO |
$538.12
|
| Rate for Payer: TriWest Veterans Administration |
$408.98
|
| Rate for Payer: United Healthcare Commercial |
$685.21
|
| Rate for Payer: United Healthcare Medicare |
$408.98
|
| Rate for Payer: WINHealth Partners Commercial |
$703.15
|
| Rate for Payer: Wise Provider Network Commercial |
$681.62
|
|
|
CANCELLOUS GRANULES 5CC 1-4MM
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
2800208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.24 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$543.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.20
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$303.24
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.20
|
| Rate for Payer: United Healthcare Commercial |
$534.80
|
| Rate for Payer: United Healthcare Medicare |
$319.20
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
CANCELLOUS GRANULES 5CC 1-4MM
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
2800208
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.52 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$358.40
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$543.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$324.52
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$341.60
|
| Rate for Payer: United Healthcare Commercial |
$534.80
|
| Rate for Payer: United Healthcare Medicare |
$341.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
CANCELLOUS GRANULES 5CC 4-10MM
|
Facility
|
OP
|
$560.00
|
|
| Hospital Charge Code |
2800228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.24 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$369.60
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$543.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$319.20
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$303.24
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$319.20
|
| Rate for Payer: United Healthcare Commercial |
$534.80
|
| Rate for Payer: United Healthcare Medicare |
$319.20
|
| Rate for Payer: WINHealth Partners Commercial |
$548.80
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
CANCELLOUS GRANULES 5CC 4-10MM
|
Facility
|
IP
|
$560.00
|
|
| Hospital Charge Code |
2800228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.52 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$548.80
|
| Rate for Payer: Aetna of WY Medicare |
$358.40
|
| Rate for Payer: Altius Commercial |
$537.60
|
| Rate for Payer: Beech Street Commercial |
$548.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$543.20
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$543.20
|
| Rate for Payer: Cigna of WY Commercial |
$548.80
|
| Rate for Payer: Entrust Commercial |
$532.00
|
| Rate for Payer: First Choice Health Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$532.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$341.60
|
| Rate for Payer: HealthUtah PPO |
$560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$543.20
|
| Rate for Payer: Multiplan Medicare/VA |
$324.52
|
| Rate for Payer: One Health Plan of WY PPO |
$548.80
|
| Rate for Payer: PacificSource Commercial |
$504.00
|
| Rate for Payer: PHCS PPO |
$548.80
|
| Rate for Payer: Three Rivers PPO |
$420.00
|
| Rate for Payer: TriWest Veterans Administration |
$341.60
|
| Rate for Payer: United Healthcare Commercial |
$534.80
|
| Rate for Payer: United Healthcare Medicare |
$341.60
|
| Rate for Payer: WINHealth Partners Commercial |
$532.00
|
| Rate for Payer: Wise Provider Network Commercial |
$532.00
|
|
|
CANDO DIGI-FLEX SET & DISPLAY
|
Facility
|
IP
|
$258.76
|
|
| Hospital Charge Code |
2900048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.95 |
| Max. Negotiated Rate |
$258.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$253.58
|
| Rate for Payer: Aetna of WY Medicare |
$165.61
|
| Rate for Payer: Altius Commercial |
$248.41
|
| Rate for Payer: Beech Street Commercial |
$253.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.00
|
| Rate for Payer: Cash Price |
$181.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$251.00
|
| Rate for Payer: Cigna of WY Commercial |
$253.58
|
| Rate for Payer: Entrust Commercial |
$245.82
|
| Rate for Payer: First Choice Health Commercial |
$245.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$245.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$157.84
|
| Rate for Payer: HealthUtah PPO |
$258.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$251.00
|
| Rate for Payer: Multiplan Medicare/VA |
$149.95
|
| Rate for Payer: One Health Plan of WY PPO |
$253.58
|
| Rate for Payer: PacificSource Commercial |
$232.88
|
| Rate for Payer: PHCS PPO |
$253.58
|
| Rate for Payer: Three Rivers PPO |
$194.07
|
| Rate for Payer: TriWest Veterans Administration |
$157.84
|
| Rate for Payer: United Healthcare Commercial |
$247.12
|
| Rate for Payer: United Healthcare Medicare |
$157.84
|
| Rate for Payer: WINHealth Partners Commercial |
$245.82
|
| Rate for Payer: Wise Provider Network Commercial |
$245.82
|
|
|
CANDO DIGI-FLEX SET & DISPLAY
|
Facility
|
OP
|
$258.76
|
|
| Hospital Charge Code |
2900048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.12 |
| Max. Negotiated Rate |
$258.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$253.58
|
| Rate for Payer: Aetna of WY Medicare |
$170.78
|
| Rate for Payer: Altius Commercial |
$248.41
|
| Rate for Payer: Beech Street Commercial |
$253.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$251.00
|
| Rate for Payer: Cash Price |
$181.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$251.00
|
| Rate for Payer: Cigna of WY Commercial |
$253.58
|
| Rate for Payer: Entrust Commercial |
$245.82
|
| Rate for Payer: First Choice Health Commercial |
$245.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$245.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.49
|
| Rate for Payer: HealthUtah PPO |
$258.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$251.00
|
| Rate for Payer: Multiplan Medicare/VA |
$140.12
|
| Rate for Payer: One Health Plan of WY PPO |
$253.58
|
| Rate for Payer: PacificSource Commercial |
$232.88
|
| Rate for Payer: PHCS PPO |
$253.58
|
| Rate for Payer: Three Rivers PPO |
$194.07
|
| Rate for Payer: TriWest Veterans Administration |
$147.49
|
| Rate for Payer: United Healthcare Commercial |
$247.12
|
| Rate for Payer: United Healthcare Medicare |
$147.49
|
| Rate for Payer: WINHealth Partners Commercial |
$253.58
|
| Rate for Payer: Wise Provider Network Commercial |
$245.82
|
|
|
CANNULA CRYSTAL AR6560 ORANGE
|
Facility
|
IP
|
$99.75
|
|
| Hospital Charge Code |
3000198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.76
|
| Rate for Payer: Aetna of WY Medicare |
$63.84
|
| Rate for Payer: Altius Commercial |
$95.76
|
| Rate for Payer: Beech Street Commercial |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.76
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.76
|
| Rate for Payer: Cigna of WY Commercial |
$97.76
|
| Rate for Payer: Entrust Commercial |
$94.76
|
| Rate for Payer: First Choice Health Commercial |
$94.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.85
|
| Rate for Payer: HealthUtah PPO |
$99.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.76
|
| Rate for Payer: Multiplan Medicare/VA |
$57.81
|
| Rate for Payer: One Health Plan of WY PPO |
$97.76
|
| Rate for Payer: PacificSource Commercial |
$89.78
|
| Rate for Payer: PHCS PPO |
$97.76
|
| Rate for Payer: Three Rivers PPO |
$74.81
|
| Rate for Payer: TriWest Veterans Administration |
$60.85
|
| Rate for Payer: United Healthcare Commercial |
$95.26
|
| Rate for Payer: United Healthcare Medicare |
$60.85
|
| Rate for Payer: WINHealth Partners Commercial |
$94.76
|
| Rate for Payer: Wise Provider Network Commercial |
$94.76
|
|
|
CANNULA CRYSTAL AR6560 ORANGE
|
Facility
|
OP
|
$99.75
|
|
| Hospital Charge Code |
3000198
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$97.76
|
| Rate for Payer: Aetna of WY Medicare |
$65.84
|
| Rate for Payer: Altius Commercial |
$95.76
|
| Rate for Payer: Beech Street Commercial |
$97.76
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.76
|
| Rate for Payer: Cash Price |
$69.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$96.76
|
| Rate for Payer: Cigna of WY Commercial |
$97.76
|
| Rate for Payer: Entrust Commercial |
$94.76
|
| Rate for Payer: First Choice Health Commercial |
$94.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$94.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.86
|
| Rate for Payer: HealthUtah PPO |
$99.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$96.76
|
| Rate for Payer: Multiplan Medicare/VA |
$54.01
|
| Rate for Payer: One Health Plan of WY PPO |
$97.76
|
| Rate for Payer: PacificSource Commercial |
$89.78
|
| Rate for Payer: PHCS PPO |
$97.76
|
| Rate for Payer: Three Rivers PPO |
$74.81
|
| Rate for Payer: TriWest Veterans Administration |
$56.86
|
| Rate for Payer: United Healthcare Commercial |
$95.26
|
| Rate for Payer: United Healthcare Medicare |
$56.86
|
| Rate for Payer: WINHealth Partners Commercial |
$97.76
|
| Rate for Payer: Wise Provider Network Commercial |
$94.76
|
|
