|
DRESSING GLASSCOCK EAR
|
Facility
|
OP
|
$75.42
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.91
|
| Rate for Payer: Aetna of WY Medicare |
$49.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.40
|
| Rate for Payer: Altius Commercial |
$72.40
|
| Rate for Payer: Beech Street Commercial |
$73.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.92
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.16
|
| Rate for Payer: Cigna of WY Commercial |
$73.91
|
| Rate for Payer: Entrust Commercial |
$71.65
|
| Rate for Payer: First Choice Health Commercial |
$71.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.74
|
| Rate for Payer: HealthUtah PPO |
$75.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.16
|
| Rate for Payer: Multiplan Medicare/VA |
$41.56
|
| Rate for Payer: One Health Plan of WY PPO |
$73.91
|
| Rate for Payer: PacificSource Commercial |
$67.88
|
| Rate for Payer: PHCS PPO |
$73.91
|
| Rate for Payer: Three Rivers PPO |
$56.56
|
| Rate for Payer: TriWest Veterans Administration |
$43.74
|
| Rate for Payer: United Healthcare Commercial |
$65.62
|
| Rate for Payer: United Healthcare Medicare |
$43.74
|
| Rate for Payer: WINHealth Partners Commercial |
$73.91
|
| Rate for Payer: Wise Provider Network Commercial |
$71.65
|
|
|
DRESSING GLASSCOCK EAR
|
Facility
|
IP
|
$75.42
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$72.40
|
| Rate for Payer: Altius Commercial |
$72.40
|
| Rate for Payer: Beech Street Commercial |
$73.91
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.92
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$73.16
|
| Rate for Payer: Cigna of WY Commercial |
$73.91
|
| Rate for Payer: Entrust Commercial |
$71.65
|
| Rate for Payer: First Choice Health Commercial |
$71.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$71.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.78
|
| Rate for Payer: HealthUtah PPO |
$75.42
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$73.16
|
| Rate for Payer: Multiplan Medicare/VA |
$47.29
|
| Rate for Payer: One Health Plan of WY PPO |
$73.91
|
| Rate for Payer: PacificSource Commercial |
$67.88
|
| Rate for Payer: PHCS PPO |
$73.91
|
| Rate for Payer: Three Rivers PPO |
$56.56
|
| Rate for Payer: TriWest Veterans Administration |
$49.78
|
| Rate for Payer: United Healthcare Commercial |
$65.62
|
| Rate for Payer: United Healthcare Medicare |
$49.78
|
| Rate for Payer: WINHealth Partners Commercial |
$71.65
|
| Rate for Payer: Wise Provider Network Commercial |
$71.65
|
|
|
DRESSING INTERDRY SILVER AG 10 X 36"
|
Facility
|
IP
|
$160.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$160.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.36
|
| Rate for Payer: Altius Commercial |
$154.36
|
| Rate for Payer: Beech Street Commercial |
$157.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.01
|
| Rate for Payer: Cash Price |
$112.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.97
|
| Rate for Payer: Cigna of WY Commercial |
$157.57
|
| Rate for Payer: Entrust Commercial |
$152.75
|
| Rate for Payer: First Choice Health Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.12
|
| Rate for Payer: HealthUtah PPO |
$160.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.97
|
| Rate for Payer: Multiplan Medicare/VA |
$100.82
|
| Rate for Payer: One Health Plan of WY PPO |
$157.57
|
| Rate for Payer: PacificSource Commercial |
$144.71
|
| Rate for Payer: PHCS PPO |
$157.57
|
| Rate for Payer: Three Rivers PPO |
$120.59
|
| Rate for Payer: TriWest Veterans Administration |
$106.12
|
| Rate for Payer: United Healthcare Commercial |
$139.89
|
| Rate for Payer: United Healthcare Medicare |
$106.12
|
| Rate for Payer: WINHealth Partners Commercial |
$152.75
|
| Rate for Payer: Wise Provider Network Commercial |
$152.75
|
|
|
DRESSING INTERDRY SILVER AG 10 X 36"
|
Facility
|
OP
|
$160.79
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$160.79 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.57
|
| Rate for Payer: Aetna of WY Medicare |
$106.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$154.36
|
| Rate for Payer: Altius Commercial |
$154.36
|
| Rate for Payer: Beech Street Commercial |
$157.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$132.01
|
| Rate for Payer: Cash Price |
$112.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$155.97
|
| Rate for Payer: Cigna of WY Commercial |
$157.57
|
| Rate for Payer: Entrust Commercial |
$152.75
|
| Rate for Payer: First Choice Health Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.26
|
| Rate for Payer: HealthUtah PPO |
$160.79
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$155.97
|
| Rate for Payer: Multiplan Medicare/VA |
$88.60
|
| Rate for Payer: One Health Plan of WY PPO |
$157.57
|
| Rate for Payer: PacificSource Commercial |
$144.71
|
| Rate for Payer: PHCS PPO |
$157.57
|
| Rate for Payer: Three Rivers PPO |
$120.59
|
| Rate for Payer: TriWest Veterans Administration |
$93.26
|
| Rate for Payer: United Healthcare Commercial |
$139.89
|
| Rate for Payer: United Healthcare Medicare |
$93.26
|
| Rate for Payer: WINHealth Partners Commercial |
$157.57
|
| Rate for Payer: Wise Provider Network Commercial |
$152.75
|
|
|
DRESSING ISLAND 4"X10"
|
Facility
|
OP
|
$2.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.81
|
| Rate for Payer: Aetna of WY Medicare |
$1.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.76
|
| Rate for Payer: Altius Commercial |
$2.76
|
| Rate for Payer: Beech Street Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.78
|
| Rate for Payer: Cigna of WY Commercial |
$2.81
|
| Rate for Payer: Entrust Commercial |
$2.73
|
| Rate for Payer: First Choice Health Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.66
|
| Rate for Payer: HealthUtah PPO |
$2.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2.81
|
| Rate for Payer: PacificSource Commercial |
$2.58
|
| Rate for Payer: PHCS PPO |
$2.81
|
| Rate for Payer: Three Rivers PPO |
$2.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$1.66
|
| Rate for Payer: WINHealth Partners Commercial |
$2.81
|
| Rate for Payer: Wise Provider Network Commercial |
$2.73
|
|
|
DRESSING ISLAND 4"X10"
|
Facility
|
IP
|
$2.87
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.76
|
| Rate for Payer: Altius Commercial |
$2.76
|
| Rate for Payer: Beech Street Commercial |
$2.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.78
|
| Rate for Payer: Cigna of WY Commercial |
$2.81
|
| Rate for Payer: Entrust Commercial |
$2.73
|
| Rate for Payer: First Choice Health Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.89
|
| Rate for Payer: HealthUtah PPO |
$2.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.78
|
| Rate for Payer: Multiplan Medicare/VA |
$1.80
|
| Rate for Payer: One Health Plan of WY PPO |
$2.81
|
| Rate for Payer: PacificSource Commercial |
$2.58
|
| Rate for Payer: PHCS PPO |
$2.81
|
| Rate for Payer: Three Rivers PPO |
$2.15
|
| Rate for Payer: TriWest Veterans Administration |
$1.89
|
| Rate for Payer: United Healthcare Commercial |
$2.50
|
| Rate for Payer: United Healthcare Medicare |
$1.89
|
| Rate for Payer: WINHealth Partners Commercial |
$2.73
|
| Rate for Payer: Wise Provider Network Commercial |
$2.73
|
|
|
DRESSING OPTIFOAM GENTLE EX 4"X4"
|
Facility
|
IP
|
$5.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.52
|
| Rate for Payer: Altius Commercial |
$5.52
|
| Rate for Payer: Beech Street Commercial |
$5.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.72
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.58
|
| Rate for Payer: Cigna of WY Commercial |
$5.64
|
| Rate for Payer: Entrust Commercial |
$5.46
|
| Rate for Payer: First Choice Health Commercial |
$5.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.80
|
| Rate for Payer: HealthUtah PPO |
$5.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.58
|
| Rate for Payer: Multiplan Medicare/VA |
$3.61
|
| Rate for Payer: One Health Plan of WY PPO |
$5.64
|
| Rate for Payer: PacificSource Commercial |
$5.18
|
| Rate for Payer: PHCS PPO |
$5.64
|
| Rate for Payer: Three Rivers PPO |
$4.31
|
| Rate for Payer: TriWest Veterans Administration |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WINHealth Partners Commercial |
$5.46
|
| Rate for Payer: Wise Provider Network Commercial |
$5.46
|
|
|
DRESSING OPTIFOAM GENTLE EX 4"X4"
|
Facility
|
OP
|
$5.75
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5.64
|
| Rate for Payer: Aetna of WY Medicare |
$3.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$5.52
|
| Rate for Payer: Altius Commercial |
$5.52
|
| Rate for Payer: Beech Street Commercial |
$5.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$4.72
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$5.58
|
| Rate for Payer: Cigna of WY Commercial |
$5.64
|
| Rate for Payer: Entrust Commercial |
$5.46
|
| Rate for Payer: First Choice Health Commercial |
$5.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.34
|
| Rate for Payer: HealthUtah PPO |
$5.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5.58
|
| Rate for Payer: Multiplan Medicare/VA |
$3.17
|
| Rate for Payer: One Health Plan of WY PPO |
$5.64
|
| Rate for Payer: PacificSource Commercial |
$5.18
|
| Rate for Payer: PHCS PPO |
$5.64
|
| Rate for Payer: Three Rivers PPO |
$4.31
|
| Rate for Payer: TriWest Veterans Administration |
$3.34
|
| Rate for Payer: United Healthcare Commercial |
$5.00
|
| Rate for Payer: United Healthcare Medicare |
$3.34
|
| Rate for Payer: WINHealth Partners Commercial |
$5.64
|
| Rate for Payer: Wise Provider Network Commercial |
$5.46
|
|
|
DRESSING OPTIVIEW 6" MULTISITE
|
Facility
|
IP
|
$19.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.04
|
| Rate for Payer: Altius Commercial |
$19.04
|
| Rate for Payer: Beech Street Commercial |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.28
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.24
|
| Rate for Payer: Cigna of WY Commercial |
$19.43
|
| Rate for Payer: Entrust Commercial |
$18.84
|
| Rate for Payer: First Choice Health Commercial |
$18.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.09
|
| Rate for Payer: HealthUtah PPO |
$19.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.24
|
| Rate for Payer: Multiplan Medicare/VA |
$12.43
|
| Rate for Payer: One Health Plan of WY PPO |
$19.43
|
| Rate for Payer: PacificSource Commercial |
$17.85
|
| Rate for Payer: PHCS PPO |
$19.43
|
| Rate for Payer: Three Rivers PPO |
$14.87
|
| Rate for Payer: TriWest Veterans Administration |
$13.09
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$13.09
|
| Rate for Payer: WINHealth Partners Commercial |
$18.84
|
| Rate for Payer: Wise Provider Network Commercial |
$18.84
|
|
|
DRESSING OPTIVIEW 6" MULTISITE
|
Facility
|
OP
|
$19.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$19.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.43
|
| Rate for Payer: Aetna of WY Medicare |
$13.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.04
|
| Rate for Payer: Altius Commercial |
$19.04
|
| Rate for Payer: Beech Street Commercial |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.28
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.24
|
| Rate for Payer: Cigna of WY Commercial |
$19.43
|
| Rate for Payer: Entrust Commercial |
$18.84
|
| Rate for Payer: First Choice Health Commercial |
$18.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.50
|
| Rate for Payer: HealthUtah PPO |
$19.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.24
|
| Rate for Payer: Multiplan Medicare/VA |
$10.93
|
| Rate for Payer: One Health Plan of WY PPO |
$19.43
|
| Rate for Payer: PacificSource Commercial |
$17.85
|
| Rate for Payer: PHCS PPO |
$19.43
|
| Rate for Payer: Three Rivers PPO |
$14.87
|
| Rate for Payer: TriWest Veterans Administration |
$11.50
|
| Rate for Payer: United Healthcare Commercial |
$17.25
|
| Rate for Payer: United Healthcare Medicare |
$11.50
|
| Rate for Payer: WINHealth Partners Commercial |
$19.43
|
| Rate for Payer: Wise Provider Network Commercial |
$18.84
|
|
|
DRESSING POLYMEMBRANE 4"X4"
|
Facility
|
OP
|
$10.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.10
|
| Rate for Payer: Aetna of WY Medicare |
$6.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.90
|
| Rate for Payer: Altius Commercial |
$9.90
|
| Rate for Payer: Beech Street Commercial |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.46
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.00
|
| Rate for Payer: Cigna of WY Commercial |
$10.10
|
| Rate for Payer: Entrust Commercial |
$9.79
|
| Rate for Payer: First Choice Health Commercial |
$9.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.98
|
| Rate for Payer: HealthUtah PPO |
$10.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.00
|
| Rate for Payer: Multiplan Medicare/VA |
$5.68
|
| Rate for Payer: One Health Plan of WY PPO |
$10.10
|
| Rate for Payer: PacificSource Commercial |
$9.28
|
| Rate for Payer: PHCS PPO |
$10.10
|
| Rate for Payer: Three Rivers PPO |
$7.73
|
| Rate for Payer: TriWest Veterans Administration |
$5.98
|
| Rate for Payer: United Healthcare Commercial |
$8.97
|
| Rate for Payer: United Healthcare Medicare |
$5.98
|
| Rate for Payer: WINHealth Partners Commercial |
$10.10
|
| Rate for Payer: Wise Provider Network Commercial |
$9.79
|
|
|
DRESSING POLYMEMBRANE 4"X4"
|
Facility
|
IP
|
$10.31
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.90
|
| Rate for Payer: Altius Commercial |
$9.90
|
| Rate for Payer: Beech Street Commercial |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.46
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.00
|
| Rate for Payer: Cigna of WY Commercial |
$10.10
|
| Rate for Payer: Entrust Commercial |
$9.79
|
| Rate for Payer: First Choice Health Commercial |
$9.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.80
|
| Rate for Payer: HealthUtah PPO |
$10.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.00
|
| Rate for Payer: Multiplan Medicare/VA |
$6.46
|
| Rate for Payer: One Health Plan of WY PPO |
$10.10
|
| Rate for Payer: PacificSource Commercial |
$9.28
|
| Rate for Payer: PHCS PPO |
$10.10
|
| Rate for Payer: Three Rivers PPO |
$7.73
|
| Rate for Payer: TriWest Veterans Administration |
$6.80
|
| Rate for Payer: United Healthcare Commercial |
$8.97
|
| Rate for Payer: United Healthcare Medicare |
$6.80
|
| Rate for Payer: WINHealth Partners Commercial |
$9.79
|
| Rate for Payer: Wise Provider Network Commercial |
$9.79
|
|
|
DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 41800
|
| Hospital Charge Code |
41800
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$1,018.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$997.64
|
| Rate for Payer: Aetna of WY Medicare |
$150.71
|
| Rate for Payer: Beech Street Commercial |
$967.10
|
| Rate for Payer: Cash Price |
$712.60
|
| Rate for Payer: Cash Price |
$712.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$987.46
|
| Rate for Payer: Cigna of WY Commercial |
$997.64
|
| Rate for Payer: First Choice Health Commercial |
$916.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$967.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$150.71
|
| Rate for Payer: HealthUtah PPO |
$1,018.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$987.46
|
| Rate for Payer: Multiplan Medicare/VA |
$128.10
|
| Rate for Payer: One Health Plan of WY PPO |
$997.64
|
| Rate for Payer: PacificSource Commercial |
$916.20
|
| Rate for Payer: PHCS PPO |
$967.10
|
| Rate for Payer: Three Rivers PPO |
$763.50
|
| Rate for Payer: TriWest Veterans Administration |
$150.71
|
| Rate for Payer: United Healthcare Commercial |
$885.66
|
| Rate for Payer: United Healthcare Medicare |
$150.71
|
| Rate for Payer: WINHealth Partners Commercial |
$865.30
|
|
|
DRILLBIT 2.5 X 125MM
|
Facility
|
OP
|
$313.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.95 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.60
|
| Rate for Payer: Aetna of WY Medicare |
$207.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$301.32
|
| Rate for Payer: Altius Commercial |
$301.32
|
| Rate for Payer: Beech Street Commercial |
$307.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.70
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.46
|
| Rate for Payer: Cigna of WY Commercial |
$307.60
|
| Rate for Payer: Entrust Commercial |
$298.19
|
| Rate for Payer: First Choice Health Commercial |
$298.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$182.05
|
| Rate for Payer: HealthUtah PPO |
$313.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.46
|
| Rate for Payer: Multiplan Medicare/VA |
$172.95
|
| Rate for Payer: One Health Plan of WY PPO |
$307.60
|
| Rate for Payer: PacificSource Commercial |
$282.49
|
| Rate for Payer: PHCS PPO |
$307.60
|
| Rate for Payer: Three Rivers PPO |
$235.41
|
| Rate for Payer: TriWest Veterans Administration |
$182.05
|
| Rate for Payer: United Healthcare Commercial |
$273.08
|
| Rate for Payer: United Healthcare Medicare |
$182.05
|
| Rate for Payer: WINHealth Partners Commercial |
$307.60
|
| Rate for Payer: Wise Provider Network Commercial |
$298.19
|
|
|
DRILLBIT 2.5 X 125MM
|
Facility
|
IP
|
$313.88
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$313.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$301.32
|
| Rate for Payer: Altius Commercial |
$301.32
|
| Rate for Payer: Beech Street Commercial |
$307.60
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$257.70
|
| Rate for Payer: Cash Price |
$219.72
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.46
|
| Rate for Payer: Cigna of WY Commercial |
$307.60
|
| Rate for Payer: Entrust Commercial |
$298.19
|
| Rate for Payer: First Choice Health Commercial |
$298.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$207.16
|
| Rate for Payer: HealthUtah PPO |
$313.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.46
|
| Rate for Payer: Multiplan Medicare/VA |
$196.80
|
| Rate for Payer: One Health Plan of WY PPO |
$307.60
|
| Rate for Payer: PacificSource Commercial |
$282.49
|
| Rate for Payer: PHCS PPO |
$307.60
|
| Rate for Payer: Three Rivers PPO |
$235.41
|
| Rate for Payer: TriWest Veterans Administration |
$207.16
|
| Rate for Payer: United Healthcare Commercial |
$273.08
|
| Rate for Payer: United Healthcare Medicare |
$207.16
|
| Rate for Payer: WINHealth Partners Commercial |
$298.19
|
| Rate for Payer: Wise Provider Network Commercial |
$298.19
|
|
|
DRILLBIT WIRE PASS 1.3MM
|
Facility
|
IP
|
$235.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.47 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.79
|
| Rate for Payer: Altius Commercial |
$225.79
|
| Rate for Payer: Beech Street Commercial |
$230.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.10
|
| Rate for Payer: Cash Price |
$164.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.14
|
| Rate for Payer: Cigna of WY Commercial |
$230.50
|
| Rate for Payer: Entrust Commercial |
$223.44
|
| Rate for Payer: First Choice Health Commercial |
$223.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$155.23
|
| Rate for Payer: HealthUtah PPO |
$235.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.14
|
| Rate for Payer: Multiplan Medicare/VA |
$147.47
|
| Rate for Payer: One Health Plan of WY PPO |
$230.50
|
| Rate for Payer: PacificSource Commercial |
$211.68
|
| Rate for Payer: PHCS PPO |
$230.50
|
| Rate for Payer: Three Rivers PPO |
$176.40
|
| Rate for Payer: TriWest Veterans Administration |
$155.23
|
| Rate for Payer: United Healthcare Commercial |
$204.62
|
| Rate for Payer: United Healthcare Medicare |
$155.23
|
| Rate for Payer: WINHealth Partners Commercial |
$223.44
|
| Rate for Payer: Wise Provider Network Commercial |
$223.44
|
|
|
DRILLBIT WIRE PASS 1.3MM
|
Facility
|
OP
|
$235.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.50
|
| Rate for Payer: Aetna of WY Medicare |
$155.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$225.79
|
| Rate for Payer: Altius Commercial |
$225.79
|
| Rate for Payer: Beech Street Commercial |
$230.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$193.10
|
| Rate for Payer: Cash Price |
$164.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$228.14
|
| Rate for Payer: Cigna of WY Commercial |
$230.50
|
| Rate for Payer: Entrust Commercial |
$223.44
|
| Rate for Payer: First Choice Health Commercial |
$223.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$136.42
|
| Rate for Payer: HealthUtah PPO |
$235.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$228.14
|
| Rate for Payer: Multiplan Medicare/VA |
$129.60
|
| Rate for Payer: One Health Plan of WY PPO |
$230.50
|
| Rate for Payer: PacificSource Commercial |
$211.68
|
| Rate for Payer: PHCS PPO |
$230.50
|
| Rate for Payer: Three Rivers PPO |
$176.40
|
| Rate for Payer: TriWest Veterans Administration |
$136.42
|
| Rate for Payer: United Healthcare Commercial |
$204.62
|
| Rate for Payer: United Healthcare Medicare |
$136.42
|
| Rate for Payer: WINHealth Partners Commercial |
$230.50
|
| Rate for Payer: Wise Provider Network Commercial |
$223.44
|
|
|
DRILL WIRE PASS 1.1 1608-2-63
|
Facility
|
OP
|
$116.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.01 |
| Max. Negotiated Rate |
$116.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.85
|
| Rate for Payer: Aetna of WY Medicare |
$76.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.52
|
| Rate for Payer: Altius Commercial |
$111.52
|
| Rate for Payer: Beech Street Commercial |
$113.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.38
|
| Rate for Payer: Cash Price |
$81.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.68
|
| Rate for Payer: Cigna of WY Commercial |
$113.85
|
| Rate for Payer: Entrust Commercial |
$110.36
|
| Rate for Payer: First Choice Health Commercial |
$110.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.38
|
| Rate for Payer: HealthUtah PPO |
$116.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.68
|
| Rate for Payer: Multiplan Medicare/VA |
$64.01
|
| Rate for Payer: One Health Plan of WY PPO |
$113.85
|
| Rate for Payer: PacificSource Commercial |
$104.55
|
| Rate for Payer: PHCS PPO |
$113.85
|
| Rate for Payer: Three Rivers PPO |
$87.13
|
| Rate for Payer: TriWest Veterans Administration |
$67.38
|
| Rate for Payer: United Healthcare Commercial |
$101.07
|
| Rate for Payer: United Healthcare Medicare |
$67.38
|
| Rate for Payer: WINHealth Partners Commercial |
$113.85
|
| Rate for Payer: Wise Provider Network Commercial |
$110.36
|
|
|
DRILL WIRE PASS 1.1 1608-2-63
|
Facility
|
IP
|
$116.17
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$116.17 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$111.52
|
| Rate for Payer: Altius Commercial |
$111.52
|
| Rate for Payer: Beech Street Commercial |
$113.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$95.38
|
| Rate for Payer: Cash Price |
$81.32
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.68
|
| Rate for Payer: Cigna of WY Commercial |
$113.85
|
| Rate for Payer: Entrust Commercial |
$110.36
|
| Rate for Payer: First Choice Health Commercial |
$110.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.67
|
| Rate for Payer: HealthUtah PPO |
$116.17
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.68
|
| Rate for Payer: Multiplan Medicare/VA |
$72.84
|
| Rate for Payer: One Health Plan of WY PPO |
$113.85
|
| Rate for Payer: PacificSource Commercial |
$104.55
|
| Rate for Payer: PHCS PPO |
$113.85
|
| Rate for Payer: Three Rivers PPO |
$87.13
|
| Rate for Payer: TriWest Veterans Administration |
$76.67
|
| Rate for Payer: United Healthcare Commercial |
$101.07
|
| Rate for Payer: United Healthcare Medicare |
$76.67
|
| Rate for Payer: WINHealth Partners Commercial |
$110.36
|
| Rate for Payer: Wise Provider Network Commercial |
$110.36
|
|
|
DRILL WIRE PASS 1.5 1608-2-59
|
Facility
|
OP
|
$136.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.36
|
| Rate for Payer: Aetna of WY Medicare |
$89.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$130.64
|
| Rate for Payer: Altius Commercial |
$130.64
|
| Rate for Payer: Beech Street Commercial |
$133.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$111.72
|
| Rate for Payer: Cash Price |
$95.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.00
|
| Rate for Payer: Cigna of WY Commercial |
$133.36
|
| Rate for Payer: Entrust Commercial |
$129.28
|
| Rate for Payer: First Choice Health Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$78.93
|
| Rate for Payer: HealthUtah PPO |
$136.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.00
|
| Rate for Payer: Multiplan Medicare/VA |
$74.98
|
| Rate for Payer: One Health Plan of WY PPO |
$133.36
|
| Rate for Payer: PacificSource Commercial |
$122.47
|
| Rate for Payer: PHCS PPO |
$133.36
|
| Rate for Payer: Three Rivers PPO |
$102.06
|
| Rate for Payer: TriWest Veterans Administration |
$78.93
|
| Rate for Payer: United Healthcare Commercial |
$118.39
|
| Rate for Payer: United Healthcare Medicare |
$78.93
|
| Rate for Payer: WINHealth Partners Commercial |
$133.36
|
| Rate for Payer: Wise Provider Network Commercial |
$129.28
|
|
|
DRILL WIRE PASS 1.5 1608-2-59
|
Facility
|
IP
|
$136.08
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$133.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$130.64
|
| Rate for Payer: Altius Commercial |
$130.64
|
| Rate for Payer: Beech Street Commercial |
$133.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$111.72
|
| Rate for Payer: Cash Price |
$95.26
|
| Rate for Payer: ChoiceCare Network Commercial |
$132.00
|
| Rate for Payer: Cigna of WY Commercial |
$133.36
|
| Rate for Payer: Entrust Commercial |
$129.28
|
| Rate for Payer: First Choice Health Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$129.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$89.81
|
| Rate for Payer: HealthUtah PPO |
$136.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$132.00
|
| Rate for Payer: Multiplan Medicare/VA |
$85.32
|
| Rate for Payer: One Health Plan of WY PPO |
$133.36
|
| Rate for Payer: PacificSource Commercial |
$122.47
|
| Rate for Payer: PHCS PPO |
$133.36
|
| Rate for Payer: Three Rivers PPO |
$102.06
|
| Rate for Payer: TriWest Veterans Administration |
$89.81
|
| Rate for Payer: United Healthcare Commercial |
$118.39
|
| Rate for Payer: United Healthcare Medicare |
$89.81
|
| Rate for Payer: WINHealth Partners Commercial |
$129.28
|
| Rate for Payer: Wise Provider Network Commercial |
$129.28
|
|
|
DRILL WIRE PASS 2.0 1608-2-61
|
Facility
|
IP
|
$115.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.46 |
| Max. Negotiated Rate |
$115.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.95
|
| Rate for Payer: Altius Commercial |
$110.95
|
| Rate for Payer: Beech Street Commercial |
$113.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.88
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.10
|
| Rate for Payer: Cigna of WY Commercial |
$113.26
|
| Rate for Payer: Entrust Commercial |
$109.79
|
| Rate for Payer: First Choice Health Commercial |
$109.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.28
|
| Rate for Payer: HealthUtah PPO |
$115.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.10
|
| Rate for Payer: Multiplan Medicare/VA |
$72.46
|
| Rate for Payer: One Health Plan of WY PPO |
$113.26
|
| Rate for Payer: PacificSource Commercial |
$104.01
|
| Rate for Payer: PHCS PPO |
$113.26
|
| Rate for Payer: Three Rivers PPO |
$86.68
|
| Rate for Payer: TriWest Veterans Administration |
$76.28
|
| Rate for Payer: United Healthcare Commercial |
$100.55
|
| Rate for Payer: United Healthcare Medicare |
$76.28
|
| Rate for Payer: WINHealth Partners Commercial |
$109.79
|
| Rate for Payer: Wise Provider Network Commercial |
$109.79
|
|
|
DRILL WIRE PASS 2.0 1608-2-61
|
Facility
|
OP
|
$115.57
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.68 |
| Max. Negotiated Rate |
$115.57 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.26
|
| Rate for Payer: Aetna of WY Medicare |
$76.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$110.95
|
| Rate for Payer: Altius Commercial |
$110.95
|
| Rate for Payer: Beech Street Commercial |
$113.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$94.88
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.10
|
| Rate for Payer: Cigna of WY Commercial |
$113.26
|
| Rate for Payer: Entrust Commercial |
$109.79
|
| Rate for Payer: First Choice Health Commercial |
$109.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$109.79
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.03
|
| Rate for Payer: HealthUtah PPO |
$115.57
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.10
|
| Rate for Payer: Multiplan Medicare/VA |
$63.68
|
| Rate for Payer: One Health Plan of WY PPO |
$113.26
|
| Rate for Payer: PacificSource Commercial |
$104.01
|
| Rate for Payer: PHCS PPO |
$113.26
|
| Rate for Payer: Three Rivers PPO |
$86.68
|
| Rate for Payer: TriWest Veterans Administration |
$67.03
|
| Rate for Payer: United Healthcare Commercial |
$100.55
|
| Rate for Payer: United Healthcare Medicare |
$67.03
|
| Rate for Payer: WINHealth Partners Commercial |
$113.26
|
| Rate for Payer: Wise Provider Network Commercial |
$109.79
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION [9438]
|
Facility
|
IP
|
$33.60
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.07 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.26
|
| Rate for Payer: Altius Commercial |
$32.26
|
| Rate for Payer: Beech Street Commercial |
$32.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$23.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.59
|
| Rate for Payer: Cigna of WY Commercial |
$32.93
|
| Rate for Payer: Entrust Commercial |
$31.92
|
| Rate for Payer: First Choice Health Commercial |
$31.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.18
|
| Rate for Payer: HealthUtah PPO |
$33.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.59
|
| Rate for Payer: Multiplan Medicare/VA |
$21.07
|
| Rate for Payer: One Health Plan of WY PPO |
$32.93
|
| Rate for Payer: PacificSource Commercial |
$30.24
|
| Rate for Payer: PHCS PPO |
$32.93
|
| Rate for Payer: Three Rivers PPO |
$25.20
|
| Rate for Payer: TriWest Veterans Administration |
$22.18
|
| Rate for Payer: United Healthcare Commercial |
$29.23
|
| Rate for Payer: United Healthcare Medicare |
$22.18
|
| Rate for Payer: WINHealth Partners Commercial |
$31.92
|
| Rate for Payer: Wise Provider Network Commercial |
$31.92
|
|
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DROPERIDOL 2.5 MG/ML INJECTION SOLUTION [9438]
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Facility
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OP
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$33.60
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Service Code
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HCPCS J1790
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Hospital Revenue Code
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636
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.93
|
| Rate for Payer: Aetna of WY Medicare |
$22.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.26
|
| Rate for Payer: Altius Commercial |
$32.26
|
| Rate for Payer: Beech Street Commercial |
$32.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$23.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.59
|
| Rate for Payer: Cigna of WY Commercial |
$32.93
|
| Rate for Payer: Entrust Commercial |
$31.92
|
| Rate for Payer: First Choice Health Commercial |
$31.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.49
|
| Rate for Payer: HealthUtah PPO |
$33.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.59
|
| Rate for Payer: Multiplan Medicare/VA |
$18.51
|
| Rate for Payer: One Health Plan of WY PPO |
$32.93
|
| Rate for Payer: PacificSource Commercial |
$30.24
|
| Rate for Payer: PHCS PPO |
$32.93
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| Rate for Payer: Three Rivers PPO |
$25.20
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| Rate for Payer: TriWest Veterans Administration |
$19.49
|
| Rate for Payer: United Healthcare Commercial |
$29.23
|
| Rate for Payer: United Healthcare Medicare |
$19.49
|
| Rate for Payer: WINHealth Partners Commercial |
$32.93
|
| Rate for Payer: Wise Provider Network Commercial |
$31.92
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