|
FIMBRIOPLASTY
|
Professional
|
Both
|
$2,918.00
|
|
|
Service Code
|
HCPCS 58760
|
| Min. Negotiated Rate |
$671.79 |
| Max. Negotiated Rate |
$2,918.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,859.64
|
| Rate for Payer: Aetna of WY Medicare |
$790.34
|
| Rate for Payer: Beech Street Commercial |
$2,772.10
|
| Rate for Payer: Cash Price |
$2,042.60
|
| Rate for Payer: Cash Price |
$2,042.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,830.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,859.64
|
| Rate for Payer: First Choice Health Commercial |
$2,626.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,772.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$790.34
|
| Rate for Payer: HealthUtah PPO |
$2,918.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,830.46
|
| Rate for Payer: Multiplan Medicare/VA |
$671.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2,859.64
|
| Rate for Payer: PacificSource Commercial |
$2,626.20
|
| Rate for Payer: PHCS PPO |
$2,772.10
|
| Rate for Payer: Three Rivers PPO |
$2,188.50
|
| Rate for Payer: TriWest Veterans Administration |
$790.34
|
| Rate for Payer: United Healthcare Commercial |
$2,772.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,480.30
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
NDC 6068742811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.84
|
| Rate for Payer: Aetna of WY Medicare |
$12.01
|
| Rate for Payer: Altius Commercial |
$17.47
|
| Rate for Payer: Beech Street Commercial |
$17.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.65
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.65
|
| Rate for Payer: Cigna of WY Commercial |
$17.84
|
| Rate for Payer: Entrust Commercial |
$17.29
|
| Rate for Payer: First Choice Health Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.37
|
| Rate for Payer: HealthUtah PPO |
$18.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.65
|
| Rate for Payer: Multiplan Medicare/VA |
$9.86
|
| Rate for Payer: One Health Plan of WY PPO |
$17.84
|
| Rate for Payer: PacificSource Commercial |
$16.38
|
| Rate for Payer: PHCS PPO |
$17.84
|
| Rate for Payer: Three Rivers PPO |
$13.65
|
| Rate for Payer: TriWest Veterans Administration |
$10.37
|
| Rate for Payer: United Healthcare Commercial |
$17.38
|
| Rate for Payer: United Healthcare Medicare |
$10.37
|
| Rate for Payer: WINHealth Partners Commercial |
$17.84
|
| Rate for Payer: Wise Provider Network Commercial |
$17.29
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
NDC 6068742811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.84
|
| Rate for Payer: Aetna of WY Medicare |
$11.65
|
| Rate for Payer: Altius Commercial |
$17.47
|
| Rate for Payer: Beech Street Commercial |
$17.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.65
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.65
|
| Rate for Payer: Cigna of WY Commercial |
$17.84
|
| Rate for Payer: Entrust Commercial |
$17.29
|
| Rate for Payer: First Choice Health Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.10
|
| Rate for Payer: HealthUtah PPO |
$18.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.65
|
| Rate for Payer: Multiplan Medicare/VA |
$10.55
|
| Rate for Payer: One Health Plan of WY PPO |
$17.84
|
| Rate for Payer: PacificSource Commercial |
$16.38
|
| Rate for Payer: PHCS PPO |
$17.84
|
| Rate for Payer: Three Rivers PPO |
$13.65
|
| Rate for Payer: TriWest Veterans Administration |
$11.10
|
| Rate for Payer: United Healthcare Commercial |
$17.38
|
| Rate for Payer: United Healthcare Medicare |
$11.10
|
| Rate for Payer: WINHealth Partners Commercial |
$17.29
|
| Rate for Payer: Wise Provider Network Commercial |
$17.29
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
OP
|
$18.60
|
|
|
Service Code
|
NDC 6068742865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.23
|
| Rate for Payer: Aetna of WY Medicare |
$12.28
|
| Rate for Payer: Altius Commercial |
$17.86
|
| Rate for Payer: Beech Street Commercial |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.04
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.04
|
| Rate for Payer: Cigna of WY Commercial |
$18.23
|
| Rate for Payer: Entrust Commercial |
$17.67
|
| Rate for Payer: First Choice Health Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.60
|
| Rate for Payer: HealthUtah PPO |
$18.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.04
|
| Rate for Payer: Multiplan Medicare/VA |
$10.07
|
| Rate for Payer: One Health Plan of WY PPO |
$18.23
|
| Rate for Payer: PacificSource Commercial |
$16.74
|
| Rate for Payer: PHCS PPO |
$18.23
|
| Rate for Payer: Three Rivers PPO |
$13.95
|
| Rate for Payer: TriWest Veterans Administration |
$10.60
|
| Rate for Payer: United Healthcare Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare |
$10.60
|
| Rate for Payer: WINHealth Partners Commercial |
$18.23
|
| Rate for Payer: Wise Provider Network Commercial |
$17.67
|
|
|
FINASTERIDE 5 MG TABLET [19510]
|
Facility
|
IP
|
$18.60
|
|
|
Service Code
|
NDC 6068742865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.23
|
| Rate for Payer: Aetna of WY Medicare |
$11.90
|
| Rate for Payer: Altius Commercial |
$17.86
|
| Rate for Payer: Beech Street Commercial |
$18.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.04
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.04
|
| Rate for Payer: Cigna of WY Commercial |
$18.23
|
| Rate for Payer: Entrust Commercial |
$17.67
|
| Rate for Payer: First Choice Health Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.67
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.35
|
| Rate for Payer: HealthUtah PPO |
$18.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.04
|
| Rate for Payer: Multiplan Medicare/VA |
$10.78
|
| Rate for Payer: One Health Plan of WY PPO |
$18.23
|
| Rate for Payer: PacificSource Commercial |
$16.74
|
| Rate for Payer: PHCS PPO |
$18.23
|
| Rate for Payer: Three Rivers PPO |
$13.95
|
| Rate for Payer: TriWest Veterans Administration |
$11.35
|
| Rate for Payer: United Healthcare Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare |
$11.35
|
| Rate for Payer: WINHealth Partners Commercial |
$17.67
|
| Rate for Payer: Wise Provider Network Commercial |
$17.67
|
|
|
FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$232.26
|
| Rate for Payer: Aetna of WY Medicare |
$52.18
|
| Rate for Payer: Beech Street Commercial |
$225.15
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$229.89
|
| Rate for Payer: Cigna of WY Commercial |
$232.26
|
| Rate for Payer: First Choice Health Commercial |
$213.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$225.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.18
|
| Rate for Payer: HealthUtah PPO |
$237.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$229.89
|
| Rate for Payer: Multiplan Medicare/VA |
$44.35
|
| Rate for Payer: One Health Plan of WY PPO |
$232.26
|
| Rate for Payer: PacificSource Commercial |
$213.30
|
| Rate for Payer: PHCS PPO |
$225.15
|
| Rate for Payer: Three Rivers PPO |
$177.75
|
| Rate for Payer: TriWest Veterans Administration |
$52.18
|
| Rate for Payer: United Healthcare Commercial |
$225.15
|
| Rate for Payer: WINHealth Partners Commercial |
$201.45
|
|
|
FINGER CONTRACTURE CUSHION LG
|
Facility
|
OP
|
$9.87
|
|
| Hospital Charge Code |
2200372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.67
|
| Rate for Payer: Aetna of WY Medicare |
$6.51
|
| Rate for Payer: Altius Commercial |
$9.48
|
| Rate for Payer: Beech Street Commercial |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.57
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.57
|
| Rate for Payer: Cigna of WY Commercial |
$9.67
|
| Rate for Payer: Entrust Commercial |
$9.38
|
| Rate for Payer: First Choice Health Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.63
|
| Rate for Payer: HealthUtah PPO |
$9.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.57
|
| Rate for Payer: Multiplan Medicare/VA |
$5.34
|
| Rate for Payer: One Health Plan of WY PPO |
$9.67
|
| Rate for Payer: PacificSource Commercial |
$8.88
|
| Rate for Payer: PHCS PPO |
$9.67
|
| Rate for Payer: Three Rivers PPO |
$7.40
|
| Rate for Payer: TriWest Veterans Administration |
$5.63
|
| Rate for Payer: United Healthcare Commercial |
$9.43
|
| Rate for Payer: United Healthcare Medicare |
$5.63
|
| Rate for Payer: WINHealth Partners Commercial |
$9.67
|
| Rate for Payer: Wise Provider Network Commercial |
$9.38
|
|
|
FINGER CONTRACTURE CUSHION LG
|
Facility
|
IP
|
$9.87
|
|
| Hospital Charge Code |
2200372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.67
|
| Rate for Payer: Aetna of WY Medicare |
$6.32
|
| Rate for Payer: Altius Commercial |
$9.48
|
| Rate for Payer: Beech Street Commercial |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.57
|
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.57
|
| Rate for Payer: Cigna of WY Commercial |
$9.67
|
| Rate for Payer: Entrust Commercial |
$9.38
|
| Rate for Payer: First Choice Health Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.02
|
| Rate for Payer: HealthUtah PPO |
$9.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.57
|
| Rate for Payer: Multiplan Medicare/VA |
$5.72
|
| Rate for Payer: One Health Plan of WY PPO |
$9.67
|
| Rate for Payer: PacificSource Commercial |
$8.88
|
| Rate for Payer: PHCS PPO |
$9.67
|
| Rate for Payer: Three Rivers PPO |
$7.40
|
| Rate for Payer: TriWest Veterans Administration |
$6.02
|
| Rate for Payer: United Healthcare Commercial |
$9.43
|
| Rate for Payer: United Healthcare Medicare |
$6.02
|
| Rate for Payer: WINHealth Partners Commercial |
$9.38
|
| Rate for Payer: Wise Provider Network Commercial |
$9.38
|
|
|
FINGER CONTRACTURE CUSHION REG
|
Facility
|
IP
|
$9.52
|
|
| Hospital Charge Code |
2200371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.33
|
| Rate for Payer: Aetna of WY Medicare |
$6.09
|
| Rate for Payer: Altius Commercial |
$9.14
|
| Rate for Payer: Beech Street Commercial |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.23
|
| Rate for Payer: Cigna of WY Commercial |
$9.33
|
| Rate for Payer: Entrust Commercial |
$9.04
|
| Rate for Payer: First Choice Health Commercial |
$9.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.81
|
| Rate for Payer: HealthUtah PPO |
$9.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.23
|
| Rate for Payer: Multiplan Medicare/VA |
$5.52
|
| Rate for Payer: One Health Plan of WY PPO |
$9.33
|
| Rate for Payer: PacificSource Commercial |
$8.57
|
| Rate for Payer: PHCS PPO |
$9.33
|
| Rate for Payer: Three Rivers PPO |
$7.14
|
| Rate for Payer: TriWest Veterans Administration |
$5.81
|
| Rate for Payer: United Healthcare Commercial |
$9.09
|
| Rate for Payer: United Healthcare Medicare |
$5.81
|
| Rate for Payer: WINHealth Partners Commercial |
$9.04
|
| Rate for Payer: Wise Provider Network Commercial |
$9.04
|
|
|
FINGER CONTRACTURE CUSHION REG
|
Facility
|
OP
|
$9.52
|
|
| Hospital Charge Code |
2200371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$9.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.33
|
| Rate for Payer: Aetna of WY Medicare |
$6.28
|
| Rate for Payer: Altius Commercial |
$9.14
|
| Rate for Payer: Beech Street Commercial |
$9.33
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.23
|
| Rate for Payer: Cigna of WY Commercial |
$9.33
|
| Rate for Payer: Entrust Commercial |
$9.04
|
| Rate for Payer: First Choice Health Commercial |
$9.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.43
|
| Rate for Payer: HealthUtah PPO |
$9.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.23
|
| Rate for Payer: Multiplan Medicare/VA |
$5.16
|
| Rate for Payer: One Health Plan of WY PPO |
$9.33
|
| Rate for Payer: PacificSource Commercial |
$8.57
|
| Rate for Payer: PHCS PPO |
$9.33
|
| Rate for Payer: Three Rivers PPO |
$7.14
|
| Rate for Payer: TriWest Veterans Administration |
$5.43
|
| Rate for Payer: United Healthcare Commercial |
$9.09
|
| Rate for Payer: United Healthcare Medicare |
$5.43
|
| Rate for Payer: WINHealth Partners Commercial |
$9.33
|
| Rate for Payer: Wise Provider Network Commercial |
$9.04
|
|
|
FINGERSHIELDS AR-7199
|
Facility
|
OP
|
$143.08
|
|
| Hospital Charge Code |
3002593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.48 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.22
|
| Rate for Payer: Aetna of WY Medicare |
$94.43
|
| Rate for Payer: Altius Commercial |
$137.36
|
| Rate for Payer: Beech Street Commercial |
$140.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.79
|
| Rate for Payer: Cash Price |
$100.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.79
|
| Rate for Payer: Cigna of WY Commercial |
$140.22
|
| Rate for Payer: Entrust Commercial |
$135.93
|
| Rate for Payer: First Choice Health Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.56
|
| Rate for Payer: HealthUtah PPO |
$143.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.79
|
| Rate for Payer: Multiplan Medicare/VA |
$77.48
|
| Rate for Payer: One Health Plan of WY PPO |
$140.22
|
| Rate for Payer: PacificSource Commercial |
$128.77
|
| Rate for Payer: PHCS PPO |
$140.22
|
| Rate for Payer: Three Rivers PPO |
$107.31
|
| Rate for Payer: TriWest Veterans Administration |
$81.56
|
| Rate for Payer: United Healthcare Commercial |
$136.64
|
| Rate for Payer: United Healthcare Medicare |
$81.56
|
| Rate for Payer: WINHealth Partners Commercial |
$140.22
|
| Rate for Payer: Wise Provider Network Commercial |
$135.93
|
|
|
FINGERSHIELDS AR-7199
|
Facility
|
IP
|
$143.08
|
|
| Hospital Charge Code |
3002593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$143.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$140.22
|
| Rate for Payer: Aetna of WY Medicare |
$91.57
|
| Rate for Payer: Altius Commercial |
$137.36
|
| Rate for Payer: Beech Street Commercial |
$140.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$138.79
|
| Rate for Payer: Cash Price |
$100.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$138.79
|
| Rate for Payer: Cigna of WY Commercial |
$140.22
|
| Rate for Payer: Entrust Commercial |
$135.93
|
| Rate for Payer: First Choice Health Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$135.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$87.28
|
| Rate for Payer: HealthUtah PPO |
$143.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$138.79
|
| Rate for Payer: Multiplan Medicare/VA |
$82.91
|
| Rate for Payer: One Health Plan of WY PPO |
$140.22
|
| Rate for Payer: PacificSource Commercial |
$128.77
|
| Rate for Payer: PHCS PPO |
$140.22
|
| Rate for Payer: Three Rivers PPO |
$107.31
|
| Rate for Payer: TriWest Veterans Administration |
$87.28
|
| Rate for Payer: United Healthcare Commercial |
$136.64
|
| Rate for Payer: United Healthcare Medicare |
$87.28
|
| Rate for Payer: WINHealth Partners Commercial |
$135.93
|
| Rate for Payer: Wise Provider Network Commercial |
$135.93
|
|
|
FINGER SPLINT, STATIC
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.86
|
| Rate for Payer: Beech Street Commercial |
$6.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.79
|
| Rate for Payer: Cigna of WY Commercial |
$6.86
|
| Rate for Payer: First Choice Health Commercial |
$6.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.65
|
| Rate for Payer: HealthUtah PPO |
$7.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.79
|
| Rate for Payer: One Health Plan of WY PPO |
$6.86
|
| Rate for Payer: PacificSource Commercial |
$6.30
|
| Rate for Payer: PHCS PPO |
$6.65
|
| Rate for Payer: Three Rivers PPO |
$5.25
|
| Rate for Payer: United Healthcare Commercial |
$6.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6.65
|
|
|
FINGER/TOE GEL 6" TUBE NARROW
|
Facility
|
OP
|
$11.77
|
|
| Hospital Charge Code |
2200097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.53
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Altius Commercial |
$11.30
|
| Rate for Payer: Beech Street Commercial |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.42
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.42
|
| Rate for Payer: Cigna of WY Commercial |
$11.53
|
| Rate for Payer: Entrust Commercial |
$11.18
|
| Rate for Payer: First Choice Health Commercial |
$11.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.71
|
| Rate for Payer: HealthUtah PPO |
$11.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.42
|
| Rate for Payer: Multiplan Medicare/VA |
$6.37
|
| Rate for Payer: One Health Plan of WY PPO |
$11.53
|
| Rate for Payer: PacificSource Commercial |
$10.59
|
| Rate for Payer: PHCS PPO |
$11.53
|
| Rate for Payer: Three Rivers PPO |
$8.83
|
| Rate for Payer: TriWest Veterans Administration |
$6.71
|
| Rate for Payer: United Healthcare Commercial |
$11.24
|
| Rate for Payer: United Healthcare Medicare |
$6.71
|
| Rate for Payer: WINHealth Partners Commercial |
$11.53
|
| Rate for Payer: Wise Provider Network Commercial |
$11.18
|
|
|
FINGER/TOE GEL 6" TUBE NARROW
|
Facility
|
IP
|
$11.77
|
|
| Hospital Charge Code |
2200097
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$11.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.53
|
| Rate for Payer: Aetna of WY Medicare |
$7.53
|
| Rate for Payer: Altius Commercial |
$11.30
|
| Rate for Payer: Beech Street Commercial |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.42
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.42
|
| Rate for Payer: Cigna of WY Commercial |
$11.53
|
| Rate for Payer: Entrust Commercial |
$11.18
|
| Rate for Payer: First Choice Health Commercial |
$11.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.18
|
| Rate for Payer: HealthUtah PPO |
$11.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.42
|
| Rate for Payer: Multiplan Medicare/VA |
$6.82
|
| Rate for Payer: One Health Plan of WY PPO |
$11.53
|
| Rate for Payer: PacificSource Commercial |
$10.59
|
| Rate for Payer: PHCS PPO |
$11.53
|
| Rate for Payer: Three Rivers PPO |
$8.83
|
| Rate for Payer: TriWest Veterans Administration |
$7.18
|
| Rate for Payer: United Healthcare Commercial |
$11.24
|
| Rate for Payer: United Healthcare Medicare |
$7.18
|
| Rate for Payer: WINHealth Partners Commercial |
$11.18
|
| Rate for Payer: Wise Provider Network Commercial |
$11.18
|
|
|
FINGER/TOE GEL 6" TUBE WIDE
|
Facility
|
OP
|
$13.32
|
|
| Hospital Charge Code |
2200098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.05
|
| Rate for Payer: Aetna of WY Medicare |
$8.79
|
| Rate for Payer: Altius Commercial |
$12.79
|
| Rate for Payer: Beech Street Commercial |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.92
|
| Rate for Payer: Cigna of WY Commercial |
$13.05
|
| Rate for Payer: Entrust Commercial |
$12.65
|
| Rate for Payer: First Choice Health Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.59
|
| Rate for Payer: HealthUtah PPO |
$13.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.92
|
| Rate for Payer: Multiplan Medicare/VA |
$7.21
|
| Rate for Payer: One Health Plan of WY PPO |
$13.05
|
| Rate for Payer: PacificSource Commercial |
$11.99
|
| Rate for Payer: PHCS PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$9.99
|
| Rate for Payer: TriWest Veterans Administration |
$7.59
|
| Rate for Payer: United Healthcare Commercial |
$12.72
|
| Rate for Payer: United Healthcare Medicare |
$7.59
|
| Rate for Payer: WINHealth Partners Commercial |
$13.05
|
| Rate for Payer: Wise Provider Network Commercial |
$12.65
|
|
|
FINGER/TOE GEL 6" TUBE WIDE
|
Facility
|
IP
|
$13.32
|
|
| Hospital Charge Code |
2200098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.05
|
| Rate for Payer: Aetna of WY Medicare |
$8.52
|
| Rate for Payer: Altius Commercial |
$12.79
|
| Rate for Payer: Beech Street Commercial |
$13.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$9.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.92
|
| Rate for Payer: Cigna of WY Commercial |
$13.05
|
| Rate for Payer: Entrust Commercial |
$12.65
|
| Rate for Payer: First Choice Health Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.13
|
| Rate for Payer: HealthUtah PPO |
$13.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.92
|
| Rate for Payer: Multiplan Medicare/VA |
$7.72
|
| Rate for Payer: One Health Plan of WY PPO |
$13.05
|
| Rate for Payer: PacificSource Commercial |
$11.99
|
| Rate for Payer: PHCS PPO |
$13.05
|
| Rate for Payer: Three Rivers PPO |
$9.99
|
| Rate for Payer: TriWest Veterans Administration |
$8.13
|
| Rate for Payer: United Healthcare Commercial |
$12.72
|
| Rate for Payer: United Healthcare Medicare |
$8.13
|
| Rate for Payer: WINHealth Partners Commercial |
$12.65
|
| Rate for Payer: Wise Provider Network Commercial |
$12.65
|
|
|
FINGER/TOE GEL CAP L/XL
|
Facility
|
IP
|
$9.92
|
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.72
|
| Rate for Payer: Aetna of WY Medicare |
$6.35
|
| Rate for Payer: Altius Commercial |
$9.52
|
| Rate for Payer: Beech Street Commercial |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.62
|
| Rate for Payer: Cigna of WY Commercial |
$9.72
|
| Rate for Payer: Entrust Commercial |
$9.42
|
| Rate for Payer: First Choice Health Commercial |
$9.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.05
|
| Rate for Payer: HealthUtah PPO |
$9.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.62
|
| Rate for Payer: Multiplan Medicare/VA |
$5.75
|
| Rate for Payer: One Health Plan of WY PPO |
$9.72
|
| Rate for Payer: PacificSource Commercial |
$8.93
|
| Rate for Payer: PHCS PPO |
$9.72
|
| Rate for Payer: Three Rivers PPO |
$7.44
|
| Rate for Payer: TriWest Veterans Administration |
$6.05
|
| Rate for Payer: United Healthcare Commercial |
$9.47
|
| Rate for Payer: United Healthcare Medicare |
$6.05
|
| Rate for Payer: WINHealth Partners Commercial |
$9.42
|
| Rate for Payer: Wise Provider Network Commercial |
$9.42
|
|
|
FINGER/TOE GEL CAP L/XL
|
Facility
|
OP
|
$9.92
|
|
| Hospital Charge Code |
2200095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.72
|
| Rate for Payer: Aetna of WY Medicare |
$6.55
|
| Rate for Payer: Altius Commercial |
$9.52
|
| Rate for Payer: Beech Street Commercial |
$9.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.62
|
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.62
|
| Rate for Payer: Cigna of WY Commercial |
$9.72
|
| Rate for Payer: Entrust Commercial |
$9.42
|
| Rate for Payer: First Choice Health Commercial |
$9.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.42
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.65
|
| Rate for Payer: HealthUtah PPO |
$9.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.62
|
| Rate for Payer: Multiplan Medicare/VA |
$5.37
|
| Rate for Payer: One Health Plan of WY PPO |
$9.72
|
| Rate for Payer: PacificSource Commercial |
$8.93
|
| Rate for Payer: PHCS PPO |
$9.72
|
| Rate for Payer: Three Rivers PPO |
$7.44
|
| Rate for Payer: TriWest Veterans Administration |
$5.65
|
| Rate for Payer: United Healthcare Commercial |
$9.47
|
| Rate for Payer: United Healthcare Medicare |
$5.65
|
| Rate for Payer: WINHealth Partners Commercial |
$9.72
|
| Rate for Payer: Wise Provider Network Commercial |
$9.42
|
|
|
FINGER/TOE GEL CAP S/M
|
Facility
|
OP
|
$9.33
|
|
| Hospital Charge Code |
2200094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.14
|
| Rate for Payer: Aetna of WY Medicare |
$6.16
|
| Rate for Payer: Altius Commercial |
$8.96
|
| Rate for Payer: Beech Street Commercial |
$9.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.05
|
| Rate for Payer: Cigna of WY Commercial |
$9.14
|
| Rate for Payer: Entrust Commercial |
$8.86
|
| Rate for Payer: First Choice Health Commercial |
$8.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.32
|
| Rate for Payer: HealthUtah PPO |
$9.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.05
|
| Rate for Payer: Multiplan Medicare/VA |
$5.05
|
| Rate for Payer: One Health Plan of WY PPO |
$9.14
|
| Rate for Payer: PacificSource Commercial |
$8.40
|
| Rate for Payer: PHCS PPO |
$9.14
|
| Rate for Payer: Three Rivers PPO |
$7.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.32
|
| Rate for Payer: United Healthcare Commercial |
$8.91
|
| Rate for Payer: United Healthcare Medicare |
$5.32
|
| Rate for Payer: WINHealth Partners Commercial |
$9.14
|
| Rate for Payer: Wise Provider Network Commercial |
$8.86
|
|
|
FINGER/TOE GEL CAP S/M
|
Facility
|
IP
|
$9.33
|
|
| Hospital Charge Code |
2200094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$9.33 |
| Rate for Payer: United Healthcare Commercial |
$8.91
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.14
|
| Rate for Payer: Aetna of WY Medicare |
$5.97
|
| Rate for Payer: Altius Commercial |
$8.96
|
| Rate for Payer: Beech Street Commercial |
$9.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.05
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.05
|
| Rate for Payer: Cigna of WY Commercial |
$9.14
|
| Rate for Payer: Entrust Commercial |
$8.86
|
| Rate for Payer: First Choice Health Commercial |
$8.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.69
|
| Rate for Payer: HealthUtah PPO |
$9.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.05
|
| Rate for Payer: Multiplan Medicare/VA |
$5.41
|
| Rate for Payer: One Health Plan of WY PPO |
$9.14
|
| Rate for Payer: PacificSource Commercial |
$8.40
|
| Rate for Payer: PHCS PPO |
$9.14
|
| Rate for Payer: Three Rivers PPO |
$7.00
|
| Rate for Payer: TriWest Veterans Administration |
$5.69
|
| Rate for Payer: United Healthcare Medicare |
$5.69
|
| Rate for Payer: WINHealth Partners Commercial |
$8.86
|
| Rate for Payer: Wise Provider Network Commercial |
$8.86
|
|
|
FINGER/TOE GEL CAP XXL
|
Facility
|
IP
|
$15.45
|
|
| Hospital Charge Code |
2200096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.14
|
| Rate for Payer: Aetna of WY Medicare |
$9.89
|
| Rate for Payer: Altius Commercial |
$14.83
|
| Rate for Payer: Beech Street Commercial |
$15.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.99
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.99
|
| Rate for Payer: Cigna of WY Commercial |
$15.14
|
| Rate for Payer: Entrust Commercial |
$14.68
|
| Rate for Payer: First Choice Health Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.42
|
| Rate for Payer: HealthUtah PPO |
$15.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.95
|
| Rate for Payer: One Health Plan of WY PPO |
$15.14
|
| Rate for Payer: PacificSource Commercial |
$13.90
|
| Rate for Payer: PHCS PPO |
$15.14
|
| Rate for Payer: Three Rivers PPO |
$11.59
|
| Rate for Payer: TriWest Veterans Administration |
$9.42
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$9.42
|
| Rate for Payer: WINHealth Partners Commercial |
$14.68
|
| Rate for Payer: Wise Provider Network Commercial |
$14.68
|
|
|
FINGER/TOE GEL CAP XXL
|
Facility
|
OP
|
$15.45
|
|
| Hospital Charge Code |
2200096
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$15.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.14
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Commercial |
$14.83
|
| Rate for Payer: Beech Street Commercial |
$15.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.99
|
| Rate for Payer: Cash Price |
$10.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.99
|
| Rate for Payer: Cigna of WY Commercial |
$15.14
|
| Rate for Payer: Entrust Commercial |
$14.68
|
| Rate for Payer: First Choice Health Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.81
|
| Rate for Payer: HealthUtah PPO |
$15.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.99
|
| Rate for Payer: Multiplan Medicare/VA |
$8.37
|
| Rate for Payer: One Health Plan of WY PPO |
$15.14
|
| Rate for Payer: PacificSource Commercial |
$13.90
|
| Rate for Payer: PHCS PPO |
$15.14
|
| Rate for Payer: Three Rivers PPO |
$11.59
|
| Rate for Payer: TriWest Veterans Administration |
$8.81
|
| Rate for Payer: United Healthcare Commercial |
$14.75
|
| Rate for Payer: United Healthcare Medicare |
$8.81
|
| Rate for Payer: WINHealth Partners Commercial |
$15.14
|
| Rate for Payer: Wise Provider Network Commercial |
$14.68
|
|
|
FINGER TRAP LG BLUE SNG W/ROPE
|
Facility
|
OP
|
$94.08
|
|
| Hospital Charge Code |
3000210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.94 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$92.20
|
| Rate for Payer: Aetna of WY Medicare |
$62.09
|
| Rate for Payer: Altius Commercial |
$90.32
|
| Rate for Payer: Beech Street Commercial |
$92.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.26
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$91.26
|
| Rate for Payer: Cigna of WY Commercial |
$92.20
|
| Rate for Payer: Entrust Commercial |
$89.38
|
| Rate for Payer: First Choice Health Commercial |
$89.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.63
|
| Rate for Payer: HealthUtah PPO |
$94.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$91.26
|
| Rate for Payer: Multiplan Medicare/VA |
$50.94
|
| Rate for Payer: One Health Plan of WY PPO |
$92.20
|
| Rate for Payer: PacificSource Commercial |
$84.67
|
| Rate for Payer: PHCS PPO |
$92.20
|
| Rate for Payer: Three Rivers PPO |
$70.56
|
| Rate for Payer: TriWest Veterans Administration |
$53.63
|
| Rate for Payer: United Healthcare Commercial |
$89.85
|
| Rate for Payer: United Healthcare Medicare |
$53.63
|
| Rate for Payer: WINHealth Partners Commercial |
$92.20
|
| Rate for Payer: Wise Provider Network Commercial |
$89.38
|
|
|
FINGER TRAP LG BLUE SNG W/ROPE
|
Facility
|
IP
|
$94.08
|
|
| Hospital Charge Code |
3000210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.52 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$92.20
|
| Rate for Payer: Aetna of WY Medicare |
$60.21
|
| Rate for Payer: Altius Commercial |
$90.32
|
| Rate for Payer: Beech Street Commercial |
$92.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$91.26
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$91.26
|
| Rate for Payer: Cigna of WY Commercial |
$92.20
|
| Rate for Payer: Entrust Commercial |
$89.38
|
| Rate for Payer: First Choice Health Commercial |
$89.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$89.38
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.39
|
| Rate for Payer: HealthUtah PPO |
$94.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$91.26
|
| Rate for Payer: Multiplan Medicare/VA |
$54.52
|
| Rate for Payer: One Health Plan of WY PPO |
$92.20
|
| Rate for Payer: PacificSource Commercial |
$84.67
|
| Rate for Payer: PHCS PPO |
$92.20
|
| Rate for Payer: Three Rivers PPO |
$70.56
|
| Rate for Payer: TriWest Veterans Administration |
$57.39
|
| Rate for Payer: United Healthcare Commercial |
$89.85
|
| Rate for Payer: United Healthcare Medicare |
$57.39
|
| Rate for Payer: WINHealth Partners Commercial |
$89.38
|
| Rate for Payer: Wise Provider Network Commercial |
$89.38
|
|
