|
FREEDOM CMC THUMBFIT LT LG
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200386
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT LG
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200386
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT MED
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200384
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT MED
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200384
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT SM
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT SM
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT XLG
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT LT XLG
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT LG
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200385
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT LG
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200385
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT MED
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200383
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT MED
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200383
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT SM
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT SM
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT XLG
|
Facility
|
OP
|
$141.75
|
|
| Hospital Charge Code |
2200387
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.76 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$93.56
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$80.80
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$76.76
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$80.80
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WINHealth Partners Commercial |
$138.92
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FREEDOM CMC THUMBFIT RT XLG
|
Facility
|
IP
|
$141.75
|
|
| Hospital Charge Code |
2200387
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$138.92
|
| Rate for Payer: Aetna of WY Medicare |
$90.72
|
| Rate for Payer: Altius Commercial |
$136.08
|
| Rate for Payer: Beech Street Commercial |
$138.92
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$137.50
|
| Rate for Payer: Cash Price |
$99.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$137.50
|
| Rate for Payer: Cigna of WY Commercial |
$138.92
|
| Rate for Payer: Entrust Commercial |
$134.66
|
| Rate for Payer: First Choice Health Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$134.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.47
|
| Rate for Payer: HealthUtah PPO |
$141.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$137.50
|
| Rate for Payer: Multiplan Medicare/VA |
$82.14
|
| Rate for Payer: One Health Plan of WY PPO |
$138.92
|
| Rate for Payer: PacificSource Commercial |
$127.58
|
| Rate for Payer: PHCS PPO |
$138.92
|
| Rate for Payer: Three Rivers PPO |
$106.31
|
| Rate for Payer: TriWest Veterans Administration |
$86.47
|
| Rate for Payer: United Healthcare Commercial |
$135.37
|
| Rate for Payer: United Healthcare Medicare |
$86.47
|
| Rate for Payer: WINHealth Partners Commercial |
$134.66
|
| Rate for Payer: Wise Provider Network Commercial |
$134.66
|
|
|
FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$208.90 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,066.24
|
| Rate for Payer: Aetna of WY Medicare |
$245.76
|
| Rate for Payer: Beech Street Commercial |
$1,033.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,055.36
|
| Rate for Payer: Cigna of WY Commercial |
$1,066.24
|
| Rate for Payer: First Choice Health Commercial |
$979.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,033.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$245.76
|
| Rate for Payer: HealthUtah PPO |
$1,088.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,055.36
|
| Rate for Payer: Multiplan Medicare/VA |
$208.90
|
| Rate for Payer: One Health Plan of WY PPO |
$1,066.24
|
| Rate for Payer: PacificSource Commercial |
$979.20
|
| Rate for Payer: PHCS PPO |
$1,033.60
|
| Rate for Payer: Three Rivers PPO |
$816.00
|
| Rate for Payer: TriWest Veterans Administration |
$245.76
|
| Rate for Payer: United Healthcare Commercial |
$1,033.60
|
| Rate for Payer: WINHealth Partners Commercial |
$924.80
|
|
|
FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$3,394.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$655.29 |
| Max. Negotiated Rate |
$3,394.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,326.12
|
| Rate for Payer: Aetna of WY Medicare |
$770.93
|
| Rate for Payer: Beech Street Commercial |
$3,224.30
|
| Rate for Payer: Cash Price |
$2,375.80
|
| Rate for Payer: Cash Price |
$2,375.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,292.18
|
| Rate for Payer: Cigna of WY Commercial |
$3,326.12
|
| Rate for Payer: First Choice Health Commercial |
$3,054.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,224.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$770.93
|
| Rate for Payer: HealthUtah PPO |
$3,394.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,292.18
|
| Rate for Payer: Multiplan Medicare/VA |
$655.29
|
| Rate for Payer: One Health Plan of WY PPO |
$3,326.12
|
| Rate for Payer: PacificSource Commercial |
$3,054.60
|
| Rate for Payer: PHCS PPO |
$3,224.30
|
| Rate for Payer: Three Rivers PPO |
$2,545.50
|
| Rate for Payer: TriWest Veterans Administration |
$770.93
|
| Rate for Payer: United Healthcare Commercial |
$3,224.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,884.90
|
|
|
FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$2,607.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$501.81 |
| Max. Negotiated Rate |
$2,607.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,554.86
|
| Rate for Payer: Aetna of WY Medicare |
$590.36
|
| Rate for Payer: Beech Street Commercial |
$2,476.65
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,528.79
|
| Rate for Payer: Cigna of WY Commercial |
$2,554.86
|
| Rate for Payer: First Choice Health Commercial |
$2,346.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,476.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$590.36
|
| Rate for Payer: HealthUtah PPO |
$2,607.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,528.79
|
| Rate for Payer: Multiplan Medicare/VA |
$501.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,554.86
|
| Rate for Payer: PacificSource Commercial |
$2,346.30
|
| Rate for Payer: PHCS PPO |
$2,476.65
|
| Rate for Payer: Three Rivers PPO |
$1,955.25
|
| Rate for Payer: TriWest Veterans Administration |
$590.36
|
| Rate for Payer: United Healthcare Commercial |
$2,476.65
|
| Rate for Payer: WINHealth Partners Commercial |
$2,215.95
|
|
|
FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM/<
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$55.53 |
| Max. Negotiated Rate |
$301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$294.98
|
| Rate for Payer: Aetna of WY Medicare |
$65.33
|
| Rate for Payer: Beech Street Commercial |
$285.95
|
| Rate for Payer: Cash Price |
$210.70
|
| Rate for Payer: Cash Price |
$210.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$291.97
|
| Rate for Payer: Cigna of WY Commercial |
$294.98
|
| Rate for Payer: First Choice Health Commercial |
$270.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$285.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.33
|
| Rate for Payer: HealthUtah PPO |
$301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$291.97
|
| Rate for Payer: Multiplan Medicare/VA |
$55.53
|
| Rate for Payer: One Health Plan of WY PPO |
$294.98
|
| Rate for Payer: PacificSource Commercial |
$270.90
|
| Rate for Payer: PHCS PPO |
$285.95
|
| Rate for Payer: Three Rivers PPO |
$225.75
|
| Rate for Payer: TriWest Veterans Administration |
$65.33
|
| Rate for Payer: United Healthcare Commercial |
$285.95
|
| Rate for Payer: WINHealth Partners Commercial |
$255.85
|
|
|
FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$394.50 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$515.48
|
| Rate for Payer: Beech Street Commercial |
$499.70
|
| Rate for Payer: Cash Price |
$368.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$510.22
|
| Rate for Payer: Cigna of WY Commercial |
$515.48
|
| Rate for Payer: First Choice Health Commercial |
$473.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$499.70
|
| Rate for Payer: HealthUtah PPO |
$526.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$510.22
|
| Rate for Payer: One Health Plan of WY PPO |
$515.48
|
| Rate for Payer: PacificSource Commercial |
$473.40
|
| Rate for Payer: PHCS PPO |
$499.70
|
| Rate for Payer: Three Rivers PPO |
$394.50
|
| Rate for Payer: United Healthcare Commercial |
$499.70
|
| Rate for Payer: WINHealth Partners Commercial |
$499.70
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [23757]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J9393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Medicare |
$38.40
|
| Rate for Payer: Aetna of WY Medicare |
$60.80
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.60
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$55.05
|
| Rate for Payer: Multiplan Medicare/VA |
$34.77
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$57.95
|
| Rate for Payer: TriWest Veterans Administration |
$36.60
|
| Rate for Payer: United Healthcare Commercial |
$57.30
|
| Rate for Payer: United Healthcare Commercial |
$90.72
|
| Rate for Payer: United Healthcare Medicare |
$36.60
|
| Rate for Payer: United Healthcare Medicare |
$57.95
|
| Rate for Payer: WINHealth Partners Commercial |
$90.25
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE [23757]
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS J9393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: First Choice Health Commercial |
$57.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.10
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$62.70
|
| Rate for Payer: Aetna of WY Medicare |
$39.60
|
| Rate for Payer: Altius Commercial |
$57.60
|
| Rate for Payer: Altius Commercial |
$91.20
|
| Rate for Payer: Beech Street Commercial |
$58.80
|
| Rate for Payer: Beech Street Commercial |
$93.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.15
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: Cigna of WY Commercial |
$93.10
|
| Rate for Payer: Entrust Commercial |
$57.00
|
| Rate for Payer: Entrust Commercial |
$90.25
|
| Rate for Payer: First Choice Health Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.20
|
| Rate for Payer: HealthUtah PPO |
$95.00
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.15
|
| Rate for Payer: Multiplan Medicare/VA |
$32.49
|
| Rate for Payer: Multiplan Medicare/VA |
$51.44
|
| Rate for Payer: One Health Plan of WY PPO |
$93.10
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$85.50
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$58.80
|
| Rate for Payer: PHCS PPO |
$93.10
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: Three Rivers PPO |
$71.25
|
| Rate for Payer: TriWest Veterans Administration |
$54.15
|
| Rate for Payer: TriWest Veterans Administration |
$34.20
|
| Rate for Payer: United Healthcare Commercial |
$57.30
|
| Rate for Payer: United Healthcare Commercial |
$90.72
|
| Rate for Payer: United Healthcare Medicare |
$34.20
|
| Rate for Payer: United Healthcare Medicare |
$54.15
|
| Rate for Payer: WINHealth Partners Commercial |
$58.80
|
| Rate for Payer: WINHealth Partners Commercial |
$93.10
|
| Rate for Payer: Wise Provider Network Commercial |
$90.25
|
| Rate for Payer: Wise Provider Network Commercial |
$57.00
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [686]
|
Facility
|
OP
|
$19.20
|
|
|
Service Code
|
HCPCS J1940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.54
|
| Rate for Payer: Aetna of WY Medicare |
$12.67
|
| Rate for Payer: Aetna of WY Medicare |
$11.81
|
| Rate for Payer: Altius Commercial |
$17.18
|
| Rate for Payer: Altius Commercial |
$18.43
|
| Rate for Payer: Beech Street Commercial |
$17.54
|
| Rate for Payer: Beech Street Commercial |
$18.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$17.54
|
| Rate for Payer: Cigna of WY Commercial |
$18.82
|
| Rate for Payer: Entrust Commercial |
$17.00
|
| Rate for Payer: Entrust Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$17.00
|
| Rate for Payer: First Choice Health Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$17.90
|
| Rate for Payer: HealthUtah PPO |
$19.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.36
|
| Rate for Payer: Multiplan Medicare/VA |
$10.40
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| Rate for Payer: One Health Plan of WY PPO |
$17.54
|
| Rate for Payer: One Health Plan of WY PPO |
$18.82
|
| Rate for Payer: PacificSource Commercial |
$16.11
|
| Rate for Payer: PacificSource Commercial |
$17.28
|
| Rate for Payer: PHCS PPO |
$17.54
|
| Rate for Payer: PHCS PPO |
$18.82
|
| Rate for Payer: Three Rivers PPO |
$14.40
|
| Rate for Payer: Three Rivers PPO |
$13.42
|
| Rate for Payer: TriWest Veterans Administration |
$10.20
|
| Rate for Payer: TriWest Veterans Administration |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
| Rate for Payer: United Healthcare Commercial |
$17.09
|
| Rate for Payer: United Healthcare Medicare |
$10.94
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$17.54
|
| Rate for Payer: WINHealth Partners Commercial |
$18.82
|
| Rate for Payer: Wise Provider Network Commercial |
$17.00
|
| Rate for Payer: Wise Provider Network Commercial |
$18.24
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION [686]
|
Facility
|
IP
|
$19.20
|
|
|
Service Code
|
HCPCS J1940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.82
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.54
|
| Rate for Payer: Aetna of WY Medicare |
$11.46
|
| Rate for Payer: Aetna of WY Medicare |
$12.29
|
| Rate for Payer: Altius Commercial |
$17.18
|
| Rate for Payer: Altius Commercial |
$18.43
|
| Rate for Payer: Beech Street Commercial |
$18.82
|
| Rate for Payer: Beech Street Commercial |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.62
|
| Rate for Payer: Cigna of WY Commercial |
$18.82
|
| Rate for Payer: Cigna of WY Commercial |
$17.54
|
| Rate for Payer: Entrust Commercial |
$17.00
|
| Rate for Payer: Entrust Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$18.24
|
| Rate for Payer: First Choice Health Commercial |
$17.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.71
|
| Rate for Payer: HealthUtah PPO |
$19.20
|
| Rate for Payer: HealthUtah PPO |
$17.90
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.62
|
| Rate for Payer: Multiplan Medicare/VA |
$10.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.13
|
| Rate for Payer: One Health Plan of WY PPO |
$18.82
|
| Rate for Payer: One Health Plan of WY PPO |
$17.54
|
| Rate for Payer: PacificSource Commercial |
$16.11
|
| Rate for Payer: PacificSource Commercial |
$17.28
|
| Rate for Payer: PHCS PPO |
$18.82
|
| Rate for Payer: PHCS PPO |
$17.54
|
| Rate for Payer: Three Rivers PPO |
$14.40
|
| Rate for Payer: Three Rivers PPO |
$13.42
|
| Rate for Payer: TriWest Veterans Administration |
$10.92
|
| Rate for Payer: TriWest Veterans Administration |
$11.71
|
| Rate for Payer: United Healthcare Commercial |
$17.09
|
| Rate for Payer: United Healthcare Commercial |
$18.34
|
| Rate for Payer: United Healthcare Medicare |
$11.71
|
| Rate for Payer: United Healthcare Medicare |
$10.92
|
| Rate for Payer: WINHealth Partners Commercial |
$17.00
|
| Rate for Payer: WINHealth Partners Commercial |
$18.24
|
| Rate for Payer: Wise Provider Network Commercial |
$17.00
|
| Rate for Payer: Wise Provider Network Commercial |
$18.24
|
|
