|
APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Aetna of WY Medicare |
$13.99
|
| Rate for Payer: Beech Street Commercial |
$85.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: First Choice Health Commercial |
$81.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.99
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: Multiplan Medicare/VA |
$11.89
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$85.50
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: TriWest Veterans Administration |
$13.99
|
| Rate for Payer: United Healthcare Commercial |
$85.50
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
|
|
APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$214.62
|
| Rate for Payer: Aetna of WY Medicare |
$18.91
|
| Rate for Payer: Beech Street Commercial |
$208.05
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$212.43
|
| Rate for Payer: Cigna of WY Commercial |
$214.62
|
| Rate for Payer: First Choice Health Commercial |
$197.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$208.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.91
|
| Rate for Payer: HealthUtah PPO |
$219.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$212.43
|
| Rate for Payer: Multiplan Medicare/VA |
$16.07
|
| Rate for Payer: One Health Plan of WY PPO |
$214.62
|
| Rate for Payer: PacificSource Commercial |
$197.10
|
| Rate for Payer: PHCS PPO |
$208.05
|
| Rate for Payer: Three Rivers PPO |
$164.25
|
| Rate for Payer: TriWest Veterans Administration |
$18.91
|
| Rate for Payer: United Healthcare Commercial |
$208.05
|
| Rate for Payer: WINHealth Partners Commercial |
$208.05
|
|
|
APPL MODALITY 1/> AREAS PARAFFIN BATH
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 97018
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.72
|
| Rate for Payer: Beech Street Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$9.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.58
|
| Rate for Payer: Cigna of WY Commercial |
$13.72
|
| Rate for Payer: First Choice Health Commercial |
$12.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.30
|
| Rate for Payer: HealthUtah PPO |
$14.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.58
|
| Rate for Payer: One Health Plan of WY PPO |
$13.72
|
| Rate for Payer: PacificSource Commercial |
$12.60
|
| Rate for Payer: PHCS PPO |
$13.30
|
| Rate for Payer: Three Rivers PPO |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$13.30
|
| Rate for Payer: WINHealth Partners Commercial |
$13.30
|
|
|
APPL MODALITY 1/> AREAS TRACTION MECHANICAL
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 97012
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.90
|
| Rate for Payer: Aetna of WY Medicare |
$13.67
|
| Rate for Payer: Beech Street Commercial |
$99.75
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.85
|
| Rate for Payer: Cigna of WY Commercial |
$102.90
|
| Rate for Payer: First Choice Health Commercial |
$94.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.67
|
| Rate for Payer: HealthUtah PPO |
$105.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.85
|
| Rate for Payer: Multiplan Medicare/VA |
$11.62
|
| Rate for Payer: One Health Plan of WY PPO |
$102.90
|
| Rate for Payer: PacificSource Commercial |
$94.50
|
| Rate for Payer: PHCS PPO |
$99.75
|
| Rate for Payer: Three Rivers PPO |
$78.75
|
| Rate for Payer: TriWest Veterans Administration |
$13.67
|
| Rate for Payer: United Healthcare Commercial |
$99.75
|
| Rate for Payer: WINHealth Partners Commercial |
$99.75
|
|
|
APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$76.44
|
| Rate for Payer: Aetna of WY Medicare |
$13.67
|
| Rate for Payer: Beech Street Commercial |
$74.10
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$75.66
|
| Rate for Payer: Cigna of WY Commercial |
$76.44
|
| Rate for Payer: First Choice Health Commercial |
$70.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$74.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.67
|
| Rate for Payer: HealthUtah PPO |
$78.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$75.66
|
| Rate for Payer: Multiplan Medicare/VA |
$11.62
|
| Rate for Payer: One Health Plan of WY PPO |
$76.44
|
| Rate for Payer: PacificSource Commercial |
$70.20
|
| Rate for Payer: PHCS PPO |
$74.10
|
| Rate for Payer: Three Rivers PPO |
$58.50
|
| Rate for Payer: TriWest Veterans Administration |
$13.67
|
| Rate for Payer: United Healthcare Commercial |
$74.10
|
| Rate for Payer: WINHealth Partners Commercial |
$74.10
|
|
|
APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 97016
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$81.34
|
| Rate for Payer: Aetna of WY Medicare |
$11.38
|
| Rate for Payer: Beech Street Commercial |
$78.85
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: Cash Price |
$58.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$80.51
|
| Rate for Payer: Cigna of WY Commercial |
$81.34
|
| Rate for Payer: First Choice Health Commercial |
$74.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$78.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.38
|
| Rate for Payer: HealthUtah PPO |
$83.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$80.51
|
| Rate for Payer: Multiplan Medicare/VA |
$9.67
|
| Rate for Payer: One Health Plan of WY PPO |
$81.34
|
| Rate for Payer: PacificSource Commercial |
$74.70
|
| Rate for Payer: PHCS PPO |
$78.85
|
| Rate for Payer: Three Rivers PPO |
$62.25
|
| Rate for Payer: TriWest Veterans Administration |
$11.38
|
| Rate for Payer: United Healthcare Commercial |
$78.85
|
| Rate for Payer: WINHealth Partners Commercial |
$78.85
|
|
|
APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$355.74
|
| Rate for Payer: Aetna of WY Medicare |
$79.98
|
| Rate for Payer: Beech Street Commercial |
$344.85
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: Cash Price |
$254.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$352.11
|
| Rate for Payer: Cigna of WY Commercial |
$355.74
|
| Rate for Payer: First Choice Health Commercial |
$326.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$344.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.98
|
| Rate for Payer: HealthUtah PPO |
$363.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$352.11
|
| Rate for Payer: Multiplan Medicare/VA |
$67.98
|
| Rate for Payer: One Health Plan of WY PPO |
$355.74
|
| Rate for Payer: PacificSource Commercial |
$326.70
|
| Rate for Payer: PHCS PPO |
$344.85
|
| Rate for Payer: Three Rivers PPO |
$272.25
|
| Rate for Payer: TriWest Veterans Administration |
$79.98
|
| Rate for Payer: United Healthcare Commercial |
$344.85
|
| Rate for Payer: WINHealth Partners Commercial |
$308.55
|
|
|
AQUACEL AG DRESSING 10"
|
Facility
|
OP
|
$94.93
|
|
| Hospital Charge Code |
2000093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$94.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.03
|
| Rate for Payer: Aetna of WY Medicare |
$62.65
|
| Rate for Payer: Altius Commercial |
$91.13
|
| Rate for Payer: Beech Street Commercial |
$93.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.08
|
| Rate for Payer: Cash Price |
$66.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.08
|
| Rate for Payer: Cigna of WY Commercial |
$93.03
|
| Rate for Payer: Entrust Commercial |
$90.18
|
| Rate for Payer: First Choice Health Commercial |
$90.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$54.11
|
| Rate for Payer: HealthUtah PPO |
$94.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.08
|
| Rate for Payer: Multiplan Medicare/VA |
$51.40
|
| Rate for Payer: One Health Plan of WY PPO |
$93.03
|
| Rate for Payer: PacificSource Commercial |
$85.44
|
| Rate for Payer: PHCS PPO |
$93.03
|
| Rate for Payer: Three Rivers PPO |
$71.20
|
| Rate for Payer: TriWest Veterans Administration |
$54.11
|
| Rate for Payer: United Healthcare Commercial |
$90.66
|
| Rate for Payer: United Healthcare Medicare |
$54.11
|
| Rate for Payer: WINHealth Partners Commercial |
$93.03
|
| Rate for Payer: Wise Provider Network Commercial |
$90.18
|
|
|
AQUACEL AG DRESSING 10"
|
Facility
|
IP
|
$94.93
|
|
| Hospital Charge Code |
2000093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$94.93 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$93.03
|
| Rate for Payer: Aetna of WY Medicare |
$60.76
|
| Rate for Payer: Altius Commercial |
$91.13
|
| Rate for Payer: Beech Street Commercial |
$93.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.08
|
| Rate for Payer: Cash Price |
$66.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$92.08
|
| Rate for Payer: Cigna of WY Commercial |
$93.03
|
| Rate for Payer: Entrust Commercial |
$90.18
|
| Rate for Payer: First Choice Health Commercial |
$90.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$90.18
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.91
|
| Rate for Payer: HealthUtah PPO |
$94.93
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$92.08
|
| Rate for Payer: Multiplan Medicare/VA |
$55.01
|
| Rate for Payer: One Health Plan of WY PPO |
$93.03
|
| Rate for Payer: PacificSource Commercial |
$85.44
|
| Rate for Payer: PHCS PPO |
$93.03
|
| Rate for Payer: Three Rivers PPO |
$71.20
|
| Rate for Payer: TriWest Veterans Administration |
$57.91
|
| Rate for Payer: United Healthcare Commercial |
$90.66
|
| Rate for Payer: United Healthcare Medicare |
$57.91
|
| Rate for Payer: WINHealth Partners Commercial |
$90.18
|
| Rate for Payer: Wise Provider Network Commercial |
$90.18
|
|
|
AQUACEL AG DRESSING 12"
|
Facility
|
OP
|
$104.67
|
|
| Hospital Charge Code |
2000070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.68 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.58
|
| Rate for Payer: Aetna of WY Medicare |
$69.08
|
| Rate for Payer: Altius Commercial |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$102.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.53
|
| Rate for Payer: Cash Price |
$73.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.53
|
| Rate for Payer: Cigna of WY Commercial |
$102.58
|
| Rate for Payer: Entrust Commercial |
$99.44
|
| Rate for Payer: First Choice Health Commercial |
$99.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.66
|
| Rate for Payer: HealthUtah PPO |
$104.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.53
|
| Rate for Payer: Multiplan Medicare/VA |
$56.68
|
| Rate for Payer: One Health Plan of WY PPO |
$102.58
|
| Rate for Payer: PacificSource Commercial |
$94.20
|
| Rate for Payer: PHCS PPO |
$102.58
|
| Rate for Payer: Three Rivers PPO |
$78.50
|
| Rate for Payer: TriWest Veterans Administration |
$59.66
|
| Rate for Payer: United Healthcare Commercial |
$99.96
|
| Rate for Payer: United Healthcare Medicare |
$59.66
|
| Rate for Payer: WINHealth Partners Commercial |
$102.58
|
| Rate for Payer: Wise Provider Network Commercial |
$99.44
|
|
|
AQUACEL AG DRESSING 12"
|
Facility
|
IP
|
$104.67
|
|
| Hospital Charge Code |
2000070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$104.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$102.58
|
| Rate for Payer: Aetna of WY Medicare |
$66.99
|
| Rate for Payer: Altius Commercial |
$100.48
|
| Rate for Payer: Beech Street Commercial |
$102.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$101.53
|
| Rate for Payer: Cash Price |
$73.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$101.53
|
| Rate for Payer: Cigna of WY Commercial |
$102.58
|
| Rate for Payer: Entrust Commercial |
$99.44
|
| Rate for Payer: First Choice Health Commercial |
$99.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$99.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.85
|
| Rate for Payer: HealthUtah PPO |
$104.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$101.53
|
| Rate for Payer: Multiplan Medicare/VA |
$60.66
|
| Rate for Payer: One Health Plan of WY PPO |
$102.58
|
| Rate for Payer: PacificSource Commercial |
$94.20
|
| Rate for Payer: PHCS PPO |
$102.58
|
| Rate for Payer: Three Rivers PPO |
$78.50
|
| Rate for Payer: TriWest Veterans Administration |
$63.85
|
| Rate for Payer: United Healthcare Commercial |
$99.96
|
| Rate for Payer: United Healthcare Medicare |
$63.85
|
| Rate for Payer: WINHealth Partners Commercial |
$99.44
|
| Rate for Payer: Wise Provider Network Commercial |
$99.44
|
|
|
AQUACEL AG DRESSING 14"
|
Facility
|
IP
|
$105.73
|
|
| Hospital Charge Code |
2000064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.27 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.62
|
| Rate for Payer: Aetna of WY Medicare |
$67.67
|
| Rate for Payer: Altius Commercial |
$101.50
|
| Rate for Payer: Beech Street Commercial |
$103.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.56
|
| Rate for Payer: Cash Price |
$74.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.56
|
| Rate for Payer: Cigna of WY Commercial |
$103.62
|
| Rate for Payer: Entrust Commercial |
$100.44
|
| Rate for Payer: First Choice Health Commercial |
$100.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.50
|
| Rate for Payer: HealthUtah PPO |
$105.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.56
|
| Rate for Payer: Multiplan Medicare/VA |
$61.27
|
| Rate for Payer: One Health Plan of WY PPO |
$103.62
|
| Rate for Payer: PacificSource Commercial |
$95.16
|
| Rate for Payer: PHCS PPO |
$103.62
|
| Rate for Payer: Three Rivers PPO |
$79.30
|
| Rate for Payer: TriWest Veterans Administration |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$100.97
|
| Rate for Payer: United Healthcare Medicare |
$64.50
|
| Rate for Payer: WINHealth Partners Commercial |
$100.44
|
| Rate for Payer: Wise Provider Network Commercial |
$100.44
|
|
|
AQUACEL AG DRESSING 14"
|
Facility
|
OP
|
$105.73
|
|
| Hospital Charge Code |
2000064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.25 |
| Max. Negotiated Rate |
$105.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$103.62
|
| Rate for Payer: Aetna of WY Medicare |
$69.78
|
| Rate for Payer: Altius Commercial |
$101.50
|
| Rate for Payer: Beech Street Commercial |
$103.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$102.56
|
| Rate for Payer: Cash Price |
$74.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$102.56
|
| Rate for Payer: Cigna of WY Commercial |
$103.62
|
| Rate for Payer: Entrust Commercial |
$100.44
|
| Rate for Payer: First Choice Health Commercial |
$100.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$100.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.27
|
| Rate for Payer: HealthUtah PPO |
$105.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$102.56
|
| Rate for Payer: Multiplan Medicare/VA |
$57.25
|
| Rate for Payer: One Health Plan of WY PPO |
$103.62
|
| Rate for Payer: PacificSource Commercial |
$95.16
|
| Rate for Payer: PHCS PPO |
$103.62
|
| Rate for Payer: Three Rivers PPO |
$79.30
|
| Rate for Payer: TriWest Veterans Administration |
$60.27
|
| Rate for Payer: United Healthcare Commercial |
$100.97
|
| Rate for Payer: United Healthcare Medicare |
$60.27
|
| Rate for Payer: WINHealth Partners Commercial |
$103.62
|
| Rate for Payer: Wise Provider Network Commercial |
$100.44
|
|
|
AQUAMANTIS 6.0 BIPOLAR SEALER
|
Facility
|
OP
|
$1,221.99
|
|
| Hospital Charge Code |
3001932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$661.71 |
| Max. Negotiated Rate |
$1,221.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.55
|
| Rate for Payer: Aetna of WY Medicare |
$806.51
|
| Rate for Payer: Altius Commercial |
$1,173.11
|
| Rate for Payer: Beech Street Commercial |
$1,197.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,185.33
|
| Rate for Payer: Cash Price |
$855.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,185.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.55
|
| Rate for Payer: Entrust Commercial |
$1,160.89
|
| Rate for Payer: First Choice Health Commercial |
$1,160.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$696.53
|
| Rate for Payer: HealthUtah PPO |
$1,221.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,185.33
|
| Rate for Payer: Multiplan Medicare/VA |
$661.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.55
|
| Rate for Payer: PacificSource Commercial |
$1,099.79
|
| Rate for Payer: PHCS PPO |
$1,197.55
|
| Rate for Payer: Three Rivers PPO |
$916.49
|
| Rate for Payer: TriWest Veterans Administration |
$696.53
|
| Rate for Payer: United Healthcare Commercial |
$1,167.00
|
| Rate for Payer: United Healthcare Medicare |
$696.53
|
| Rate for Payer: WINHealth Partners Commercial |
$1,197.55
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.89
|
|
|
AQUAMANTIS 6.0 BIPOLAR SEALER
|
Facility
|
IP
|
$1,221.99
|
|
| Hospital Charge Code |
3001932
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.14 |
| Max. Negotiated Rate |
$1,221.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.55
|
| Rate for Payer: Aetna of WY Medicare |
$782.07
|
| Rate for Payer: Altius Commercial |
$1,173.11
|
| Rate for Payer: Beech Street Commercial |
$1,197.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,185.33
|
| Rate for Payer: Cash Price |
$855.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,185.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.55
|
| Rate for Payer: Entrust Commercial |
$1,160.89
|
| Rate for Payer: First Choice Health Commercial |
$1,160.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$745.41
|
| Rate for Payer: HealthUtah PPO |
$1,221.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,185.33
|
| Rate for Payer: Multiplan Medicare/VA |
$708.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.55
|
| Rate for Payer: PacificSource Commercial |
$1,099.79
|
| Rate for Payer: PHCS PPO |
$1,197.55
|
| Rate for Payer: Three Rivers PPO |
$916.49
|
| Rate for Payer: TriWest Veterans Administration |
$745.41
|
| Rate for Payer: United Healthcare Commercial |
$1,167.00
|
| Rate for Payer: United Healthcare Medicare |
$745.41
|
| Rate for Payer: WINHealth Partners Commercial |
$1,160.89
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.89
|
|
|
AQUAPLAST 1/16" 18X24 CHARCOAL
|
Facility
|
OP
|
$163.66
|
|
| Hospital Charge Code |
2250156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$163.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.39
|
| Rate for Payer: Aetna of WY Medicare |
$108.02
|
| Rate for Payer: Altius Commercial |
$157.11
|
| Rate for Payer: Beech Street Commercial |
$160.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.75
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.75
|
| Rate for Payer: Cigna of WY Commercial |
$160.39
|
| Rate for Payer: Entrust Commercial |
$155.48
|
| Rate for Payer: First Choice Health Commercial |
$155.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.29
|
| Rate for Payer: HealthUtah PPO |
$163.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.75
|
| Rate for Payer: Multiplan Medicare/VA |
$88.62
|
| Rate for Payer: One Health Plan of WY PPO |
$160.39
|
| Rate for Payer: PacificSource Commercial |
$147.29
|
| Rate for Payer: PHCS PPO |
$160.39
|
| Rate for Payer: Three Rivers PPO |
$122.74
|
| Rate for Payer: TriWest Veterans Administration |
$93.29
|
| Rate for Payer: United Healthcare Commercial |
$156.30
|
| Rate for Payer: United Healthcare Medicare |
$93.29
|
| Rate for Payer: WINHealth Partners Commercial |
$160.39
|
| Rate for Payer: Wise Provider Network Commercial |
$155.48
|
|
|
AQUAPLAST 1/16" 18X24 CHARCOAL
|
Facility
|
IP
|
$163.66
|
|
| Hospital Charge Code |
2250156
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$163.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$160.39
|
| Rate for Payer: Aetna of WY Medicare |
$104.74
|
| Rate for Payer: Altius Commercial |
$157.11
|
| Rate for Payer: Beech Street Commercial |
$160.39
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$158.75
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$158.75
|
| Rate for Payer: Cigna of WY Commercial |
$160.39
|
| Rate for Payer: Entrust Commercial |
$155.48
|
| Rate for Payer: First Choice Health Commercial |
$155.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$155.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.83
|
| Rate for Payer: HealthUtah PPO |
$163.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$158.75
|
| Rate for Payer: Multiplan Medicare/VA |
$94.84
|
| Rate for Payer: One Health Plan of WY PPO |
$160.39
|
| Rate for Payer: PacificSource Commercial |
$147.29
|
| Rate for Payer: PHCS PPO |
$160.39
|
| Rate for Payer: Three Rivers PPO |
$122.74
|
| Rate for Payer: TriWest Veterans Administration |
$99.83
|
| Rate for Payer: United Healthcare Commercial |
$156.30
|
| Rate for Payer: United Healthcare Medicare |
$99.83
|
| Rate for Payer: WINHealth Partners Commercial |
$155.48
|
| Rate for Payer: Wise Provider Network Commercial |
$155.48
|
|
|
AQUAPLAST 1/8X18X24" A96210
|
Facility
|
IP
|
$164.29
|
|
| Hospital Charge Code |
2250145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$164.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.00
|
| Rate for Payer: Aetna of WY Medicare |
$105.15
|
| Rate for Payer: Altius Commercial |
$157.72
|
| Rate for Payer: Beech Street Commercial |
$161.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.36
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.36
|
| Rate for Payer: Cigna of WY Commercial |
$161.00
|
| Rate for Payer: Entrust Commercial |
$156.08
|
| Rate for Payer: First Choice Health Commercial |
$156.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.22
|
| Rate for Payer: HealthUtah PPO |
$164.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.36
|
| Rate for Payer: Multiplan Medicare/VA |
$95.21
|
| Rate for Payer: One Health Plan of WY PPO |
$161.00
|
| Rate for Payer: PacificSource Commercial |
$147.86
|
| Rate for Payer: PHCS PPO |
$161.00
|
| Rate for Payer: Three Rivers PPO |
$123.22
|
| Rate for Payer: TriWest Veterans Administration |
$100.22
|
| Rate for Payer: United Healthcare Commercial |
$156.90
|
| Rate for Payer: United Healthcare Medicare |
$100.22
|
| Rate for Payer: WINHealth Partners Commercial |
$156.08
|
| Rate for Payer: Wise Provider Network Commercial |
$156.08
|
|
|
AQUAPLAST 1/8X18X24" A96210
|
Facility
|
OP
|
$164.29
|
|
| Hospital Charge Code |
2250145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.96 |
| Max. Negotiated Rate |
$164.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$161.00
|
| Rate for Payer: Aetna of WY Medicare |
$108.43
|
| Rate for Payer: Altius Commercial |
$157.72
|
| Rate for Payer: Beech Street Commercial |
$161.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$159.36
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$159.36
|
| Rate for Payer: Cigna of WY Commercial |
$161.00
|
| Rate for Payer: Entrust Commercial |
$156.08
|
| Rate for Payer: First Choice Health Commercial |
$156.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$156.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.65
|
| Rate for Payer: HealthUtah PPO |
$164.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$159.36
|
| Rate for Payer: Multiplan Medicare/VA |
$88.96
|
| Rate for Payer: One Health Plan of WY PPO |
$161.00
|
| Rate for Payer: PacificSource Commercial |
$147.86
|
| Rate for Payer: PHCS PPO |
$161.00
|
| Rate for Payer: Three Rivers PPO |
$123.22
|
| Rate for Payer: TriWest Veterans Administration |
$93.65
|
| Rate for Payer: United Healthcare Commercial |
$156.90
|
| Rate for Payer: United Healthcare Medicare |
$93.65
|
| Rate for Payer: WINHealth Partners Commercial |
$161.00
|
| Rate for Payer: Wise Provider Network Commercial |
$156.08
|
|
|
AQUAPLAST 3/32" 18X24 CHARCOAL
|
Facility
|
OP
|
$166.52
|
|
| Hospital Charge Code |
2250166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.19
|
| Rate for Payer: Aetna of WY Medicare |
$109.90
|
| Rate for Payer: Altius Commercial |
$159.86
|
| Rate for Payer: Beech Street Commercial |
$163.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.52
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.52
|
| Rate for Payer: Cigna of WY Commercial |
$163.19
|
| Rate for Payer: Entrust Commercial |
$158.19
|
| Rate for Payer: First Choice Health Commercial |
$158.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$94.92
|
| Rate for Payer: HealthUtah PPO |
$166.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.52
|
| Rate for Payer: Multiplan Medicare/VA |
$90.17
|
| Rate for Payer: One Health Plan of WY PPO |
$163.19
|
| Rate for Payer: PacificSource Commercial |
$149.87
|
| Rate for Payer: PHCS PPO |
$163.19
|
| Rate for Payer: Three Rivers PPO |
$124.89
|
| Rate for Payer: TriWest Veterans Administration |
$94.92
|
| Rate for Payer: United Healthcare Commercial |
$159.03
|
| Rate for Payer: United Healthcare Medicare |
$94.92
|
| Rate for Payer: WINHealth Partners Commercial |
$163.19
|
| Rate for Payer: Wise Provider Network Commercial |
$158.19
|
|
|
AQUAPLAST 3/32" 18X24 CHARCOAL
|
Facility
|
IP
|
$166.52
|
|
| Hospital Charge Code |
2250166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.50 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$163.19
|
| Rate for Payer: Aetna of WY Medicare |
$106.57
|
| Rate for Payer: Altius Commercial |
$159.86
|
| Rate for Payer: Beech Street Commercial |
$163.19
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$161.52
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$161.52
|
| Rate for Payer: Cigna of WY Commercial |
$163.19
|
| Rate for Payer: Entrust Commercial |
$158.19
|
| Rate for Payer: First Choice Health Commercial |
$158.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$158.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$101.58
|
| Rate for Payer: HealthUtah PPO |
$166.52
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$161.52
|
| Rate for Payer: Multiplan Medicare/VA |
$96.50
|
| Rate for Payer: One Health Plan of WY PPO |
$163.19
|
| Rate for Payer: PacificSource Commercial |
$149.87
|
| Rate for Payer: PHCS PPO |
$163.19
|
| Rate for Payer: Three Rivers PPO |
$124.89
|
| Rate for Payer: TriWest Veterans Administration |
$101.58
|
| Rate for Payer: United Healthcare Commercial |
$159.03
|
| Rate for Payer: United Healthcare Medicare |
$101.58
|
| Rate for Payer: WINHealth Partners Commercial |
$158.19
|
| Rate for Payer: Wise Provider Network Commercial |
$158.19
|
|
|
AQUILEX INFLOW TUBE
|
Facility
|
OP
|
$308.00
|
|
| Hospital Charge Code |
2450052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.78 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$203.28
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.76
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$175.56
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$166.78
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$175.56
|
| Rate for Payer: United Healthcare Commercial |
$294.14
|
| Rate for Payer: United Healthcare Medicare |
$175.56
|
| Rate for Payer: WINHealth Partners Commercial |
$301.84
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
AQUILEX INFLOW TUBE
|
Facility
|
IP
|
$308.00
|
|
| Hospital Charge Code |
2450052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$197.12
|
| Rate for Payer: Altius Commercial |
$295.68
|
| Rate for Payer: Beech Street Commercial |
$301.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$298.76
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$298.76
|
| Rate for Payer: Cigna of WY Commercial |
$301.84
|
| Rate for Payer: Entrust Commercial |
$292.60
|
| Rate for Payer: First Choice Health Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$187.88
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$178.49
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$301.84
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$187.88
|
| Rate for Payer: United Healthcare Commercial |
$294.14
|
| Rate for Payer: United Healthcare Medicare |
$187.88
|
| Rate for Payer: WINHealth Partners Commercial |
$292.60
|
| Rate for Payer: Wise Provider Network Commercial |
$292.60
|
|
|
AQUILEX OUTFLOW TUBING
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
2450053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$36.96
|
| Rate for Payer: Altius Commercial |
$53.76
|
| Rate for Payer: Beech Street Commercial |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.32
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: Entrust Commercial |
$53.20
|
| Rate for Payer: First Choice Health Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.92
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$30.32
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$54.88
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$31.92
|
| Rate for Payer: United Healthcare Commercial |
$53.48
|
| Rate for Payer: United Healthcare Medicare |
$31.92
|
| Rate for Payer: WINHealth Partners Commercial |
$54.88
|
| Rate for Payer: Wise Provider Network Commercial |
$53.20
|
|
|
AQUILEX OUTFLOW TUBING
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
2450053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$54.88
|
| Rate for Payer: Aetna of WY Medicare |
$35.84
|
| Rate for Payer: Altius Commercial |
$53.76
|
| Rate for Payer: Beech Street Commercial |
$54.88
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.32
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.32
|
| Rate for Payer: Cigna of WY Commercial |
$54.88
|
| Rate for Payer: Entrust Commercial |
$53.20
|
| Rate for Payer: First Choice Health Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.16
|
| Rate for Payer: HealthUtah PPO |
$56.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.32
|
| Rate for Payer: Multiplan Medicare/VA |
$32.45
|
| Rate for Payer: One Health Plan of WY PPO |
$54.88
|
| Rate for Payer: PacificSource Commercial |
$50.40
|
| Rate for Payer: PHCS PPO |
$54.88
|
| Rate for Payer: Three Rivers PPO |
$42.00
|
| Rate for Payer: TriWest Veterans Administration |
$34.16
|
| Rate for Payer: United Healthcare Commercial |
$53.48
|
| Rate for Payer: United Healthcare Medicare |
$34.16
|
| Rate for Payer: WINHealth Partners Commercial |
$53.20
|
| Rate for Payer: Wise Provider Network Commercial |
$53.20
|
|
