|
BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [28964]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 6800147745
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
| Rate for Payer: Aetna of WY Medicare |
$0.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
| Rate for Payer: Altius Commercial |
$0.51
|
| Rate for Payer: Beech Street Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
| Rate for Payer: Cigna of WY Commercial |
$0.52
|
| Rate for Payer: Entrust Commercial |
$0.50
|
| Rate for Payer: First Choice Health Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.31
|
| Rate for Payer: HealthUtah PPO |
$0.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.29
|
| Rate for Payer: One Health Plan of WY PPO |
$0.52
|
| Rate for Payer: PacificSource Commercial |
$0.48
|
| Rate for Payer: PHCS PPO |
$0.52
|
| Rate for Payer: Three Rivers PPO |
$0.40
|
| Rate for Payer: TriWest Veterans Administration |
$0.31
|
| Rate for Payer: United Healthcare Commercial |
$0.46
|
| Rate for Payer: United Healthcare Medicare |
$0.31
|
| Rate for Payer: WINHealth Partners Commercial |
$0.52
|
| Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
|
BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [28964]
|
Facility
|
IP
|
$0.53
|
|
|
Service Code
|
NDC 4580206000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.51
|
| Rate for Payer: Altius Commercial |
$0.51
|
| Rate for Payer: Beech Street Commercial |
$0.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.44
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.51
|
| Rate for Payer: Cigna of WY Commercial |
$0.52
|
| Rate for Payer: Entrust Commercial |
$0.50
|
| Rate for Payer: First Choice Health Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.35
|
| Rate for Payer: HealthUtah PPO |
$0.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.51
|
| Rate for Payer: Multiplan Medicare/VA |
$0.33
|
| Rate for Payer: One Health Plan of WY PPO |
$0.52
|
| Rate for Payer: PacificSource Commercial |
$0.48
|
| Rate for Payer: PHCS PPO |
$0.52
|
| Rate for Payer: Three Rivers PPO |
$0.40
|
| Rate for Payer: TriWest Veterans Administration |
$0.35
|
| Rate for Payer: United Healthcare Commercial |
$0.46
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
| Rate for Payer: WINHealth Partners Commercial |
$0.50
|
| Rate for Payer: Wise Provider Network Commercial |
$0.50
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 5026810615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.99
|
| Rate for Payer: Altius Commercial |
$1.99
|
| Rate for Payer: Beech Street Commercial |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.01
|
| Rate for Payer: Cigna of WY Commercial |
$2.03
|
| Rate for Payer: Entrust Commercial |
$1.97
|
| Rate for Payer: First Choice Health Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.37
|
| Rate for Payer: HealthUtah PPO |
$2.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2.03
|
| Rate for Payer: PacificSource Commercial |
$1.86
|
| Rate for Payer: PHCS PPO |
$2.03
|
| Rate for Payer: Three Rivers PPO |
$1.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$1.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1.97
|
| Rate for Payer: Wise Provider Network Commercial |
$1.97
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 6808485501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Aetna of WY Medicare |
$1.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.19
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.98
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
| Rate for Payer: WINHealth Partners Commercial |
$2.23
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 5026810615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.03
|
| Rate for Payer: Aetna of WY Medicare |
$1.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.99
|
| Rate for Payer: Altius Commercial |
$1.99
|
| Rate for Payer: Beech Street Commercial |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.01
|
| Rate for Payer: Cigna of WY Commercial |
$2.03
|
| Rate for Payer: Entrust Commercial |
$1.97
|
| Rate for Payer: First Choice Health Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$2.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2.03
|
| Rate for Payer: PacificSource Commercial |
$1.86
|
| Rate for Payer: PHCS PPO |
$2.03
|
| Rate for Payer: Three Rivers PPO |
$1.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.97
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 6808485501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.19
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.50
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.98
|
| Rate for Payer: United Healthcare Medicare |
$1.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2.17
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 5026810611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.03
|
| Rate for Payer: Aetna of WY Medicare |
$1.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.99
|
| Rate for Payer: Altius Commercial |
$1.99
|
| Rate for Payer: Beech Street Commercial |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.01
|
| Rate for Payer: Cigna of WY Commercial |
$2.03
|
| Rate for Payer: Entrust Commercial |
$1.97
|
| Rate for Payer: First Choice Health Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$2.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$2.03
|
| Rate for Payer: PacificSource Commercial |
$1.86
|
| Rate for Payer: PHCS PPO |
$2.03
|
| Rate for Payer: Three Rivers PPO |
$1.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$2.03
|
| Rate for Payer: Wise Provider Network Commercial |
$1.97
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 6808485511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Aetna of WY Medicare |
$1.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.19
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.32
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.98
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
| Rate for Payer: WINHealth Partners Commercial |
$2.23
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 6808485511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.19
|
| Rate for Payer: Altius Commercial |
$2.19
|
| Rate for Payer: Beech Street Commercial |
$2.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.87
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.21
|
| Rate for Payer: Cigna of WY Commercial |
$2.23
|
| Rate for Payer: Entrust Commercial |
$2.17
|
| Rate for Payer: First Choice Health Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.50
|
| Rate for Payer: HealthUtah PPO |
$2.28
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.21
|
| Rate for Payer: Multiplan Medicare/VA |
$1.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2.23
|
| Rate for Payer: PacificSource Commercial |
$2.05
|
| Rate for Payer: PHCS PPO |
$2.23
|
| Rate for Payer: Three Rivers PPO |
$1.71
|
| Rate for Payer: TriWest Veterans Administration |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.98
|
| Rate for Payer: United Healthcare Medicare |
$1.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2.17
|
| Rate for Payer: Wise Provider Network Commercial |
$2.17
|
|
|
BACLOFEN 10 MG TABLET [11710]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 5026810611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.99
|
| Rate for Payer: Altius Commercial |
$1.99
|
| Rate for Payer: Beech Street Commercial |
$2.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.70
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.01
|
| Rate for Payer: Cigna of WY Commercial |
$2.03
|
| Rate for Payer: Entrust Commercial |
$1.97
|
| Rate for Payer: First Choice Health Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.37
|
| Rate for Payer: HealthUtah PPO |
$2.07
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.01
|
| Rate for Payer: Multiplan Medicare/VA |
$1.30
|
| Rate for Payer: One Health Plan of WY PPO |
$2.03
|
| Rate for Payer: PacificSource Commercial |
$1.86
|
| Rate for Payer: PHCS PPO |
$2.03
|
| Rate for Payer: Three Rivers PPO |
$1.55
|
| Rate for Payer: TriWest Veterans Administration |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Medicare |
$1.37
|
| Rate for Payer: WINHealth Partners Commercial |
$1.97
|
| Rate for Payer: Wise Provider Network Commercial |
$1.97
|
|
|
BACLOFEN 40,000 MCG/20 ML (2,000 MCG/ML) INTRATHECAL SOLUTION [91337]
|
Facility
|
IP
|
$47.30
|
|
|
Service Code
|
HCPCS J0475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$47.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.41
|
| Rate for Payer: Altius Commercial |
$45.41
|
| Rate for Payer: Beech Street Commercial |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.83
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.88
|
| Rate for Payer: Cigna of WY Commercial |
$46.35
|
| Rate for Payer: Entrust Commercial |
$44.94
|
| Rate for Payer: First Choice Health Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.22
|
| Rate for Payer: HealthUtah PPO |
$47.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.88
|
| Rate for Payer: Multiplan Medicare/VA |
$29.66
|
| Rate for Payer: One Health Plan of WY PPO |
$46.35
|
| Rate for Payer: PacificSource Commercial |
$42.57
|
| Rate for Payer: PHCS PPO |
$46.35
|
| Rate for Payer: Three Rivers PPO |
$35.48
|
| Rate for Payer: TriWest Veterans Administration |
$31.22
|
| Rate for Payer: United Healthcare Commercial |
$41.15
|
| Rate for Payer: United Healthcare Medicare |
$31.22
|
| Rate for Payer: WINHealth Partners Commercial |
$44.94
|
| Rate for Payer: Wise Provider Network Commercial |
$44.94
|
|
|
BACLOFEN 40,000 MCG/20 ML (2,000 MCG/ML) INTRATHECAL SOLUTION [91337]
|
Facility
|
OP
|
$47.30
|
|
|
Service Code
|
HCPCS J0475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$47.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.35
|
| Rate for Payer: Aetna of WY Medicare |
$31.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$45.41
|
| Rate for Payer: Altius Commercial |
$45.41
|
| Rate for Payer: Beech Street Commercial |
$46.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.83
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.88
|
| Rate for Payer: Cigna of WY Commercial |
$46.35
|
| Rate for Payer: Entrust Commercial |
$44.94
|
| Rate for Payer: First Choice Health Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.43
|
| Rate for Payer: HealthUtah PPO |
$47.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.88
|
| Rate for Payer: Multiplan Medicare/VA |
$26.06
|
| Rate for Payer: One Health Plan of WY PPO |
$46.35
|
| Rate for Payer: PacificSource Commercial |
$42.57
|
| Rate for Payer: PHCS PPO |
$46.35
|
| Rate for Payer: Three Rivers PPO |
$35.48
|
| Rate for Payer: TriWest Veterans Administration |
$27.43
|
| Rate for Payer: United Healthcare Commercial |
$41.15
|
| Rate for Payer: United Healthcare Medicare |
$27.43
|
| Rate for Payer: WINHealth Partners Commercial |
$46.35
|
| Rate for Payer: Wise Provider Network Commercial |
$44.94
|
|
|
BACTISURE WOUND LAVAGE
|
Facility
|
OP
|
$2,599.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,432.16 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,547.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,715.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,495.23
|
| Rate for Payer: Altius Commercial |
$2,495.23
|
| Rate for Payer: Beech Street Commercial |
$2,547.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,133.94
|
| Rate for Payer: Cash Price |
$1,819.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,521.22
|
| Rate for Payer: Cigna of WY Commercial |
$2,547.22
|
| Rate for Payer: Entrust Commercial |
$2,469.24
|
| Rate for Payer: First Choice Health Commercial |
$2,469.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,469.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,507.54
|
| Rate for Payer: HealthUtah PPO |
$2,599.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,521.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1,432.16
|
| Rate for Payer: One Health Plan of WY PPO |
$2,547.22
|
| Rate for Payer: PacificSource Commercial |
$2,339.28
|
| Rate for Payer: PHCS PPO |
$2,547.22
|
| Rate for Payer: Three Rivers PPO |
$1,949.40
|
| Rate for Payer: TriWest Veterans Administration |
$1,507.54
|
| Rate for Payer: United Healthcare Commercial |
$2,261.30
|
| Rate for Payer: United Healthcare Medicare |
$1,507.54
|
| Rate for Payer: WINHealth Partners Commercial |
$2,547.22
|
| Rate for Payer: Wise Provider Network Commercial |
$2,469.24
|
|
|
BACTISURE WOUND LAVAGE
|
Facility
|
IP
|
$2,599.20
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,629.70 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,547.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,495.23
|
| Rate for Payer: Altius Commercial |
$2,495.23
|
| Rate for Payer: Beech Street Commercial |
$2,547.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,133.94
|
| Rate for Payer: Cash Price |
$1,819.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,521.22
|
| Rate for Payer: Cigna of WY Commercial |
$2,547.22
|
| Rate for Payer: Entrust Commercial |
$2,469.24
|
| Rate for Payer: First Choice Health Commercial |
$2,469.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,469.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,715.47
|
| Rate for Payer: HealthUtah PPO |
$2,599.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,521.22
|
| Rate for Payer: Multiplan Medicare/VA |
$1,629.70
|
| Rate for Payer: One Health Plan of WY PPO |
$2,547.22
|
| Rate for Payer: PacificSource Commercial |
$2,339.28
|
| Rate for Payer: PHCS PPO |
$2,547.22
|
| Rate for Payer: Three Rivers PPO |
$1,949.40
|
| Rate for Payer: TriWest Veterans Administration |
$1,715.47
|
| Rate for Payer: United Healthcare Commercial |
$2,261.30
|
| Rate for Payer: United Healthcare Medicare |
$1,715.47
|
| Rate for Payer: WINHealth Partners Commercial |
$2,469.24
|
| Rate for Payer: Wise Provider Network Commercial |
$2,469.24
|
|
|
BAG STERILE ELASTIC BAND 30" X 36"
|
Facility
|
OP
|
$8.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.80
|
| Rate for Payer: Aetna of WY Medicare |
$5.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.62
|
| Rate for Payer: Altius Commercial |
$8.62
|
| Rate for Payer: Beech Street Commercial |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.71
|
| Rate for Payer: Cigna of WY Commercial |
$8.80
|
| Rate for Payer: Entrust Commercial |
$8.53
|
| Rate for Payer: First Choice Health Commercial |
$8.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.21
|
| Rate for Payer: HealthUtah PPO |
$8.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.71
|
| Rate for Payer: Multiplan Medicare/VA |
$4.95
|
| Rate for Payer: One Health Plan of WY PPO |
$8.80
|
| Rate for Payer: PacificSource Commercial |
$8.08
|
| Rate for Payer: PHCS PPO |
$8.80
|
| Rate for Payer: Three Rivers PPO |
$6.74
|
| Rate for Payer: TriWest Veterans Administration |
$5.21
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
| Rate for Payer: United Healthcare Medicare |
$5.21
|
| Rate for Payer: WINHealth Partners Commercial |
$8.80
|
| Rate for Payer: Wise Provider Network Commercial |
$8.53
|
|
|
BAG STERILE ELASTIC BAND 30" X 36"
|
Facility
|
IP
|
$8.98
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$8.98 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.62
|
| Rate for Payer: Altius Commercial |
$8.62
|
| Rate for Payer: Beech Street Commercial |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$6.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.71
|
| Rate for Payer: Cigna of WY Commercial |
$8.80
|
| Rate for Payer: Entrust Commercial |
$8.53
|
| Rate for Payer: First Choice Health Commercial |
$8.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.93
|
| Rate for Payer: HealthUtah PPO |
$8.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.71
|
| Rate for Payer: Multiplan Medicare/VA |
$5.63
|
| Rate for Payer: One Health Plan of WY PPO |
$8.80
|
| Rate for Payer: PacificSource Commercial |
$8.08
|
| Rate for Payer: PHCS PPO |
$8.80
|
| Rate for Payer: Three Rivers PPO |
$6.74
|
| Rate for Payer: TriWest Veterans Administration |
$5.93
|
| Rate for Payer: United Healthcare Commercial |
$7.81
|
| Rate for Payer: United Healthcare Medicare |
$5.93
|
| Rate for Payer: WINHealth Partners Commercial |
$8.53
|
| Rate for Payer: Wise Provider Network Commercial |
$8.53
|
|
|
BAG STERILE ELASTIC BAND 36" X 36"
|
Facility
|
IP
|
$10.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.78
|
| Rate for Payer: Altius Commercial |
$9.78
|
| Rate for Payer: Beech Street Commercial |
$9.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.37
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.88
|
| Rate for Payer: Cigna of WY Commercial |
$9.99
|
| Rate for Payer: Entrust Commercial |
$9.68
|
| Rate for Payer: First Choice Health Commercial |
$9.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.73
|
| Rate for Payer: HealthUtah PPO |
$10.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.88
|
| Rate for Payer: Multiplan Medicare/VA |
$6.39
|
| Rate for Payer: One Health Plan of WY PPO |
$9.99
|
| Rate for Payer: PacificSource Commercial |
$9.17
|
| Rate for Payer: PHCS PPO |
$9.99
|
| Rate for Payer: Three Rivers PPO |
$7.64
|
| Rate for Payer: TriWest Veterans Administration |
$6.73
|
| Rate for Payer: United Healthcare Commercial |
$8.87
|
| Rate for Payer: United Healthcare Medicare |
$6.73
|
| Rate for Payer: WINHealth Partners Commercial |
$9.68
|
| Rate for Payer: Wise Provider Network Commercial |
$9.68
|
|
|
BAG STERILE ELASTIC BAND 36" X 36"
|
Facility
|
OP
|
$10.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.99
|
| Rate for Payer: Aetna of WY Medicare |
$6.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.78
|
| Rate for Payer: Altius Commercial |
$9.78
|
| Rate for Payer: Beech Street Commercial |
$9.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.37
|
| Rate for Payer: Cash Price |
$7.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.88
|
| Rate for Payer: Cigna of WY Commercial |
$9.99
|
| Rate for Payer: Entrust Commercial |
$9.68
|
| Rate for Payer: First Choice Health Commercial |
$9.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.91
|
| Rate for Payer: HealthUtah PPO |
$10.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.88
|
| Rate for Payer: Multiplan Medicare/VA |
$5.61
|
| Rate for Payer: One Health Plan of WY PPO |
$9.99
|
| Rate for Payer: PacificSource Commercial |
$9.17
|
| Rate for Payer: PHCS PPO |
$9.99
|
| Rate for Payer: Three Rivers PPO |
$7.64
|
| Rate for Payer: TriWest Veterans Administration |
$5.91
|
| Rate for Payer: United Healthcare Commercial |
$8.87
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
| Rate for Payer: WINHealth Partners Commercial |
$9.99
|
| Rate for Payer: Wise Provider Network Commercial |
$9.68
|
|
|
BAG STERILE ELASTIC BAND 48" X 48"
|
Facility
|
OP
|
$10.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.59
|
| Rate for Payer: Aetna of WY Medicare |
$7.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.38
|
| Rate for Payer: Altius Commercial |
$10.38
|
| Rate for Payer: Beech Street Commercial |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.88
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.49
|
| Rate for Payer: Cigna of WY Commercial |
$10.59
|
| Rate for Payer: Entrust Commercial |
$10.27
|
| Rate for Payer: First Choice Health Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.27
|
| Rate for Payer: HealthUtah PPO |
$10.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.49
|
| Rate for Payer: Multiplan Medicare/VA |
$5.96
|
| Rate for Payer: One Health Plan of WY PPO |
$10.59
|
| Rate for Payer: PacificSource Commercial |
$9.73
|
| Rate for Payer: PHCS PPO |
$10.59
|
| Rate for Payer: Three Rivers PPO |
$8.11
|
| Rate for Payer: TriWest Veterans Administration |
$6.27
|
| Rate for Payer: United Healthcare Commercial |
$9.40
|
| Rate for Payer: United Healthcare Medicare |
$6.27
|
| Rate for Payer: WINHealth Partners Commercial |
$10.59
|
| Rate for Payer: Wise Provider Network Commercial |
$10.27
|
|
|
BAG STERILE ELASTIC BAND 48" X 48"
|
Facility
|
IP
|
$10.81
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$10.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.38
|
| Rate for Payer: Altius Commercial |
$10.38
|
| Rate for Payer: Beech Street Commercial |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.88
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.49
|
| Rate for Payer: Cigna of WY Commercial |
$10.59
|
| Rate for Payer: Entrust Commercial |
$10.27
|
| Rate for Payer: First Choice Health Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.27
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.13
|
| Rate for Payer: HealthUtah PPO |
$10.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.49
|
| Rate for Payer: Multiplan Medicare/VA |
$6.78
|
| Rate for Payer: One Health Plan of WY PPO |
$10.59
|
| Rate for Payer: PacificSource Commercial |
$9.73
|
| Rate for Payer: PHCS PPO |
$10.59
|
| Rate for Payer: Three Rivers PPO |
$8.11
|
| Rate for Payer: TriWest Veterans Administration |
$7.13
|
| Rate for Payer: United Healthcare Commercial |
$9.40
|
| Rate for Payer: United Healthcare Medicare |
$7.13
|
| Rate for Payer: WINHealth Partners Commercial |
$10.27
|
| Rate for Payer: Wise Provider Network Commercial |
$10.27
|
|
|
BAIR HUGGER FULL BODY
|
Facility
|
OP
|
$16.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.69
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.48
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$9.00
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.48
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$9.48
|
| Rate for Payer: WINHealth Partners Commercial |
$16.01
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
BAIR HUGGER FULL BODY
|
Facility
|
IP
|
$16.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.69
|
| Rate for Payer: Altius Commercial |
$15.69
|
| Rate for Payer: Beech Street Commercial |
$16.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.85
|
| Rate for Payer: Cigna of WY Commercial |
$16.01
|
| Rate for Payer: Entrust Commercial |
$15.52
|
| Rate for Payer: First Choice Health Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.78
|
| Rate for Payer: HealthUtah PPO |
$16.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.85
|
| Rate for Payer: Multiplan Medicare/VA |
$10.25
|
| Rate for Payer: One Health Plan of WY PPO |
$16.01
|
| Rate for Payer: PacificSource Commercial |
$14.71
|
| Rate for Payer: PHCS PPO |
$16.01
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Medicare |
$10.78
|
| Rate for Payer: WINHealth Partners Commercial |
$15.52
|
| Rate for Payer: Wise Provider Network Commercial |
$15.52
|
|
|
BAIR HUGGER FULL UNDER BODY
|
Facility
|
IP
|
$84.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$84.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.67
|
| Rate for Payer: Altius Commercial |
$80.67
|
| Rate for Payer: Beech Street Commercial |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.99
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.51
|
| Rate for Payer: Cigna of WY Commercial |
$82.35
|
| Rate for Payer: Entrust Commercial |
$79.83
|
| Rate for Payer: First Choice Health Commercial |
$79.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$55.46
|
| Rate for Payer: HealthUtah PPO |
$84.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.51
|
| Rate for Payer: Multiplan Medicare/VA |
$52.69
|
| Rate for Payer: One Health Plan of WY PPO |
$82.35
|
| Rate for Payer: PacificSource Commercial |
$75.63
|
| Rate for Payer: PHCS PPO |
$82.35
|
| Rate for Payer: Three Rivers PPO |
$63.02
|
| Rate for Payer: TriWest Veterans Administration |
$55.46
|
| Rate for Payer: United Healthcare Commercial |
$73.11
|
| Rate for Payer: United Healthcare Medicare |
$55.46
|
| Rate for Payer: WINHealth Partners Commercial |
$79.83
|
| Rate for Payer: Wise Provider Network Commercial |
$79.83
|
|
|
BAIR HUGGER FULL UNDER BODY
|
Facility
|
OP
|
$84.03
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$84.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$82.35
|
| Rate for Payer: Aetna of WY Medicare |
$55.46
|
| Rate for Payer: Altius Auto/Workers Compensation |
$80.67
|
| Rate for Payer: Altius Commercial |
$80.67
|
| Rate for Payer: Beech Street Commercial |
$82.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$68.99
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$81.51
|
| Rate for Payer: Cigna of WY Commercial |
$82.35
|
| Rate for Payer: Entrust Commercial |
$79.83
|
| Rate for Payer: First Choice Health Commercial |
$79.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$79.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.74
|
| Rate for Payer: HealthUtah PPO |
$84.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$81.51
|
| Rate for Payer: Multiplan Medicare/VA |
$46.30
|
| Rate for Payer: One Health Plan of WY PPO |
$82.35
|
| Rate for Payer: PacificSource Commercial |
$75.63
|
| Rate for Payer: PHCS PPO |
$82.35
|
| Rate for Payer: Three Rivers PPO |
$63.02
|
| Rate for Payer: TriWest Veterans Administration |
$48.74
|
| Rate for Payer: United Healthcare Commercial |
$73.11
|
| Rate for Payer: United Healthcare Medicare |
$48.74
|
| Rate for Payer: WINHealth Partners Commercial |
$82.35
|
| Rate for Payer: Wise Provider Network Commercial |
$79.83
|
|
|
BAIR HUGGER LOWER BODY
|
Facility
|
IP
|
$15.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.14
|
| Rate for Payer: Altius Commercial |
$15.14
|
| Rate for Payer: Beech Street Commercial |
$15.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.95
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.30
|
| Rate for Payer: Cigna of WY Commercial |
$15.45
|
| Rate for Payer: Entrust Commercial |
$14.98
|
| Rate for Payer: First Choice Health Commercial |
$14.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.41
|
| Rate for Payer: HealthUtah PPO |
$15.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.30
|
| Rate for Payer: Multiplan Medicare/VA |
$9.89
|
| Rate for Payer: One Health Plan of WY PPO |
$15.45
|
| Rate for Payer: PacificSource Commercial |
$14.19
|
| Rate for Payer: PHCS PPO |
$15.45
|
| Rate for Payer: Three Rivers PPO |
$11.83
|
| Rate for Payer: TriWest Veterans Administration |
$10.41
|
| Rate for Payer: United Healthcare Commercial |
$13.72
|
| Rate for Payer: United Healthcare Medicare |
$10.41
|
| Rate for Payer: WINHealth Partners Commercial |
$14.98
|
| Rate for Payer: Wise Provider Network Commercial |
$14.98
|
|
