|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [5025]
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
NDC 5167213103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.65
|
| Rate for Payer: Altius Commercial |
$3.65
|
| Rate for Payer: Beech Street Commercial |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.69
|
| Rate for Payer: Cigna of WY Commercial |
$3.72
|
| Rate for Payer: Entrust Commercial |
$3.61
|
| Rate for Payer: First Choice Health Commercial |
$3.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.51
|
| Rate for Payer: HealthUtah PPO |
$3.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.69
|
| Rate for Payer: Multiplan Medicare/VA |
$2.38
|
| Rate for Payer: One Health Plan of WY PPO |
$3.72
|
| Rate for Payer: PacificSource Commercial |
$3.42
|
| Rate for Payer: PHCS PPO |
$3.72
|
| Rate for Payer: Three Rivers PPO |
$2.85
|
| Rate for Payer: TriWest Veterans Administration |
$2.51
|
| Rate for Payer: United Healthcare Commercial |
$3.31
|
| Rate for Payer: United Healthcare Medicare |
$2.51
|
| Rate for Payer: WINHealth Partners Commercial |
$3.61
|
| Rate for Payer: Wise Provider Network Commercial |
$3.61
|
|
|
BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM [5025]
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
NDC 5167213103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.72
|
| Rate for Payer: Aetna of WY Medicare |
$2.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$3.65
|
| Rate for Payer: Altius Commercial |
$3.65
|
| Rate for Payer: Beech Street Commercial |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.69
|
| Rate for Payer: Cigna of WY Commercial |
$3.72
|
| Rate for Payer: Entrust Commercial |
$3.61
|
| Rate for Payer: First Choice Health Commercial |
$3.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.20
|
| Rate for Payer: HealthUtah PPO |
$3.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.69
|
| Rate for Payer: Multiplan Medicare/VA |
$2.09
|
| Rate for Payer: One Health Plan of WY PPO |
$3.72
|
| Rate for Payer: PacificSource Commercial |
$3.42
|
| Rate for Payer: PHCS PPO |
$3.72
|
| Rate for Payer: Three Rivers PPO |
$2.85
|
| Rate for Payer: TriWest Veterans Administration |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$3.31
|
| Rate for Payer: United Healthcare Medicare |
$2.20
|
| Rate for Payer: WINHealth Partners Commercial |
$3.72
|
| Rate for Payer: Wise Provider Network Commercial |
$3.61
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [18420]
|
Facility
|
OP
|
$7.03
|
|
|
Service Code
|
NDC 0472038145
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.89
|
| Rate for Payer: Aetna of WY Medicare |
$4.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.75
|
| Rate for Payer: Altius Commercial |
$6.75
|
| Rate for Payer: Beech Street Commercial |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.82
|
| Rate for Payer: Cigna of WY Commercial |
$6.89
|
| Rate for Payer: Entrust Commercial |
$6.68
|
| Rate for Payer: First Choice Health Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.08
|
| Rate for Payer: HealthUtah PPO |
$7.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.82
|
| Rate for Payer: Multiplan Medicare/VA |
$3.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6.89
|
| Rate for Payer: PacificSource Commercial |
$6.33
|
| Rate for Payer: PHCS PPO |
$6.89
|
| Rate for Payer: Three Rivers PPO |
$5.27
|
| Rate for Payer: TriWest Veterans Administration |
$4.08
|
| Rate for Payer: United Healthcare Commercial |
$6.12
|
| Rate for Payer: United Healthcare Medicare |
$4.08
|
| Rate for Payer: WINHealth Partners Commercial |
$6.89
|
| Rate for Payer: Wise Provider Network Commercial |
$6.68
|
|
|
BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL OINTMENT [18420]
|
Facility
|
IP
|
$7.03
|
|
|
Service Code
|
NDC 0472038145
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$6.75
|
| Rate for Payer: Altius Commercial |
$6.75
|
| Rate for Payer: Beech Street Commercial |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.82
|
| Rate for Payer: Cigna of WY Commercial |
$6.89
|
| Rate for Payer: Entrust Commercial |
$6.68
|
| Rate for Payer: First Choice Health Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.64
|
| Rate for Payer: HealthUtah PPO |
$7.03
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.82
|
| Rate for Payer: Multiplan Medicare/VA |
$4.41
|
| Rate for Payer: One Health Plan of WY PPO |
$6.89
|
| Rate for Payer: PacificSource Commercial |
$6.33
|
| Rate for Payer: PHCS PPO |
$6.89
|
| Rate for Payer: Three Rivers PPO |
$5.27
|
| Rate for Payer: TriWest Veterans Administration |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$6.12
|
| Rate for Payer: United Healthcare Medicare |
$4.64
|
| Rate for Payer: WINHealth Partners Commercial |
$6.68
|
| Rate for Payer: Wise Provider Network Commercial |
$6.68
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION [156345]
|
Facility
|
OP
|
$245.02
|
|
|
Service Code
|
HCPCS Q5118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$245.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.12
|
| Rate for Payer: Aetna of WY Medicare |
$161.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.22
|
| Rate for Payer: Altius Commercial |
$235.22
|
| Rate for Payer: Beech Street Commercial |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.16
|
| Rate for Payer: Cash Price |
$171.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.67
|
| Rate for Payer: Cigna of WY Commercial |
$240.12
|
| Rate for Payer: Entrust Commercial |
$232.77
|
| Rate for Payer: First Choice Health Commercial |
$232.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$142.11
|
| Rate for Payer: HealthUtah PPO |
$245.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.67
|
| Rate for Payer: Multiplan Medicare/VA |
$135.01
|
| Rate for Payer: One Health Plan of WY PPO |
$240.12
|
| Rate for Payer: PacificSource Commercial |
$220.52
|
| Rate for Payer: PHCS PPO |
$240.12
|
| Rate for Payer: Three Rivers PPO |
$183.76
|
| Rate for Payer: TriWest Veterans Administration |
$142.11
|
| Rate for Payer: United Healthcare Commercial |
$213.17
|
| Rate for Payer: United Healthcare Medicare |
$142.11
|
| Rate for Payer: WINHealth Partners Commercial |
$240.12
|
| Rate for Payer: Wise Provider Network Commercial |
$232.77
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION [156345]
|
Facility
|
IP
|
$245.02
|
|
|
Service Code
|
HCPCS Q5118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.63 |
| Max. Negotiated Rate |
$245.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$240.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$235.22
|
| Rate for Payer: Altius Commercial |
$235.22
|
| Rate for Payer: Beech Street Commercial |
$240.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.16
|
| Rate for Payer: Cash Price |
$171.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$237.67
|
| Rate for Payer: Cigna of WY Commercial |
$240.12
|
| Rate for Payer: Entrust Commercial |
$232.77
|
| Rate for Payer: First Choice Health Commercial |
$232.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$232.77
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$161.71
|
| Rate for Payer: HealthUtah PPO |
$245.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$237.67
|
| Rate for Payer: Multiplan Medicare/VA |
$153.63
|
| Rate for Payer: One Health Plan of WY PPO |
$240.12
|
| Rate for Payer: PacificSource Commercial |
$220.52
|
| Rate for Payer: PHCS PPO |
$240.12
|
| Rate for Payer: Three Rivers PPO |
$183.76
|
| Rate for Payer: TriWest Veterans Administration |
$161.71
|
| Rate for Payer: United Healthcare Commercial |
$213.17
|
| Rate for Payer: United Healthcare Medicare |
$161.71
|
| Rate for Payer: WINHealth Partners Commercial |
$232.77
|
| Rate for Payer: Wise Provider Network Commercial |
$232.77
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [147183]
|
Facility
|
IP
|
$181.25
|
|
|
Service Code
|
HCPCS J0565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$181.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$177.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$174.00
|
| Rate for Payer: Altius Commercial |
$174.00
|
| Rate for Payer: Beech Street Commercial |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.81
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$175.81
|
| Rate for Payer: Cigna of WY Commercial |
$177.62
|
| Rate for Payer: Entrust Commercial |
$172.19
|
| Rate for Payer: First Choice Health Commercial |
$172.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$119.62
|
| Rate for Payer: HealthUtah PPO |
$181.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$175.81
|
| Rate for Payer: Multiplan Medicare/VA |
$113.64
|
| Rate for Payer: One Health Plan of WY PPO |
$177.62
|
| Rate for Payer: PacificSource Commercial |
$163.12
|
| Rate for Payer: PHCS PPO |
$177.62
|
| Rate for Payer: Three Rivers PPO |
$135.94
|
| Rate for Payer: TriWest Veterans Administration |
$119.62
|
| Rate for Payer: United Healthcare Commercial |
$157.69
|
| Rate for Payer: United Healthcare Medicare |
$119.62
|
| Rate for Payer: WINHealth Partners Commercial |
$172.19
|
| Rate for Payer: Wise Provider Network Commercial |
$172.19
|
|
|
BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION [147183]
|
Facility
|
OP
|
$181.25
|
|
|
Service Code
|
HCPCS J0565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.87 |
| Max. Negotiated Rate |
$181.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$177.62
|
| Rate for Payer: Aetna of WY Medicare |
$119.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$174.00
|
| Rate for Payer: Altius Commercial |
$174.00
|
| Rate for Payer: Beech Street Commercial |
$177.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$148.81
|
| Rate for Payer: Cash Price |
$126.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$175.81
|
| Rate for Payer: Cigna of WY Commercial |
$177.62
|
| Rate for Payer: Entrust Commercial |
$172.19
|
| Rate for Payer: First Choice Health Commercial |
$172.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$172.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$105.12
|
| Rate for Payer: HealthUtah PPO |
$181.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$175.81
|
| Rate for Payer: Multiplan Medicare/VA |
$99.87
|
| Rate for Payer: One Health Plan of WY PPO |
$177.62
|
| Rate for Payer: PacificSource Commercial |
$163.12
|
| Rate for Payer: PHCS PPO |
$177.62
|
| Rate for Payer: Three Rivers PPO |
$135.94
|
| Rate for Payer: TriWest Veterans Administration |
$105.12
|
| Rate for Payer: United Healthcare Commercial |
$157.69
|
| Rate for Payer: United Healthcare Medicare |
$105.12
|
| Rate for Payer: WINHealth Partners Commercial |
$177.62
|
| Rate for Payer: Wise Provider Network Commercial |
$172.19
|
|
|
BICEP BUTTON DRILL PIN AR-2263
|
Facility
|
IP
|
$470.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.77 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.32
|
| Rate for Payer: Altius Commercial |
$451.32
|
| Rate for Payer: Beech Street Commercial |
$460.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.97
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$456.02
|
| Rate for Payer: Cigna of WY Commercial |
$460.72
|
| Rate for Payer: Entrust Commercial |
$446.61
|
| Rate for Payer: First Choice Health Commercial |
$446.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$310.28
|
| Rate for Payer: HealthUtah PPO |
$470.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$456.02
|
| Rate for Payer: Multiplan Medicare/VA |
$294.77
|
| Rate for Payer: One Health Plan of WY PPO |
$460.72
|
| Rate for Payer: PacificSource Commercial |
$423.11
|
| Rate for Payer: PHCS PPO |
$460.72
|
| Rate for Payer: Three Rivers PPO |
$352.59
|
| Rate for Payer: TriWest Veterans Administration |
$310.28
|
| Rate for Payer: United Healthcare Commercial |
$409.00
|
| Rate for Payer: United Healthcare Medicare |
$310.28
|
| Rate for Payer: WINHealth Partners Commercial |
$446.61
|
| Rate for Payer: Wise Provider Network Commercial |
$446.61
|
|
|
BICEP BUTTON DRILL PIN AR-2263
|
Facility
|
OP
|
$470.12
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.04 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.72
|
| Rate for Payer: Aetna of WY Medicare |
$310.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$451.32
|
| Rate for Payer: Altius Commercial |
$451.32
|
| Rate for Payer: Beech Street Commercial |
$460.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$385.97
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$456.02
|
| Rate for Payer: Cigna of WY Commercial |
$460.72
|
| Rate for Payer: Entrust Commercial |
$446.61
|
| Rate for Payer: First Choice Health Commercial |
$446.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$272.67
|
| Rate for Payer: HealthUtah PPO |
$470.12
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$456.02
|
| Rate for Payer: Multiplan Medicare/VA |
$259.04
|
| Rate for Payer: One Health Plan of WY PPO |
$460.72
|
| Rate for Payer: PacificSource Commercial |
$423.11
|
| Rate for Payer: PHCS PPO |
$460.72
|
| Rate for Payer: Three Rivers PPO |
$352.59
|
| Rate for Payer: TriWest Veterans Administration |
$272.67
|
| Rate for Payer: United Healthcare Commercial |
$409.00
|
| Rate for Payer: United Healthcare Medicare |
$272.67
|
| Rate for Payer: WINHealth Partners Commercial |
$460.72
|
| Rate for Payer: Wise Provider Network Commercial |
$446.61
|
|
|
BICEPS BUTTON AR-2261
|
Facility
|
OP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.48 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Aetna of WY Medicare |
$795.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$699.46
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$664.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$699.46
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$699.46
|
| Rate for Payer: WINHealth Partners Commercial |
$1,181.84
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
BICEPS BUTTON AR-2261
|
Facility
|
IP
|
$1,205.96
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$756.14 |
| Max. Negotiated Rate |
$1,205.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,181.84
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,157.72
|
| Rate for Payer: Altius Commercial |
$1,157.72
|
| Rate for Payer: Beech Street Commercial |
$1,181.84
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$990.09
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,169.78
|
| Rate for Payer: Cigna of WY Commercial |
$1,181.84
|
| Rate for Payer: Entrust Commercial |
$1,145.66
|
| Rate for Payer: First Choice Health Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,145.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$795.93
|
| Rate for Payer: HealthUtah PPO |
$1,205.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,169.78
|
| Rate for Payer: Multiplan Medicare/VA |
$756.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1,181.84
|
| Rate for Payer: PacificSource Commercial |
$1,085.36
|
| Rate for Payer: PHCS PPO |
$1,181.84
|
| Rate for Payer: Three Rivers PPO |
$904.47
|
| Rate for Payer: TriWest Veterans Administration |
$795.93
|
| Rate for Payer: United Healthcare Commercial |
$1,049.19
|
| Rate for Payer: United Healthcare Medicare |
$795.93
|
| Rate for Payer: WINHealth Partners Commercial |
$1,145.66
|
| Rate for Payer: Wise Provider Network Commercial |
$1,145.66
|
|
|
BICEPS BUTTON INSERTER AR-2262
|
Facility
|
OP
|
$572.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.35 |
| Max. Negotiated Rate |
$572.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.87
|
| Rate for Payer: Aetna of WY Medicare |
$377.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$549.43
|
| Rate for Payer: Altius Commercial |
$549.43
|
| Rate for Payer: Beech Street Commercial |
$560.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$469.87
|
| Rate for Payer: Cash Price |
$400.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.15
|
| Rate for Payer: Cigna of WY Commercial |
$560.87
|
| Rate for Payer: Entrust Commercial |
$543.70
|
| Rate for Payer: First Choice Health Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$331.95
|
| Rate for Payer: HealthUtah PPO |
$572.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.15
|
| Rate for Payer: Multiplan Medicare/VA |
$315.35
|
| Rate for Payer: One Health Plan of WY PPO |
$560.87
|
| Rate for Payer: PacificSource Commercial |
$515.09
|
| Rate for Payer: PHCS PPO |
$560.87
|
| Rate for Payer: Three Rivers PPO |
$429.24
|
| Rate for Payer: TriWest Veterans Administration |
$331.95
|
| Rate for Payer: United Healthcare Commercial |
$497.92
|
| Rate for Payer: United Healthcare Medicare |
$331.95
|
| Rate for Payer: WINHealth Partners Commercial |
$560.87
|
| Rate for Payer: Wise Provider Network Commercial |
$543.70
|
|
|
BICEPS BUTTON INSERTER AR-2262
|
Facility
|
IP
|
$572.32
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.84 |
| Max. Negotiated Rate |
$572.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$560.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$549.43
|
| Rate for Payer: Altius Commercial |
$549.43
|
| Rate for Payer: Beech Street Commercial |
$560.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$469.87
|
| Rate for Payer: Cash Price |
$400.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$555.15
|
| Rate for Payer: Cigna of WY Commercial |
$560.87
|
| Rate for Payer: Entrust Commercial |
$543.70
|
| Rate for Payer: First Choice Health Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$543.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$377.73
|
| Rate for Payer: HealthUtah PPO |
$572.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$555.15
|
| Rate for Payer: Multiplan Medicare/VA |
$358.84
|
| Rate for Payer: One Health Plan of WY PPO |
$560.87
|
| Rate for Payer: PacificSource Commercial |
$515.09
|
| Rate for Payer: PHCS PPO |
$560.87
|
| Rate for Payer: Three Rivers PPO |
$429.24
|
| Rate for Payer: TriWest Veterans Administration |
$377.73
|
| Rate for Payer: United Healthcare Commercial |
$497.92
|
| Rate for Payer: United Healthcare Medicare |
$377.73
|
| Rate for Payer: WINHealth Partners Commercial |
$543.70
|
| Rate for Payer: Wise Provider Network Commercial |
$543.70
|
|
|
BILI BED CHUX
|
Facility
|
OP
|
$1.82
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Aetna of WY Medicare |
$1.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.75
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.06
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.00
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.06
|
| Rate for Payer: WINHealth Partners Commercial |
$1.78
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
BILI BED CHUX
|
Facility
|
IP
|
$1.82
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.78
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.75
|
| Rate for Payer: Altius Commercial |
$1.75
|
| Rate for Payer: Beech Street Commercial |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.77
|
| Rate for Payer: Cigna of WY Commercial |
$1.78
|
| Rate for Payer: Entrust Commercial |
$1.73
|
| Rate for Payer: First Choice Health Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.20
|
| Rate for Payer: HealthUtah PPO |
$1.82
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.14
|
| Rate for Payer: One Health Plan of WY PPO |
$1.78
|
| Rate for Payer: PacificSource Commercial |
$1.64
|
| Rate for Payer: PHCS PPO |
$1.78
|
| Rate for Payer: Three Rivers PPO |
$1.36
|
| Rate for Payer: TriWest Veterans Administration |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$1.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.73
|
|
|
BILI BED MATTRESS
|
Facility
|
OP
|
$24.85
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.35
|
| Rate for Payer: Aetna of WY Medicare |
$16.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.86
|
| Rate for Payer: Altius Commercial |
$23.86
|
| Rate for Payer: Beech Street Commercial |
$24.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.10
|
| Rate for Payer: Cigna of WY Commercial |
$24.35
|
| Rate for Payer: Entrust Commercial |
$23.61
|
| Rate for Payer: First Choice Health Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.41
|
| Rate for Payer: HealthUtah PPO |
$24.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.10
|
| Rate for Payer: Multiplan Medicare/VA |
$13.69
|
| Rate for Payer: One Health Plan of WY PPO |
$24.35
|
| Rate for Payer: PacificSource Commercial |
$22.36
|
| Rate for Payer: PHCS PPO |
$24.35
|
| Rate for Payer: Three Rivers PPO |
$18.64
|
| Rate for Payer: TriWest Veterans Administration |
$14.41
|
| Rate for Payer: United Healthcare Commercial |
$21.62
|
| Rate for Payer: United Healthcare Medicare |
$14.41
|
| Rate for Payer: WINHealth Partners Commercial |
$24.35
|
| Rate for Payer: Wise Provider Network Commercial |
$23.61
|
|
|
BILI BED MATTRESS
|
Facility
|
IP
|
$24.85
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$24.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$24.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$23.86
|
| Rate for Payer: Altius Commercial |
$23.86
|
| Rate for Payer: Beech Street Commercial |
$24.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$24.10
|
| Rate for Payer: Cigna of WY Commercial |
$24.35
|
| Rate for Payer: Entrust Commercial |
$23.61
|
| Rate for Payer: First Choice Health Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.40
|
| Rate for Payer: HealthUtah PPO |
$24.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$24.10
|
| Rate for Payer: Multiplan Medicare/VA |
$15.58
|
| Rate for Payer: One Health Plan of WY PPO |
$24.35
|
| Rate for Payer: PacificSource Commercial |
$22.36
|
| Rate for Payer: PHCS PPO |
$24.35
|
| Rate for Payer: Three Rivers PPO |
$18.64
|
| Rate for Payer: TriWest Veterans Administration |
$16.40
|
| Rate for Payer: United Healthcare Commercial |
$21.62
|
| Rate for Payer: United Healthcare Medicare |
$16.40
|
| Rate for Payer: WINHealth Partners Commercial |
$23.61
|
| Rate for Payer: Wise Provider Network Commercial |
$23.61
|
|
|
BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 92504
|
| Hospital Charge Code |
92504
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$100.94
|
| Rate for Payer: Aetna of WY Medicare |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$97.85
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$99.91
|
| Rate for Payer: Cigna of WY Commercial |
$100.94
|
| Rate for Payer: First Choice Health Commercial |
$92.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$97.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: HealthUtah PPO |
$103.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$99.91
|
| Rate for Payer: Multiplan Medicare/VA |
$7.45
|
| Rate for Payer: One Health Plan of WY PPO |
$100.94
|
| Rate for Payer: PacificSource Commercial |
$92.70
|
| Rate for Payer: PHCS PPO |
$97.85
|
| Rate for Payer: Three Rivers PPO |
$77.25
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$89.61
|
| Rate for Payer: United Healthcare Medicare |
$8.76
|
| Rate for Payer: WINHealth Partners Commercial |
$97.85
|
|
|
BIOCOMP SWIVEL 6.25X19.1MM
|
Facility
|
IP
|
$1,218.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$763.69 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,169.28
|
| Rate for Payer: Altius Commercial |
$1,169.28
|
| Rate for Payer: Beech Street Commercial |
$1,193.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$999.98
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: Entrust Commercial |
$1,157.10
|
| Rate for Payer: First Choice Health Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$803.88
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$763.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PHCS PPO |
$1,193.64
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$803.88
|
| Rate for Payer: United Healthcare Commercial |
$1,059.66
|
| Rate for Payer: United Healthcare Medicare |
$803.88
|
| Rate for Payer: WINHealth Partners Commercial |
$1,157.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,157.10
|
|
|
BIOCOMP SWIVEL 6.25X19.1MM
|
Facility
|
OP
|
$1,218.00
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.12 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,193.64
|
| Rate for Payer: Aetna of WY Medicare |
$803.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,169.28
|
| Rate for Payer: Altius Commercial |
$1,169.28
|
| Rate for Payer: Beech Street Commercial |
$1,193.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$999.98
|
| Rate for Payer: Cash Price |
$852.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,181.46
|
| Rate for Payer: Cigna of WY Commercial |
$1,193.64
|
| Rate for Payer: Entrust Commercial |
$1,157.10
|
| Rate for Payer: First Choice Health Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,157.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$706.44
|
| Rate for Payer: HealthUtah PPO |
$1,218.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,181.46
|
| Rate for Payer: Multiplan Medicare/VA |
$671.12
|
| Rate for Payer: One Health Plan of WY PPO |
$1,193.64
|
| Rate for Payer: PacificSource Commercial |
$1,096.20
|
| Rate for Payer: PHCS PPO |
$1,193.64
|
| Rate for Payer: Three Rivers PPO |
$913.50
|
| Rate for Payer: TriWest Veterans Administration |
$706.44
|
| Rate for Payer: United Healthcare Commercial |
$1,059.66
|
| Rate for Payer: United Healthcare Medicare |
$706.44
|
| Rate for Payer: WINHealth Partners Commercial |
$1,193.64
|
| Rate for Payer: Wise Provider Network Commercial |
$1,157.10
|
|
|
BIOINDUCTIVE LARGE W/ DELIVERY
|
Facility
|
IP
|
$13,532.26
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,484.73 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,990.97
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,109.99
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,931.29
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$8,484.73
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$8,931.29
|
| Rate for Payer: United Healthcare Commercial |
$11,773.07
|
| Rate for Payer: United Healthcare Medicare |
$8,931.29
|
| Rate for Payer: WINHealth Partners Commercial |
$12,855.65
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOINDUCTIVE LARGE W/ DELIVERY
|
Facility
|
OP
|
$13,532.26
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,456.28 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Aetna of WY Medicare |
$8,931.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,990.97
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,109.99
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,848.71
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$7,456.28
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$7,848.71
|
| Rate for Payer: United Healthcare Commercial |
$11,773.07
|
| Rate for Payer: United Healthcare Medicare |
$7,848.71
|
| Rate for Payer: WINHealth Partners Commercial |
$13,261.61
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOINDUCTIVE MED W/ DELIVERY
|
Facility
|
OP
|
$13,532.26
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,456.28 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Aetna of WY Medicare |
$8,931.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,990.97
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,109.99
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7,848.71
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$7,456.28
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$7,848.71
|
| Rate for Payer: United Healthcare Commercial |
$11,773.07
|
| Rate for Payer: United Healthcare Medicare |
$7,848.71
|
| Rate for Payer: WINHealth Partners Commercial |
$13,261.61
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
|
BIOINDUCTIVE MED W/ DELIVERY
|
Facility
|
IP
|
$13,532.26
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,484.73 |
| Max. Negotiated Rate |
$13,532.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13,261.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12,990.97
|
| Rate for Payer: Altius Commercial |
$12,990.97
|
| Rate for Payer: Beech Street Commercial |
$13,261.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11,109.99
|
| Rate for Payer: Cash Price |
$9,472.58
|
| Rate for Payer: ChoiceCare Network Commercial |
$13,126.29
|
| Rate for Payer: Cigna of WY Commercial |
$13,261.61
|
| Rate for Payer: Entrust Commercial |
$12,855.65
|
| Rate for Payer: First Choice Health Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12,855.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8,931.29
|
| Rate for Payer: HealthUtah PPO |
$13,532.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13,126.29
|
| Rate for Payer: Multiplan Medicare/VA |
$8,484.73
|
| Rate for Payer: One Health Plan of WY PPO |
$13,261.61
|
| Rate for Payer: PacificSource Commercial |
$12,179.03
|
| Rate for Payer: PHCS PPO |
$13,261.61
|
| Rate for Payer: Three Rivers PPO |
$10,149.20
|
| Rate for Payer: TriWest Veterans Administration |
$8,931.29
|
| Rate for Payer: United Healthcare Commercial |
$11,773.07
|
| Rate for Payer: United Healthcare Medicare |
$8,931.29
|
| Rate for Payer: WINHealth Partners Commercial |
$12,855.65
|
| Rate for Payer: Wise Provider Network Commercial |
$12,855.65
|
|
