|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6928]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 6808437601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.05
|
| Rate for Payer: Altius Commercial |
$2.05
|
| Rate for Payer: Beech Street Commercial |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.08
|
| Rate for Payer: Cigna of WY Commercial |
$2.10
|
| Rate for Payer: Entrust Commercial |
$2.03
|
| Rate for Payer: First Choice Health Commercial |
$2.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.41
|
| Rate for Payer: HealthUtah PPO |
$2.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2.10
|
| Rate for Payer: PacificSource Commercial |
$1.93
|
| Rate for Payer: PHCS PPO |
$2.10
|
| Rate for Payer: Three Rivers PPO |
$1.60
|
| Rate for Payer: TriWest Veterans Administration |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Medicare |
$1.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2.03
|
| Rate for Payer: Wise Provider Network Commercial |
$2.03
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE [6928]
|
Facility
|
IP
|
$2.14
|
|
|
Service Code
|
NDC 6808437611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.05
|
| Rate for Payer: Altius Commercial |
$2.05
|
| Rate for Payer: Beech Street Commercial |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.08
|
| Rate for Payer: Cigna of WY Commercial |
$2.10
|
| Rate for Payer: Entrust Commercial |
$2.03
|
| Rate for Payer: First Choice Health Commercial |
$2.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.41
|
| Rate for Payer: HealthUtah PPO |
$2.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.08
|
| Rate for Payer: Multiplan Medicare/VA |
$1.34
|
| Rate for Payer: One Health Plan of WY PPO |
$2.10
|
| Rate for Payer: PacificSource Commercial |
$1.93
|
| Rate for Payer: PHCS PPO |
$2.10
|
| Rate for Payer: Three Rivers PPO |
$1.60
|
| Rate for Payer: TriWest Veterans Administration |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Medicare |
$1.41
|
| Rate for Payer: WINHealth Partners Commercial |
$2.03
|
| Rate for Payer: Wise Provider Network Commercial |
$2.03
|
|
|
PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 99195
|
| Hospital Charge Code |
99195
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$301.84
|
| Rate for Payer: Aetna of WY Medicare |
$93.46
|
| Rate for Payer: Beech Street Commercial |
$292.60
|
| Rate for Payer: Cash Price |
$215.60
|
| 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: First Choice Health Commercial |
$277.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$292.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.46
|
| Rate for Payer: HealthUtah PPO |
$308.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$298.76
|
| Rate for Payer: Multiplan Medicare/VA |
$79.44
|
| Rate for Payer: One Health Plan of WY PPO |
$301.84
|
| Rate for Payer: PacificSource Commercial |
$277.20
|
| Rate for Payer: PHCS PPO |
$292.60
|
| Rate for Payer: Three Rivers PPO |
$231.00
|
| Rate for Payer: TriWest Veterans Administration |
$93.46
|
| Rate for Payer: United Healthcare Commercial |
$267.96
|
| Rate for Payer: United Healthcare Medicare |
$93.46
|
| Rate for Payer: WINHealth Partners Commercial |
$292.60
|
|
|
PHS MINOR ORTHOPEDIC PACK
|
Facility
|
OP
|
$152.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.94 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.29
|
| Rate for Payer: Aetna of WY Medicare |
$100.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$146.25
|
| Rate for Payer: Altius Commercial |
$146.25
|
| Rate for Payer: Beech Street Commercial |
$149.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.07
|
| Rate for Payer: Cash Price |
$106.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.77
|
| Rate for Payer: Cigna of WY Commercial |
$149.29
|
| Rate for Payer: Entrust Commercial |
$144.72
|
| Rate for Payer: First Choice Health Commercial |
$144.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.36
|
| Rate for Payer: HealthUtah PPO |
$152.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.77
|
| Rate for Payer: Multiplan Medicare/VA |
$83.94
|
| Rate for Payer: One Health Plan of WY PPO |
$149.29
|
| Rate for Payer: PacificSource Commercial |
$137.11
|
| Rate for Payer: PHCS PPO |
$149.29
|
| Rate for Payer: Three Rivers PPO |
$114.26
|
| Rate for Payer: TriWest Veterans Administration |
$88.36
|
| Rate for Payer: United Healthcare Commercial |
$132.54
|
| Rate for Payer: United Healthcare Medicare |
$88.36
|
| Rate for Payer: WINHealth Partners Commercial |
$149.29
|
| Rate for Payer: Wise Provider Network Commercial |
$144.72
|
|
|
PHS MINOR ORTHOPEDIC PACK
|
Facility
|
IP
|
$152.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$149.29
|
| Rate for Payer: Altius Auto/Workers Compensation |
$146.25
|
| Rate for Payer: Altius Commercial |
$146.25
|
| Rate for Payer: Beech Street Commercial |
$149.29
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$125.07
|
| Rate for Payer: Cash Price |
$106.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.77
|
| Rate for Payer: Cigna of WY Commercial |
$149.29
|
| Rate for Payer: Entrust Commercial |
$144.72
|
| Rate for Payer: First Choice Health Commercial |
$144.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.54
|
| Rate for Payer: HealthUtah PPO |
$152.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.77
|
| Rate for Payer: Multiplan Medicare/VA |
$95.52
|
| Rate for Payer: One Health Plan of WY PPO |
$149.29
|
| Rate for Payer: PacificSource Commercial |
$137.11
|
| Rate for Payer: PHCS PPO |
$149.29
|
| Rate for Payer: Three Rivers PPO |
$114.26
|
| Rate for Payer: TriWest Veterans Administration |
$100.54
|
| Rate for Payer: United Healthcare Commercial |
$132.54
|
| Rate for Payer: United Healthcare Medicare |
$100.54
|
| Rate for Payer: WINHealth Partners Commercial |
$144.72
|
| Rate for Payer: Wise Provider Network Commercial |
$144.72
|
|
|
PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 97750
|
| Hospital Charge Code |
97750
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$137.20
|
| Rate for Payer: Aetna of WY Medicare |
$33.31
|
| Rate for Payer: Beech Street Commercial |
$133.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: Cash Price |
$98.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$135.80
|
| Rate for Payer: Cigna of WY Commercial |
$137.20
|
| Rate for Payer: First Choice Health Commercial |
$126.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$133.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.31
|
| Rate for Payer: HealthUtah PPO |
$140.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$135.80
|
| Rate for Payer: Multiplan Medicare/VA |
$28.31
|
| Rate for Payer: One Health Plan of WY PPO |
$137.20
|
| Rate for Payer: PacificSource Commercial |
$126.00
|
| Rate for Payer: PHCS PPO |
$133.00
|
| Rate for Payer: Three Rivers PPO |
$105.00
|
| Rate for Payer: TriWest Veterans Administration |
$33.31
|
| Rate for Payer: United Healthcare Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare |
$33.31
|
| Rate for Payer: WINHealth Partners Commercial |
$133.00
|
|
|
PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 97163
|
| Hospital Charge Code |
97163
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$438.06
|
| Rate for Payer: Aetna of WY Medicare |
$98.22
|
| Rate for Payer: Beech Street Commercial |
$424.65
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$433.59
|
| Rate for Payer: Cigna of WY Commercial |
$438.06
|
| Rate for Payer: First Choice Health Commercial |
$402.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$424.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.22
|
| Rate for Payer: HealthUtah PPO |
$447.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$433.59
|
| Rate for Payer: Multiplan Medicare/VA |
$83.49
|
| Rate for Payer: One Health Plan of WY PPO |
$438.06
|
| Rate for Payer: PacificSource Commercial |
$402.30
|
| Rate for Payer: PHCS PPO |
$424.65
|
| Rate for Payer: Three Rivers PPO |
$335.25
|
| Rate for Payer: TriWest Veterans Administration |
$98.22
|
| Rate for Payer: United Healthcare Commercial |
$388.89
|
| Rate for Payer: United Healthcare Medicare |
$98.22
|
| Rate for Payer: WINHealth Partners Commercial |
$424.65
|
|
|
PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 97161
|
| Hospital Charge Code |
97161
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$317.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$310.66
|
| Rate for Payer: Aetna of WY Medicare |
$98.22
|
| Rate for Payer: Beech Street Commercial |
$301.15
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$307.49
|
| Rate for Payer: Cigna of WY Commercial |
$310.66
|
| Rate for Payer: First Choice Health Commercial |
$285.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$301.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.22
|
| Rate for Payer: HealthUtah PPO |
$317.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$307.49
|
| Rate for Payer: Multiplan Medicare/VA |
$83.49
|
| Rate for Payer: One Health Plan of WY PPO |
$310.66
|
| Rate for Payer: PacificSource Commercial |
$285.30
|
| Rate for Payer: PHCS PPO |
$301.15
|
| Rate for Payer: Three Rivers PPO |
$237.75
|
| Rate for Payer: TriWest Veterans Administration |
$98.22
|
| Rate for Payer: United Healthcare Commercial |
$275.79
|
| Rate for Payer: United Healthcare Medicare |
$98.22
|
| Rate for Payer: WINHealth Partners Commercial |
$301.15
|
|
|
PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 97162
|
| Hospital Charge Code |
97162
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$331.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$324.38
|
| Rate for Payer: Aetna of WY Medicare |
$98.22
|
| Rate for Payer: Beech Street Commercial |
$314.45
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: Cash Price |
$231.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$321.07
|
| Rate for Payer: Cigna of WY Commercial |
$324.38
|
| Rate for Payer: First Choice Health Commercial |
$297.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$314.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$98.22
|
| Rate for Payer: HealthUtah PPO |
$331.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$321.07
|
| Rate for Payer: Multiplan Medicare/VA |
$83.49
|
| Rate for Payer: One Health Plan of WY PPO |
$324.38
|
| Rate for Payer: PacificSource Commercial |
$297.90
|
| Rate for Payer: PHCS PPO |
$314.45
|
| Rate for Payer: Three Rivers PPO |
$248.25
|
| Rate for Payer: TriWest Veterans Administration |
$98.22
|
| Rate for Payer: United Healthcare Commercial |
$287.97
|
| Rate for Payer: United Healthcare Medicare |
$98.22
|
| Rate for Payer: WINHealth Partners Commercial |
$314.45
|
|
|
PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 97164
|
| Hospital Charge Code |
97164
|
| Min. Negotiated Rate |
$57.95 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.84
|
| Rate for Payer: Aetna of WY Medicare |
$68.18
|
| Rate for Payer: Beech Street Commercial |
$197.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.76
|
| Rate for Payer: Cigna of WY Commercial |
$203.84
|
| Rate for Payer: First Choice Health Commercial |
$187.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.18
|
| Rate for Payer: HealthUtah PPO |
$208.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.76
|
| Rate for Payer: Multiplan Medicare/VA |
$57.95
|
| Rate for Payer: One Health Plan of WY PPO |
$203.84
|
| Rate for Payer: PacificSource Commercial |
$187.20
|
| Rate for Payer: PHCS PPO |
$197.60
|
| Rate for Payer: Three Rivers PPO |
$156.00
|
| Rate for Payer: TriWest Veterans Administration |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$180.96
|
| Rate for Payer: United Healthcare Medicare |
$68.18
|
| Rate for Payer: WINHealth Partners Commercial |
$197.60
|
|
|
PHYS/QHP TELEPHONE EVALUATION 11-20 MIN
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 99442
|
| Hospital Charge Code |
99442
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$63.08
|
| Rate for Payer: Beech Street Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: First Choice Health Commercial |
$80.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$63.08
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$53.62
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$84.55
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$63.08
|
| Rate for Payer: United Healthcare Commercial |
$77.43
|
| Rate for Payer: United Healthcare Medicare |
$63.08
|
| Rate for Payer: WINHealth Partners Commercial |
$84.55
|
|
|
PHYS/QHP TELEPHONE EVALUATION 21-30 MIN
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 99443
|
| Hospital Charge Code |
99443
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$129.36
|
| Rate for Payer: Aetna of WY Medicare |
$93.43
|
| Rate for Payer: Beech Street Commercial |
$125.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$128.04
|
| Rate for Payer: Cigna of WY Commercial |
$129.36
|
| Rate for Payer: First Choice Health Commercial |
$118.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$125.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.43
|
| Rate for Payer: HealthUtah PPO |
$132.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$128.04
|
| Rate for Payer: Multiplan Medicare/VA |
$79.42
|
| Rate for Payer: One Health Plan of WY PPO |
$129.36
|
| Rate for Payer: PacificSource Commercial |
$118.80
|
| Rate for Payer: PHCS PPO |
$125.40
|
| Rate for Payer: Three Rivers PPO |
$99.00
|
| Rate for Payer: TriWest Veterans Administration |
$93.43
|
| Rate for Payer: United Healthcare Commercial |
$114.84
|
| Rate for Payer: United Healthcare Medicare |
$93.43
|
| Rate for Payer: WINHealth Partners Commercial |
$125.40
|
|
|
PHYS/QHP TELEPHONE EVALUATION 5-10 MIN
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 99441
|
| Hospital Charge Code |
99441
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.12
|
| Rate for Payer: Aetna of WY Medicare |
$33.63
|
| Rate for Payer: Beech Street Commercial |
$41.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: Cash Price |
$30.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.68
|
| Rate for Payer: Cigna of WY Commercial |
$43.12
|
| Rate for Payer: First Choice Health Commercial |
$39.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.63
|
| Rate for Payer: HealthUtah PPO |
$44.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.68
|
| Rate for Payer: Multiplan Medicare/VA |
$28.59
|
| Rate for Payer: One Health Plan of WY PPO |
$43.12
|
| Rate for Payer: PacificSource Commercial |
$39.60
|
| Rate for Payer: PHCS PPO |
$41.80
|
| Rate for Payer: Three Rivers PPO |
$33.00
|
| Rate for Payer: TriWest Veterans Administration |
$33.63
|
| Rate for Payer: United Healthcare Commercial |
$38.28
|
| Rate for Payer: United Healthcare Medicare |
$33.63
|
| Rate for Payer: WINHealth Partners Commercial |
$41.80
|
|
|
PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 99360
|
| Hospital Charge Code |
99360
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$277.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$271.46
|
| Rate for Payer: Beech Street Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$193.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$268.69
|
| Rate for Payer: Cigna of WY Commercial |
$271.46
|
| Rate for Payer: First Choice Health Commercial |
$249.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$263.15
|
| Rate for Payer: HealthUtah PPO |
$277.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$268.69
|
| Rate for Payer: One Health Plan of WY PPO |
$271.46
|
| Rate for Payer: PacificSource Commercial |
$249.30
|
| Rate for Payer: PHCS PPO |
$263.15
|
| Rate for Payer: Three Rivers PPO |
$207.75
|
| Rate for Payer: United Healthcare Commercial |
$240.99
|
| Rate for Payer: WINHealth Partners Commercial |
$263.15
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [2822]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS J3430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Medicare |
$33.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.58
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$28.10
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.58
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
| Rate for Payer: WINHealth Partners Commercial |
$49.98
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION [2822]
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS J3430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.66
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$31.98
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.66
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$33.66
|
| Rate for Payer: WINHealth Partners Commercial |
$48.45
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION (WRAPPED) [4000715]
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS J3430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.98 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.02
|
| Rate for Payer: Altius Commercial |
$44.02
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Beech Street Commercial |
$44.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$32.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Cigna of WY Commercial |
$44.93
|
| Rate for Payer: Entrust Commercial |
$43.56
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: First Choice Health Commercial |
$43.56
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.26
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: HealthUtah PPO |
$45.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$31.98
|
| Rate for Payer: Multiplan Medicare/VA |
$28.75
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: One Health Plan of WY PPO |
$44.93
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PacificSource Commercial |
$41.26
|
| Rate for Payer: PHCS PPO |
$44.93
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$34.39
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$33.66
|
| Rate for Payer: TriWest Veterans Administration |
$30.26
|
| Rate for Payer: United Healthcare Commercial |
$39.89
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$33.66
|
| Rate for Payer: United Healthcare Medicare |
$30.26
|
| Rate for Payer: WINHealth Partners Commercial |
$43.56
|
| Rate for Payer: WINHealth Partners Commercial |
$48.45
|
| Rate for Payer: Wise Provider Network Commercial |
$43.56
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION (WRAPPED) [4000715]
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS J3430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$49.98
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.93
|
| Rate for Payer: Aetna of WY Medicare |
$33.66
|
| Rate for Payer: Aetna of WY Medicare |
$30.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$44.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$48.96
|
| Rate for Payer: Altius Commercial |
$48.96
|
| Rate for Payer: Altius Commercial |
$44.02
|
| Rate for Payer: Beech Street Commercial |
$44.93
|
| Rate for Payer: Beech Street Commercial |
$49.98
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.64
|
| Rate for Payer: Cash Price |
$32.09
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.47
|
| Rate for Payer: ChoiceCare Network Commercial |
$44.47
|
| Rate for Payer: Cigna of WY Commercial |
$44.93
|
| Rate for Payer: Cigna of WY Commercial |
$49.98
|
| Rate for Payer: Entrust Commercial |
$48.45
|
| Rate for Payer: Entrust Commercial |
$43.56
|
| Rate for Payer: First Choice Health Commercial |
$43.56
|
| Rate for Payer: First Choice Health Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$43.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.59
|
| Rate for Payer: HealthUtah PPO |
$45.85
|
| Rate for Payer: HealthUtah PPO |
$51.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$44.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.47
|
| Rate for Payer: Multiplan Medicare/VA |
$28.10
|
| Rate for Payer: Multiplan Medicare/VA |
$25.26
|
| Rate for Payer: One Health Plan of WY PPO |
$44.93
|
| Rate for Payer: One Health Plan of WY PPO |
$49.98
|
| Rate for Payer: PacificSource Commercial |
$45.90
|
| Rate for Payer: PacificSource Commercial |
$41.26
|
| Rate for Payer: PHCS PPO |
$44.93
|
| Rate for Payer: PHCS PPO |
$49.98
|
| Rate for Payer: Three Rivers PPO |
$34.39
|
| Rate for Payer: Three Rivers PPO |
$38.25
|
| Rate for Payer: TriWest Veterans Administration |
$29.58
|
| Rate for Payer: TriWest Veterans Administration |
$26.59
|
| Rate for Payer: United Healthcare Commercial |
$39.89
|
| Rate for Payer: United Healthcare Commercial |
$44.37
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
| Rate for Payer: United Healthcare Medicare |
$26.59
|
| Rate for Payer: WINHealth Partners Commercial |
$44.93
|
| Rate for Payer: WINHealth Partners Commercial |
$49.98
|
| Rate for Payer: Wise Provider Network Commercial |
$43.56
|
| Rate for Payer: Wise Provider Network Commercial |
$48.45
|
|
|
PIGAZZI PINK PAD
|
Facility
|
OP
|
$233.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$128.72 |
| Max. Negotiated Rate |
$233.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.95
|
| Rate for Payer: Aetna of WY Medicare |
$154.19
|
| Rate for Payer: Altius Auto/Workers Compensation |
$224.28
|
| Rate for Payer: Altius Commercial |
$224.28
|
| Rate for Payer: Beech Street Commercial |
$228.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$163.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.61
|
| Rate for Payer: Cigna of WY Commercial |
$228.95
|
| Rate for Payer: Entrust Commercial |
$221.94
|
| Rate for Payer: First Choice Health Commercial |
$221.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$135.50
|
| Rate for Payer: HealthUtah PPO |
$233.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.61
|
| Rate for Payer: Multiplan Medicare/VA |
$128.72
|
| Rate for Payer: One Health Plan of WY PPO |
$228.95
|
| Rate for Payer: PacificSource Commercial |
$210.26
|
| Rate for Payer: PHCS PPO |
$228.95
|
| Rate for Payer: Three Rivers PPO |
$175.22
|
| Rate for Payer: TriWest Veterans Administration |
$135.50
|
| Rate for Payer: United Healthcare Commercial |
$203.25
|
| Rate for Payer: United Healthcare Medicare |
$135.50
|
| Rate for Payer: WINHealth Partners Commercial |
$228.95
|
| Rate for Payer: Wise Provider Network Commercial |
$221.94
|
|
|
PIGAZZI PINK PAD
|
Facility
|
IP
|
$233.62
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.48 |
| Max. Negotiated Rate |
$233.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$228.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$224.28
|
| Rate for Payer: Altius Commercial |
$224.28
|
| Rate for Payer: Beech Street Commercial |
$228.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$163.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$226.61
|
| Rate for Payer: Cigna of WY Commercial |
$228.95
|
| Rate for Payer: Entrust Commercial |
$221.94
|
| Rate for Payer: First Choice Health Commercial |
$221.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$221.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$154.19
|
| Rate for Payer: HealthUtah PPO |
$233.62
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$226.61
|
| Rate for Payer: Multiplan Medicare/VA |
$146.48
|
| Rate for Payer: One Health Plan of WY PPO |
$228.95
|
| Rate for Payer: PacificSource Commercial |
$210.26
|
| Rate for Payer: PHCS PPO |
$228.95
|
| Rate for Payer: Three Rivers PPO |
$175.22
|
| Rate for Payer: TriWest Veterans Administration |
$154.19
|
| Rate for Payer: United Healthcare Commercial |
$203.25
|
| Rate for Payer: United Healthcare Medicare |
$154.19
|
| Rate for Payer: WINHealth Partners Commercial |
$221.94
|
| Rate for Payer: Wise Provider Network Commercial |
$221.94
|
|
|
PILLOW DISPOSA VIEW HEAD POSITIONER
|
Facility
|
IP
|
$128.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.48
|
| Rate for Payer: Altius Auto/Workers Compensation |
$122.92
|
| Rate for Payer: Altius Commercial |
$122.92
|
| Rate for Payer: Beech Street Commercial |
$125.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.12
|
| Rate for Payer: Cash Price |
$89.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.20
|
| Rate for Payer: Cigna of WY Commercial |
$125.48
|
| Rate for Payer: Entrust Commercial |
$121.64
|
| Rate for Payer: First Choice Health Commercial |
$121.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.51
|
| Rate for Payer: HealthUtah PPO |
$128.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.20
|
| Rate for Payer: Multiplan Medicare/VA |
$80.28
|
| Rate for Payer: One Health Plan of WY PPO |
$125.48
|
| Rate for Payer: PacificSource Commercial |
$115.24
|
| Rate for Payer: PHCS PPO |
$125.48
|
| Rate for Payer: Three Rivers PPO |
$96.03
|
| Rate for Payer: TriWest Veterans Administration |
$84.51
|
| Rate for Payer: United Healthcare Commercial |
$111.39
|
| Rate for Payer: United Healthcare Medicare |
$84.51
|
| Rate for Payer: WINHealth Partners Commercial |
$121.64
|
| Rate for Payer: Wise Provider Network Commercial |
$121.64
|
|
|
PILLOW DISPOSA VIEW HEAD POSITIONER
|
Facility
|
OP
|
$128.04
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$128.04 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$125.48
|
| Rate for Payer: Aetna of WY Medicare |
$84.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$122.92
|
| Rate for Payer: Altius Commercial |
$122.92
|
| Rate for Payer: Beech Street Commercial |
$125.48
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$105.12
|
| Rate for Payer: Cash Price |
$89.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$124.20
|
| Rate for Payer: Cigna of WY Commercial |
$125.48
|
| Rate for Payer: Entrust Commercial |
$121.64
|
| Rate for Payer: First Choice Health Commercial |
$121.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$121.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.26
|
| Rate for Payer: HealthUtah PPO |
$128.04
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$124.20
|
| Rate for Payer: Multiplan Medicare/VA |
$70.55
|
| Rate for Payer: One Health Plan of WY PPO |
$125.48
|
| Rate for Payer: PacificSource Commercial |
$115.24
|
| Rate for Payer: PHCS PPO |
$125.48
|
| Rate for Payer: Three Rivers PPO |
$96.03
|
| Rate for Payer: TriWest Veterans Administration |
$74.26
|
| Rate for Payer: United Healthcare Commercial |
$111.39
|
| Rate for Payer: United Healthcare Medicare |
$74.26
|
| Rate for Payer: WINHealth Partners Commercial |
$125.48
|
| Rate for Payer: Wise Provider Network Commercial |
$121.64
|
|
|
PILLOW GENTLE TOUCH BLUE/WHITE
|
Facility
|
OP
|
$19.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.81
|
| Rate for Payer: Aetna of WY Medicare |
$12.67
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.42
|
| Rate for Payer: Altius Commercial |
$18.42
|
| Rate for Payer: Beech Street Commercial |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.75
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.61
|
| Rate for Payer: Cigna of WY Commercial |
$18.81
|
| Rate for Payer: Entrust Commercial |
$18.23
|
| Rate for Payer: First Choice Health Commercial |
$18.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.13
|
| Rate for Payer: HealthUtah PPO |
$19.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.61
|
| Rate for Payer: Multiplan Medicare/VA |
$10.57
|
| Rate for Payer: One Health Plan of WY PPO |
$18.81
|
| Rate for Payer: PacificSource Commercial |
$17.27
|
| Rate for Payer: PHCS PPO |
$18.81
|
| Rate for Payer: Three Rivers PPO |
$14.39
|
| Rate for Payer: TriWest Veterans Administration |
$11.13
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$11.13
|
| Rate for Payer: WINHealth Partners Commercial |
$18.81
|
| Rate for Payer: Wise Provider Network Commercial |
$18.23
|
|
|
PILLOW GENTLE TOUCH BLUE/WHITE
|
Facility
|
IP
|
$19.19
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.42
|
| Rate for Payer: Altius Commercial |
$18.42
|
| Rate for Payer: Beech Street Commercial |
$18.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.75
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.61
|
| Rate for Payer: Cigna of WY Commercial |
$18.81
|
| Rate for Payer: Entrust Commercial |
$18.23
|
| Rate for Payer: First Choice Health Commercial |
$18.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.67
|
| Rate for Payer: HealthUtah PPO |
$19.19
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.61
|
| Rate for Payer: Multiplan Medicare/VA |
$12.03
|
| Rate for Payer: One Health Plan of WY PPO |
$18.81
|
| Rate for Payer: PacificSource Commercial |
$17.27
|
| Rate for Payer: PHCS PPO |
$18.81
|
| Rate for Payer: Three Rivers PPO |
$14.39
|
| Rate for Payer: TriWest Veterans Administration |
$12.67
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare |
$12.67
|
| Rate for Payer: WINHealth Partners Commercial |
$18.23
|
| Rate for Payer: Wise Provider Network Commercial |
$18.23
|
|
|
PILLOW HEAD POSITIONER PURPLE
|
Facility
|
IP
|
$15.26
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$15.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.65
|
| Rate for Payer: Altius Commercial |
$14.65
|
| Rate for Payer: Beech Street Commercial |
$14.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.80
|
| Rate for Payer: Cigna of WY Commercial |
$14.95
|
| Rate for Payer: Entrust Commercial |
$14.50
|
| Rate for Payer: First Choice Health Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.07
|
| Rate for Payer: HealthUtah PPO |
$15.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.80
|
| Rate for Payer: Multiplan Medicare/VA |
$9.57
|
| Rate for Payer: One Health Plan of WY PPO |
$14.95
|
| Rate for Payer: PacificSource Commercial |
$13.73
|
| Rate for Payer: PHCS PPO |
$14.95
|
| Rate for Payer: Three Rivers PPO |
$11.44
|
| Rate for Payer: TriWest Veterans Administration |
$10.07
|
| Rate for Payer: United Healthcare Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare |
$10.07
|
| Rate for Payer: WINHealth Partners Commercial |
$14.50
|
| Rate for Payer: Wise Provider Network Commercial |
$14.50
|
|
