|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$15.32
|
|
|
Service Code
|
NDC 0409488723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Aetna of WY Medicare |
$10.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.71
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.89
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$8.44
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$8.89
|
| Rate for Payer: United Healthcare Commercial |
$13.33
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
| Rate for Payer: WINHealth Partners Commercial |
$15.01
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$15.24
|
|
|
Service Code
|
NDC 0409488724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.63
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.06
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$9.56
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$10.06
|
| Rate for Payer: WINHealth Partners Commercial |
$14.48
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
NDC 0409488724
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.63
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.40
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$15.24
|
|
|
Service Code
|
NDC 0409488750
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.63
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.06
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$9.56
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$10.06
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$10.06
|
| Rate for Payer: WINHealth Partners Commercial |
$14.48
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
NDC 0409488750
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$14.94
|
| Rate for Payer: Aetna of WY Medicare |
$10.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.63
|
| Rate for Payer: Altius Commercial |
$14.63
|
| Rate for Payer: Beech Street Commercial |
$14.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.51
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.78
|
| Rate for Payer: Cigna of WY Commercial |
$14.94
|
| Rate for Payer: Entrust Commercial |
$14.48
|
| Rate for Payer: First Choice Health Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.84
|
| Rate for Payer: HealthUtah PPO |
$15.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.78
|
| Rate for Payer: Multiplan Medicare/VA |
$8.40
|
| Rate for Payer: One Health Plan of WY PPO |
$14.94
|
| Rate for Payer: PacificSource Commercial |
$13.72
|
| Rate for Payer: PHCS PPO |
$14.94
|
| Rate for Payer: Three Rivers PPO |
$11.43
|
| Rate for Payer: TriWest Veterans Administration |
$8.84
|
| Rate for Payer: United Healthcare Commercial |
$13.26
|
| Rate for Payer: United Healthcare Medicare |
$8.84
|
| Rate for Payer: WINHealth Partners Commercial |
$14.94
|
| Rate for Payer: Wise Provider Network Commercial |
$14.48
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
NDC 6332318507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.06
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$11.06
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$16.76
|
|
|
Service Code
|
NDC 6332318507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.23
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$16.15
|
|
|
Service Code
|
NDC 6332318508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.83
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.50
|
| Rate for Payer: Altius Commercial |
$15.50
|
| Rate for Payer: Beech Street Commercial |
$15.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.67
|
| Rate for Payer: Cigna of WY Commercial |
$15.83
|
| Rate for Payer: Entrust Commercial |
$15.34
|
| Rate for Payer: First Choice Health Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.66
|
| Rate for Payer: HealthUtah PPO |
$16.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.67
|
| Rate for Payer: Multiplan Medicare/VA |
$10.13
|
| Rate for Payer: One Health Plan of WY PPO |
$15.83
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.83
|
| Rate for Payer: Three Rivers PPO |
$12.11
|
| Rate for Payer: TriWest Veterans Administration |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$14.05
|
| Rate for Payer: United Healthcare Medicare |
$10.66
|
| Rate for Payer: WINHealth Partners Commercial |
$15.34
|
| Rate for Payer: Wise Provider Network Commercial |
$15.34
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$16.15
|
|
|
Service Code
|
NDC 6332318508
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.83
|
| Rate for Payer: Aetna of WY Medicare |
$10.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.50
|
| Rate for Payer: Altius Commercial |
$15.50
|
| Rate for Payer: Beech Street Commercial |
$15.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.26
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.67
|
| Rate for Payer: Cigna of WY Commercial |
$15.83
|
| Rate for Payer: Entrust Commercial |
$15.34
|
| Rate for Payer: First Choice Health Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.37
|
| Rate for Payer: HealthUtah PPO |
$16.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.67
|
| Rate for Payer: Multiplan Medicare/VA |
$8.90
|
| Rate for Payer: One Health Plan of WY PPO |
$15.83
|
| Rate for Payer: PacificSource Commercial |
$14.54
|
| Rate for Payer: PHCS PPO |
$15.83
|
| Rate for Payer: Three Rivers PPO |
$12.11
|
| Rate for Payer: TriWest Veterans Administration |
$9.37
|
| Rate for Payer: United Healthcare Commercial |
$14.05
|
| Rate for Payer: United Healthcare Medicare |
$9.37
|
| Rate for Payer: WINHealth Partners Commercial |
$15.83
|
| Rate for Payer: Wise Provider Network Commercial |
$15.34
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
IP
|
$16.76
|
|
|
Service Code
|
NDC 6332318510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.06
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$11.06
|
| Rate for Payer: WINHealth Partners Commercial |
$15.92
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
WATER FOR INJECTION, STERILE INJECTION SOLUTION [8978]
|
Facility
|
OP
|
$16.76
|
|
|
Service Code
|
NDC 6332318510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.42
|
| Rate for Payer: Aetna of WY Medicare |
$11.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$16.09
|
| Rate for Payer: Altius Commercial |
$16.09
|
| Rate for Payer: Beech Street Commercial |
$16.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.76
|
| Rate for Payer: Cash Price |
$11.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.26
|
| Rate for Payer: Cigna of WY Commercial |
$16.42
|
| Rate for Payer: Entrust Commercial |
$15.92
|
| Rate for Payer: First Choice Health Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.72
|
| Rate for Payer: HealthUtah PPO |
$16.76
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.26
|
| Rate for Payer: Multiplan Medicare/VA |
$9.23
|
| Rate for Payer: One Health Plan of WY PPO |
$16.42
|
| Rate for Payer: PacificSource Commercial |
$15.08
|
| Rate for Payer: PHCS PPO |
$16.42
|
| Rate for Payer: Three Rivers PPO |
$12.57
|
| Rate for Payer: TriWest Veterans Administration |
$9.72
|
| Rate for Payer: United Healthcare Commercial |
$14.58
|
| Rate for Payer: United Healthcare Medicare |
$9.72
|
| Rate for Payer: WINHealth Partners Commercial |
$16.42
|
| Rate for Payer: Wise Provider Network Commercial |
$15.92
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION [9797]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0264210100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION [9797]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0264210100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION [9797]
|
Facility
|
IP
|
$0.02
|
|
|
Service Code
|
NDC 0990797308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION [9797]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 0990797308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.02
|
| Rate for Payer: Aetna of WY Medicare |
$0.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.02
|
| Rate for Payer: Altius Commercial |
$0.02
|
| Rate for Payer: Beech Street Commercial |
$0.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.02
|
| Rate for Payer: Cigna of WY Commercial |
$0.02
|
| Rate for Payer: Entrust Commercial |
$0.02
|
| Rate for Payer: First Choice Health Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.02
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.01
|
| Rate for Payer: HealthUtah PPO |
$0.02
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.02
|
| Rate for Payer: Multiplan Medicare/VA |
$0.01
|
| Rate for Payer: One Health Plan of WY PPO |
$0.02
|
| Rate for Payer: PacificSource Commercial |
$0.02
|
| Rate for Payer: PHCS PPO |
$0.02
|
| Rate for Payer: Three Rivers PPO |
$0.02
|
| Rate for Payer: TriWest Veterans Administration |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$0.02
|
| Rate for Payer: United Healthcare Medicare |
$0.01
|
| Rate for Payer: WINHealth Partners Commercial |
$0.02
|
| Rate for Payer: Wise Provider Network Commercial |
$0.02
|
|
|
WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
11765
|
| Min. Negotiated Rate |
$77.21 |
| Max. Negotiated Rate |
$463.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$453.74
|
| Rate for Payer: Aetna of WY Medicare |
$90.83
|
| Rate for Payer: Beech Street Commercial |
$439.85
|
| Rate for Payer: Cash Price |
$324.10
|
| Rate for Payer: Cash Price |
$324.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$449.11
|
| Rate for Payer: Cigna of WY Commercial |
$453.74
|
| Rate for Payer: First Choice Health Commercial |
$416.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$439.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.83
|
| Rate for Payer: HealthUtah PPO |
$463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$449.11
|
| Rate for Payer: Multiplan Medicare/VA |
$77.21
|
| Rate for Payer: One Health Plan of WY PPO |
$453.74
|
| Rate for Payer: PacificSource Commercial |
$416.70
|
| Rate for Payer: PHCS PPO |
$439.85
|
| Rate for Payer: Three Rivers PPO |
$347.25
|
| Rate for Payer: TriWest Veterans Administration |
$90.83
|
| Rate for Payer: United Healthcare Commercial |
$402.81
|
| Rate for Payer: United Healthcare Medicare |
$90.83
|
| Rate for Payer: WINHealth Partners Commercial |
$393.55
|
|
|
WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$2,964.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
58920
|
| Min. Negotiated Rate |
$585.40 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,904.72
|
| Rate for Payer: Aetna of WY Medicare |
$688.70
|
| Rate for Payer: Beech Street Commercial |
$2,815.80
|
| Rate for Payer: Cash Price |
$2,074.80
|
| Rate for Payer: Cash Price |
$2,074.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,875.08
|
| Rate for Payer: Cigna of WY Commercial |
$2,904.72
|
| Rate for Payer: First Choice Health Commercial |
$2,667.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,815.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$688.70
|
| Rate for Payer: HealthUtah PPO |
$2,964.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,875.08
|
| Rate for Payer: Multiplan Medicare/VA |
$585.40
|
| Rate for Payer: One Health Plan of WY PPO |
$2,904.72
|
| Rate for Payer: PacificSource Commercial |
$2,667.60
|
| Rate for Payer: PHCS PPO |
$2,815.80
|
| Rate for Payer: Three Rivers PPO |
$2,223.00
|
| Rate for Payer: TriWest Veterans Administration |
$688.70
|
| Rate for Payer: United Healthcare Commercial |
$2,578.68
|
| Rate for Payer: United Healthcare Medicare |
$688.70
|
| Rate for Payer: WINHealth Partners Commercial |
$2,519.40
|
|
|
WEREWOLF 50 COBLATION WAND
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.68 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$699.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$685.44
|
| Rate for Payer: Altius Commercial |
$685.44
|
| Rate for Payer: Beech Street Commercial |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$586.19
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$692.58
|
| Rate for Payer: Cigna of WY Commercial |
$699.72
|
| Rate for Payer: Entrust Commercial |
$678.30
|
| Rate for Payer: First Choice Health Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.24
|
| Rate for Payer: HealthUtah PPO |
$714.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$692.58
|
| Rate for Payer: Multiplan Medicare/VA |
$447.68
|
| Rate for Payer: One Health Plan of WY PPO |
$699.72
|
| Rate for Payer: PacificSource Commercial |
$642.60
|
| Rate for Payer: PHCS PPO |
$699.72
|
| Rate for Payer: Three Rivers PPO |
$535.50
|
| Rate for Payer: TriWest Veterans Administration |
$471.24
|
| Rate for Payer: United Healthcare Commercial |
$621.18
|
| Rate for Payer: United Healthcare Medicare |
$471.24
|
| Rate for Payer: WINHealth Partners Commercial |
$678.30
|
| Rate for Payer: Wise Provider Network Commercial |
$678.30
|
|
|
WEREWOLF 50 COBLATION WAND
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.41 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$699.72
|
| Rate for Payer: Aetna of WY Medicare |
$471.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$685.44
|
| Rate for Payer: Altius Commercial |
$685.44
|
| Rate for Payer: Beech Street Commercial |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$586.19
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$692.58
|
| Rate for Payer: Cigna of WY Commercial |
$699.72
|
| Rate for Payer: Entrust Commercial |
$678.30
|
| Rate for Payer: First Choice Health Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.12
|
| Rate for Payer: HealthUtah PPO |
$714.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$692.58
|
| Rate for Payer: Multiplan Medicare/VA |
$393.41
|
| Rate for Payer: One Health Plan of WY PPO |
$699.72
|
| Rate for Payer: PacificSource Commercial |
$642.60
|
| Rate for Payer: PHCS PPO |
$699.72
|
| Rate for Payer: Three Rivers PPO |
$535.50
|
| Rate for Payer: TriWest Veterans Administration |
$414.12
|
| Rate for Payer: United Healthcare Commercial |
$621.18
|
| Rate for Payer: United Healthcare Medicare |
$414.12
|
| Rate for Payer: WINHealth Partners Commercial |
$699.72
|
| Rate for Payer: Wise Provider Network Commercial |
$678.30
|
|
|
WEREWOLF 90 COBLATION WAND
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.41 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$699.72
|
| Rate for Payer: Aetna of WY Medicare |
$471.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$685.44
|
| Rate for Payer: Altius Commercial |
$685.44
|
| Rate for Payer: Beech Street Commercial |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$586.19
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$692.58
|
| Rate for Payer: Cigna of WY Commercial |
$699.72
|
| Rate for Payer: Entrust Commercial |
$678.30
|
| Rate for Payer: First Choice Health Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.12
|
| Rate for Payer: HealthUtah PPO |
$714.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$692.58
|
| Rate for Payer: Multiplan Medicare/VA |
$393.41
|
| Rate for Payer: One Health Plan of WY PPO |
$699.72
|
| Rate for Payer: PacificSource Commercial |
$642.60
|
| Rate for Payer: PHCS PPO |
$699.72
|
| Rate for Payer: Three Rivers PPO |
$535.50
|
| Rate for Payer: TriWest Veterans Administration |
$414.12
|
| Rate for Payer: United Healthcare Commercial |
$621.18
|
| Rate for Payer: United Healthcare Medicare |
$414.12
|
| Rate for Payer: WINHealth Partners Commercial |
$699.72
|
| Rate for Payer: Wise Provider Network Commercial |
$678.30
|
|
|
WEREWOLF 90 COBLATION WAND
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.68 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$699.72
|
| Rate for Payer: Altius Auto/Workers Compensation |
$685.44
|
| Rate for Payer: Altius Commercial |
$685.44
|
| Rate for Payer: Beech Street Commercial |
$699.72
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$586.19
|
| Rate for Payer: Cash Price |
$499.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$692.58
|
| Rate for Payer: Cigna of WY Commercial |
$699.72
|
| Rate for Payer: Entrust Commercial |
$678.30
|
| Rate for Payer: First Choice Health Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$678.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$471.24
|
| Rate for Payer: HealthUtah PPO |
$714.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$692.58
|
| Rate for Payer: Multiplan Medicare/VA |
$447.68
|
| Rate for Payer: One Health Plan of WY PPO |
$699.72
|
| Rate for Payer: PacificSource Commercial |
$642.60
|
| Rate for Payer: PHCS PPO |
$699.72
|
| Rate for Payer: Three Rivers PPO |
$535.50
|
| Rate for Payer: TriWest Veterans Administration |
$471.24
|
| Rate for Payer: United Healthcare Commercial |
$621.18
|
| Rate for Payer: United Healthcare Medicare |
$471.24
|
| Rate for Payer: WINHealth Partners Commercial |
$678.30
|
| Rate for Payer: Wise Provider Network Commercial |
$678.30
|
|
|
WEREWOLF FASTSEAL 6.0 WAND
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$655.69 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,166.20
|
| Rate for Payer: Aetna of WY Medicare |
$785.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,142.40
|
| Rate for Payer: Altius Commercial |
$1,142.40
|
| Rate for Payer: Beech Street Commercial |
$1,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$976.99
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,154.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,166.20
|
| Rate for Payer: Entrust Commercial |
$1,130.50
|
| Rate for Payer: First Choice Health Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$690.20
|
| Rate for Payer: HealthUtah PPO |
$1,190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,154.30
|
| Rate for Payer: Multiplan Medicare/VA |
$655.69
|
| Rate for Payer: One Health Plan of WY PPO |
$1,166.20
|
| Rate for Payer: PacificSource Commercial |
$1,071.00
|
| Rate for Payer: PHCS PPO |
$1,166.20
|
| Rate for Payer: Three Rivers PPO |
$892.50
|
| Rate for Payer: TriWest Veterans Administration |
$690.20
|
| Rate for Payer: United Healthcare Commercial |
$1,035.30
|
| Rate for Payer: United Healthcare Medicare |
$690.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,166.20
|
| Rate for Payer: Wise Provider Network Commercial |
$1,130.50
|
|
|
WEREWOLF FASTSEAL 6.0 WAND
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.13 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,166.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,142.40
|
| Rate for Payer: Altius Commercial |
$1,142.40
|
| Rate for Payer: Beech Street Commercial |
$1,166.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$976.99
|
| Rate for Payer: Cash Price |
$833.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,154.30
|
| Rate for Payer: Cigna of WY Commercial |
$1,166.20
|
| Rate for Payer: Entrust Commercial |
$1,130.50
|
| Rate for Payer: First Choice Health Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,130.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$785.40
|
| Rate for Payer: HealthUtah PPO |
$1,190.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,154.30
|
| Rate for Payer: Multiplan Medicare/VA |
$746.13
|
| Rate for Payer: One Health Plan of WY PPO |
$1,166.20
|
| Rate for Payer: PacificSource Commercial |
$1,071.00
|
| Rate for Payer: PHCS PPO |
$1,166.20
|
| Rate for Payer: Three Rivers PPO |
$892.50
|
| Rate for Payer: TriWest Veterans Administration |
$785.40
|
| Rate for Payer: United Healthcare Commercial |
$1,035.30
|
| Rate for Payer: United Healthcare Medicare |
$785.40
|
| Rate for Payer: WINHealth Partners Commercial |
$1,130.50
|
| Rate for Payer: Wise Provider Network Commercial |
$1,130.50
|
|
|
WEREWOLF IRRIGATION TUBE SET
|
Facility
|
OP
|
$85.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$85.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.69
|
| Rate for Payer: Aetna of WY Medicare |
$56.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.98
|
| Rate for Payer: Altius Commercial |
$81.98
|
| Rate for Payer: Beech Street Commercial |
$83.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.11
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.84
|
| Rate for Payer: Cigna of WY Commercial |
$83.69
|
| Rate for Payer: Entrust Commercial |
$81.13
|
| Rate for Payer: First Choice Health Commercial |
$81.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.53
|
| Rate for Payer: HealthUtah PPO |
$85.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.84
|
| Rate for Payer: Multiplan Medicare/VA |
$47.06
|
| Rate for Payer: One Health Plan of WY PPO |
$83.69
|
| Rate for Payer: PacificSource Commercial |
$76.86
|
| Rate for Payer: PHCS PPO |
$83.69
|
| Rate for Payer: Three Rivers PPO |
$64.05
|
| Rate for Payer: TriWest Veterans Administration |
$49.53
|
| Rate for Payer: United Healthcare Commercial |
$74.30
|
| Rate for Payer: United Healthcare Medicare |
$49.53
|
| Rate for Payer: WINHealth Partners Commercial |
$83.69
|
| Rate for Payer: Wise Provider Network Commercial |
$81.13
|
|
|
WEREWOLF IRRIGATION TUBE SET
|
Facility
|
IP
|
$85.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$85.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$83.69
|
| Rate for Payer: Altius Auto/Workers Compensation |
$81.98
|
| Rate for Payer: Altius Commercial |
$81.98
|
| Rate for Payer: Beech Street Commercial |
$83.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.11
|
| Rate for Payer: Cash Price |
$59.78
|
| Rate for Payer: ChoiceCare Network Commercial |
$82.84
|
| Rate for Payer: Cigna of WY Commercial |
$83.69
|
| Rate for Payer: Entrust Commercial |
$81.13
|
| Rate for Payer: First Choice Health Commercial |
$81.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.36
|
| Rate for Payer: HealthUtah PPO |
$85.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$82.84
|
| Rate for Payer: Multiplan Medicare/VA |
$53.55
|
| Rate for Payer: One Health Plan of WY PPO |
$83.69
|
| Rate for Payer: PacificSource Commercial |
$76.86
|
| Rate for Payer: PHCS PPO |
$83.69
|
| Rate for Payer: Three Rivers PPO |
$64.05
|
| Rate for Payer: TriWest Veterans Administration |
$56.36
|
| Rate for Payer: United Healthcare Commercial |
$74.30
|
| Rate for Payer: United Healthcare Medicare |
$56.36
|
| Rate for Payer: WINHealth Partners Commercial |
$81.13
|
| Rate for Payer: Wise Provider Network Commercial |
$81.13
|
|
