|
WHFO, RIGID W/O JOINTS
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS L3808
|
| Hospital Charge Code |
L3808
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$539.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$528.22
|
| Rate for Payer: Aetna of WY Medicare |
$392.87
|
| Rate for Payer: Beech Street Commercial |
$512.05
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: Cash Price |
$377.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$522.83
|
| Rate for Payer: Cigna of WY Commercial |
$528.22
|
| Rate for Payer: First Choice Health Commercial |
$485.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$512.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$392.87
|
| Rate for Payer: HealthUtah PPO |
$539.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$522.83
|
| Rate for Payer: Multiplan Medicare/VA |
$333.94
|
| Rate for Payer: One Health Plan of WY PPO |
$528.22
|
| Rate for Payer: PacificSource Commercial |
$485.10
|
| Rate for Payer: PHCS PPO |
$512.05
|
| Rate for Payer: Three Rivers PPO |
$404.25
|
| Rate for Payer: TriWest Veterans Administration |
$392.87
|
| Rate for Payer: United Healthcare Commercial |
$468.93
|
| Rate for Payer: United Healthcare Medicare |
$392.87
|
| Rate for Payer: WINHealth Partners Commercial |
$512.05
|
|
|
WHFO W/O JOINTS PRE CST
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
L3807
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Beech Street Commercial |
$51.30
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: First Choice Health Commercial |
$48.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$51.30
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: United Healthcare Commercial |
$46.98
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
|
|
WHFO W/O JOINTS PRE OTS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
L3809
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Beech Street Commercial |
$86.45
|
| Rate for Payer: Cash Price |
$63.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$88.27
|
| Rate for Payer: Cigna of WY Commercial |
$89.18
|
| Rate for Payer: First Choice Health Commercial |
$81.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$86.45
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$79.17
|
| Rate for Payer: WINHealth Partners Commercial |
$86.45
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT [45985]
|
Facility
|
IP
|
$10.47
|
|
|
Service Code
|
NDC 0023031204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.05
|
| Rate for Payer: Altius Commercial |
$10.05
|
| Rate for Payer: Beech Street Commercial |
$10.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.16
|
| Rate for Payer: Cigna of WY Commercial |
$10.26
|
| Rate for Payer: Entrust Commercial |
$9.95
|
| Rate for Payer: First Choice Health Commercial |
$9.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.91
|
| Rate for Payer: HealthUtah PPO |
$10.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.16
|
| Rate for Payer: Multiplan Medicare/VA |
$6.56
|
| Rate for Payer: One Health Plan of WY PPO |
$10.26
|
| Rate for Payer: PacificSource Commercial |
$9.42
|
| Rate for Payer: PHCS PPO |
$10.26
|
| Rate for Payer: Three Rivers PPO |
$7.85
|
| Rate for Payer: TriWest Veterans Administration |
$6.91
|
| Rate for Payer: United Healthcare Commercial |
$9.11
|
| Rate for Payer: United Healthcare Medicare |
$6.91
|
| Rate for Payer: WINHealth Partners Commercial |
$9.95
|
| Rate for Payer: Wise Provider Network Commercial |
$9.95
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT [45985]
|
Facility
|
OP
|
$10.47
|
|
|
Service Code
|
NDC 0023031204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.26
|
| Rate for Payer: Aetna of WY Medicare |
$6.91
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.05
|
| Rate for Payer: Altius Commercial |
$10.05
|
| Rate for Payer: Beech Street Commercial |
$10.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.16
|
| Rate for Payer: Cigna of WY Commercial |
$10.26
|
| Rate for Payer: Entrust Commercial |
$9.95
|
| Rate for Payer: First Choice Health Commercial |
$9.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.07
|
| Rate for Payer: HealthUtah PPO |
$10.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.16
|
| Rate for Payer: Multiplan Medicare/VA |
$5.77
|
| Rate for Payer: One Health Plan of WY PPO |
$10.26
|
| Rate for Payer: PacificSource Commercial |
$9.42
|
| Rate for Payer: PHCS PPO |
$10.26
|
| Rate for Payer: Three Rivers PPO |
$7.85
|
| Rate for Payer: TriWest Veterans Administration |
$6.07
|
| Rate for Payer: United Healthcare Commercial |
$9.11
|
| Rate for Payer: United Healthcare Medicare |
$6.07
|
| Rate for Payer: WINHealth Partners Commercial |
$10.26
|
| Rate for Payer: Wise Provider Network Commercial |
$9.95
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [88827]
|
Facility
|
IP
|
$9.81
|
|
|
Service Code
|
NDC 0023024004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.42
|
| Rate for Payer: Altius Commercial |
$9.42
|
| Rate for Payer: Beech Street Commercial |
$9.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.52
|
| Rate for Payer: Cigna of WY Commercial |
$9.61
|
| Rate for Payer: Entrust Commercial |
$9.32
|
| Rate for Payer: First Choice Health Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.47
|
| Rate for Payer: HealthUtah PPO |
$9.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.52
|
| Rate for Payer: Multiplan Medicare/VA |
$6.15
|
| Rate for Payer: One Health Plan of WY PPO |
$9.61
|
| Rate for Payer: PacificSource Commercial |
$8.83
|
| Rate for Payer: PHCS PPO |
$9.61
|
| Rate for Payer: Three Rivers PPO |
$7.36
|
| Rate for Payer: TriWest Veterans Administration |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.53
|
| Rate for Payer: United Healthcare Medicare |
$6.47
|
| Rate for Payer: WINHealth Partners Commercial |
$9.32
|
| Rate for Payer: Wise Provider Network Commercial |
$9.32
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [88827]
|
Facility
|
OP
|
$9.81
|
|
|
Service Code
|
NDC 0023024004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.61
|
| Rate for Payer: Aetna of WY Medicare |
$6.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.42
|
| Rate for Payer: Altius Commercial |
$9.42
|
| Rate for Payer: Beech Street Commercial |
$9.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.52
|
| Rate for Payer: Cigna of WY Commercial |
$9.61
|
| Rate for Payer: Entrust Commercial |
$9.32
|
| Rate for Payer: First Choice Health Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.69
|
| Rate for Payer: HealthUtah PPO |
$9.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.52
|
| Rate for Payer: Multiplan Medicare/VA |
$5.41
|
| Rate for Payer: One Health Plan of WY PPO |
$9.61
|
| Rate for Payer: PacificSource Commercial |
$8.83
|
| Rate for Payer: PHCS PPO |
$9.61
|
| Rate for Payer: Three Rivers PPO |
$7.36
|
| Rate for Payer: TriWest Veterans Administration |
$5.69
|
| Rate for Payer: United Healthcare Commercial |
$8.53
|
| Rate for Payer: United Healthcare Medicare |
$5.69
|
| Rate for Payer: WINHealth Partners Commercial |
$9.61
|
| Rate for Payer: Wise Provider Network Commercial |
$9.32
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [88827]
|
Facility
|
IP
|
$9.81
|
|
|
Service Code
|
NDC 0023066704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.42
|
| Rate for Payer: Altius Commercial |
$9.42
|
| Rate for Payer: Beech Street Commercial |
$9.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.52
|
| Rate for Payer: Cigna of WY Commercial |
$9.61
|
| Rate for Payer: Entrust Commercial |
$9.32
|
| Rate for Payer: First Choice Health Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.47
|
| Rate for Payer: HealthUtah PPO |
$9.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.52
|
| Rate for Payer: Multiplan Medicare/VA |
$6.15
|
| Rate for Payer: One Health Plan of WY PPO |
$9.61
|
| Rate for Payer: PacificSource Commercial |
$8.83
|
| Rate for Payer: PHCS PPO |
$9.61
|
| Rate for Payer: Three Rivers PPO |
$7.36
|
| Rate for Payer: TriWest Veterans Administration |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.53
|
| Rate for Payer: United Healthcare Medicare |
$6.47
|
| Rate for Payer: WINHealth Partners Commercial |
$9.32
|
| Rate for Payer: Wise Provider Network Commercial |
$9.32
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT [88827]
|
Facility
|
OP
|
$9.81
|
|
|
Service Code
|
NDC 0023066704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$9.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.61
|
| Rate for Payer: Aetna of WY Medicare |
$6.47
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.42
|
| Rate for Payer: Altius Commercial |
$9.42
|
| Rate for Payer: Beech Street Commercial |
$9.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.05
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.52
|
| Rate for Payer: Cigna of WY Commercial |
$9.61
|
| Rate for Payer: Entrust Commercial |
$9.32
|
| Rate for Payer: First Choice Health Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.69
|
| Rate for Payer: HealthUtah PPO |
$9.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.52
|
| Rate for Payer: Multiplan Medicare/VA |
$5.41
|
| Rate for Payer: One Health Plan of WY PPO |
$9.61
|
| Rate for Payer: PacificSource Commercial |
$8.83
|
| Rate for Payer: PHCS PPO |
$9.61
|
| Rate for Payer: Three Rivers PPO |
$7.36
|
| Rate for Payer: TriWest Veterans Administration |
$5.69
|
| Rate for Payer: United Healthcare Commercial |
$8.53
|
| Rate for Payer: United Healthcare Medicare |
$5.69
|
| Rate for Payer: WINHealth Partners Commercial |
$9.61
|
| Rate for Payer: Wise Provider Network Commercial |
$9.32
|
|
|
WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [53812]
|
Facility
|
IP
|
$9.31
|
|
|
Service Code
|
NDC 0065050935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.88
|
| Rate for Payer: Altius Commercial |
$9.88
|
| Rate for Payer: Altius Commercial |
$8.94
|
| Rate for Payer: Beech Street Commercial |
$9.12
|
| Rate for Payer: Beech Street Commercial |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.03
|
| Rate for Payer: Cigna of WY Commercial |
$9.12
|
| Rate for Payer: Cigna of WY Commercial |
$10.08
|
| Rate for Payer: Entrust Commercial |
$9.78
|
| Rate for Payer: Entrust Commercial |
$8.84
|
| Rate for Payer: First Choice Health Commercial |
$9.78
|
| Rate for Payer: First Choice Health Commercial |
$8.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.79
|
| Rate for Payer: HealthUtah PPO |
$9.31
|
| Rate for Payer: HealthUtah PPO |
$10.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.03
|
| Rate for Payer: Multiplan Medicare/VA |
$5.84
|
| Rate for Payer: Multiplan Medicare/VA |
$6.45
|
| Rate for Payer: One Health Plan of WY PPO |
$9.12
|
| Rate for Payer: One Health Plan of WY PPO |
$10.08
|
| Rate for Payer: PacificSource Commercial |
$8.38
|
| Rate for Payer: PacificSource Commercial |
$9.26
|
| Rate for Payer: PHCS PPO |
$10.08
|
| Rate for Payer: PHCS PPO |
$9.12
|
| Rate for Payer: Three Rivers PPO |
$7.72
|
| Rate for Payer: Three Rivers PPO |
$6.98
|
| Rate for Payer: TriWest Veterans Administration |
$6.14
|
| Rate for Payer: TriWest Veterans Administration |
$6.79
|
| Rate for Payer: United Healthcare Commercial |
$8.95
|
| Rate for Payer: United Healthcare Commercial |
$8.10
|
| Rate for Payer: United Healthcare Medicare |
$6.14
|
| Rate for Payer: United Healthcare Medicare |
$6.79
|
| Rate for Payer: WINHealth Partners Commercial |
$9.78
|
| Rate for Payer: WINHealth Partners Commercial |
$8.84
|
| Rate for Payer: Wise Provider Network Commercial |
$9.78
|
| Rate for Payer: Wise Provider Network Commercial |
$8.84
|
|
|
WHITE PETROLATUM-MINERAL OIL 94 %-3 % EYE OINTMENT [53812]
|
Facility
|
OP
|
$9.31
|
|
|
Service Code
|
NDC 0065050935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.08
|
| Rate for Payer: Aetna of WY Medicare |
$6.14
|
| Rate for Payer: Aetna of WY Medicare |
$6.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$8.94
|
| Rate for Payer: Altius Commercial |
$8.94
|
| Rate for Payer: Altius Commercial |
$9.88
|
| Rate for Payer: Beech Street Commercial |
$10.08
|
| Rate for Payer: Beech Street Commercial |
$9.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.45
|
| Rate for Payer: Cash Price |
$7.21
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.98
|
| Rate for Payer: Cigna of WY Commercial |
$10.08
|
| Rate for Payer: Cigna of WY Commercial |
$9.12
|
| Rate for Payer: Entrust Commercial |
$8.84
|
| Rate for Payer: Entrust Commercial |
$9.78
|
| Rate for Payer: First Choice Health Commercial |
$9.78
|
| Rate for Payer: First Choice Health Commercial |
$8.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9.78
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.97
|
| Rate for Payer: HealthUtah PPO |
$10.29
|
| Rate for Payer: HealthUtah PPO |
$9.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.98
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.03
|
| Rate for Payer: Multiplan Medicare/VA |
$5.13
|
| Rate for Payer: Multiplan Medicare/VA |
$5.67
|
| Rate for Payer: One Health Plan of WY PPO |
$10.08
|
| Rate for Payer: One Health Plan of WY PPO |
$9.12
|
| Rate for Payer: PacificSource Commercial |
$8.38
|
| Rate for Payer: PacificSource Commercial |
$9.26
|
| Rate for Payer: PHCS PPO |
$10.08
|
| Rate for Payer: PHCS PPO |
$9.12
|
| Rate for Payer: Three Rivers PPO |
$7.72
|
| Rate for Payer: Three Rivers PPO |
$6.98
|
| Rate for Payer: TriWest Veterans Administration |
$5.40
|
| Rate for Payer: TriWest Veterans Administration |
$5.97
|
| Rate for Payer: United Healthcare Commercial |
$8.95
|
| Rate for Payer: United Healthcare Commercial |
$8.10
|
| Rate for Payer: United Healthcare Medicare |
$5.40
|
| Rate for Payer: United Healthcare Medicare |
$5.97
|
| Rate for Payer: WINHealth Partners Commercial |
$10.08
|
| Rate for Payer: WINHealth Partners Commercial |
$9.12
|
| Rate for Payer: Wise Provider Network Commercial |
$9.78
|
| Rate for Payer: Wise Provider Network Commercial |
$8.84
|
|
|
WHITNEY CEM KNIFE TK BONE
|
Facility
|
IP
|
$57.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.07 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.38
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.23
|
| Rate for Payer: Altius Commercial |
$55.23
|
| Rate for Payer: Beech Street Commercial |
$56.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.23
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.80
|
| Rate for Payer: Cigna of WY Commercial |
$56.38
|
| Rate for Payer: Entrust Commercial |
$54.65
|
| Rate for Payer: First Choice Health Commercial |
$54.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.97
|
| Rate for Payer: HealthUtah PPO |
$57.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.80
|
| Rate for Payer: Multiplan Medicare/VA |
$36.07
|
| Rate for Payer: One Health Plan of WY PPO |
$56.38
|
| Rate for Payer: PacificSource Commercial |
$51.78
|
| Rate for Payer: PHCS PPO |
$56.38
|
| Rate for Payer: Three Rivers PPO |
$43.15
|
| Rate for Payer: TriWest Veterans Administration |
$37.97
|
| Rate for Payer: United Healthcare Commercial |
$50.05
|
| Rate for Payer: United Healthcare Medicare |
$37.97
|
| Rate for Payer: WINHealth Partners Commercial |
$54.65
|
| Rate for Payer: Wise Provider Network Commercial |
$54.65
|
|
|
WHITNEY CEM KNIFE TK BONE
|
Facility
|
OP
|
$57.53
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$56.38
|
| Rate for Payer: Aetna of WY Medicare |
$37.97
|
| Rate for Payer: Altius Auto/Workers Compensation |
$55.23
|
| Rate for Payer: Altius Commercial |
$55.23
|
| Rate for Payer: Beech Street Commercial |
$56.38
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$47.23
|
| Rate for Payer: Cash Price |
$40.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$55.80
|
| Rate for Payer: Cigna of WY Commercial |
$56.38
|
| Rate for Payer: Entrust Commercial |
$54.65
|
| Rate for Payer: First Choice Health Commercial |
$54.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$54.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.37
|
| Rate for Payer: HealthUtah PPO |
$57.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$55.80
|
| Rate for Payer: Multiplan Medicare/VA |
$31.70
|
| Rate for Payer: One Health Plan of WY PPO |
$56.38
|
| Rate for Payer: PacificSource Commercial |
$51.78
|
| Rate for Payer: PHCS PPO |
$56.38
|
| Rate for Payer: Three Rivers PPO |
$43.15
|
| Rate for Payer: TriWest Veterans Administration |
$33.37
|
| Rate for Payer: United Healthcare Commercial |
$50.05
|
| Rate for Payer: United Healthcare Medicare |
$33.37
|
| Rate for Payer: WINHealth Partners Commercial |
$56.38
|
| Rate for Payer: Wise Provider Network Commercial |
$54.65
|
|
|
WHO COCK-UP NONMOLDE PRE OTS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS L3908
|
| Hospital Charge Code |
L3908
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$88.20
|
| Rate for Payer: Beech Street Commercial |
$85.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$87.30
|
| Rate for Payer: Cigna of WY Commercial |
$88.20
|
| Rate for Payer: First Choice Health Commercial |
$81.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$85.50
|
| Rate for Payer: HealthUtah PPO |
$90.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$87.30
|
| Rate for Payer: One Health Plan of WY PPO |
$88.20
|
| Rate for Payer: PacificSource Commercial |
$81.00
|
| Rate for Payer: PHCS PPO |
$85.50
|
| Rate for Payer: Three Rivers PPO |
$67.50
|
| Rate for Payer: United Healthcare Commercial |
$78.30
|
| Rate for Payer: WINHealth Partners Commercial |
$85.50
|
|
|
WHOLEY WIRE .035X260CM
|
Facility
|
IP
|
$395.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.98 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.68
|
| Rate for Payer: Altius Commercial |
$379.68
|
| Rate for Payer: Beech Street Commercial |
$387.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.71
|
| Rate for Payer: Cash Price |
$276.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.64
|
| Rate for Payer: Cigna of WY Commercial |
$387.59
|
| Rate for Payer: Entrust Commercial |
$375.72
|
| Rate for Payer: First Choice Health Commercial |
$375.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.03
|
| Rate for Payer: HealthUtah PPO |
$395.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.64
|
| Rate for Payer: Multiplan Medicare/VA |
$247.98
|
| Rate for Payer: One Health Plan of WY PPO |
$387.59
|
| Rate for Payer: PacificSource Commercial |
$355.95
|
| Rate for Payer: PHCS PPO |
$387.59
|
| Rate for Payer: Three Rivers PPO |
$296.62
|
| Rate for Payer: TriWest Veterans Administration |
$261.03
|
| Rate for Payer: United Healthcare Commercial |
$344.08
|
| Rate for Payer: United Healthcare Medicare |
$261.03
|
| Rate for Payer: WINHealth Partners Commercial |
$375.72
|
| Rate for Payer: Wise Provider Network Commercial |
$375.72
|
|
|
WHOLEY WIRE .035X260CM
|
Facility
|
OP
|
$395.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.92 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$387.59
|
| Rate for Payer: Aetna of WY Medicare |
$261.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$379.68
|
| Rate for Payer: Altius Commercial |
$379.68
|
| Rate for Payer: Beech Street Commercial |
$387.59
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$324.71
|
| Rate for Payer: Cash Price |
$276.85
|
| Rate for Payer: ChoiceCare Network Commercial |
$383.64
|
| Rate for Payer: Cigna of WY Commercial |
$387.59
|
| Rate for Payer: Entrust Commercial |
$375.72
|
| Rate for Payer: First Choice Health Commercial |
$375.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$375.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$229.39
|
| Rate for Payer: HealthUtah PPO |
$395.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$383.64
|
| Rate for Payer: Multiplan Medicare/VA |
$217.92
|
| Rate for Payer: One Health Plan of WY PPO |
$387.59
|
| Rate for Payer: PacificSource Commercial |
$355.95
|
| Rate for Payer: PHCS PPO |
$387.59
|
| Rate for Payer: Three Rivers PPO |
$296.62
|
| Rate for Payer: TriWest Veterans Administration |
$229.39
|
| Rate for Payer: United Healthcare Commercial |
$344.08
|
| Rate for Payer: United Healthcare Medicare |
$229.39
|
| Rate for Payer: WINHealth Partners Commercial |
$387.59
|
| Rate for Payer: Wise Provider Network Commercial |
$375.72
|
|
|
WHO W/NONTORSION JNT(S) CF
|
Professional
|
Both
|
$1,473.00
|
|
|
Service Code
|
HCPCS L3905
|
| Hospital Charge Code |
L3905
|
| Min. Negotiated Rate |
$1,104.75 |
| Max. Negotiated Rate |
$1,473.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,443.54
|
| Rate for Payer: Beech Street Commercial |
$1,399.35
|
| Rate for Payer: Cash Price |
$1,031.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,428.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,443.54
|
| Rate for Payer: First Choice Health Commercial |
$1,325.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,399.35
|
| Rate for Payer: HealthUtah PPO |
$1,473.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,428.81
|
| Rate for Payer: One Health Plan of WY PPO |
$1,443.54
|
| Rate for Payer: PacificSource Commercial |
$1,325.70
|
| Rate for Payer: PHCS PPO |
$1,399.35
|
| Rate for Payer: Three Rivers PPO |
$1,104.75
|
| Rate for Payer: United Healthcare Commercial |
$1,281.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,399.35
|
|
|
WHO W/O JOINTS CF
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS L3906
|
| Hospital Charge Code |
L3906
|
| Min. Negotiated Rate |
$453.00 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$591.92
|
| Rate for Payer: Beech Street Commercial |
$573.80
|
| Rate for Payer: Cash Price |
$422.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$585.88
|
| Rate for Payer: Cigna of WY Commercial |
$591.92
|
| Rate for Payer: First Choice Health Commercial |
$543.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$573.80
|
| Rate for Payer: HealthUtah PPO |
$604.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$585.88
|
| Rate for Payer: One Health Plan of WY PPO |
$591.92
|
| Rate for Payer: PacificSource Commercial |
$543.60
|
| Rate for Payer: PHCS PPO |
$573.80
|
| Rate for Payer: Three Rivers PPO |
$453.00
|
| Rate for Payer: United Healthcare Commercial |
$525.48
|
| Rate for Payer: WINHealth Partners Commercial |
$573.80
|
|
|
WITCH HAZEL 50 % TOPICAL PADS [89118]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 0904682960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
WITCH HAZEL 50 % TOPICAL PADS [89118]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 0904682960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
WITCH HAZEL 50 % TOPICAL PADS [89118]
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 7139901101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.11
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.11
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.11
|
| Rate for Payer: WINHealth Partners Commercial |
$0.15
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
WITCH HAZEL 50 % TOPICAL PADS [89118]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 7139901101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.16
|
| Rate for Payer: Aetna of WY Medicare |
$0.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.15
|
| Rate for Payer: Altius Commercial |
$0.15
|
| Rate for Payer: Beech Street Commercial |
$0.16
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.16
|
| Rate for Payer: Cigna of WY Commercial |
$0.16
|
| Rate for Payer: Entrust Commercial |
$0.15
|
| Rate for Payer: First Choice Health Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.09
|
| Rate for Payer: HealthUtah PPO |
$0.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.16
|
| Rate for Payer: Multiplan Medicare/VA |
$0.09
|
| Rate for Payer: One Health Plan of WY PPO |
$0.16
|
| Rate for Payer: PacificSource Commercial |
$0.14
|
| Rate for Payer: PHCS PPO |
$0.16
|
| Rate for Payer: Three Rivers PPO |
$0.12
|
| Rate for Payer: TriWest Veterans Administration |
$0.09
|
| Rate for Payer: United Healthcare Commercial |
$0.14
|
| Rate for Payer: United Healthcare Medicare |
$0.09
|
| Rate for Payer: WINHealth Partners Commercial |
$0.16
|
| Rate for Payer: Wise Provider Network Commercial |
$0.15
|
|
|
WITCH HAZEL WITH LIDOCAINE TOPICAL PADS [400791]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 9999400791
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.77
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.73
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.77
|
| Rate for Payer: WINHealth Partners Commercial |
$1.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
WITCH HAZEL WITH LIDOCAINE TOPICAL PADS [400791]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 9999400791
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.14
|
| Rate for Payer: Aetna of WY Medicare |
$0.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.11
|
| Rate for Payer: Altius Commercial |
$1.11
|
| Rate for Payer: Beech Street Commercial |
$1.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.13
|
| Rate for Payer: Cigna of WY Commercial |
$1.14
|
| Rate for Payer: Entrust Commercial |
$1.10
|
| Rate for Payer: First Choice Health Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.67
|
| Rate for Payer: HealthUtah PPO |
$1.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.13
|
| Rate for Payer: Multiplan Medicare/VA |
$0.64
|
| Rate for Payer: One Health Plan of WY PPO |
$1.14
|
| Rate for Payer: PacificSource Commercial |
$1.04
|
| Rate for Payer: PHCS PPO |
$1.14
|
| Rate for Payer: Three Rivers PPO |
$0.87
|
| Rate for Payer: TriWest Veterans Administration |
$0.67
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
| Rate for Payer: WINHealth Partners Commercial |
$1.14
|
| Rate for Payer: Wise Provider Network Commercial |
$1.10
|
|
|
WOLVERINE CUTTING BALLOON 2.5MM X 10MM
|
Facility
|
OP
|
$2,660.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,465.66 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,606.80
|
| Rate for Payer: Aetna of WY Medicare |
$1,755.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2,553.60
|
| Rate for Payer: Altius Commercial |
$2,553.60
|
| Rate for Payer: Beech Street Commercial |
$2,606.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,183.86
|
| Rate for Payer: Cash Price |
$1,862.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,580.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,606.80
|
| Rate for Payer: Entrust Commercial |
$2,527.00
|
| Rate for Payer: First Choice Health Commercial |
$2,527.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,527.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,542.80
|
| Rate for Payer: HealthUtah PPO |
$2,660.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,580.20
|
| Rate for Payer: Multiplan Medicare/VA |
$1,465.66
|
| Rate for Payer: One Health Plan of WY PPO |
$2,606.80
|
| Rate for Payer: PacificSource Commercial |
$2,394.00
|
| Rate for Payer: PHCS PPO |
$2,606.80
|
| Rate for Payer: Three Rivers PPO |
$1,995.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,542.80
|
| Rate for Payer: United Healthcare Commercial |
$2,314.20
|
| Rate for Payer: United Healthcare Medicare |
$1,542.80
|
| Rate for Payer: WINHealth Partners Commercial |
$2,606.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2,527.00
|
|
