|
1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
99460
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$303.80
|
| Rate for Payer: Aetna of WY Medicare |
$88.94
|
| Rate for Payer: Beech Street Commercial |
$294.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$300.70
|
| Rate for Payer: Cigna of WY Commercial |
$303.80
|
| Rate for Payer: First Choice Health Commercial |
$279.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$294.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$88.94
|
| Rate for Payer: HealthUtah PPO |
$310.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$300.70
|
| Rate for Payer: Multiplan Medicare/VA |
$75.60
|
| Rate for Payer: One Health Plan of WY PPO |
$303.80
|
| Rate for Payer: PacificSource Commercial |
$279.00
|
| Rate for Payer: PHCS PPO |
$294.50
|
| Rate for Payer: Three Rivers PPO |
$232.50
|
| Rate for Payer: TriWest Veterans Administration |
$88.94
|
| Rate for Payer: United Healthcare Commercial |
$269.70
|
| Rate for Payer: United Healthcare Medicare |
$88.94
|
| Rate for Payer: WINHealth Partners Commercial |
$294.50
|
|
|
1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 99463
|
| Hospital Charge Code |
99463
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$485.10
|
| Rate for Payer: Aetna of WY Medicare |
$103.83
|
| Rate for Payer: Beech Street Commercial |
$470.25
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$480.15
|
| Rate for Payer: Cigna of WY Commercial |
$485.10
|
| Rate for Payer: First Choice Health Commercial |
$445.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$470.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.83
|
| Rate for Payer: HealthUtah PPO |
$495.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$480.15
|
| Rate for Payer: Multiplan Medicare/VA |
$88.26
|
| Rate for Payer: One Health Plan of WY PPO |
$485.10
|
| Rate for Payer: PacificSource Commercial |
$445.50
|
| Rate for Payer: PHCS PPO |
$470.25
|
| Rate for Payer: Three Rivers PPO |
$371.25
|
| Rate for Payer: TriWest Veterans Administration |
$103.83
|
| Rate for Payer: United Healthcare Commercial |
$430.65
|
| Rate for Payer: United Healthcare Medicare |
$103.83
|
| Rate for Payer: WINHealth Partners Commercial |
$470.25
|
|
|
1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
99223
|
| Min. Negotiated Rate |
$141.17 |
| Max. Negotiated Rate |
$500.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$500.78
|
| Rate for Payer: Aetna of WY Medicare |
$166.08
|
| Rate for Payer: Beech Street Commercial |
$485.45
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: Cash Price |
$357.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$495.67
|
| Rate for Payer: Cigna of WY Commercial |
$500.78
|
| Rate for Payer: First Choice Health Commercial |
$459.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$485.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$166.08
|
| Rate for Payer: HealthUtah PPO |
$191.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$495.67
|
| Rate for Payer: Multiplan Medicare/VA |
$141.17
|
| Rate for Payer: One Health Plan of WY PPO |
$500.78
|
| Rate for Payer: PacificSource Commercial |
$459.90
|
| Rate for Payer: PHCS PPO |
$485.45
|
| Rate for Payer: Three Rivers PPO |
$383.25
|
| Rate for Payer: TriWest Veterans Administration |
$166.08
|
| Rate for Payer: United Healthcare Commercial |
$444.57
|
| Rate for Payer: United Healthcare Medicare |
$166.08
|
| Rate for Payer: WINHealth Partners Commercial |
$485.45
|
|
|
1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
99222
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$405.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$405.72
|
| Rate for Payer: Aetna of WY Medicare |
$125.08
|
| Rate for Payer: Beech Street Commercial |
$393.30
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$401.58
|
| Rate for Payer: Cigna of WY Commercial |
$405.72
|
| Rate for Payer: First Choice Health Commercial |
$372.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$393.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$125.08
|
| Rate for Payer: HealthUtah PPO |
$137.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$401.58
|
| Rate for Payer: Multiplan Medicare/VA |
$106.32
|
| Rate for Payer: One Health Plan of WY PPO |
$405.72
|
| Rate for Payer: PacificSource Commercial |
$372.60
|
| Rate for Payer: PHCS PPO |
$393.30
|
| Rate for Payer: Three Rivers PPO |
$310.50
|
| Rate for Payer: TriWest Veterans Administration |
$125.08
|
| Rate for Payer: United Healthcare Commercial |
$360.18
|
| Rate for Payer: United Healthcare Medicare |
$125.08
|
| Rate for Payer: WINHealth Partners Commercial |
$393.30
|
|
|
1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
99221
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$304.78
|
| Rate for Payer: Aetna of WY Medicare |
$79.01
|
| Rate for Payer: Beech Street Commercial |
$295.45
|
| Rate for Payer: Cash Price |
$217.70
|
| Rate for Payer: Cash Price |
$217.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$301.67
|
| Rate for Payer: Cigna of WY Commercial |
$304.78
|
| Rate for Payer: First Choice Health Commercial |
$279.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$295.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$79.01
|
| Rate for Payer: HealthUtah PPO |
$82.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$301.67
|
| Rate for Payer: Multiplan Medicare/VA |
$67.16
|
| Rate for Payer: One Health Plan of WY PPO |
$304.78
|
| Rate for Payer: PacificSource Commercial |
$279.90
|
| Rate for Payer: PHCS PPO |
$295.45
|
| Rate for Payer: Three Rivers PPO |
$233.25
|
| Rate for Payer: TriWest Veterans Administration |
$79.01
|
| Rate for Payer: United Healthcare Commercial |
$270.57
|
| Rate for Payer: United Healthcare Medicare |
$79.01
|
| Rate for Payer: WINHealth Partners Commercial |
$295.45
|
|
|
1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$2,133.00
|
|
|
Service Code
|
HCPCS 99468
|
| Hospital Charge Code |
99468
|
| Min. Negotiated Rate |
$727.86 |
| Max. Negotiated Rate |
$2,133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,090.34
|
| Rate for Payer: Aetna of WY Medicare |
$856.30
|
| Rate for Payer: Beech Street Commercial |
$2,026.35
|
| Rate for Payer: Cash Price |
$1,493.10
|
| Rate for Payer: Cash Price |
$1,493.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,069.01
|
| Rate for Payer: Cigna of WY Commercial |
$2,090.34
|
| Rate for Payer: First Choice Health Commercial |
$1,919.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,026.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$856.30
|
| Rate for Payer: HealthUtah PPO |
$2,133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,069.01
|
| Rate for Payer: Multiplan Medicare/VA |
$727.86
|
| Rate for Payer: One Health Plan of WY PPO |
$2,090.34
|
| Rate for Payer: PacificSource Commercial |
$1,919.70
|
| Rate for Payer: PHCS PPO |
$2,026.35
|
| Rate for Payer: Three Rivers PPO |
$1,599.75
|
| Rate for Payer: TriWest Veterans Administration |
$856.30
|
| Rate for Payer: United Healthcare Commercial |
$1,855.71
|
| Rate for Payer: United Healthcare Medicare |
$856.30
|
| Rate for Payer: WINHealth Partners Commercial |
$2,026.35
|
|
|
2-0 FIBERSTICK & 2-0 FIBERWIRE
|
Facility
|
OP
|
$171.71
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.61 |
| Max. Negotiated Rate |
$171.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.28
|
| Rate for Payer: Aetna of WY Medicare |
$113.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$164.84
|
| Rate for Payer: Altius Commercial |
$164.84
|
| Rate for Payer: Beech Street Commercial |
$168.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.97
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.56
|
| Rate for Payer: Cigna of WY Commercial |
$168.28
|
| Rate for Payer: Entrust Commercial |
$163.12
|
| Rate for Payer: First Choice Health Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$99.59
|
| Rate for Payer: HealthUtah PPO |
$171.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.56
|
| Rate for Payer: Multiplan Medicare/VA |
$94.61
|
| Rate for Payer: One Health Plan of WY PPO |
$168.28
|
| Rate for Payer: PacificSource Commercial |
$154.54
|
| Rate for Payer: PHCS PPO |
$168.28
|
| Rate for Payer: Three Rivers PPO |
$128.78
|
| Rate for Payer: TriWest Veterans Administration |
$99.59
|
| Rate for Payer: United Healthcare Commercial |
$149.39
|
| Rate for Payer: United Healthcare Medicare |
$99.59
|
| Rate for Payer: WINHealth Partners Commercial |
$168.28
|
| Rate for Payer: Wise Provider Network Commercial |
$163.12
|
|
|
2-0 FIBERSTICK & 2-0 FIBERWIRE
|
Facility
|
IP
|
$171.71
|
|
| Hospital Charge Code |
27800000S1
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.66 |
| Max. Negotiated Rate |
$171.71 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$168.28
|
| Rate for Payer: Altius Auto/Workers Compensation |
$164.84
|
| Rate for Payer: Altius Commercial |
$164.84
|
| Rate for Payer: Beech Street Commercial |
$168.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$140.97
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$166.56
|
| Rate for Payer: Cigna of WY Commercial |
$168.28
|
| Rate for Payer: Entrust Commercial |
$163.12
|
| Rate for Payer: First Choice Health Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$163.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$113.33
|
| Rate for Payer: HealthUtah PPO |
$171.71
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$166.56
|
| Rate for Payer: Multiplan Medicare/VA |
$107.66
|
| Rate for Payer: One Health Plan of WY PPO |
$168.28
|
| Rate for Payer: PacificSource Commercial |
$154.54
|
| Rate for Payer: PHCS PPO |
$168.28
|
| Rate for Payer: Three Rivers PPO |
$128.78
|
| Rate for Payer: TriWest Veterans Administration |
$113.33
|
| Rate for Payer: United Healthcare Commercial |
$149.39
|
| Rate for Payer: United Healthcare Medicare |
$113.33
|
| Rate for Payer: WINHealth Partners Commercial |
$163.12
|
| Rate for Payer: Wise Provider Network Commercial |
$163.12
|
|
|
4 PORT MANIFOLD
|
Facility
|
IP
|
$51.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$51.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.09
|
| Rate for Payer: Altius Commercial |
$49.09
|
| Rate for Payer: Beech Street Commercial |
$50.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.99
|
| Rate for Payer: Cash Price |
$35.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.61
|
| Rate for Payer: Cigna of WY Commercial |
$50.12
|
| Rate for Payer: Entrust Commercial |
$48.58
|
| Rate for Payer: First Choice Health Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$33.75
|
| Rate for Payer: HealthUtah PPO |
$51.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.61
|
| Rate for Payer: Multiplan Medicare/VA |
$32.06
|
| Rate for Payer: One Health Plan of WY PPO |
$50.12
|
| Rate for Payer: PacificSource Commercial |
$46.03
|
| Rate for Payer: PHCS PPO |
$50.12
|
| Rate for Payer: Three Rivers PPO |
$38.36
|
| Rate for Payer: TriWest Veterans Administration |
$33.75
|
| Rate for Payer: United Healthcare Commercial |
$44.49
|
| Rate for Payer: United Healthcare Medicare |
$33.75
|
| Rate for Payer: WINHealth Partners Commercial |
$48.58
|
| Rate for Payer: Wise Provider Network Commercial |
$48.58
|
|
|
4 PORT MANIFOLD
|
Facility
|
OP
|
$51.14
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$51.14 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$50.12
|
| Rate for Payer: Aetna of WY Medicare |
$33.75
|
| Rate for Payer: Altius Auto/Workers Compensation |
$49.09
|
| Rate for Payer: Altius Commercial |
$49.09
|
| Rate for Payer: Beech Street Commercial |
$50.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$41.99
|
| Rate for Payer: Cash Price |
$35.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$49.61
|
| Rate for Payer: Cigna of WY Commercial |
$50.12
|
| Rate for Payer: Entrust Commercial |
$48.58
|
| Rate for Payer: First Choice Health Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$48.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$29.66
|
| Rate for Payer: HealthUtah PPO |
$51.14
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$49.61
|
| Rate for Payer: Multiplan Medicare/VA |
$28.18
|
| Rate for Payer: One Health Plan of WY PPO |
$50.12
|
| Rate for Payer: PacificSource Commercial |
$46.03
|
| Rate for Payer: PHCS PPO |
$50.12
|
| Rate for Payer: Three Rivers PPO |
$38.36
|
| Rate for Payer: TriWest Veterans Administration |
$29.66
|
| Rate for Payer: United Healthcare Commercial |
$44.49
|
| Rate for Payer: United Healthcare Medicare |
$29.66
|
| Rate for Payer: WINHealth Partners Commercial |
$50.12
|
| Rate for Payer: Wise Provider Network Commercial |
$48.58
|
|
|
4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 90649
|
| Hospital Charge Code |
90649
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$290.08
|
| Rate for Payer: Beech Street Commercial |
$281.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$287.12
|
| Rate for Payer: Cigna of WY Commercial |
$290.08
|
| Rate for Payer: First Choice Health Commercial |
$266.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$281.20
|
| Rate for Payer: HealthUtah PPO |
$296.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$287.12
|
| Rate for Payer: One Health Plan of WY PPO |
$290.08
|
| Rate for Payer: PacificSource Commercial |
$266.40
|
| Rate for Payer: PHCS PPO |
$281.20
|
| Rate for Payer: Three Rivers PPO |
$222.00
|
| Rate for Payer: United Healthcare Commercial |
$257.52
|
| Rate for Payer: WINHealth Partners Commercial |
$296.00
|
|
|
9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
90651
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$478.24
|
| Rate for Payer: Beech Street Commercial |
$463.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$473.36
|
| Rate for Payer: Cigna of WY Commercial |
$478.24
|
| Rate for Payer: First Choice Health Commercial |
$439.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$463.60
|
| Rate for Payer: HealthUtah PPO |
$488.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$473.36
|
| Rate for Payer: One Health Plan of WY PPO |
$478.24
|
| Rate for Payer: PacificSource Commercial |
$439.20
|
| Rate for Payer: PHCS PPO |
$463.60
|
| Rate for Payer: Three Rivers PPO |
$366.00
|
| Rate for Payer: United Healthcare Commercial |
$424.56
|
| Rate for Payer: WINHealth Partners Commercial |
$488.00
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [40098]
|
Facility
|
IP
|
$1,528.67
|
|
|
Service Code
|
HCPCS J0129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$958.48 |
| Max. Negotiated Rate |
$1,528.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,498.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,467.52
|
| Rate for Payer: Altius Commercial |
$1,467.52
|
| Rate for Payer: Beech Street Commercial |
$1,498.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,255.04
|
| Rate for Payer: Cash Price |
$1,070.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,482.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,498.10
|
| Rate for Payer: Entrust Commercial |
$1,452.24
|
| Rate for Payer: First Choice Health Commercial |
$1,452.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,452.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,008.92
|
| Rate for Payer: HealthUtah PPO |
$1,528.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,482.81
|
| Rate for Payer: Multiplan Medicare/VA |
$958.48
|
| Rate for Payer: One Health Plan of WY PPO |
$1,498.10
|
| Rate for Payer: PacificSource Commercial |
$1,375.80
|
| Rate for Payer: PHCS PPO |
$1,498.10
|
| Rate for Payer: Three Rivers PPO |
$1,146.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,008.92
|
| Rate for Payer: United Healthcare Commercial |
$1,329.94
|
| Rate for Payer: United Healthcare Medicare |
$1,008.92
|
| Rate for Payer: WINHealth Partners Commercial |
$1,452.24
|
| Rate for Payer: Wise Provider Network Commercial |
$1,452.24
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION [40098]
|
Facility
|
OP
|
$1,528.67
|
|
|
Service Code
|
HCPCS J0129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$842.30 |
| Max. Negotiated Rate |
$1,528.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,498.10
|
| Rate for Payer: Aetna of WY Medicare |
$1,008.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,467.52
|
| Rate for Payer: Altius Commercial |
$1,467.52
|
| Rate for Payer: Beech Street Commercial |
$1,498.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,255.04
|
| Rate for Payer: Cash Price |
$1,070.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,482.81
|
| Rate for Payer: Cigna of WY Commercial |
$1,498.10
|
| Rate for Payer: Entrust Commercial |
$1,452.24
|
| Rate for Payer: First Choice Health Commercial |
$1,452.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,452.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$886.63
|
| Rate for Payer: HealthUtah PPO |
$1,528.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,482.81
|
| Rate for Payer: Multiplan Medicare/VA |
$842.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,498.10
|
| Rate for Payer: PacificSource Commercial |
$1,375.80
|
| Rate for Payer: PHCS PPO |
$1,498.10
|
| Rate for Payer: Three Rivers PPO |
$1,146.50
|
| Rate for Payer: TriWest Veterans Administration |
$886.63
|
| Rate for Payer: United Healthcare Commercial |
$1,329.94
|
| Rate for Payer: United Healthcare Medicare |
$886.63
|
| Rate for Payer: WINHealth Partners Commercial |
$1,498.10
|
| Rate for Payer: Wise Provider Network Commercial |
$1,452.24
|
|
|
ABDOMIANL BINDER XL 79-89328
|
Facility
|
IP
|
$42.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.81
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.95
|
| Rate for Payer: Altius Commercial |
$40.95
|
| Rate for Payer: Beech Street Commercial |
$41.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.02
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.38
|
| Rate for Payer: Cigna of WY Commercial |
$41.81
|
| Rate for Payer: Entrust Commercial |
$40.53
|
| Rate for Payer: First Choice Health Commercial |
$40.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.16
|
| Rate for Payer: HealthUtah PPO |
$42.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.38
|
| Rate for Payer: Multiplan Medicare/VA |
$26.75
|
| Rate for Payer: One Health Plan of WY PPO |
$41.81
|
| Rate for Payer: PacificSource Commercial |
$38.39
|
| Rate for Payer: PHCS PPO |
$41.81
|
| Rate for Payer: Three Rivers PPO |
$32.00
|
| Rate for Payer: TriWest Veterans Administration |
$28.16
|
| Rate for Payer: United Healthcare Commercial |
$37.11
|
| Rate for Payer: United Healthcare Medicare |
$28.16
|
| Rate for Payer: WINHealth Partners Commercial |
$40.53
|
| Rate for Payer: Wise Provider Network Commercial |
$40.53
|
|
|
ABDOMIANL BINDER XL 79-89328
|
Facility
|
OP
|
$42.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$41.81
|
| Rate for Payer: Aetna of WY Medicare |
$28.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$40.95
|
| Rate for Payer: Altius Commercial |
$40.95
|
| Rate for Payer: Beech Street Commercial |
$41.81
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.02
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$41.38
|
| Rate for Payer: Cigna of WY Commercial |
$41.81
|
| Rate for Payer: Entrust Commercial |
$40.53
|
| Rate for Payer: First Choice Health Commercial |
$40.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$40.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.74
|
| Rate for Payer: HealthUtah PPO |
$42.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$41.38
|
| Rate for Payer: Multiplan Medicare/VA |
$23.51
|
| Rate for Payer: One Health Plan of WY PPO |
$41.81
|
| Rate for Payer: PacificSource Commercial |
$38.39
|
| Rate for Payer: PHCS PPO |
$41.81
|
| Rate for Payer: Three Rivers PPO |
$32.00
|
| Rate for Payer: TriWest Veterans Administration |
$24.74
|
| Rate for Payer: United Healthcare Commercial |
$37.11
|
| Rate for Payer: United Healthcare Medicare |
$24.74
|
| Rate for Payer: WINHealth Partners Commercial |
$41.81
|
| Rate for Payer: Wise Provider Network Commercial |
$40.53
|
|
|
ABDOMINAL BINDER 2XL 79-89189
|
Facility
|
IP
|
$31.64
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.01
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.37
|
| Rate for Payer: Altius Commercial |
$30.37
|
| Rate for Payer: Beech Street Commercial |
$31.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.98
|
| Rate for Payer: Cash Price |
$22.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.69
|
| Rate for Payer: Cigna of WY Commercial |
$31.01
|
| Rate for Payer: Entrust Commercial |
$30.06
|
| Rate for Payer: First Choice Health Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.88
|
| Rate for Payer: HealthUtah PPO |
$31.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.69
|
| Rate for Payer: Multiplan Medicare/VA |
$19.84
|
| Rate for Payer: One Health Plan of WY PPO |
$31.01
|
| Rate for Payer: PacificSource Commercial |
$28.48
|
| Rate for Payer: PHCS PPO |
$31.01
|
| Rate for Payer: Three Rivers PPO |
$23.73
|
| Rate for Payer: TriWest Veterans Administration |
$20.88
|
| Rate for Payer: United Healthcare Commercial |
$27.53
|
| Rate for Payer: United Healthcare Medicare |
$20.88
|
| Rate for Payer: WINHealth Partners Commercial |
$30.06
|
| Rate for Payer: Wise Provider Network Commercial |
$30.06
|
|
|
ABDOMINAL BINDER 2XL 79-89189
|
Facility
|
OP
|
$31.64
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$31.01
|
| Rate for Payer: Aetna of WY Medicare |
$20.88
|
| Rate for Payer: Altius Auto/Workers Compensation |
$30.37
|
| Rate for Payer: Altius Commercial |
$30.37
|
| Rate for Payer: Beech Street Commercial |
$31.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.98
|
| Rate for Payer: Cash Price |
$22.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$30.69
|
| Rate for Payer: Cigna of WY Commercial |
$31.01
|
| Rate for Payer: Entrust Commercial |
$30.06
|
| Rate for Payer: First Choice Health Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$30.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.35
|
| Rate for Payer: HealthUtah PPO |
$31.64
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$30.69
|
| Rate for Payer: Multiplan Medicare/VA |
$17.43
|
| Rate for Payer: One Health Plan of WY PPO |
$31.01
|
| Rate for Payer: PacificSource Commercial |
$28.48
|
| Rate for Payer: PHCS PPO |
$31.01
|
| Rate for Payer: Three Rivers PPO |
$23.73
|
| Rate for Payer: TriWest Veterans Administration |
$18.35
|
| Rate for Payer: United Healthcare Commercial |
$27.53
|
| Rate for Payer: United Healthcare Medicare |
$18.35
|
| Rate for Payer: WINHealth Partners Commercial |
$31.01
|
| Rate for Payer: Wise Provider Network Commercial |
$30.06
|
|
|
ABDOMINAL BINDER L&D LG/XL
|
Facility
|
IP
|
$66.47
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$66.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.14
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.81
|
| Rate for Payer: Altius Commercial |
$63.81
|
| Rate for Payer: Beech Street Commercial |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.48
|
| Rate for Payer: Cigna of WY Commercial |
$65.14
|
| Rate for Payer: Entrust Commercial |
$63.15
|
| Rate for Payer: First Choice Health Commercial |
$63.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.87
|
| Rate for Payer: HealthUtah PPO |
$66.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.48
|
| Rate for Payer: Multiplan Medicare/VA |
$41.68
|
| Rate for Payer: One Health Plan of WY PPO |
$65.14
|
| Rate for Payer: PacificSource Commercial |
$59.82
|
| Rate for Payer: PHCS PPO |
$65.14
|
| Rate for Payer: Three Rivers PPO |
$49.85
|
| Rate for Payer: TriWest Veterans Administration |
$43.87
|
| Rate for Payer: United Healthcare Commercial |
$57.83
|
| Rate for Payer: United Healthcare Medicare |
$43.87
|
| Rate for Payer: WINHealth Partners Commercial |
$63.15
|
| Rate for Payer: Wise Provider Network Commercial |
$63.15
|
|
|
ABDOMINAL BINDER L&D LG/XL
|
Facility
|
OP
|
$66.47
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$66.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$65.14
|
| Rate for Payer: Aetna of WY Medicare |
$43.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$63.81
|
| Rate for Payer: Altius Commercial |
$63.81
|
| Rate for Payer: Beech Street Commercial |
$65.14
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.57
|
| Rate for Payer: Cash Price |
$46.53
|
| Rate for Payer: ChoiceCare Network Commercial |
$64.48
|
| Rate for Payer: Cigna of WY Commercial |
$65.14
|
| Rate for Payer: Entrust Commercial |
$63.15
|
| Rate for Payer: First Choice Health Commercial |
$63.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$63.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.55
|
| Rate for Payer: HealthUtah PPO |
$66.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$64.48
|
| Rate for Payer: Multiplan Medicare/VA |
$36.62
|
| Rate for Payer: One Health Plan of WY PPO |
$65.14
|
| Rate for Payer: PacificSource Commercial |
$59.82
|
| Rate for Payer: PHCS PPO |
$65.14
|
| Rate for Payer: Three Rivers PPO |
$49.85
|
| Rate for Payer: TriWest Veterans Administration |
$38.55
|
| Rate for Payer: United Healthcare Commercial |
$57.83
|
| Rate for Payer: United Healthcare Medicare |
$38.55
|
| Rate for Payer: WINHealth Partners Commercial |
$65.14
|
| Rate for Payer: Wise Provider Network Commercial |
$63.15
|
|
|
ABDOMINAL BINDER L&D SM/MD
|
Facility
|
IP
|
$62.97
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.45
|
| Rate for Payer: Altius Commercial |
$60.45
|
| Rate for Payer: Beech Street Commercial |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.70
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.08
|
| Rate for Payer: Cigna of WY Commercial |
$61.71
|
| Rate for Payer: Entrust Commercial |
$59.82
|
| Rate for Payer: First Choice Health Commercial |
$59.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.56
|
| Rate for Payer: HealthUtah PPO |
$62.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.08
|
| Rate for Payer: Multiplan Medicare/VA |
$39.48
|
| Rate for Payer: One Health Plan of WY PPO |
$61.71
|
| Rate for Payer: PacificSource Commercial |
$56.67
|
| Rate for Payer: PHCS PPO |
$61.71
|
| Rate for Payer: Three Rivers PPO |
$47.23
|
| Rate for Payer: TriWest Veterans Administration |
$41.56
|
| Rate for Payer: United Healthcare Commercial |
$54.78
|
| Rate for Payer: United Healthcare Medicare |
$41.56
|
| Rate for Payer: WINHealth Partners Commercial |
$59.82
|
| Rate for Payer: Wise Provider Network Commercial |
$59.82
|
|
|
ABDOMINAL BINDER L&D SM/MD
|
Facility
|
OP
|
$62.97
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.71
|
| Rate for Payer: Aetna of WY Medicare |
$41.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$60.45
|
| Rate for Payer: Altius Commercial |
$60.45
|
| Rate for Payer: Beech Street Commercial |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$51.70
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.08
|
| Rate for Payer: Cigna of WY Commercial |
$61.71
|
| Rate for Payer: Entrust Commercial |
$59.82
|
| Rate for Payer: First Choice Health Commercial |
$59.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.82
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.52
|
| Rate for Payer: HealthUtah PPO |
$62.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.08
|
| Rate for Payer: Multiplan Medicare/VA |
$34.70
|
| Rate for Payer: One Health Plan of WY PPO |
$61.71
|
| Rate for Payer: PacificSource Commercial |
$56.67
|
| Rate for Payer: PHCS PPO |
$61.71
|
| Rate for Payer: Three Rivers PPO |
$47.23
|
| Rate for Payer: TriWest Veterans Administration |
$36.52
|
| Rate for Payer: United Healthcare Commercial |
$54.78
|
| Rate for Payer: United Healthcare Medicare |
$36.52
|
| Rate for Payer: WINHealth Partners Commercial |
$61.71
|
| Rate for Payer: Wise Provider Network Commercial |
$59.82
|
|
|
ABDOMINAL BINDER LG 79-89327
|
Facility
|
OP
|
$39.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.87
|
| Rate for Payer: Aetna of WY Medicare |
$26.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.07
|
| Rate for Payer: Altius Commercial |
$38.07
|
| Rate for Payer: Beech Street Commercial |
$38.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.47
|
| Rate for Payer: Cigna of WY Commercial |
$38.87
|
| Rate for Payer: Entrust Commercial |
$37.68
|
| Rate for Payer: First Choice Health Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.00
|
| Rate for Payer: HealthUtah PPO |
$39.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.47
|
| Rate for Payer: Multiplan Medicare/VA |
$21.85
|
| Rate for Payer: One Health Plan of WY PPO |
$38.87
|
| Rate for Payer: PacificSource Commercial |
$35.69
|
| Rate for Payer: PHCS PPO |
$38.87
|
| Rate for Payer: Three Rivers PPO |
$29.74
|
| Rate for Payer: TriWest Veterans Administration |
$23.00
|
| Rate for Payer: United Healthcare Commercial |
$34.50
|
| Rate for Payer: United Healthcare Medicare |
$23.00
|
| Rate for Payer: WINHealth Partners Commercial |
$38.87
|
| Rate for Payer: Wise Provider Network Commercial |
$37.68
|
|
|
ABDOMINAL BINDER LG 79-89327
|
Facility
|
IP
|
$39.66
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.87 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.87
|
| Rate for Payer: Altius Auto/Workers Compensation |
$38.07
|
| Rate for Payer: Altius Commercial |
$38.07
|
| Rate for Payer: Beech Street Commercial |
$38.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$32.56
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.47
|
| Rate for Payer: Cigna of WY Commercial |
$38.87
|
| Rate for Payer: Entrust Commercial |
$37.68
|
| Rate for Payer: First Choice Health Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.18
|
| Rate for Payer: HealthUtah PPO |
$39.66
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.47
|
| Rate for Payer: Multiplan Medicare/VA |
$24.87
|
| Rate for Payer: One Health Plan of WY PPO |
$38.87
|
| Rate for Payer: PacificSource Commercial |
$35.69
|
| Rate for Payer: PHCS PPO |
$38.87
|
| Rate for Payer: Three Rivers PPO |
$29.74
|
| Rate for Payer: TriWest Veterans Administration |
$26.18
|
| Rate for Payer: United Healthcare Commercial |
$34.50
|
| Rate for Payer: United Healthcare Medicare |
$26.18
|
| Rate for Payer: WINHealth Partners Commercial |
$37.68
|
| Rate for Payer: Wise Provider Network Commercial |
$37.68
|
|
|
ABDOMINAL BINDER MED 79-89325
|
Facility
|
IP
|
$38.88
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.10
|
| Rate for Payer: Altius Auto/Workers Compensation |
$37.32
|
| Rate for Payer: Altius Commercial |
$37.32
|
| Rate for Payer: Beech Street Commercial |
$38.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$31.92
|
| Rate for Payer: Cash Price |
$27.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.71
|
| Rate for Payer: Cigna of WY Commercial |
$38.10
|
| Rate for Payer: Entrust Commercial |
$36.94
|
| Rate for Payer: First Choice Health Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.66
|
| Rate for Payer: HealthUtah PPO |
$38.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.71
|
| Rate for Payer: Multiplan Medicare/VA |
$24.38
|
| Rate for Payer: One Health Plan of WY PPO |
$38.10
|
| Rate for Payer: PacificSource Commercial |
$34.99
|
| Rate for Payer: PHCS PPO |
$38.10
|
| Rate for Payer: Three Rivers PPO |
$29.16
|
| Rate for Payer: TriWest Veterans Administration |
$25.66
|
| Rate for Payer: United Healthcare Commercial |
$33.83
|
| Rate for Payer: United Healthcare Medicare |
$25.66
|
| Rate for Payer: WINHealth Partners Commercial |
$36.94
|
| Rate for Payer: Wise Provider Network Commercial |
$36.94
|
|
