|
DELIVERY PLACENTA SEPARATE PROCEDURE
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
59414
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$269.50
|
| Rate for Payer: Aetna of WY Medicare |
$84.88
|
| Rate for Payer: Beech Street Commercial |
$261.25
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$266.75
|
| Rate for Payer: Cigna of WY Commercial |
$269.50
|
| Rate for Payer: First Choice Health Commercial |
$247.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$261.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.88
|
| Rate for Payer: HealthUtah PPO |
$275.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$266.75
|
| Rate for Payer: Multiplan Medicare/VA |
$72.15
|
| Rate for Payer: One Health Plan of WY PPO |
$269.50
|
| Rate for Payer: PacificSource Commercial |
$247.50
|
| Rate for Payer: PHCS PPO |
$261.25
|
| Rate for Payer: Three Rivers PPO |
$206.25
|
| Rate for Payer: TriWest Veterans Administration |
$84.88
|
| Rate for Payer: United Healthcare Commercial |
$239.25
|
| Rate for Payer: United Healthcare Medicare |
$84.88
|
| Rate for Payer: WINHealth Partners Commercial |
$233.75
|
|
|
DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
94664
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$80.36
|
| Rate for Payer: Aetna of WY Medicare |
$17.51
|
| Rate for Payer: Beech Street Commercial |
$77.90
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: Cash Price |
$57.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$79.54
|
| Rate for Payer: Cigna of WY Commercial |
$80.36
|
| Rate for Payer: First Choice Health Commercial |
$73.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$77.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.51
|
| Rate for Payer: HealthUtah PPO |
$82.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$79.54
|
| Rate for Payer: Multiplan Medicare/VA |
$14.88
|
| Rate for Payer: One Health Plan of WY PPO |
$80.36
|
| Rate for Payer: PacificSource Commercial |
$73.80
|
| Rate for Payer: PHCS PPO |
$77.90
|
| Rate for Payer: Three Rivers PPO |
$61.50
|
| Rate for Payer: TriWest Veterans Administration |
$17.51
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Medicare |
$17.51
|
| Rate for Payer: WINHealth Partners Commercial |
$77.90
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [91054]
|
Facility
|
OP
|
$2,044.26
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,126.39 |
| Max. Negotiated Rate |
$2,044.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.37
|
| Rate for Payer: Aetna of WY Medicare |
$1,349.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,962.49
|
| Rate for Payer: Altius Commercial |
$1,962.49
|
| Rate for Payer: Beech Street Commercial |
$2,003.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,678.34
|
| Rate for Payer: Cash Price |
$1,430.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.37
|
| Rate for Payer: Entrust Commercial |
$1,942.05
|
| Rate for Payer: First Choice Health Commercial |
$1,942.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,942.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,185.67
|
| Rate for Payer: HealthUtah PPO |
$2,044.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.93
|
| Rate for Payer: Multiplan Medicare/VA |
$1,126.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.37
|
| Rate for Payer: PacificSource Commercial |
$1,839.83
|
| Rate for Payer: PHCS PPO |
$2,003.37
|
| Rate for Payer: Three Rivers PPO |
$1,533.20
|
| Rate for Payer: TriWest Veterans Administration |
$1,185.67
|
| Rate for Payer: United Healthcare Commercial |
$1,778.51
|
| Rate for Payer: United Healthcare Medicare |
$1,185.67
|
| Rate for Payer: WINHealth Partners Commercial |
$2,003.37
|
| Rate for Payer: Wise Provider Network Commercial |
$1,942.05
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION [91054]
|
Facility
|
IP
|
$2,044.26
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,281.75 |
| Max. Negotiated Rate |
$2,044.26 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,003.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,962.49
|
| Rate for Payer: Altius Commercial |
$1,962.49
|
| Rate for Payer: Beech Street Commercial |
$2,003.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,678.34
|
| Rate for Payer: Cash Price |
$1,430.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,982.93
|
| Rate for Payer: Cigna of WY Commercial |
$2,003.37
|
| Rate for Payer: Entrust Commercial |
$1,942.05
|
| Rate for Payer: First Choice Health Commercial |
$1,942.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,942.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,349.21
|
| Rate for Payer: HealthUtah PPO |
$2,044.26
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,982.93
|
| Rate for Payer: Multiplan Medicare/VA |
$1,281.75
|
| Rate for Payer: One Health Plan of WY PPO |
$2,003.37
|
| Rate for Payer: PacificSource Commercial |
$1,839.83
|
| Rate for Payer: PHCS PPO |
$2,003.37
|
| Rate for Payer: Three Rivers PPO |
$1,533.20
|
| Rate for Payer: TriWest Veterans Administration |
$1,349.21
|
| Rate for Payer: United Healthcare Commercial |
$1,778.51
|
| Rate for Payer: United Healthcare Medicare |
$1,349.21
|
| Rate for Payer: WINHealth Partners Commercial |
$1,942.05
|
| Rate for Payer: Wise Provider Network Commercial |
$1,942.05
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [89894]
|
Facility
|
OP
|
$1,890.43
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,041.63 |
| Max. Negotiated Rate |
$1,890.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,852.62
|
| Rate for Payer: Aetna of WY Medicare |
$1,247.68
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,814.81
|
| Rate for Payer: Altius Commercial |
$1,814.81
|
| Rate for Payer: Beech Street Commercial |
$1,852.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,552.04
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,833.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,852.62
|
| Rate for Payer: Entrust Commercial |
$1,795.91
|
| Rate for Payer: First Choice Health Commercial |
$1,795.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,795.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,096.45
|
| Rate for Payer: HealthUtah PPO |
$1,890.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,833.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1,041.63
|
| Rate for Payer: One Health Plan of WY PPO |
$1,852.62
|
| Rate for Payer: PacificSource Commercial |
$1,701.39
|
| Rate for Payer: PHCS PPO |
$1,852.62
|
| Rate for Payer: Three Rivers PPO |
$1,417.82
|
| Rate for Payer: TriWest Veterans Administration |
$1,096.45
|
| Rate for Payer: United Healthcare Commercial |
$1,644.67
|
| Rate for Payer: United Healthcare Medicare |
$1,096.45
|
| Rate for Payer: WINHealth Partners Commercial |
$1,852.62
|
| Rate for Payer: Wise Provider Network Commercial |
$1,795.91
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE [89894]
|
Facility
|
IP
|
$1,890.43
|
|
|
Service Code
|
HCPCS J0897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,185.30 |
| Max. Negotiated Rate |
$1,890.43 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,852.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,814.81
|
| Rate for Payer: Altius Commercial |
$1,814.81
|
| Rate for Payer: Beech Street Commercial |
$1,852.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,552.04
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,833.72
|
| Rate for Payer: Cigna of WY Commercial |
$1,852.62
|
| Rate for Payer: Entrust Commercial |
$1,795.91
|
| Rate for Payer: First Choice Health Commercial |
$1,795.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,795.91
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,247.68
|
| Rate for Payer: HealthUtah PPO |
$1,890.43
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,833.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1,185.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,852.62
|
| Rate for Payer: PacificSource Commercial |
$1,701.39
|
| Rate for Payer: PHCS PPO |
$1,852.62
|
| Rate for Payer: Three Rivers PPO |
$1,417.82
|
| Rate for Payer: TriWest Veterans Administration |
$1,247.68
|
| Rate for Payer: United Healthcare Commercial |
$1,644.67
|
| Rate for Payer: United Healthcare Medicare |
$1,247.68
|
| Rate for Payer: WINHealth Partners Commercial |
$1,795.91
|
| Rate for Payer: Wise Provider Network Commercial |
$1,795.91
|
|
|
DENTURE ADHESIVE CRM MDS136408
|
Facility
|
OP
|
$12.47
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.22
|
| Rate for Payer: Aetna of WY Medicare |
$8.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.97
|
| Rate for Payer: Altius Commercial |
$11.97
|
| Rate for Payer: Beech Street Commercial |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.24
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.10
|
| Rate for Payer: Cigna of WY Commercial |
$12.22
|
| Rate for Payer: Entrust Commercial |
$11.85
|
| Rate for Payer: First Choice Health Commercial |
$11.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.23
|
| Rate for Payer: HealthUtah PPO |
$12.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.10
|
| Rate for Payer: Multiplan Medicare/VA |
$6.87
|
| Rate for Payer: One Health Plan of WY PPO |
$12.22
|
| Rate for Payer: PacificSource Commercial |
$11.22
|
| Rate for Payer: PHCS PPO |
$12.22
|
| Rate for Payer: Three Rivers PPO |
$9.35
|
| Rate for Payer: TriWest Veterans Administration |
$7.23
|
| Rate for Payer: United Healthcare Commercial |
$10.85
|
| Rate for Payer: United Healthcare Medicare |
$7.23
|
| Rate for Payer: WINHealth Partners Commercial |
$12.22
|
| Rate for Payer: Wise Provider Network Commercial |
$11.85
|
|
|
DENTURE ADHESIVE CRM MDS136408
|
Facility
|
IP
|
$12.47
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$12.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.97
|
| Rate for Payer: Altius Commercial |
$11.97
|
| Rate for Payer: Beech Street Commercial |
$12.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.24
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.10
|
| Rate for Payer: Cigna of WY Commercial |
$12.22
|
| Rate for Payer: Entrust Commercial |
$11.85
|
| Rate for Payer: First Choice Health Commercial |
$11.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.23
|
| Rate for Payer: HealthUtah PPO |
$12.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.10
|
| Rate for Payer: Multiplan Medicare/VA |
$7.82
|
| Rate for Payer: One Health Plan of WY PPO |
$12.22
|
| Rate for Payer: PacificSource Commercial |
$11.22
|
| Rate for Payer: PHCS PPO |
$12.22
|
| Rate for Payer: Three Rivers PPO |
$9.35
|
| Rate for Payer: TriWest Veterans Administration |
$8.23
|
| Rate for Payer: United Healthcare Commercial |
$10.85
|
| Rate for Payer: United Healthcare Medicare |
$8.23
|
| Rate for Payer: WINHealth Partners Commercial |
$11.85
|
| Rate for Payer: Wise Provider Network Commercial |
$11.85
|
|
|
DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
G0444
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$58.80
|
| Rate for Payer: Aetna of WY Medicare |
$8.76
|
| Rate for Payer: Beech Street Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$58.20
|
| Rate for Payer: Cigna of WY Commercial |
$58.80
|
| Rate for Payer: First Choice Health Commercial |
$54.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.76
|
| Rate for Payer: HealthUtah PPO |
$60.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$58.20
|
| Rate for Payer: Multiplan Medicare/VA |
$7.45
|
| Rate for Payer: One Health Plan of WY PPO |
$58.80
|
| Rate for Payer: PacificSource Commercial |
$54.00
|
| Rate for Payer: PHCS PPO |
$57.00
|
| Rate for Payer: Three Rivers PPO |
$45.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.76
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Medicare |
$8.76
|
| Rate for Payer: WINHealth Partners Commercial |
$57.00
|
|
|
DERMABOND LIQUIBAND ADHESIVE LARGE
|
Facility
|
OP
|
$54.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$54.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.25
|
| Rate for Payer: Aetna of WY Medicare |
$35.86
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.17
|
| Rate for Payer: Altius Commercial |
$52.17
|
| Rate for Payer: Beech Street Commercial |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.61
|
| Rate for Payer: Cash Price |
$38.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.71
|
| Rate for Payer: Cigna of WY Commercial |
$53.25
|
| Rate for Payer: Entrust Commercial |
$51.62
|
| Rate for Payer: First Choice Health Commercial |
$51.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$31.52
|
| Rate for Payer: HealthUtah PPO |
$54.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.71
|
| Rate for Payer: Multiplan Medicare/VA |
$29.94
|
| Rate for Payer: One Health Plan of WY PPO |
$53.25
|
| Rate for Payer: PacificSource Commercial |
$48.91
|
| Rate for Payer: PHCS PPO |
$53.25
|
| Rate for Payer: Three Rivers PPO |
$40.76
|
| Rate for Payer: TriWest Veterans Administration |
$31.52
|
| Rate for Payer: United Healthcare Commercial |
$47.28
|
| Rate for Payer: United Healthcare Medicare |
$31.52
|
| Rate for Payer: WINHealth Partners Commercial |
$53.25
|
| Rate for Payer: Wise Provider Network Commercial |
$51.62
|
|
|
DERMABOND LIQUIBAND ADHESIVE LARGE
|
Facility
|
IP
|
$54.34
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.07 |
| Max. Negotiated Rate |
$54.34 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$53.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$52.17
|
| Rate for Payer: Altius Commercial |
$52.17
|
| Rate for Payer: Beech Street Commercial |
$53.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$44.61
|
| Rate for Payer: Cash Price |
$38.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.71
|
| Rate for Payer: Cigna of WY Commercial |
$53.25
|
| Rate for Payer: Entrust Commercial |
$51.62
|
| Rate for Payer: First Choice Health Commercial |
$51.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.86
|
| Rate for Payer: HealthUtah PPO |
$54.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.71
|
| Rate for Payer: Multiplan Medicare/VA |
$34.07
|
| Rate for Payer: One Health Plan of WY PPO |
$53.25
|
| Rate for Payer: PacificSource Commercial |
$48.91
|
| Rate for Payer: PHCS PPO |
$53.25
|
| Rate for Payer: Three Rivers PPO |
$40.76
|
| Rate for Payer: TriWest Veterans Administration |
$35.86
|
| Rate for Payer: United Healthcare Commercial |
$47.28
|
| Rate for Payer: United Healthcare Medicare |
$35.86
|
| Rate for Payer: WINHealth Partners Commercial |
$51.62
|
| Rate for Payer: Wise Provider Network Commercial |
$51.62
|
|
|
DERMABOND SKIN AFFIX ADHESIVE MINI
|
Facility
|
IP
|
$34.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.99
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$21.84
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$22.99
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$22.99
|
| Rate for Payer: WINHealth Partners Commercial |
$33.09
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
DERMABOND SKIN AFFIX ADHESIVE MINI
|
Facility
|
OP
|
$34.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$34.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$34.13
|
| Rate for Payer: Aetna of WY Medicare |
$22.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$33.44
|
| Rate for Payer: Altius Commercial |
$33.44
|
| Rate for Payer: Beech Street Commercial |
$34.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$24.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$33.79
|
| Rate for Payer: Cigna of WY Commercial |
$34.13
|
| Rate for Payer: Entrust Commercial |
$33.09
|
| Rate for Payer: First Choice Health Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$33.09
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.20
|
| Rate for Payer: HealthUtah PPO |
$34.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$33.79
|
| Rate for Payer: Multiplan Medicare/VA |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$34.13
|
| Rate for Payer: PacificSource Commercial |
$31.35
|
| Rate for Payer: PHCS PPO |
$34.13
|
| Rate for Payer: Three Rivers PPO |
$26.12
|
| Rate for Payer: TriWest Veterans Administration |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WINHealth Partners Commercial |
$34.13
|
| Rate for Payer: Wise Provider Network Commercial |
$33.09
|
|
|
DERMACARRIER II 1.5:1 ZIMMER
|
Facility
|
OP
|
$71.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$71.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.82
|
| Rate for Payer: Aetna of WY Medicare |
$47.02
|
| Rate for Payer: Altius Auto/Workers Compensation |
$68.39
|
| Rate for Payer: Altius Commercial |
$68.39
|
| Rate for Payer: Beech Street Commercial |
$69.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.49
|
| Rate for Payer: Cash Price |
$49.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.10
|
| Rate for Payer: Cigna of WY Commercial |
$69.82
|
| Rate for Payer: Entrust Commercial |
$67.68
|
| Rate for Payer: First Choice Health Commercial |
$67.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$41.32
|
| Rate for Payer: HealthUtah PPO |
$71.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.10
|
| Rate for Payer: Multiplan Medicare/VA |
$39.25
|
| Rate for Payer: One Health Plan of WY PPO |
$69.82
|
| Rate for Payer: PacificSource Commercial |
$64.12
|
| Rate for Payer: PHCS PPO |
$69.82
|
| Rate for Payer: Three Rivers PPO |
$53.43
|
| Rate for Payer: TriWest Veterans Administration |
$41.32
|
| Rate for Payer: United Healthcare Commercial |
$61.98
|
| Rate for Payer: United Healthcare Medicare |
$41.32
|
| Rate for Payer: WINHealth Partners Commercial |
$69.82
|
| Rate for Payer: Wise Provider Network Commercial |
$67.68
|
|
|
DERMACARRIER II 1.5:1 ZIMMER
|
Facility
|
IP
|
$71.24
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$71.24 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$68.39
|
| Rate for Payer: Altius Commercial |
$68.39
|
| Rate for Payer: Beech Street Commercial |
$69.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$58.49
|
| Rate for Payer: Cash Price |
$49.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$69.10
|
| Rate for Payer: Cigna of WY Commercial |
$69.82
|
| Rate for Payer: Entrust Commercial |
$67.68
|
| Rate for Payer: First Choice Health Commercial |
$67.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$47.02
|
| Rate for Payer: HealthUtah PPO |
$71.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$69.10
|
| Rate for Payer: Multiplan Medicare/VA |
$44.67
|
| Rate for Payer: One Health Plan of WY PPO |
$69.82
|
| Rate for Payer: PacificSource Commercial |
$64.12
|
| Rate for Payer: PHCS PPO |
$69.82
|
| Rate for Payer: Three Rivers PPO |
$53.43
|
| Rate for Payer: TriWest Veterans Administration |
$47.02
|
| Rate for Payer: United Healthcare Commercial |
$61.98
|
| Rate for Payer: United Healthcare Medicare |
$47.02
|
| Rate for Payer: WINHealth Partners Commercial |
$67.68
|
| Rate for Payer: Wise Provider Network Commercial |
$67.68
|
|
|
DERMATOME BLADE ZIMMER
|
Facility
|
IP
|
$96.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$96.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.09
|
| Rate for Payer: Altius Commercial |
$93.09
|
| Rate for Payer: Beech Street Commercial |
$95.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.61
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.06
|
| Rate for Payer: Cigna of WY Commercial |
$95.03
|
| Rate for Payer: Entrust Commercial |
$92.12
|
| Rate for Payer: First Choice Health Commercial |
$92.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$64.00
|
| Rate for Payer: HealthUtah PPO |
$96.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.06
|
| Rate for Payer: Multiplan Medicare/VA |
$60.80
|
| Rate for Payer: One Health Plan of WY PPO |
$95.03
|
| Rate for Payer: PacificSource Commercial |
$87.27
|
| Rate for Payer: PHCS PPO |
$95.03
|
| Rate for Payer: Three Rivers PPO |
$72.73
|
| Rate for Payer: TriWest Veterans Administration |
$64.00
|
| Rate for Payer: United Healthcare Commercial |
$84.36
|
| Rate for Payer: United Healthcare Medicare |
$64.00
|
| Rate for Payer: WINHealth Partners Commercial |
$92.12
|
| Rate for Payer: Wise Provider Network Commercial |
$92.12
|
|
|
DERMATOME BLADE ZIMMER
|
Facility
|
OP
|
$96.97
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.43 |
| Max. Negotiated Rate |
$96.97 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.03
|
| Rate for Payer: Aetna of WY Medicare |
$64.00
|
| Rate for Payer: Altius Auto/Workers Compensation |
$93.09
|
| Rate for Payer: Altius Commercial |
$93.09
|
| Rate for Payer: Beech Street Commercial |
$95.03
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$79.61
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.06
|
| Rate for Payer: Cigna of WY Commercial |
$95.03
|
| Rate for Payer: Entrust Commercial |
$92.12
|
| Rate for Payer: First Choice Health Commercial |
$92.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$56.24
|
| Rate for Payer: HealthUtah PPO |
$96.97
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.06
|
| Rate for Payer: Multiplan Medicare/VA |
$53.43
|
| Rate for Payer: One Health Plan of WY PPO |
$95.03
|
| Rate for Payer: PacificSource Commercial |
$87.27
|
| Rate for Payer: PHCS PPO |
$95.03
|
| Rate for Payer: Three Rivers PPO |
$72.73
|
| Rate for Payer: TriWest Veterans Administration |
$56.24
|
| Rate for Payer: United Healthcare Commercial |
$84.36
|
| Rate for Payer: United Healthcare Medicare |
$56.24
|
| Rate for Payer: WINHealth Partners Commercial |
$95.03
|
| Rate for Payer: Wise Provider Network Commercial |
$92.12
|
|
|
DESFLURANE 100 % INHALATION LIQUID [6276]
|
Facility
|
IP
|
$2.67
|
|
|
Service Code
|
NDC 1001964164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.56
|
| Rate for Payer: Altius Commercial |
$2.56
|
| Rate for Payer: Beech Street Commercial |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.59
|
| Rate for Payer: Cigna of WY Commercial |
$2.62
|
| Rate for Payer: Entrust Commercial |
$2.54
|
| Rate for Payer: First Choice Health Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.76
|
| Rate for Payer: HealthUtah PPO |
$2.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.67
|
| Rate for Payer: One Health Plan of WY PPO |
$2.62
|
| Rate for Payer: PacificSource Commercial |
$2.40
|
| Rate for Payer: PHCS PPO |
$2.62
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$1.76
|
| Rate for Payer: WINHealth Partners Commercial |
$2.54
|
| Rate for Payer: Wise Provider Network Commercial |
$2.54
|
|
|
DESFLURANE 100 % INHALATION LIQUID [6276]
|
Facility
|
OP
|
$2.67
|
|
|
Service Code
|
NDC 1001964164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.62
|
| Rate for Payer: Aetna of WY Medicare |
$1.76
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.56
|
| Rate for Payer: Altius Commercial |
$2.56
|
| Rate for Payer: Beech Street Commercial |
$2.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.59
|
| Rate for Payer: Cigna of WY Commercial |
$2.62
|
| Rate for Payer: Entrust Commercial |
$2.54
|
| Rate for Payer: First Choice Health Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.54
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.55
|
| Rate for Payer: HealthUtah PPO |
$2.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.59
|
| Rate for Payer: Multiplan Medicare/VA |
$1.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2.62
|
| Rate for Payer: PacificSource Commercial |
$2.40
|
| Rate for Payer: PHCS PPO |
$2.62
|
| Rate for Payer: Three Rivers PPO |
$2.00
|
| Rate for Payer: TriWest Veterans Administration |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.32
|
| Rate for Payer: United Healthcare Medicare |
$1.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2.62
|
| Rate for Payer: Wise Provider Network Commercial |
$2.54
|
|
|
DESIPRAMINE 50 MG TABLET [10820]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 6923810571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.91
|
| Rate for Payer: Altius Commercial |
$1.91
|
| Rate for Payer: Beech Street Commercial |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.93
|
| Rate for Payer: Cigna of WY Commercial |
$1.95
|
| Rate for Payer: Entrust Commercial |
$1.89
|
| Rate for Payer: First Choice Health Commercial |
$1.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.31
|
| Rate for Payer: HealthUtah PPO |
$1.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.93
|
| Rate for Payer: Multiplan Medicare/VA |
$1.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1.95
|
| Rate for Payer: PacificSource Commercial |
$1.79
|
| Rate for Payer: PHCS PPO |
$1.95
|
| Rate for Payer: Three Rivers PPO |
$1.49
|
| Rate for Payer: TriWest Veterans Administration |
$1.31
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Medicare |
$1.31
|
| Rate for Payer: WINHealth Partners Commercial |
$1.89
|
| Rate for Payer: Wise Provider Network Commercial |
$1.89
|
|
|
DESIPRAMINE 50 MG TABLET [10820]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 5074211401
|
|
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
|
|
|
DESIPRAMINE 50 MG TABLET [10820]
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 5074211401
|
|
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
|
|
|
DESIPRAMINE 50 MG TABLET [10820]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 6923810571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.95
|
| Rate for Payer: Aetna of WY Medicare |
$1.31
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.91
|
| Rate for Payer: Altius Commercial |
$1.91
|
| Rate for Payer: Beech Street Commercial |
$1.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.93
|
| Rate for Payer: Cigna of WY Commercial |
$1.95
|
| Rate for Payer: Entrust Commercial |
$1.89
|
| Rate for Payer: First Choice Health Commercial |
$1.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.15
|
| Rate for Payer: HealthUtah PPO |
$1.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.93
|
| Rate for Payer: Multiplan Medicare/VA |
$1.10
|
| Rate for Payer: One Health Plan of WY PPO |
$1.95
|
| Rate for Payer: PacificSource Commercial |
$1.79
|
| Rate for Payer: PHCS PPO |
$1.95
|
| Rate for Payer: Three Rivers PPO |
$1.49
|
| Rate for Payer: TriWest Veterans Administration |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Medicare |
$1.15
|
| Rate for Payer: WINHealth Partners Commercial |
$1.95
|
| Rate for Payer: Wise Provider Network Commercial |
$1.89
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [1442]
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS J2597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.06 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$87.36
|
| Rate for Payer: Altius Commercial |
$87.36
|
| Rate for Payer: Beech Street Commercial |
$89.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.71
|
| 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: Entrust Commercial |
$86.45
|
| Rate for Payer: First Choice Health Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$60.06
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: Multiplan Medicare/VA |
$57.06
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$89.18
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: TriWest Veterans Administration |
$60.06
|
| Rate for Payer: United Healthcare Commercial |
$79.17
|
| Rate for Payer: United Healthcare Medicare |
$60.06
|
| Rate for Payer: WINHealth Partners Commercial |
$86.45
|
| Rate for Payer: Wise Provider Network Commercial |
$86.45
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION [1442]
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS J2597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$89.18
|
| Rate for Payer: Aetna of WY Medicare |
$60.06
|
| Rate for Payer: Altius Auto/Workers Compensation |
$87.36
|
| Rate for Payer: Altius Commercial |
$87.36
|
| Rate for Payer: Beech Street Commercial |
$89.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$74.71
|
| 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: Entrust Commercial |
$86.45
|
| Rate for Payer: First Choice Health Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$86.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$52.78
|
| Rate for Payer: HealthUtah PPO |
$91.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$88.27
|
| Rate for Payer: Multiplan Medicare/VA |
$50.14
|
| Rate for Payer: One Health Plan of WY PPO |
$89.18
|
| Rate for Payer: PacificSource Commercial |
$81.90
|
| Rate for Payer: PHCS PPO |
$89.18
|
| Rate for Payer: Three Rivers PPO |
$68.25
|
| Rate for Payer: TriWest Veterans Administration |
$52.78
|
| Rate for Payer: United Healthcare Commercial |
$79.17
|
| Rate for Payer: United Healthcare Medicare |
$52.78
|
| Rate for Payer: WINHealth Partners Commercial |
$89.18
|
| Rate for Payer: Wise Provider Network Commercial |
$86.45
|
|
